Success of smoke-free spaces in the Netherlands

Driven by a national programme aimed at a Tobacco-Free Generation by 2040, the Netherlands has seen an increase in the number of tobacco-free spaces over the last two years. A successful example of the local implementation of a national public health plan.

In the Netherlands, the generalisation of smoke-free spaces was one of the stated objectives to achieve a Tobacco-Free Generation by 2040, i.e. fewer than 5,100 smokers in the population. Drawing on the network of 25 Regional Health Services (GGD), the Ministry of Health, Welfare and Sport launched a two-year programme in 2019 involving municipalities in the development of smoke-free spaces.[1].

Two years later, 98 % Dutch municipalities (344 out of 352, as of March 2022) have set up multiple smoke-free areas, although they were not previously specifically involved in tobacco control. These smoke-free areas have been primarily deployed around schools, children's playgrounds and sports facilities, but also in bus shelters and municipal buildings.

A structured program involving all territorial levels

The development of local initiatives was stimulated and coordinated by the GGDs, which were themselves steered at national level by GGD GHOR Nederland. The GGDs received a modest budget for this operation, and were responsible for legal advice and knowledge transfer between the different levels. Several partners, such as the Association of Dutch Municipalities, the Fund for Tobacco-Free Health, the Trimbos Institute (mental health) and the Pharos Centre (social inequalities), were also involved in the establishment of the smoke-free spaces.

The success of the programme is attributed to the involvement of local and regional levels, as well as different partners, in a national health programme. A link with the Environmental Act, also being rolled out, was established, thus facilitating the adoption of local measures.[2]The positive approach of the project and the broad social support it generated explain its success.

One of the other pillars of this program was to facilitate access to smoking cessation care. Several local actions have been implemented, with that of the GGD in Freysen having been particularly followed, leading to an explosion in requests for care and record smoking cessation rates. Ongoing for several decades, the reduction in smoking prevalence has in fact stabilized in the Netherlands at 21 % in 2021 and needs to be relaunched to hope to achieve the 2040 objective.

In France, decentralized initiatives

In France, initiatives around smoke-free spaces have also multiplied locally, sometimes supported by regional health agencies (ARS), without however being the subject of a coordinated national policy. The Interministerial Mission to Combat Drugs and Addictive Behavior (MILDECA) has for its part updated its guide of advice and recommendations to municipalities that would like to engage in this approach[3]. Many operations to set up smoke-free areas are also organized by the departmental sections of the League against cancer.

The device Free city without tobacco intends to give a more structured boost to this movement, in order to implement genuine local policies to combat smoking. Led by the Grand Est sans tabac (GEST) association and the National Committee against Smoking (CNCT), this project is explicitly situated in the perspective of a Tobacco-Free Generation in France by 2032. It proposes a set of measures to reduce the consumption of tobacco and nicotine products and make cities more pleasant.

Keywords: Netherlands, Smoke-free areas, Smoke-free city

©Tobacco Free Generation

M.F.

[1] Rouwenhorst S, Koornstra A, Creating smoke free environments by local policy, European Journal of Public Health, Vol. 32, Supp. 3, 2022, 15th European Public Health Conference 2022.

[2] GGD GHOR Netherlands, Boost smoke-free environments: how small incentives for local policy can trigger big changes, factsheet, 2022.

[3] The mayor facing addictive behavior, Practical guide, MILDECA, 2022.