The Netherlands, European champion of tobacco control among the population

“A pack of blonde, please,” asks a customer at a The Hague branch of a Dutch multinational supermarket. The cashier turns around, pulls out a key, and opens a metal cabinet with a white-painted door. She closes, collects and attends to the next payment. Tobacco and its products are no longer on view in these establishments since 2020, and the Government plans to prohibit their sale there by 2024. From 2030 they will not be able to be purchased at gas stations either. Since 2032, only in tobacconists. “Sorry, you can’t smoke out here,” a waiter says to a group just sitting on a terrace, some of whom are vaping. Restaurant owners can legally decide if they want their open spaces to be smoke-free, and the gang of friends leaves. This year, the Netherlands has become the first state in the European Union to adopt the six measures that help reduce the demand for tobacco recommended by the World Health Organization (WHO). Achieving this has been possible thanks to the collaboration between the Executive, health organizations and society.

The supermarket cabinet with the rest of the packs is also a kind of photo gallery designed to warn of the dangers of smoking, particularly to minors and young people. A quick glance returns photos of destroyed dentures, intubated patients, black lungs, emaciated skin, and children with respiratory problems due to being passive smokers. On the terrace, the group that intended to use their electronic cigarettes has been shouting in search of another place. In the famous coffeeshops, where the consumption of marijuana is tolerated by the authorities if the user does not have more than five grams, you cannot smoke traditional tobacco either. They are part of the hospitality sector and, since 2020, they must comply with the same standards as other bars, cafeterias or restaurants. You can use the drug without tobacco, mixed with substitutes such as lavender, rosemary, sage… and vaping. It is a situation that surprises many tourists.

According to a report published this July by the WHO itself, Turkey, Brazil and Mauritius have also managed to reduce the demand for tobacco, and the organization recalls that almost 40% of countries already have smoke-free indoor public places. Introduced by the WHO in 2008, the six measures are grouped under the term Mpower and are these: monitor tobacco use, warn of its dangers, protect from smoke, offer help to quit smoking, comply with advertising bans, promotion and sponsorship, and increase taxes on this product. Without them, the organization estimates that there would be 300 million more smokers in the world. The work in turn emphasizes electronic cigarettes, “mainly aimed at children and young adults, although few countries have rules to protect them.” In the Netherlands, photos and videos of these inhalers are prohibited in the digital stores that sell them. Nor can links be included that lead to other websites of the same type. Since 2023, moreover, it is no longer possible to bring new added flavors to the market for vaping. The current offer includes, among others, tastes of strawberry, mango, hazelnut or mojito ice cream. Manufacturing companies will be able to sell existing reserves until January 1, 2024. From then on, “only the tobacco flavor will be allowed to make it less attractive to a young audience,” explain sources from the Ministry of Health. Even less can be advertised with slogans that promote the alleged attractiveness of the smoker or tobacco itself.

The Dutch association that brings together sellers of this type of cigarettes and their accessories (Esigbond) maintains on its website that “they constitute one of the less harmful alternatives and it is important that they are not more strictly regulated than traditional ones.” To illustrate the health benefits of vaping, the association cites a 2016 study by the Institute for Health and the Environment (RIVM, in its Dutch acronym) which states the following: “This system evaporates a liquid that normally contains nicotine. In this way, the user is not exposed to as much toxicity as when smoking tobacco”. However, the same work adds this: “The long-term effects on the population as a whole are not yet clear and more data is needed to be able to provide a balanced opinion on its harmfulness. For example, about the behavior of the smoker”.

According to calculations by the Dutch Central Statistics Office, the proportion of smokers has risen from 25.7% of those over 18 years of age in 2014 to 18.9% in 2022. Of the 17.8 million inhabitants, 1, 6 million are between 18 and 25 years old. At the door of secondary schools and universities there are still students in groups, cigarettes in hand. “None of my friends smoke, but I guess affinities include these things as well, and you go with people who share your likings,” says Daniel J., a history major. The data corresponding to 2021 from Trimbos, an institute specializing in mental health and addictions, estimated that 17.2% of children between 12 and 16 years old had lit a cigarette. In the last month, 9.5% have done so. Until this January, smokers could gather on railway platforms around a pole with ashtrays. The area was marked, but they ended up mixing with the other passengers at rush hour. Now, the metal poles have disappeared and the containers for the butts are at the exit of the stations. In France, Belgium and the United Kingdom this rule also applies.

The good Dutch results are due to three factors: the awareness work carried out in recent years by the so-called Alliance for a Smoke Free Society; consensus on the approach to the problem and its solutions included in a National Prevention Agreement; and political will. “The Alliance’s strategy mentioned above has focused on making it easier for parents to raise their children free from exposure to tobacco smoke, and the temptation to start smoking, so that children born after 2017 choose not to. do it”, explains Sigrid Troelstra, a researcher at the Trimbos Institute. The government’s goal is to achieve “a smoke-free generation” by 2040, and Maarten van Ooijen, Secretary of State for Health, has said: “Social organisations, health experts and doctors are the driving force behind achievement in the tobacco control”. The tobacco industry did not get permission to participate in drafting the prevention agreement, which does not ban e-cigarettes. It does exclude it in bars, restaurants, buildings and public transport, airports, platforms, workplaces, hospitals, schools and their patios. The same spaces closed to classic tobacco.

Among the countries that are available to the Mpower group to join the four already in the lead is Spain. On an international scale, the WHO itself indicates that 5.6 billion people —71% of the world population— are protected with at least one prevention policy against tobacco use. It is five times more than in 2007. On the other hand, Angela Ciobanu, an expert from the organization, affirms that around 8.7 million people die each year due to tobacco and its products. “The response from the Dutch public has been positive, and one of the reasons is the emphasis placed on child protection. The majority of the population, including many smokers, support smoke-free policies in places frequented by minors. From the schoolyard to private cars”, says Sigrid Troelstra in an email.

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