Moving Towards the Right Track?

Dutch Tobacco Control:
Moving Towards the
Right Track?
FCTC Shadow Report 2014
FCTC Shadow Report 2014
1
Colophon
This report is an initiative of and funded by:
Hartstichting (Dutch Heart Foundation)
KWF Kankerbestrijding (Dutch Cancer Society)
Longfonds (Dutch Lung Foundation)
These parties collaborate in the Alliantie Nederland Rookvrij (Dutch alliance for a
smokefree society)
Text and Compilation
Suzanne M. Heijndijk & Marc C. Willemsen
Correspondence to sanne.heijndijk@alliantienr.nl
Graphic Design
Bruksvoort Design & Content
Cover Photo
Nationale Beeldbank
© 2015, Alliantie Nederland Rookvrij
Reproduction allowed with reference:
Heijndijk, S.M., & Willemsen, M.C. (2015). Dutch Tobacco Control: Moving
Towards the Right Track? FCTC shadow report 2014. Den Haag: Alliantie
Nederland Rookvrij.
ISBN 978-90-823396-0-4
Dutch Tobacco Control:
Moving Towards the
Right Track?
FCTC Shadow Report 2014
FCTC Shadow Report 2014
3
Preface
Michael Rutgers
Worldwide 179 countries and the European Union collaborate
to reduce tobacco use and its deadly consequences. The
Netherlands is a Party to the global health treaty that was
developed to this end: on January 27th 2015, it will be ten years
since our country ratified the Framework Convention on Tobacco
Control (FCTC) of the World Health Organisation (WHO). With this
ratification, the Netherlands is obliged to implement measures to
pursue a smokefree society. The Dutch government is committed
to report on the progress to the WHO.
As non-governmental organisations we critically follow the
Dutch policy on tobacco control. In March 2012 we presented
a first FCTC shadow report. We concluded that internationally,
the Netherlands scored badly. Moreover, the Dutch tobacco policy showed a downward tendency.
Now, three years later, it appears as if the Netherlands is regaining some momentum. The age limit
for tobacco sales has been increased to 18, the smoking ban in all hospitality venues has been
re-established and the Netherlands voted in favour of the European Tobacco Products Directive (TPD)
that requires important measures by May 2016. However, the government is still wasting too many
opportunities to protect the youth against the consequences of tobacco use.
The Dutch alliance for a smokefree society is working towards a smokefree future. We consider
it unacceptable that young people become addicted to nicotine for life and are enslaved by
tobacco and the tobacco industry. We contribute, for example, by (mass media) campaigns on
the unacceptability of smoking, encouraging schools to introduce a smokefree schoolyard, and
through introducing a national month for smoking cessation: Stoptober. We appreciate the Dutch
government’s current support in relation to these activities and look forward to the government
joining us in our future efforts to protect our children in a healthy and smokefree society.
This report points out where there is room for improvement: for example by introducing a
comprehensive tobacco policy including increasing budget. This policy should, among other things,
consist of annual increases in excise duties, campaigns on the harmfulness of (passive) smoking,
a display ban, and introducing generic packaging. With these measures, the government can help
prevent young people from starting to smoke.
Let us join forces to create a smokefree society!
Michael Rutgers
Chairman Dutch alliance for a smokefree society
FCTC Shadow Report 2014
5
Preface
Laurent Huber
The release of this second shadow report on efforts by
the Dutch government to address the continuing tobacco
epidemic coincides with the tenth anniversary of the country’s
adoption of the WHO Framework Convention on Tobacco
Control (FCTC). The story of those ten years, at least for the
Netherlands, has not all been positive, but this report’s
findings demonstrate that there is hope for the near future.
It is imperative that the government, civil society and the
general public grasp this hope and move forward, for present
and future generations, and for the Netherlands and the world.
The hope stems from several policy moves since the last
report, including tightening and greater enforcement of
smokefree laws, raising the minimum age for purchasing tobacco products, recognition of the problem
posed by tobacco industry interference in public policy, a rise in tobacco excise taxes, and a renewed
public education campaign. These are vital steps. They move the Netherlands closer to international
best practices, and will no doubt have an impact on the health of Dutch citizens. The coming
implementation of the EU Tobacco Products Directive promises to push policy forward further.
But it is only the beginning of what is needed to end the tobacco epidemic, and there are several
areas of Dutch policy that can be improved, as this report shows. There is still no comprehensive
national tobacco control policy in place. Tobacco control has been folded into a general “lifestyle”
health program, increasing chances it will not get the proper level of attention. Public education, and
therefore public awareness of health harms, can be improved by following the examples of countries
like Australia and Norway, which have implemented media campaigns in order to warn citizens about
the harms of tobacco use.
While taxes on tobacco products have increased, allocations to tobacco control programs are not
adequate. More of the proceeds from tobacco taxes need to be spent on tobacco control, as is done
in Thailand and Panama. Tax increases are among the most effective tools to reduce smoking. When
France tripled its inflation-adjusted cigarette prices, sales fell more than 50%, and a few years later the
number of young men dying from lung cancer began to decline. A year after the Philippines increased
its tobacco taxes, the government collected more than the expected revenue and was able to spend
about 85% of these funds on health services. For these reasons the Dutch government should consider
implementing the recommendations of the recently adopted Guidelines for implementation of Article
6 of the FCTC (Tax and Price measures) which calls on governments to “establish coherent long-term
policies on their tobacco taxation structure and monitor on a regular basis including targets for their tax
rates, in order to achieve their public health and fiscal objectives within a certain period of time.”
6
Dutch Tobacco Control: Moving Towards the Right Track?
The Netherlands should not only move towards the use of effective graphic warnings but it should also
consider the implementation of plain packaging, as Australia has done. All of these steps will help the
Dutch government in its efforts to reach targets on reducing non communicable diseases and tobacco
use, which have been unanimously adopted by the World Health Assembly: a 25% reduction in deaths
caused by NCDs and a 30% reduction in tobacco use by 2025.
