Pergamon 0277-9536(94)~9 Soc. Sci. Med. Vol.40, No. 3, pp. 331-338, 1995 Copyright© 1995Elsevier ScienceLtd Printed in Great Britain.All rightsreserved 0277-9536/95 $7.00+ 0.00 HEALTH POLICY MAKING: THE DUTCH EXPERIENCE EVELYNEDE LEEUW and LOESPOLMAN Department of Health Ethics and Philosophy, School of Health Sciences, University of Limburg, PO Box 616, 6200 MD Maastricht, The Netherlands Abstract--The European Strategy for Health for All by the Year 2000 urged member states to develop a national health policy. In the developmental process of HFA2000 the notion of 'healthy public policy' was conceived in the framework of the WHO Health Promotion Programme. Such 'healthy public policy'--simply referred to as 'health policy' in this article--would take health consequences in all governmental and societal realms into account. Health policy development in The Netherlands was laid down in a 1986 memorandum, 'Nota 2000'. The developmental process of the document is reviewed, and chances for factual implementation analysed. The article concludes with a list of actions to be pursued if health policy is to be successful. Key words--health policy, health promotion, The Netherlands, policy studies Since the Public Health Memorandum of 1966 the Dutch government has adopted a prevention rhetoric. Policy documents which have been pub- lished the past 25 years increasingly stress the import- ance of prevention. Initially a change in individual behaviour was considered to be of major significance. Nevertheless, Nota 2000 was published in 1986, the document in which the prevention idea culminated [1]. It describes prevention from a more integrated and comprehen- sive view of all prevention modes (health education, environmental protection, population screening, etc.), preventable causes of ill health and eventually health promotion in the widest sense. Prevention was described as a broad concept, no longer restricted to the modification of individual behaviour. With this document the Dutch government fol- lowed the international developments in Health Promotion and the 'new public health'. Nora 2000 was widely respected as an example of vigorous policy making. The following pages will describe the conceptual developments of health promotion and the impli- cations which have been attached to it by the Dutch government. Then an investigation which studied the feasibility of the proposed measures as part of these implications is described. Finally an assessment will be made about the future of Dutch health policy. RATIONALE: DEMEDICALIZATION OF HEALTH Emancipatory and democratic movements of the sixties have resulted in an increasing acknowledge- *It should be noted, though, that the Regional Committee of the European office of WHO recently (1991) adopted a set of completely revised and updated targets. ment of the dependency which exists between patients, consumers and the medical-industrial complex. Consequently the number of patient organizations, interest groups and self-help groups rose sharply and in academic circles stronger pleas for a new approach of health problems arose [2]. Among those who translated these developments into policy development were Laframboise [3], Blum [4] and Lalonde [5]. They found that health policy must not only be directed toward the quality and the volume of health care facilities but specifically also at other factors which affect health, for example individ- ual lifestyle, hereditary and biological constitution and the social and physical environment. Empirical research has shown that indeed these other factors have a strong effect on public health and it is not just the health care system that is of major importance [6-101. WHO became also aware of these developments as a consequence of the primary health care approach [I 1]. This approach had been considered primarily as a way to promote health in less developed countries, but soon the concept was translated to fit the indus- trialized countries in the WHO Health For All by the Year 2000 programme [i, 12, 13]. It appeared that especially in Europe the added value of an expanding health care system was limited. The health status of Europeans appeared to be determined by housing, employment, education, pollution, social networks, etc. [14]. The European member states of WHO developed 38 health targets which ought to be pursued as a part of the Health for All strategy. The member states committed themselves to develop a national policy document which reflected the ideas of Health for All and the 38 targets*. The HFA document and 331