Non-binding prevention is no prevention

The Ministry of Health, Welfare and Sport (VWS) recently presented its new prevention strategy , the follow-up to the 2018 National Prevention Agreement (NPA). The new "Coherent Prevention Strategy" places special emphasis on young people. The strategy rightly opts for an environment-based approach rather than isolated themes. In doing so, the government demonstrates that health is not solely an individual responsibility, but is strongly linked to the context in which people live. The focus on young people is also understandable and important: habits, even the less healthy ones, are formed at a young age and have lifelong impact. The ambition for a healthy generation by 2040 rightly remains.

But no concrete agreements are attached to this ambition. The path to a healthy generation in 2040 remains unclear with the current package of measures and remains too non-committal. This makes the prevention strategy, which emphasizes individual freedom of choice, vulnerable. The question also arises as to how the strategy was developed and with which partners. The measures lack coherence, pay little attention to the bigger picture, and leave considerable room for other – read: commercial – interests.

Prevention is a duty

It's telling that the strategy is explicitly "not intended to sneak behind the front door or peek into your shopping basket, but rather to make the healthy choice the easy choice." In our view, this is the wrong approach. Better protecting the Dutch, even if it initially seems to come at the expense of commercial interests or apparent individual freedom, is crucial for achieving health benefits.

Protecting the health of citizens is a government duty and goes beyond simply providing information and advice, as half a century of prevention has taught us. Many measures in the new strategy assume that parents and young people can understand and apply health information, but in practice, this is only partially successful. In fact, well-intentioned advice widens the gap between population groups: people with sufficient income and stable housing have the flexibility to pursue the measures, but for many others, the daily reality is more challenging.

There's a lack of reflection on the underlying reasons why and how people make unhealthy choices. Current generations are facing various crises that are eroding the security of our existence. This can lead to distrust of the government and short-term thinking. Unhealthy living environments, including indoor and outdoor air pollution, are barely mentioned in the strategy. The same applies to unhealthy homes, such as cold, damp, and moldy houses. Climate change also remains unmentioned... All of these are things that cannot be changed by the individual, especially not for vulnerable groups.

Clear frameworks and strong measures

So what is the right approach? A successful approach isn't just about making healthy choices easier, but also about preventing unhealthy ones. This requires firm agreements with providers, with investments in monitoring, evaluation, and research. It's up to the government to establish frameworks and standards. Local governments must then have sufficient resources to enforce dynamic regulations, preventing practices like adding a dash of dairy to soft drinks or fruit juice to avoid the sugar tax. Clear communication about the measures is crucial, because in today's politicized landscape, the populist term "patronizing" is easily used. While it's not about patronizing, but about maintaining and protecting health, a fundamental right.

The prevention strategy focuses on seven environments: home, school, work, supermarkets, online, healthcare settings, and day trips. The strategy aims to establish concrete agreements with day attractions and amusement park operators regarding healthy choices. But the occasional French fry at the amusement park or a sweet snack at the cinema isn't the problem. It's about places where unhealthy products are consistently offered, and where people frequent. Think of (sports) canteens, snack bars near schools, and, not to forget, supermarkets.

At the same time, learning and work environments also hinder adherence to a healthy lifestyle. It is crucial to invest in schools and employers who are actively committed to reducing unhealthy lifestyles in the coming years. This can be achieved by investing in prevention and promoting a healthy lifestyle among students and employees. Such efforts increase the employability of both current and future employees and can positively impact labor productivity and the optimal utilization of the labor potential in the Netherlands.

Starting in 2026, legislation will be in effect that will restrict "unwanted" marketing of unhealthy foods to children, according to the strategy. This formulation still allows companies to influence children with marketing. Strict and clear rules are needed to truly tackle child-targeted (food) marketing. According to the new strategy, municipalities will have the opportunity to implement additional measures to support children and young people in making healthy choices. This sounds promising, but a nationwide and systematic implementation of these measures with binding frameworks is more efficient and effective.

The prevention strategy rightly acknowledges the influence of supermarkets, but it focuses primarily on non-binding agreements regarding product range and marketing. What's missing is a forward-looking behavioral strategy that structurally makes healthy choices easier and more attractive. Pricing and differentiated VAT rates are among the tools. Supermarkets can also use data to support consumers in making informed choices, without appearing patronizing. Attention to sustainable food production is also necessary, but not addressed in the strategy. A key example is improving soil health. This leads to healthier crops, reduced pesticide use, and higher nutritional value.

Involve young people yourself

The strategy's focus on the online environment is commendable. The online world plays a significant role in daily social life, especially that of young people. Social media is often seen as a risk, but it can also have a positive impact on mental health. Therefore, it's crucial to involve young people themselves, because as "digital natives," they offer valuable insights. The strategy also lacks the perspective of young people themselves when it comes to reducing substance use. For example, how do the ambitious targets for reducing substance use relate to the social normalization of drug use within certain groups in society?

While the perspective of young people themselves is lacking, the strategy does envision clear steps against substance use and addiction among young people, such as tightening regulations around the sale of tobacco and vapes and an approach to reducing problematic smartphone and social media use. However, it remains largely unclear how the influence of large commercial players will be effectively curbed. Another notable gap is the absence of a targeted approach to online gambling. Despite the growth of online gambling behavior—particularly among young people and young adults—and the rise in gambling problems, a structural policy response is lacking. This clearly requires additional legislation and regulations.

Mental health and meaning

The government also has a responsibility in the area of ​​mental health. The sharp rise in mental health problems among young people, especially young women, is one of the most worrying health trends and calls for preventive measures. Mental health problems are often associated with physical health problems, a low socioeconomic status, and poverty. The prevention strategy lacks ambitions or concrete measures for the mental health of young people. It also lacks a coherent approach to loneliness, chronic stress, sleep deprivation, and the importance of exposure to nature.

Finally, we note that more attention should be paid to emotional development and meaning. Insights into meaning help us better understand why young people prefer sitting at their computers to going outside. In games and on social media, young people find like-minded people and support during difficult times. This also partly explains why they smoke, gamble, drink, or use drugs: these substances offer stability or an escape in a stressful, performance-driven society where perfectionism is expected, yet seemingly has little influence.

Politics in action

While the strategy emphasizes the importance of prevention, its implementation is lacking. The document highlights the loss of resources and the increasing tightness of the labor market. However, the scaling back of ambitions and the lack of robust policy measures will backfire in the long run, resulting in rising healthcare demand and costs. Without clear legislation and regulations, structural change will be delayed, and the strategy risks becoming bogged down in good intentions without lasting impact. By investing now in genuine prevention, with binding frameworks and targets, we are investing in a resilient and sustainable labor market. Now is the time to do everything we can to prevent it.

In addition to responding to the Coherent Prevention Strategy, we are making an explicit and urgent appeal to all political parties to incorporate the importance of a robust prevention policy into their election manifestos and at the negotiating table. 2040 is just around the corner, and we must pull out all the stops. At the Aletta Jacobs School of Public Health, we have therefore been working tirelessly for some time now.