Policy change to better address tobacco is not merely something the Netherland should do; it has a
legally-binding obligation under the FCTC. In the ten years since it adopted the FCTC, and many years
before, the Dutch government seems to have valued the interests of the tobacco industry over the
interests of public health. The Netherlands has a moral obligation, as well as a legal one, to implement
the treaty’s measures, an obligation that it owes to the world as well as to its own citizens. Tobacco
remains, by far, the leading cause of preventable death in the Netherlands and globally. In spite of
the promise of the FCTC, worldwide we are still on track to see one billion deaths this century from
tobacco. Society can prevent the vast majority of these deaths, but it requires concerted action from
every government (and from every part of each government), civil society and the public. Recent
changes are a step in the right direction. Much more needs to be done, and the knowledge necessary
to move forward is readily available. Civil society will continue to support, educate, advocate, and
monitor.
Laurent Huber
Director Framework Convention Alliance
FCTC Shadow Report 2014
7
Endorsements
This report is an initiative of and funded by:
This report is endorsed by:
ClaudicatioNet
landelijk
netwerk
looptherapie
oude
g
gracht
roep
managers & consultants
via syl via
8
Dutch Tobacco Control: Moving Towards the Right Track?
Contents
Samenvatting
11
Summary
16
Introduction
21
Data Collection and Methods
24
FCTC Article-by-Article Review
27
Article 5 General Obligations
27
Article 6 Price and Tax Measures
34
Article 8 Protection from Exposure to Tobacco Smoke 39
Articles 9 and 10 Regulation of the Contents of Tobacco Products and Disclosures
45
Article 11 Packaging and Labelling of Tobacco Products
52
Article 12 Education, Communication, Training and Public Awareness
59
Article 13 Tobacco Advertising, Promotion and Sponsorship
66
Article 14 Tobacco Dependence and Cessation
73
Article 15 Illicit Trade in Tobacco Products
80
Article 16 Sales to and by Minors
86
Article 20 Research and Surveillance
91
Article 26 Financial Resources
94
Conclusions
References
FCTC Shadow Report 2014
96
100
9
10
Dutch Tobacco Control: Moving Towards the Right Track?
Samenvatting
Jaarlijks overlijden er in Nederland meer dan 19.000 mensen aan de gevolgen van roken en enkele
duizenden aan de gevolgen van meeroken. Roken is veruit de belangrijkste vermijdbare oorzaak van
sterfte en ziekte in de Nederlandse samenleving. In januari 2005 heeft Nederland het WHO-Kaderverdrag inzake Tabaksontmoediging (FCTC) geratificeerd, het eerste internationale volksgezondheidsverdrag. Het verdrag beoogt huidige en toekomstige generaties te beschermen tegen de verwoestende effecten van tabaksgebruik en blootstelling aan tabaksrook. Het biedt hiertoe een kader voor
tabaksontmoedigingsmaatregelen die door de verdragspartijen moeten worden uitgevoerd. Landen
zijn verplicht om periodiek verslag uit te brengen over de vooruitgang die is geboekt ten aanzien
van de implementatie van de maatregelen. In april 2014 heeft de Nederlandse regering haar vierde
voortgangsrapport ingediend. Als tegenhanger van deze overheidsrapportages, zetten non-gouvernementele organisaties schaduwrapporten in om te evalueren of overheden voldoen aan hun FCTCverplichtingen. Dit is het tweede Nederlandse FCTC schaduwrapport. Het eerste rapport werd gepubliceerd in 2012 en beoordeelde in hoeverre de Nederlandse overheid halverwege 2011 handelde in
overeenstemming met het FCTC. Dit tweede rapport gaat in op de ontwikkelingen die nadien hebben
plaatsgevonden. Het rapport bevat een nieuwe beoordeling van het functioneren van de Nederlandse
overheid in termen van het FCTC (anno december 2014) en geeft aanbevelingen voor een betere
implementatie van het verdrag. Hieronder worden de belangrijkste conclusies samengevat.
Artikel 5.1 vereist de ontwikkeling en uitvoering van allesomvattende, multisectorale nationale strategieën, plannen en programma’s voor tabaksontmoediging. Een dergelijke nationale strategie, plan
of programma ten aanzien van tabaksontmoediging is nog niet ontwikkeld in Nederland. Roken is wel
opgenomen als (beperkt) onderdeel van meer algemene gezondheids- en preventieprogramma’s, maar
er ontbreken voldoende concrete doelstellingen voor de bestrijding van tabaksgebruik. Coördinatie
tussen de verschillende ministeries lijkt te zijn toegenomen, hoewel nog geen sprake is van een geïnstitutionaliseerd coördinatiemechanisme specifiek voor het tabaksontmoedigingsbeleid (Artikel 5.2).
Artikel 5.3 schrijft voor dat overheden maatregelen nemen om hun tabaksontmoedigings­beleid te
beschermen tegen commerciële en andere gevestigde belangen van de tabaks­industrie. Het bewustzijn ten aanzien van deze verdragsbepaling is de afgelopen jaren ogenschijnlijk gegroeid. Bewindslieden hebben herhaaldelijk bevestigd dat alleen noodzakelijke interacties plaatsvinden met de tabaksindustrie en dat bij dergelijke interacties trans­parantie wordt betracht. De praktijk laat echter zien
dat deze principes nog niet structureel zijn ingebed in alle overheidslagen. Er is geen protocol vastgesteld. De transparantie neemt bovendien slechts beperkte vormen aan, omdat informatie zelden
proactief wordt aangeboden en omdat notulen van bijeenkomsten vaak niet beschikbaar zijn.
