A Dutch Dilemma
While much of the Western world was tightening restrictions on smoking, one European nation, the Netherlands, found itself embroiled in a political struggle between individual freedoms and public health.
By Cynthia Ryan
In May 2015, I sat outside Café Hoppe, a traditional “brown bar” established in 1670 in Amsterdam, the Netherlands, chatting with smokers who had been forced outside by a government-imposed smoking ban. Brown bars—popular gathering places with dark wood interiors and walls stained from years of patrons’ smoking—are a familiar sight in the Netherlands. They are also at the center of recent shifts in tobacco policy that have affected many Dutch citizens—smokers and nonsmokers alike. As I sat talking with locals, I discovered that even among smokers, there is disagreement about what kinds of tobacco regulation are appropriate in their country.
The Netherlands, a low-lying country of nearly 17 million people situated on the North Sea between Belgium and Germany, has a reputation as a progressive and technologically advanced nation. Yet, as I observed many innovative examples of environmental sustainability and healthy living during a two-week visit, I came to realize that the country has trailed many Western nations on one front that’s dear to many progressive thinkers and health advocates: comprehensive tobacco-control measures supported by long-standing research showing the dangers of smoking and exposure to secondhand smoke, particularly the risk of developing cancer.
Between 2010 and 2013, the Dutch government even took steps backward in tobacco control and public health, weakening an existing smoking ban on hospitality businesses and reducing funding for programs that educate the public about smoking and that help smokers to quit. The full ban was reinstated in late 2014, but anti-smoking organizations are still working to raise awareness of smoking’s health risks.
The Netherlands is not alone in failing to follow through with all the recommendations for reducing cancer risk in the World Health Organization (WHO) Framework Convention on Tobacco Control, which the country signed in 2003. But according to a report published in 2012 by the Dutch Cancer Society, Dutch Heart Foundation, and the Asthma Foundation (now the Lung Foundation Netherlands), the nation increasingly lagged behind others on implementing many articles of the convention, such as the addition of warning labels with pictures on tobacco products and the development of a comprehensive ban on tobacco advertising, promotion and sponsorship.
When I looked further into the national debate about smoking regulation, I discovered what seemed to me to be a tug-of-war more about political ideology than about the dangers of smoking: an emphasis on individual freedoms that is at odds with tobacco legislation aimed at improving public health—and with efforts to stop adolescents from becoming addicted to tobacco before they have the maturity to make an informed decision about using it.
As Tim Rombouts, the tobacco prevention officer at the Dutch Cancer Society, says, “In recent years, the Netherlands hasn’t been the most progressive nation” regarding tobacco policy.
Personal Freedom vs. Government Regulation
The Dutch have been long recognized as masters of technology and enterprise. Just over a quarter of all land in the Netherlands sits below sea level, and by the 15th century the Dutch had engineered windmills to pump water out of the lowlands, dikes to protect land they reclaimed from the sea, and other innovative methods for managing all that water. While they were at it, the Dutch built an impressive culture of trade, sailing and deal-making the world over and established their coastal cities as some of the world’s most influential ports by the 17th century.
The Dutch have also been known for their tolerance of diverse values and behaviors: Amsterdam is home to coffee shops where marijuana can be bought and consumed, even though pot remains technically illegal, and in the city’s Red Light District, legalized prostitution is on display.
This cultural backdrop supporting individual rights over government regulation perhaps plays one of the biggest roles in the Netherlands’ route through the murky waters of tobacco control. Many who chafe at tobacco restrictions believe that individual Dutch citizens should make up their own minds about their behaviors, including smoking. Meanwhile, owners of small drinking establishments have suggested that bans on smoking hurt their business, and the tobacco industry has argued that it has a right to produce, market and sell its products to adults as it sees fit.
According to Heleen Weyers, an assistant professor specializing in law and society at the University of Groningen, in the Netherlands, the “Dutch government will only design a law when society is not able to regulate the problem.”
In 1990, the government’s Tobacco Act went into force, banning smoking in limited locations, including government buildings and public buildings of government-funded organizations. More widespread concerns about smoking in the workplace led the government to amend the law so that in 2004 smoking bans went into effect in most workplaces and on public transportation. Businesses in the hospitality sector—including pubs, restaurants and brown bars like Café Hoppe—were exempt from this ban.
In 2006, when the Netherlands Food and Consumer Product Safety Authority (known by its Dutch abbreviation NVWA) surveyed about 1,400 businesses, the workplaces were close to 86 percent smoke-free, representing a large increase from previous years. According to a 2013 study in the journal Health Policy, which used telephone surveys, compliance increased to 96 percent overall in 2008 from about 83 percent in 2006 for workplaces covered by the ban.