People and communities in the Netherlands are affected by a heavy alcohol burden. Proven and cost-effective alcohol policy solutions do exist to better protect the Dutch people from alcohol harm. But these best buy solutions are absent from the toolbox the government wants to use. Why? The alcohol industry has a seat at the alcohol policy table. Big Alcohol lobbies relentlessly, at times bordering on threats to make sure their profits are not affected by alcohol policy making.
The alcohol industry blocks and derails public health oriented alcohol policy development. With these strategies and tactics, they fuel and perpetuate alcohol harms in the Netherlands. Dutch people use alcohol on 112 days in the year, which is only behind high-consuming countries France and New Zealand. Alcohol has become normalized not just in daily lives but also in politics.
The price of this alcoholization of society is paid by the people and communities across the country.
- 2000 lives are lost every year due to alcohol-specific causes.
- Alcohol is a factor in additional 7500 deaths.
- In 2021, according to CBS (Statistics Netherlands, 2022): 7,3% of Dutch people (adults above the age of 18) consumed alcohol excessively (i.e. for women more than 14 alcoholic glasses per week, for men more than 21 alcoholic glasses per week).
- Ca. 1 million Dutch adults above the age of 18 years.
- In 2021, according to CBS (Statistics Netherlands, 2022): 8,3% of Dutch people engaged in heavy episodic alcohol use at least once a week
- Ca. 1,2 million Dutch adults above the age of 18 years.
56% of Dutch adults above 18 years of age consume more alcohol than the low-risk alcohol consumption guidelines of the Dutch Health Council.
The advice of the Health Council is: “Do not drink alcohol or in any case no more than one glass a day.” (www.stap.nl, 2020)
The Netherlands has a population of more than 17 million people.
Alcohol harm in the Netherlands
Society in the Netherlands is dominated by a pervasive alcohol norm, fueling serious alcohol harm. The World Health Organization (WHO) country profile provides a snapshot of the issues:
- 50% of all alcohol consuming young people between the age of 15 to 19 years engage in binge alcohol consumption.
- More than 51% of alcohol consuming adult men engage in binge alcohol use.
- In 2016, more than 2400 people died from cancer due to alcohol.
The debate about alcohol policy solutions
Proven and evidence-based alcohol policy solutions are available for the Dutch government to effectively prevent and reduce alcohol harm.
The WHO recommends three alcohol policy best buys:
- Increasing prices of alcohol products through alcohol excise taxes.
- Decreasing availability of alcohol products.
- Banning or comprehensively regulating alcohol advertising, sponsorship, and promotion.
For example, if prices of alcohol products are increased these products become unattractive to young people who are sensitive to price increases.
If alcohol products are not easily available everywhere via supermarkets high-risk alcohol use declines.
Alcohol advertising bans or comprehensive regulation prevents initiation to alcohol and reduces alcohol consumption. Banning alcohol advertising also help change the alcohol norm in Dutch society. By making alcohol less visible, it is denormalized and therefore consumption reduces.
Big Alcohol interference watered down the ‘Prevention Agreement’
The National Prevention Agreement of the Netherlands was signed by 70 parties on November 23, 2018.
The sub-agreement for alcohol included ambitious targets to be achieved by 2040:
- Reducing binge alcohol use among young people by 30-40%,
- Reducing heavy and high-risk alcohol use by 40%, and
- Cutting in half the use of alcohol by pregnant women.
But alcohol industry lobbying watered down the Prevention Agreement substantially. The alcohol lobby managed to remove all alcohol policy best buy solutions from the National Prevention Agreement of 2018.
As soon as the National Prevention Agreement was signed the National Institute for Public Health and the Environment (RVIM) wrote that “the package of proposed actions and measures is insufficient to realize the ambitions”. RVIM expressed concern that proven effective measures such as increasing excise duties and limiting availability are not being used to achieve the goals.
Civil society organization such as the Netherlands Institute for Alcohol Policy (STAP) and Addiction Studies in the Netherlands (VKN) did not want to sign the agreement since it did not include indexation of alcohol excise taxes. These organizations have been advocating for WHO’s alcohol policy best buys for years.
But eventually, all participants signed a prevention agreement in 2018 even despite the totally absent Best Buys.