FCTC Shadow Report 2014
11
Vooruitgang op het gebied van prijs- en belastingmaatregelen voor tabaksproducten (Artikel 6)
verloopt traag, hoewel in 2013 voor Nederlandse begrippen een relatief grote accijnsverhoging voor
sigaretten en shag is doorgevoerd. De overheid gebruikt accijnzen nog steeds primair voor financiële
doeleinden in plaats van gezondheidsredenen, accijnsverschillen tussen de diverse tabaksproducten
zijn grotendeels in stand gebleven en er zijn geen nieuwe maatregelen getroffen met betrekking tot
de verkoop en/of uitvoer van accijnsvrije tabaksproducten.
Op het gebied van bescherming tegen blootstelling aan tabaksrook (Artikel 8) is een aantal positieve
ontwikkelingen zichtbaar. Vooral van belang is dat de uitzondering op het rookverbod voor kleine
horecagelegenheden niet meer van kracht is en dat de handhavingscapaciteit is vergroot. Rookruimtes zijn echter nog steeds toegestaan.
In de afgelopen jaren heeft de Nederlandse overheid verschillende maatregelen genomen om de
implementatie van Artikel 10, betreffende de informatievoorziening over tabaksproducten, te verbeteren. In het bijzonder is tegenwoordig op websites informatie beschikbaar voor het Nederlandse
publiek over de additieven in alle in Nederland verkrijgbare tabaksproducten. Met betrekking tot
de regulering van de inhoud van tabaksproducten (Artikel 9) is weinig voortuitgang geconstateerd.
Indien de herziene EU Tabaksproductenrichtlijn correct zal worden omgezet in Nederlands beleid, zal
dit echter belangrijke verbeteringen op dit gebied met zich meebrengen in de vorm van een verbod
op een aantal ingrediënten.
Overheidshandelen op het gebied van de etikettering en verpakking van tabaksproducten (Artikel 11)
is beperkt geweest, waardoor Nederland nog steeds relatief slecht scoort op dit gebied. De zelf-ervaren
effectiviteit van gezondheidswaarschuwingen is erg laag onder Nederlandse rokers. Nieuwe teksten zijn
ingevoerd voor de bijkomende gezondheidswaarschuwingen (op de achterkant van de verpakking), maar
producten met de oude waarschuwingsteksten mogen nog worden verkocht tot maart 2016. De regering
heeft steun verleend aan de herziene EU Tabaksproductenrichtlijn. Omzetting hiervan zal leiden tot een
aantal belangrijke veranderingen, zoals de invoering van grotere, grafische gezondheidswaarschuwingen. De regering overweegt nog niet om generieke verpakkingen (plain packaging) in te voeren.
Het overheidsbeleid op het gebied van educatie, communicatie en training (Artikel 12) heeft in de
afgelopen jaren verschillende gezichten gehad. Terwijl aanvankelijk een stop op alle massamediale
campagnes bekend werd gemaakt, zijn er sinds eind 2013 toch massamediale initiatieven uitgevoerd
en aangekondigd. Educatie van kinderen en hun ouders (via scholen en de gezondheidszorg) speelt
een belangrijke rol in de Nederlandse aanpak om publiek bewustzijn te creëren. Ondanks deze initiatieven, is de kennis over de gezondheidsrisico’s van (mee)roken, internationaal gezien, nog steeds erg
laag en wordt roken, vergeleken met andere landen, nog steeds beschouwd als relatief normaal gedrag.
Nederland heeft nog steeds geen volledig verbod op tabaksreclame, -promotie en -sponsoring
(Artikel 13). Nieuwe initiatieven van overheidswege om dergelijke reclame, promotie en sponsoring
te voorkomen, zijn schaars geweest. Recent heeft de regering wel onderzoeken laten uitvoeren om de
effecten van een uitstalverbod (display ban) en het terugdringen van het aantal verkooppunten van
tabaksproducten (onder andere via een verbod op automaten) in kaart te brengen. Op grond hiervan
zijn tot nu toe geen concrete maatregelen aangekondigd of uitgevoerd.
12
Dutch Tobacco Control: Moving Towards the Right Track?
De kwaliteit van de behandeling van tabaksverslaving (Artikel 14) lijkt gewaarborgd in Nederland en
recente initiatieven hebben bijgedragen tot een verdere inbedding van kwaliteitsnormen. Met betrekking tot het bevorderen van stoppen met roken, wijzen de waargenomen ontwikkelingen minder
duidelijk in een bepaalde richting. Dit geldt bijvoorbeeld voor de schommelingen in de vergoeding
van farmacotherapie (beschikbaar in 2011, 2013 en 2014, maar niet in 2012). Bezorgdheid is in het
bijzonder op zijn plaats met betrekking tot het gebrek aan actieve communicatie over de verschillende effectieve middelen en methoden van stoppen met roken en aan een nationale strategie om
stoppen met roken te stimuleren en ondersteunen.
De strijd tegen de illegale handel in tabaksproducten (Artikel 15) lijkt nog niet te worden beschouwd
als een prioriteit in Nederland, hoewel onlangs een aantal maatregelen is genomen om de handhavingsinspanningen te vergroten. Recent hebben zich verschillende ontwikkelingen voorgedaan op het
niveau van de WHO en de EU. Hoewel de Nederlandse regering vaak meegaat in deze ontwikkelingen,
vervult zij geen voortrekkersrol. Nederland heeft het FCTC Protocol tot uitbanning van illegale handel
bijvoorbeeld nog niet geratificeerd. De overheid lijkt bereid om te vertrouwen op gegevens of systemen die zijn verstrekt of ontwikkeld door de tabaksindustrie.
De overheid heeft verschillende maatregelen getroffen om de verkoop aan minderjarigen (Artikel 16)
tegen te gaan. De wettelijke leeftijdsgrens is verhoogd van 16 naar 18, de handhavingscapaciteit is
versterkt en er zijn strengere sancties mogelijk. Er is echter nog geen verbod op de verkoop van tabak
via tabaksautomaten en er zijn geen verdere maatregelen genomen in relatie tot de verkoop door
minderjarigen, waardoor een discrepantie is ontstaan tussen de wettelijke leeftijdsgrens voor het
kopen van tabaksproducten (18 jaar) en het verkopen van tabaksproducten (16 jaar).
