Tobacco Control Policy in the Netherlands

385 Pages·2018·4.747 MB·English

by  Marc C. Willemsen

TOBACCO
CONTROL
POLICY IN THE
NETHERLANDS
Between Economy, Public
Health, and Ideology
Marc C. Willemsen
Palgrave Studies in Public Health Policy Research
Series Editors
Patrick Fafard
University of Ottawa
Ottawa, ON, Canada
Evelyne de Leeuw
University of New South Wales Australia
Liverpool, NSW, Australia
Public health has increasingly cast the net wider. The field has moved on
from a hygiene perspective and infectious and occupational disease base
(where it was born in the 19th century) to a concern for unhealthy life-
styles post-WWII, and more recently to the uneven distribution of health
and its (re)sources. It is of course interesting that these ‘paradigms’ in
many places around the world live right next to each other. Hygiene, life-
styles, and health equity form the complex (indeed, wicked) policy agen-
das for health and social/sustainable development. All of these, it is now
recognized, are part of the ‘social determinants of health’.
The broad new public health agenda, with its multitude of competing
issues, professions, and perspectives requires a much more sophisticated
understanding of government and the policy process. In effect, there is a
growing recognition of the extent to which the public health community
writ large needs to better understand government and move beyond what
has traditionally been a certain naiveté about politics and the process of
policy making. Public health scholars and practitioners have embraced this
need to understand, and influence, how governments at all levels make
policy choices and decisions. Political scientists and international relations
scholars and practitioners are engaging in the growing public health
agenda as it forms an interesting expanse of glocal policy development and
implementation.
Broader, more detailed, and more profound scholarship is required at
the interface between health and political science. This series will thus be
a powerful tool to build bridges between political science, international
relations and public health. It will showcase the potential of rigorous polit-
ical and international relations science for better understanding public
health issues. It will also support the public health professional with a new
theoretical and methodological toolbox. The series will include mono-
graphs (both conventional and shorter Pivots) and collections that appeal
to three audiences: scholars of public health, public health practitioners,
and members of the political science community with an interest in public
health policy and politics.
More information about this series at
http://www.palgrave.com/gp/series/15414
Marc C. Willemsen
Tobacco Control
Policy in the
Netherlands
Between Economy, Public Health, and Ideology
Marc C. Willemsen
Maastricht University
Maastricht, The Netherlands
Palgrave Studies in Public Health Policy Research
ISBN 978-3-319-72367-9 ISBN 978-3-319-72368-6 (eBook)
https://doi.org/10.1007/978-3-319-72368-6
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For Jacqueline, Emma, and Julia
P
reface
We doubt whether a man ever brings his faculties to bear with their
whole force on a subject, until he writes upon it for the instruction or
gratification of others.
—William Ellery Channing, 1890
If one is lucky, at some point in one’s life, things fall into place. The pro-
cess of writing this book and doing research for it was such an experience.
For me, writing a book about Dutch tobacco control policy was the next
logical step after more than a quarter of a century of research into tobacco
control. I started my academic career developing and studying smoking
cessation interventions. In the 1990s I became frustrated by the fact that
regardless how much attention and counselling smokers who try to quit
receive, the majority of quitters relapse within a year—most in the first
month after treatment. Realising that even a combination of the best and
most intensive treatment does not produce success rates much higher
than 30%, I turned to more fundamental questions: what makes cigarettes
so addictive, and what can be done to motivate whole populations to quit
smoking? In 1998 I started to work for the Stichting Volksgezondheid en
Roken (Dutch Smoking or Health Foundation) (STIVORO), the national
expert centre on tobacco control. This gave me first-hand knowledge of
tobacco control in practice, and I gradually learned about the political
aspects of tobacco control. My appointment as Professor in Tobacco
Control Research at the Department of Health Promotion at Maastricht
University gave me the opportunity to cross the bridge from tobacco
vii
viii PREFACE
control research to tobacco policy research. I familiarised myself with the
public policy literature, contacted political scientists, and attended the
fifth Framework Convention on Tobacco Control Conference of the
Parties (FCTC COP) in 2012 in Seoul to witness tobacco control politics
and advocacy in action at the global level. I discovered that tobacco policy
is an important topic for public policy scientists, but that insights from