31 parties joined the “alcohol policy roundtable” set up in early 2018 to work together on effective policy measures to reduce the alcohol problem in the Netherlands. In this alcohol policy roundtable civil society organizations would draw up a joint sub-agreement on harm due to alcohol, as part of the National Prevention Agreement.
Outside of the agreement a new Alcohol Act came into effect in the Netherlands on July 1, 2021. The Act included measures such as:
- A ban on price promotions of more than 25%,
- Prohibiting adults to pass on alcohol to a minor in a public space (redistribution), and
- Age verification at point of sale and delivery for online alcohol sale.
But why did the National Prevention Agreement not include a single Best Buy policy solution?
The answer is aggressive alcohol industry lobbying. Big Alcohol was allowed to also sit at the alcohol policy roundtable in 2018 and it ensured no measures would be adopted that would threaten alcohol companies’ profit interests.
Alcohol industry strategy to weaken Dutch alcohol policy
The Foundation for Responsible Alcohol Consumption (STIVA), the major alcohol industry lobby group in the Netherlands, is a part of the alcohol policy roundtable. The group was clear from the start about Big Alcohol’s intent to shape long-term alcohol policy by joining the roundtable.
They wanted no new major changes to alcohol policies outside the table. This lobby push indicated from the outset the alcohol industry’s strategy to limit and stop effective alcohol policy solutions.
The alcohol industry used its presence at the roundtable to lobby against both alcohol excise duty increases and alcohol marketing regulations. But their lobby frenzy did not stop there. STIVA went on to threaten that the alcohol industry would withdraw support of the agreement if there was any increase in excise duty during the term of the prevention agreement until 2040.
Even while being part of the Prevention Agreement and the alcohol policy roundtable, Big Alcohol has worked aggressively to create confusion about proven evidence-based alcohol policy measures. This is a well-documented alcohol industry strategy to counter scientific evidence. Eus Peters of the Dutch Drinks Trade Association (VDN) – another alcohol industry lobby group – undermined the best buys on several occasions. He had gone so far as to say that the best buys won’t help reduce alcohol use among young people and pregnant women. This is factually untrue as the WHO shows price increases reduce alcohol use by youth since they are sensitive to price changes.
Better alcohol policy solutions needed to reach targets in the agreement
The National Institute for Public Health and the Environment (RVIM) states that far more needs to be done to reach the targets in the agreement. Heavy and high-risk alcohol use has decreased slightly in 2019 and 2020. Figures on alcohol use among pregnant women are not yet available. But the targets to reduce alcohol use among young people by 2040 are still a long way off.
- The target is to limit youth binge alcohol use to 7% prevalence by 2040.
- But the prevalence of heavy episodic alcohol use in Dutch youth was still at 18.5% in 2019.
- The target is to limit the prevalence of ever alcohol use among young people to a quarter.
- But the prevalence of alcohol use among Dutch youth was still at 46.6% in 2019.
Former State Secretary Paul Blokhuis called on the RVIM to look into introducing a minimum unit price for alcohol to reach the targets by 2040. RVIM’s study into minimum unit pricing showed promising results.
An MUP would decrease heavy and high-risk alcohol use and thus reduce alcohol harm.
RVIM released an inventory of alcohol policy measures in April 2021 that would have the most impact on reducing the Netherlands’ alcohol burden. The inventory includes pricing measures, such as an excise tax increase, and minimum unit pricing for alcohol products.
New coalition government wants to increase alcohol availability
Despite the RVIM’s recommendations, the new coalition government which was formed in December 2021 is set to further increase alcohol availability. The coalition agreement contains the sentence that “We allow blending by regulating “blurring” in retail areas in a responsible manner, closely monitoring alcohol abuse.”
What is blurring?
Blurring is colloquially known as “wine at the hairdresser”. It means to allow alcohol sales in places other than alcohol outlets, such as at the hairdresser.
Blurring will increase alcohol availability in the Netherlands even more.
- Right now, there are 55,000 to 70,000 alcohol outlets.
- If barbers were allowed sell alcohol, there would be potentially 100,000 additional dispensing points.
- Therefore, blurring is in direct contradiction to the goal of reducing alcohol harm.