De monitoring van tabaksgebruik (Artikel 20) is een gebied waarop een duidelijke neerwaartse trend
zichtbaar is sinds het vorige schaduwrapport. De regering heeft besloten om twee gerenommeerde
en kwalitatief hoogwaardige nationale monitors (het Continu Onderzoek Rookgewoonten (COR) en de
Roken Jeugd Monitor (RJM)) te staken. Met name de stopzetting van de RJM is opvallend in het licht
van de focus van het kabinet op het terugdringen van tabaksgebruik onder jongeren. Hoewel andere
monitors worden ingezet, bieden deze instrumenten niet dezelfde mate van detaillering. Geen verbeteringen zijn waargenomen met betrekking tot het bevorderen van wetenschappelijk onderzoek op het
gebied van tabaksontmoediging. Als al sprake is van een ontwikkeling, lijkt het juist moeilijker te zijn
geworden om overheidssubsidies te verwerven voor onderzoek naar de bestrijding van tabaks­gebruik.
De dalende trend in de financiële middelen voor tabaksontmoediging (Artikel 26) die in het vorige
schaduwrapport werd geïdentificeerd, lijkt zich te hebben doorgezet, hoewel een inschatting van het
specifieke budget hiervoor wordt bemoeilijkt door de toenemende nadruk van de overheid op een
geïntegreerde benadering van preventie. In de afgelopen jaren zijn de beleidsontwikkelingen ten
aanzien van tabaksontmoediging (deels) ingegeven door budgettaire overwegingen.
Tabel 1a illustreert in hoeverre de Nederlandse overheid op dit moment handelt in overeenstemming met het Kaderverdrag en de Richtlijnen. Bij het beoordelen van het overheidshandelen is een
onderscheid gemaakt tussen FCTC verplichtingen, aanbevelingen en suggesties. Per verdragsartikel is
beoordeeld in hoeverre de overheid aan de verschillende verplichtingen, aanbevelingen en sugges-
FCTC Shadow Report 2014
13
ties voldoet. Deze scores zijn samengevoegd in Tabel 1a, waarbij de slechtste score op de bepalingen
doorslaggevend is geweest voor de uiteindelijke beoordeling. Een ‘rode score’ betekent daarom niet
per definitie dat de overheid geen enkele maatregel treft op dit gebied. Deze score geeft echter wel
aan dat de overheid niet voldoet aan ten minste één van de verdragsverplichtingen. De scoreoverzichten in de afzonderlijke hoofdstukken geven meer inzicht en nuances in de sterktes en zwaktes
van het Nederlandse tabaksontmoedigingsbeleid.
Tabel 1a
Evaluatie van de implementatie van de belangrijkste FCTC maatregelen in Nederland in 2014
Niet in overeenstemming
met FCTC verplichtingen
Niet in overeenstemming
met FCTC aanbevelingen,
maar wel met (eventuele)
verplichtingen
Niet in overeenstemming
met FCTC suggesties,
maar wel met (eventuele)
verplichtingen en/of
aanbevelingen
In overeenstemming
met FCTC verplichtingen,
aanbevelingen en/of
suggesties
Alomvattende strategie en
centrale coördinatie
(Art. 5.1 & 5.2)
Bescherming tegen
belangen tabaksindustrie
(Art. 5.3)
Prijs- en belasting­
maatregelen (Art. 6)
Bescherming tegen
blootstelling aan tabaksrook
(Art. 8)
Inhoud tabaksproducten en
informatieverschaffing
(Art. 9 & 10)
Verpakking en etikettering
(Art. 11)
Educatie, communicatie en
training (Art. 12)
Reclame, promotie en
sponsoring (Art. 13)
Tabaksverslaving en stoppen
met roken (Art. 14)
Illegale handel (Art. 15)
Verkoop aan en door
minderjarigen (Art. 16)
Onderzoek en monitoring
(Art. 20)
Financiële middelen (Art.
26)
De methodologie voor het beoordelen van het handelen van de overheid in relatie tot het FCTC
is enigszins aangepast ten opzichte van het vorige rapport. Het vorige rapport stond met name in
het teken van het positioneren van Nederland in een internationaal perspectief. De methodologie
waarvoor toen is gekozen was dan ook grotendeels gebaseerd op een vergelijkende component. Het
doel van dit tweede schaduwrapport is meer nationaal gericht. De beoordeling van het functioneren
van de overheid richt zich daarom meer op de Nederlandse uitvoering van de tekst en geest van
het verdrag. Door de veranderde methodologie zijn één-op-één vergelijkingen tussen de twee
verschillende rapporten niet mogelijk.
14
Dutch Tobacco Control: Moving Towards the Right Track?
Voornaamste aanbevelingen
Uitgaande van de inhoud van het FCTC – en rekening houdende met de recente ontwikkelingen en
het huidige presteren van Nederland – zijn de voornaamste aanbevelingen aan de Nederlandse regering om:
• Een allesomvattende, multisectorale nationale tabaksontmoedigingsstrategie te ontwikkelen.
• Verdere maatregelen te treffen om het tabaksontmoedigingsbeleid te beschermen tegen de
belangen van de tabaksindustrie, waaronder het ontwikkelen van een protocol en het vergroten
van transparantie in relatie tot alle contacten met de tabaksindustrie.
• Regelmatig aanzienlijke accijnsverhogingen door te voeren en accijnzen in te zetten om het
prijsverschil tussen vervangbare tabaksproducten te reduceren.
• Rookruimtes niet langer toe te staan.
• De herziene EU Tabaksproductenrichtlijn juist en snel in te voeren en het Nederlandse publiek te
informeren over (de gezondheidsredenen voor) deze maatregelen.
