Sterre Schrijver

Tarred and Feathered

 

At the end of January, the Dutch state-owned railway company Nederlandse Spoorwegen revealed that, starting on the first of April 2020, their stores will stop selling tobacco at Dutch train stations. In the same vein, Prorail, the main passenger railway operator of the Netherlands, announced they will gradually remove all the currently designated smoking spots on platforms.

Herewith, the two companies are clearly voicing their support for the Nationaal Preventieakkoord (National Prevention Agreement) of 2018 signed by the Dutch government as well as by more than seventy individual organisations in the Netherlanders. The agreement is focused on strongly decreasing the amount of smokers, obesity, and the problematic use of alcohol. Concerning the first component, the goal is to eventually have a smoking free generation by 2040. Several measures have been and will be taken in 2020 and the next coming years. To meet this goal, on the first of April, the excise tax on tobacco will be raised, meaning that a standard sized package will be one euro more expensive, bringing the price of a standard sized pack from 6,90 to 7,90 euros. The Netherlands now has the sixth highest price of cigarettes in Europe, just behind several Scandinavian countries and the British Isles. Regarding the amount of anti-smoking measurements, the Netherlanders places itself, quite literally, in between Germany, which holds a less tight attitude, albeit to varying extents due to the federal system, and the United Kingdom, which maintains even more ambitious goals than the Netherlands. Hopefully, this will not mean that even more British stag weekends will be spend in Amsterdam. Furthermore, as has been observable since the first of January of 2020, tobacco products are not visible at selling points such as supermarkets anymore (you may have noticed the new white cupboards at the Albert Heijn where you can collect your cigarettes and voetbalplaatjes).

‘remember the days when you could easily light one up in an airplane and enjoy one with your meal in a restaurant (banned 1997 & 2008 respectively).’

These anti-smoking encouragements have been nothing new.I bet your parents can still remember the days when you could easily light one up in an airplane and enjoy one with your meal in a restaurant (banned 1997 & 2008 respectively).

Such days though are far behind us and anti-smoking measures have become a modern fixture. The last few years especially have seen a drastic increase in such measures, notably inspired by the organisation Clean Air Nederland which successfully sued the Dutch government in 2016 with the aim of removing smoking areas in the hotel and catering industry. In 2019, the Dutch supreme court decided in the favour of the organisation, meaning that from the first of April, all the designated smoking areas in bars, clubs, and pubs must be removed.

The constant implementation of new anti-smoking measures has led to a debate – inside my peculiar brain – between securing public health and freedom. On the one hand, it is undoubtedly important that the government takes care of its citizens, attempting to prevent them from illnesses.

The argument that “the people surrounding the smoker almost acquire the same effects created by the tobacco in the near air as the smoker itself,” is frequently heard. The consequences of ‘passive smoking’ or ‘second-hand smoking’ are well-established.

‘The Smoker, 1890 by Paul Cezanne’

To make matters worse, children especially are some of the most at risk from its damaging effects. Unsurprisingly, as the effects of second-hand smoking have become increasingly visible and publicly known, several measures have been taken against smoking near the presence of children. However, recent restrictions have seemed to go further than just protecting children as the new actions als

o drive away smokers wanting to light up a cigarette in a cramped stuffy room at the end of a bar full of drunk and stoned tourists at four o’clock in the morning, where there is hopefully no child near to be seen. Hence, perhaps more discussion should be focused on what public smoking places would actually affect the national health, perchance making the measures more effective.

At the other side of the debate, questions have arisen concerning this principle called ‘freedom’. Smokers feel like the government has been restricting their freedom to smoke as they are increasingly pushed into a corner. This might sound a bit odd for a country where the biggest political party for ten years now has been the centre-right liberal Party for Freedom and Democracy (VVD). According to their website, they want to protect ‘our’ children against tobacco and alcohol. Therefore, they wish to stimulate people to live a healthy life. Nonetheless, they are not aiming to force nor patronise smokers and therefore do not support motions to make the current rules even stricter. After having gone through the previously mentioned measures, this may sound a bit hypocritical as the VVD has been leading the party ever since 2010.

The chief science officer at research institute IVO, Gera Nagelhout, states that stigmatising smoking is dangerous as smokers “should not feel like it is not allowed to be themselves anymore.” Besides, according to Nagelhout, more initiatives are needed in order to decrease the amount of smokers, stating that more help should be offered to those who wish to quit. Moreover, according to the authority of medicines, CBG, smokers attempting to stop increasingly reach for medicines. It concerns medicines only available through a doctor’s receipt such as varenicline and bupropion; drugs that affect the central nervous system, eradicating the desire to smoke. The percentage of smokers reaching for such medicines has increased by 35 per cent in the last five years only. Thus, if we want to have a smoking free society by the end of 2040, perhaps the government should consider to help its citizens to quit smoking as well instead of merely condescending them.

Another frequently heard argument concerns that of the costs for public health care caused by the smokers.

The yearly healthcare costs of smoking amounts to almost three billion euros a year which amounts to 3,8 per cent of the total healthcare costs. If smoking would be completely banished, these costs would not necessarily decrease as the life expectancy would then incline as well as the cases of several diseases such as dementia, according to the National Health Institute for Health and Environment (RIVM). Nonetheless, we must also not forget related costs to smoking, such as funding programs which assist people in trying to quit and campaigns to prevent smoking. However, the benefits that the government receives from excise duties on tobacco are much higher than its spendings. Concerning these excise duties, they form the biggest benefits for the government as a result of their several anti-smoking and prevention measures. Lastly, after the costs and benefits analysis made by the Maastricht University, the RIVM, and the Trimbos Institute on knowledge about health and addiction, it became painfully clear how the numbers on both side of the equation are so close that there is no financial incentive to change current smoking behaviour. Thus, there is no attractive business for any party involved to invest in discouraging the use of tobacco. An example of this can be found in the branch of supermarkets and petrol stations where tobacco forms a significant part of their revenues. Due the high benefits of selling tobacco, as well as the fear of losing customers to rivals who do still sell tobacco, there are few incentives for these branches to support the Nationaal Preventieakkoord.

All in all, the successful results of the recently taken measures to decrease smoking cannot be denied. According to website of the official Dutch Ministry of public health, the total percentage of smokers above the age of 18 has significantly declined from 35,7 to 22,9 per cent between 1990 and 2017. Moreover, the percentage of school children between 12 and 16 who smoke on a daily basis has decreased from 13,4 per cent in 1992 to 2,1 per cent in 2017. Besides the mentioned measures taken to reduce smoking, these successful results can also be ascribed to the heightened negative image people hold of smokers. By banning cigarettes from certain outside locations such as playgrounds and sports accommodations, people, specifically youngsters, increasingly regard smoking as “not cool.”

‘perhaps the discussion should be less focused on the health effects of smoking and more on what places are and are not appropriate to smoke’

Nonetheless, all these anti-smoking measures have led to smokers feeling cornered, patronized, and not accepted. The freedom to smoke is increasingly getting taken away, leading up to the question on the exact limit between protecting citizen’s health and protecting their freedom. Likewise, perhaps the discussion should be less focused on the health effects of smoking and more on what places are and are not appropriate to smoke. Reasonably, in line with the liberal-VVD spirit, bars and clubs should possibly decide for themselves how to handle their smoking guests instead of being forced to ratify certain measurements. Just like the people, the Dutch government seem to have not yet unravelled the enduring question between safeguarding public health and freedom. For now, the anti-smokers seem to be on the winning side of the story.

 

 

         

 

 

First published Online. March 2020. Volume 15, Issue 3.