A study from May 2019 reported wide-ranging negative effects from blurring, including increased health damage, threats to road safety, and the need for additional enforcement capacity which is costly and already limited.
Civil society organizations are against “Blurring”
When blurring was talked about at the alcohol policy roundtable in 2018 participants supported a ban of the practice. However, under pressure from government parties, the footnote on blurring was removed two days before the signing of the Prevention Agreement.
Civil society has criticized the practice saying all the work in the prevention agreement would be for nothing if blurring came into effect.
How can you achieve the goals in the prevention agreement if you turn on the alcohol tap?” asked Wim van Dalen, Director of the Netherlands Institute for Alcohol Policy (STAP), as per Follow The Money.
All those agreements become hot air.”Wim van Dalen, Director, Netherlands Institute for Alcohol Policy (STAP)
STAP has called on the government to stop the introduction of “blurring”. The Trimbos Institute also joined the call against “blurring” releasing a statement in January signed by 29 professors, saying that blurring undermines the prevention agreement.
Uneven playing field at the alcohol policy roundtable
What I saw was an uneven playing field. We are researchers and do not employ people to lobby. We were not prepared for the situation at the alcohol table to be very political,” said Ninette van Hasselt from the Trimbos Insititute, as per Follow The Money.
It became clear that the game was not just played at the roundtable. We went for a meeting with the alcohol roundtable and found the industry already at the elevator. They had already held preliminary consultations with each other.”Ninette van Hasselt, Trimbos Institute
The alcohol industry continues to put its own private interest of profit maximization over the people’s interest in better health and well-being through the best alcohol policy solutions. Big Alcohol exploits the alcohol policy roundtable setting to achieve corporate goals.
For example, a representative of the independent liquor stores lobby group was more concerned about including border effects on alcohol sales in the RVIM report than alcohol policy solutions.
However, public health organizations are taking a stand at the alcohol roundtable. Bart Takkenberg, a Gastrointestinal Liver doctor, directly criticized the alcohol industry’s involvement in policymaking at the last alcohol policy roundtable meeting on February 9, 2022.
As a doctor, I don’t benefit from industry sitting at the table. I see the points being taken from the industry,” said Bart Takkenberg, a gastrointestinal liver doctor at the alcohol policy table, as per Follow The Money.
Then the question is what the role of that roundtable is and to what extent we can make our voice heard. I need to talk to the minister and the secretary of state. I have to make sure that they are convinced that it is best for public health to at least pass the minimum unit price.”Bart Takkenberg, gastrointestinal liver doctor
Alcohol pricing policies remain difficult to advance through the alcohol policy roundtable because of alcohol industry interference. There is some momentum being built by public health organizations and advocates for minimum unit pricing outside of the agreement. Another avenue is submitting of a private member’s bill for alcohol prevention by a Member of Parliament.
The new State Secretary Maarten van Ooijen will have to determine how to go forward with alcohol policy in the Netherlands. It is evident that urgent action is needed. Meanwhile, the Ministry of Health, Welfare, and Sport (VWS) plans to implement both the contradictory objectives in the coalition agreement: to introduce blurring at the same time as trying to reduce alcohol harm in the country.
The main participants at the alcohol policy roundtable
- Wim van Dalen – Director of the Netherlands Institute for Alcohol Policy STAP and a passionate advocate of effective alcohol policy,
- Peter de Wolf – Director of the Responsible Alcohol Consumption Foundation (STIVA) and the most famous face of Big Alcohol in the Netherlands. STIVA is funded by Dutch producers and importers of beer, wine and spirits,
- The Dutch Brewers,
- Floor van Bakkum – Prevention manager at addiction clinic Jellinek (VKN),
- Eus Peters – Dutch Drinks Trade Association,
- Ninette van Hasselt – Head of the Expertise Center for Alcohol and Drug Prevention of the Trimbos Institute, an independent knowledge institute,
- Petra de Boevere – Chairman of the association of independent off-licences, the Koninklijke SlijtersUnie (KSU), and
- Bart Takkenberg – Gastrointestinal Liver Doctor at Amsterdam UMC, who joined the alcohol roundtable in December 2021.