• De invoering van generieke verpakkingen (plain packaging) te overwegen.
• Verdere maatregelen, zoals massamediale campagnes, te treffen om het bewustzijn over de
schadelijkheid van roken te vergroten en voorlichting te initiëren ten aanzien van andere
onderwerpen, zoals de marketingstrategieën van de tabaksindustrie.
• Een algeheel of completer verbod op reclame en promotie van tabak te implementeren, waaronder
de invoering van een uitstalverbod (display ban) van tabak in winkels.
• Een langetermijnstrategie te ontwikkelen om rokers te helpen om te stoppen met roken, waarin
onder meer de voortzetting van vergoeding van farmacotherapie wordt vastgelegd en wordt
ingezet op maatregelen die kennis onder rokers over de effectiviteit en beschikbaarheid van
stopondersteuning vergroten.
• De rol van de bestrijding van de illegale handel in tabaksproducten als onderdeel van een
alomvattend tabaksontmoedigingsbeleid te erkennen en het Protocol tot uitbanning van illegale
handel te ratificeren.
• Tabaksautomaten te verbieden.
• Het besluit om de twee gerenommeerde en kwalitatief hoogwaardige programma’s voor de
monitoring van tabaksgebruik (COR en RJM) te staken, terug te draaien.
• Wetenschappelijk onderzoek ten bate van een effectieve tabaksontmoedigingsaanpak te
stimuleren.
• Het budget dat beschikbaar is voor tabaksontmoediging significant te verhogen.
FCTC Shadow Report 2014
15
Summary
In the Netherlands, every year more than 19,000 people die of the consequences of smoking and
several thousands of the consequences of passive smoking. Smoking is by far the leading preventable
cause of mortality and morbidity in Dutch society. In January 2005, the Netherlands ratified the
WHO Framework Convention on Tobacco Control (FCTC), the first global health treaty. The Convention
aims to protect present and future generations from the devastating consequences of tobacco
consumption and exposure to tobacco smoke. To this end, it provides a framework for tobacco
control measures to be implemented by its Parties. Countries are required to periodically report on
the progress made with regard to the implementation of these measures. In April 2014, the Dutch
government submitted its fourth progress report. As a counterpart to these official country reports,
shadow repor­ting is used by non-governmental organisations to evaluate whether governments
are complying with their FCTC obligations. This is the second Dutch FCTC shadow report. The first
report was published in 2012 and assessed to what extent the Dutch government was acting in
accordance with the FCTC the middle of 2011. This second report focuses on the developments that
have occurred since then. The report contains a new assessment of the performance of the Dutch
government in terms of the FCTC (in December 2014) and provides recommendations for a better
implementation of the Convention. The main conclusions are summarised below.
Article 5.1 requires the adoption and implementation of comprehensive, multisectoral national
tobacco control strategies, plans and programmes. No such national tobacco control strategy, plan or
programme has been developed in the Netherlands. Rather, smoking has been included as (a modest)
part of more general health and prevention strategies, plans and programmes, but no sufficiently
concrete targets have been esta­blished for tobacco control. It appears that coordination between
different ministries has increased, although no formal coordination mechanism has been put in place
(Article 5.2).
Under Article 5.3, countries are required to take measures to protect their tobacco control policies
from commercial and other vested interests of the tobacco industry. Awareness of this provision has
seemingly increased during the previous years. Members of government have repeatedly confirmed
that only necessary interactions with the tobacco industry take place and that such interactions
are conducted transparently. However, practice shows that these principles are not yet structurally
embedded throughout the government. No protocol has been established. Also, transparency is very
limited, as information is rarely provided pro-actively and minutes of meetings are often not available.
Progress in the field of price and tax measures for tobacco products (Article 6) has been slow,
although a (by Dutch standards) large excise duty increase for cigarettes and smoking tobacco
16
Dutch Tobacco Control: Moving Towards the Right Track?
was implemented in 2013. The government currently still primarily uses excise duties on tobacco
products to further financial objectives instead of public health ones, tax differences between
various types of tobacco products have largely remained in place, and no new measures have been
implemented with regard to sales and/or imports of duty-free tobacco products.
There have been some positive developments in the area of protection against exposure to tobacco
smoke (Article 8). Most importantly, the exception to the smoking ban for small hospitality venues is
no longer in place and enforcement capacity has been increased. However, designated smoking areas
are still allowed.
In previous years, the Dutch government has taken various steps to improve implemen­tation of
Article 10 on tobacco product disclosures. In particular, information about the additives in all
available tobacco products is now being disclosed to the Dutch public through websites. With regard
to the regulation of the contents of tobacco products (Article 9), few improvements were observed.
However, correct transposition of the revised EU Tobacco Products Directive will bring along major
improvements in this area by providing for a ban on certain ingredients.
Government action in relation to the labelling and packaging of tobacco products (Article 11)
has been limited, so that the Netherlands is still underperforming in this area. The self-perceived
effectiveness of health warnings is very low among Dutch smokers. New texts for the additional
health warning labels (to be placed at the back of packages) have been implemented, although
products with the old health warning labels may still be marketed until March 2016. The government
has also provided support for the revised EU Tobacco Products Directive, transposition of which will
bring along several important changes, such as the introduction of larger, pictorial health warnings.
The government does not yet consider the introduction of plain packaging.
Government policy in the area of education, communication and training (Article 12) has changed
throughout the past years. For instance, whereas initially a stop on all mass media campaigns was
declared, since late 2013, mass media initiatives have been implemented or announced. Education
of children and their parents (through schools and health care) plays an important role in the Dutch
government’s approach to raising awareness. Regardless of these initiatives, from an international
perspective, awareness of the health risks of (passive) smoking is very low and smoking is still
considered to be relatively normal behaviour in the Dutch society.