political science have not even begun to be absorbed by the tobacco con-
trol research community. I was thrilled when the opportunity arose for me
to write a book about this. Most of the time the process of writing was a
great pleasure, with many moments of excitement when I discovered new
things and my understanding was deepened. The book has also turned
into the first comprehensive historical account of tobacco control in the
Netherlands, written for an international readership.
Inspiration for this work came from two sources. One was a book by
Clavier and De Leeuw (2013) which drew attention to the fact that the
health promotion field lacks a theoretical understanding of the adoption
and implementation of health policies. The other was a book that pre-
sented an approach to the study of tobacco control policy that does justice
to insights from public policy and political sciences while being accessible
to those working outside the public policy field (Cairney, Studlar, &
Mamudu, 2012). The first source made me realise that there is an under-
recognised knowledge gap in the tobacco control field that needs to be
filled, and the second presented me with a solution. There are so many
public policy theories available that it can be quite overwhelming for a rela-
tive layperson, so I was pleased to stumble on to the general analytical
framework provided by Cairney and his colleagues. It allowed me to focus
on the basis elements of the policymaking process and to apply a logical
structure to this book. I felt confident enough to borrow insights from two
theories that I found particularly interesting, the Multiple Streams
Approach (MSA) and the Advocacy Coalition Framework (ACF). However,
I call on political scientists and public policy scholars to join me in studying
the case of Dutch tobacco control. There is much more to learn from the
enormous amount of information and data on Dutch tobacco control pol-
icy as I discovered, and it is available for further research.
I am most grateful for a grant from STIVORO, which made it possible
to afford the necessary research and to dedicate working time to write this
book. As part of STIVORO’s science team, I had obtained first-hand
knowledge of tobacco control and the workings of the broader tobacco
control coalition in the Netherlands. In addition, from 2013 until 2017,
PREFAC E ix
I worked for the Dutch Alliance for a smoke free society (ANR). These
employments gave me relevant data and information—a clear advantage,
given the complexity of the topic—but there was also the danger of bias. I
distanced myself as much as possible from my own contribution to the
processes I examined. I further reduced the risk of personal bias by having
people critically comment on the work. I thank Paul Cairney, Pieter de
Coninck, Sanne Heijndijk, Gera Nagelhout, Dewi Segaar, Fleur van
Bladeren, Bas van den Putte, and Heide Weishaar for reading and giving
feedback on draft versions of the book. Emma Willemsen was a great help
with the coding and ordering of the large amount of text from the pro-
ceedings of parliament meetings and parliamentary papers. I am most
grateful to each of the 22 people I interviewed for the book. The inter-
views were crucial for my understanding of Dutch tobacco control policy
making and assured that I had identified the main events correctly.
Regrettably, at the end, due to the need to be succinct and to stay within
the word count, much of the interesting material from these, sometime
lengthy, interviews did not make it to the book. My original plan was to
write the book in Dutch, but Evelyne de Leeuw persuaded me to write it
in English, offering to include it in the new series on public policy she was
planning with Patrick Fafard. I am very grateful for her advice and for giv-
ing me the opportunity to publish my work as part of the new series. Book
doctor Margaret Johnson did a truly wonderful job of proof reading and
polishing the final manuscript. I thank Jacqueline and Julia for their patience
and keeping things quiet around me during the many, many hours—much
more than I had anticipated—that I needed to study and write.
This book was first and foremost written to find out what drives tobacco
control policymaking and to understand its nuances and complexities
from an academic vantage point—but if tobacco control advocates learn a
thing or two from it, it will have served its purpose much better.
Maastricht, The Netherlands Marc C. Willemsen
references
Clavier, C., & De Leeuw, E. (Eds.). (2013). Framing public policy in health
promotion: Ubiquitous, yet elusive. London: Oxford University Press.
Cairney, P., Studlar, D. T., & Mamudu, H. M. (2012). Global tobacco con-
trol: Power, policy, governance and transfer. New York: Palgrave Macmillan.
c
ontents
1 Introduction 1
2 Dutch Tobacco Control Policy from the 1950s
to the Present 19
3 The Tempo of Dutch Tobacco Control Policy 77
4 The Social and Cultural Environment 89
5 Making Tobacco Control Policy Work: Rules of the Game 113
6 The International Context: EU and WHO 145
7 Scientific Evidence and Policy Learning 165
8 Tobacco Industry Influence 183
9 The Tobacco Control Coalition 231
xi