The Netherlands does not yet have a comprehensive ban on tobacco advertising, promotion and
sponsorship (Article 13). New government initiatives to prevent such advertising, promotion and
sponsorship have been scarce. Recently, studies were commissioned by the government to map
the effects of a display ban and a reduction of the number of points of sale for tobacco products
(including a ban on tobacco vending machines). So far, no concrete measures have been announced
or implemented on the basis of these studies.
Quality of tobacco dependence treatment (Article 14) seems warranted in the Netherlands and
recent initiatives have contributed to a further embedment of quality standards. With regard to
the promotion of smoking cessation, less clear-cut developments were observed. This applies, for
FCTC Shadow Report 2014
17
instance, to the fluctuations in reimbursement for pharmacotherapy (available in 2011, 2013 and
2014, but not in 2012). In particular, the lack of active communication regarding the existence and
availability of effective methods to quit smoking and the absence of a strategy to stimulate and
support smokers to quit raises concerns.
Combatting illicit trade in tobacco products (Article 15) does not seem to be considered a priority
in the Netherlands yet, although some measures have recently been taken to increase enforcement.
Recently, various developments have occurred at the WHO and EU levels. Even though the Dutch
government tends to go along with these measures, it does not adopt a leading role. The Netherlands
has, for example, not yet ratified the FCTC Protocol on Illicit Trade. The government appears willing to
rely on data or systems that have been provided or developed by the tobacco industry.
Several measures have been initiated in order to prevent sales to minors (Article 16). The legal age
limit has been increased from 16 to 18, enforcement capacity has been strengthened and more
stringent penalties have been introduced. However, currently there is no ban on tobacco vending
machines and no further measures have been taken with regard to sales by minors, causing a
discrepancy between the legal age limit for buying tobacco (18 years) and selling tobacco (16 years).
Monitoring of tobacco consumption (Article 20) is one area in which an obvious downward trend has
been observed since the previous shadow report. The government has decided to discontinue two
well-established and high-quality national surveillance programmes on smoking (the Continuous
Survey of Smoking Habits and the Smoking Youth Monitor). Especially the discontinuation of the
Smoking Youth Monitor is remarkable, given the government’s focus on prevention of smoking among
youth. Although other monitoring instruments have been put in place, these instruments do not
offer the same level of detail. No improvements have been observed in relation to the promotion of
scientific research in the area of tobacco control. If anything, it appears to have become more difficult
to obtain government subsidies for tobacco control research.
The trend of decreased financial resources for tobacco control (Article 26) that was identified in
the previous shadow report seems to have continued, although a precise assessment of the available budget for tobacco control is complicated by the Dutch government’s increased reliance on an
integrated approach to prevention. In the past years, the development of tobacco control policies has
been negatively influenced by budgetary concerns.
Table 1b shows to what extent the Dutch government is currently acting in accordance with the
Convention and its Guidelines. In assessing its performance, a distinction has been made between
FCTC obligations, recommendations and suggestions. For each treaty article, it has been assessed to
what extent the government acts in accordance with the various obligations, recommendations and
suggestions. These scores have been combined in Table 1b, with the overall score being determined
by the lowest score for the provisions. A ‘red score’, therefore, does not necessarily mean that the
government takes no action in this field. It does, however, imply that the government does not meet
at least one of its treaty obligations. The score listings at the end of the specific chapters give more
details and insights into the weaknesses and strengths of the Dutch tobacco control policy.
18
Dutch Tobacco Control: Moving Towards the Right Track?
Tabel 1b
Evaluation of the implementation of FCTC measures in the Netherlands in 2014
Not in accordance with
FCTC obligations
Not in accordance with
FCTC recommendations, but
corres­ponds to obligations
(if any)
Not in accordance with
FCTC suggestions, but
corresponds to obligations
and/or recommendations
(if any)
Corresponds to FCTC
obligations, recommenda­
tions and/or suggestions
Comprehensive strategy and
central coordination
(Art. 5.1 & 5.2)
Protection against tobacco
industry interests (Art. 5.3)
Tax and price measures
(Art. 6)
Protection against exposure
to tobacco smoke (Art. 8)
Contents of tobacco
products and disclosures
(Art. 9 & 10)
Packaging and labelling
(Art. 11)
Education, communication,
and training (Art. 12)
Advertising, promotion, and
sponsorship (Art. 13)
Tobacco dependence and
cessation (Art. 14)
Illicit trade (Art. 15)
Sales to and by minors (Art.
16)
Research and surveillance
(Art. 20)
Financial resources (Art. 26)
The methodology for assessing the performance of the government in terms of FCTC has been slightly
adjusted in comparison to the previous report. The previous report aimed primarily at positioning the
Netherlands in an international perspective. The methodology used was therefore largely based on a
comparative component. The purpose of this second shadow report is more nationally oriented. The
assessment of the government’s performance is, therefore, based more on the Dutch application of
the wording and spirit of the treaty. Due to the changed methodology, the two reports should not be
compared one-on-one.
FCTC Shadow Report 2014
19
Main recommendations
Based on the contents of FCTC – and taking into account recent developments and current
performance – the main recommendations to the Dutch government are to:
• Develop a comprehensive, multisectoral national tobacco control strategy.
• Take further measures to protect tobacco control policies against the interests of the tobacco
industry, including the development of a protocol and increased transparency with regard to all
interactions with the tobacco industry.
• Implement significant tax increases on a regular basis and use taxes to decrease the price
differentials between substitutable tobacco products.
• No longer allow designated smoking rooms.
• Correctly and promptly transpose the revised EU Tobacco Products Directive and inform the public
about (the health rationale for) these measures.
• Consider the implementation of plain packaging.
• Implement further measures, such as mass media campaigns, to increase awareness of the
harmfulness of smoking and initiate communication on other topics, such as the marketing
strategies of the tobacco industry.
• Implement a (more) comprehensive ban on tobacco advertising and promotion, including a display
ban.
• Develop a long-term strategy to help smokers quit, which includes continued reimbursement of
pharmacotherapy and measures to increase awareness among smokers about (the effectiveness of)
the support that is available for smoking cessation.
• Acknowledge the role of the fight against illicit tobacco trade as part of a comprehensive tobacco
control policy and ratify the Protocol on Illicit Trade.
• Ban tobacco vending machines.
• Reverse the decision to discontinue the two well-established and high-quality tobacco monitors on
tobacco use.
• Stimulate scientific research in the area of tobacco control.
• Significantly increase the budget for tobacco control.
20
Dutch Tobacco Control: Moving Towards the Right Track?
Introduction
Smoking is by far the leading preventable cause of mortality and morbidity in the Netherlands. Every
year more than 19,000 people die of the consequences of smoking1. Exposure to secondhand smoke
is believed to cause another couple of thousand deaths on an annual basis2. More than one-eighth
of the total disease burden in the Netherlands is attributable to smoking3. There has been a slow
decrease in smoking prevalence since the early 2000s (see Figure 1). Between 2004 and 2010, the
proportion of smokers as part of the Dutch population fluctuated between 27% and 28%. In 2011,
smoking prevalence decreased to slightly below 25%. Although there was a small increase in the
proportion of people smoking in 2012, the level of smoking prevalence returned to 25% in 2013.
It has been suggested that the proportion of smokers as part of the Dutch population is stabilising4.
Figure 1
Smoking prevalence in the Dutch population (15 years and older), from 2000 to 2013.4
In 2013, the Netherlands ranked 13th among European countries with regard to the implementation
of major tobacco control policies5. Few improvements were observed in comparison to 20106.
The Netherlands is a Party to the Framework Convention on Tobacco Control (FCTC) since 2005. On
27 January 2015, it will be ten years since the Netherlands ratified this first global health treaty.
The Convention aims to protect present and future generations from the devastating consequences
of tobacco consumption and exposure to tobacco smoke. To this end, it provides a framework
for tobacco control measures to be implemented by its Parties. The FCTC obliges its Parties to
periodically report to the World Health Organisation (WHO) on the progress made with regard to
implementing these measures (Article 21). In April 20147, the Dutch government submitted its fourth
FCTC Shadow Report 2014
21
progress report8. Previous reports were submitted in 20089, 201010 and 201211. The national reports
are primarily used by the Convention Secretariat to draw up global progress reports. An (independent)
assessment of the implementation progress or compliance is not (currently) provided12.
Since the 2014 reporting round, the FCTC reporting instrument allows the Parties to elaborate not
only on the extent to which the Convention itself has been implemented, but also to comment on the
implementation status of the various Guidelines, through a standardised questionnaire. The Dutch
government has opted not to make use of this additional (voluntary) instrument.
As a counterpart to the official country reports, shadow reporting is an instrument used by nongovernmental organisations to assess governmental implementation of the FCTC. This is the second
FCTC shadow report in the Netherlands. The first report, which was presented in March 2012,
described the state of Dutch tobacco control policy in the middle of 2011. Inspired by the report, a
motion was tabled in the House of Representatives by members of the Christian Party (CU) and Party
for the Animals (PvdD): “The House […], noting that the Netherlands does not abide by all measures
included in the WHO FCTC, which was ratified by the Netherlands; urges the government to develop a
comprehensive tobacco control policy, raise tobacco excise duties, reverse the relaxation of the smoking
ban, ban the use of additives in tobacco products, publicly disclose information about tobacco products
ingredients, renew health warning labels on tobacco products, initiate public awareness campaigns
about the health risks of smoking and passive smoking, develop a national smoking cessation strategy,
ban cigarette vending machines, pay attention to the environmental impact of tobacco production and
consumption, establish a fund for tobacco research and coordinate scientific research in this area”13.
Although the motion was not supported by a majority of the members of parliament14, the first
shadow report has contributed to an increased (political) awareness of the importance of FCTC for
Dutch tobacco control.
The assessments in the shadow reports are guided by the texts of the Convention and its Guidelines.
Using the FCTC as a benchmark has several important implications. Firstly, although the FCTC is an
evidence-based treaty, this does not imply that all effective tobacco control measures are included
in optima forma in the Convention. In drawing up international treaties, political compromises often
have to be made15. For example, Article 6 FCTC, on price and tax measures, does not contain any
obligations (‘shall’-provisions), even though tobacco taxation is often considered to be (one of) the
most effective tobacco control measure(s). Therefore, if a government performs well or sufficient in
terms of FCTC, this does not imply that the government has taken the best available measures. The
Convention itself explicitly encourages Parties to implement measures beyond those included in the
FCTC (see Article 2.1 of the Convention and the introductory remarks to various Guidelines). While the
scores presented in this report are solely based on the contents of FCTC, the recommendations are,
in some instances, more far-reaching or concrete (but still based on scientific evidence). Secondly,
although the FCTC is not a standstill treaty (see below), it has not yet been adapted to some of the
recent developments on the tobacco market, such as the emergence of the electronic cigarette. This
topic will therefore not be (extensively) addressed in this report, even though the Dutch government
has taken measures in this regard16.
22
Dutch Tobacco Control: Moving Towards the Right Track?
Since the previous shadow report, various developments have taken place in relation to the contents
of the FCTC. During the fifth Conference of the Parties (COP) in November 2012, the partial Guidelines
on Articles 9 and 10 were amended and the first Protocol to the Convention (on illicit trade) was
adopted. During the sixth COP in October 2014 new Guidelines were adopted for the implementation
of Article 6.
Important context-setting developments on the national level include a change of government. From
October 2010 to November 2012, a minority coalition between the conservative-liberals (VVD) and
the Christian democrats (CDA) was in power, supported by the populist Freedom Party (PVV). Tobacco
control fell within the portfolio of the Minister of Health, Edith Schippers (VVD). Since November
2012, the Dutch government coalition is made up of the VVD and the Labour Party (PvdA). The
responsibility for tobacco control has been transferred to the State Secretary for Health, Martin van
Rijn (PvdA).
The research questions for this second shadow report were:
• What FCTC-related developments have taken place in the Netherlands between September 2011
and December 2014?
• What is the current status of implementation of the FCTC and its Guidelines in the Netherlands?
• What points of improvement for the Dutch tobacco control policy can be derived from the FCTC?
A selection has been made with regard to the FCTC provisions under scrutiny in this report. With
the exception of Article 17 FCTC (which is less relevant, because tobacco is not grown in the
Netherlands), all provisions setting out measures to reduce the demand (Articles 5, 6, and 8 to 14)
and supply (Articles 15 and 16) of tobacco are included. In addition, the most important overarching
and supportive provisions are considered, namely the general obligations included in Article 5, the
obligations in the areas of research and surveillance (Article 20) and financial resources (Article
26). The report focuses on the development of tobacco control policies in the Netherlands. The
contribution of the Dutch government to the development of tobacco control policies in other
countries (for instance, through financial contributions) is not assessed. This is not to indicate
that such actions are not of importance in the global fight against the tobacco epidemic. Rather, it
illustrates that choices had to be made in drawing up this report and that these choices have resulted
in a focus on the implementation of the FCTC in the Dutch context.
Details of the Dutch tobacco control policy that have remained (largely) unchanged since the
publication of the previous shadow report will, in most instances, not be discussed again, although
the lack of progress does in certain instances translate into a repetition of recommendations.
For details on the situation before September 2011, the first Dutch FCTC shadow report can be
consulted17.
FCTC Shadow Report 2014
23
Data Collection and Methods
Data collection
Data were compiled and collected from July 2014 to December 2014. They cover the period from
September 2011 to December 2014. Data were primarily retrieved from the following sources: official
government documents, documents retrieved through Government Information (Public Access) Act
requests, research reports, scientific publications and news articles. Experts and public servants were
approached to fill remaining knowledge gaps.
Methods
This report assesses the performance of the Dutch government in terms of the FCTC at the end of
2014. The method of evaluation has been somewhat adjusted in comparison to the first Dutch
FCTC shadow report. In the previous report, the Dutch government’s performance was assessed
by comparing its actions to those of other countries. This suited the objective of positioning the
Netherlands in an international perspective. The purpose of this second report was more nationally
oriented. Evaluation was based on compliance with all relevant FCTC provisions, building on the
exact wording of the Convention and its Guidelines. Such an approach provides more detailed
information on the elements that still need to be improved by the government in order for it to act
in accordance with the FCTC. While the report gives an extensive overview of the policy changes that
have occurred since the previous report, due to this change in methodology, caution is required in
drawing conclusions concerning changes in FCTC compliance by the Dutch government. In particular,
the colour code schemes presented in the two reports cannot be compared one-on-one.
Selection of provisions
To evaluate the government’s performance, a distinction was made between three types of
commitments, with various strengths, that can be found in the FCTC and its Guidelines. These are
obligations, recommendations and suggestions. This classification derives from the verbs that are
used to communicate the commitment (see also Table 2). Only provisions that represent an obligation,
recommendation or suggestion for the Parties were included in the analysis. Provisions that are
targeted primarily at cooperation with or assistance to other Parties or that concern procedural
commitments in relation to the World Health Organisation (WHO) were excluded from the analysis.
Given the large number of commitments included in the Guidelines, some further selections were made.
If the Guidelines contain an explicit reference to the term “recommendations”, followed by one or more
concrete recommendations, only these recommendations were selected. This applies to the Guidelines
for implementation of Article 5.3, Articles 9 and 10, and Article 13. The Guidelines for implementation
of Article 12 and Article 14 also contain such explicit references to “recommendations”, but these
24
Dutch Tobacco Control: Moving Towards the Right Track?
recommendations are further specified through “action points”. Because the Guidelines explicitly
link these action points to a successful implementation of the recommendations, these action points
were used to assess the government’s performance. For Article 8 and Article 11, provisions from the
Guidelines were selected on the basis of the wording of provisions, as well as their topic. For Article
11, those provisions were selected that relate to the development of effective packaging and labelling
requirement and restrictions, and that contain a commitment directed at the Parties (e.g., “Parties
should”) or a commitment related directly to the measures to be taken (e.g., “Health warnings should”).
Commitments directed at the Parties included in the Guidelines for implementation of Article 8 are
scarce. Provisions were included if they are targeted at the Parties or build directly on the measures to
be taken by the government (e.g., “Legislation should”).
To prevent extremely long tables, commitments were combined if appropriate. This was done for the
Article 5.3, Article 12 and Article 14 Guidelines. In these cases, the overarching recommendations
were provided by the Guidelines themselves. To score compliance with these commitments, the
same approach was used as the approach that was employed to compute the overall scores for treaty
articles (see below).
Provisions were removed in cases of a clear overlap with other provisions. This applies, for example,
to the Article 14 Guidelines’ section on a stepwise approach to developing cessation support. In
addition, several Guidelines’ provisions were deemed non-applicable in the Dutch context, such as
the Article 5.3 Guidelines on state-owned tobacco industry.
Guidelines for implementation of Article 6 were adopted by the Conference of the Parties in
October 2014. Given the short period of time between this adoption and the assessment provided
in this report, the Dutch government’s performance has not yet been scored on the basis of the
recommendations and suggestions included in these Guidelines.
Table 2
The colour scheme to reflect compliance with FCTC commitments
Not in accordance with
FCTC obligations
Obligations:
Shall
Not in accordance with Not in accordance with
FCTC recommendations FCTC suggestions
No
Recommendations:
Should
Shall endeavour
Suggestions:
May
Shall consider
Should consider
Corresponds to FCTC
Yes
No
Yes
No
Yes
Scoring system
For each selected provision it was determined whether or not the government complied with the
commitment (obligation, recommendation or suggestion), using December 2014 as point of reference.
Compliance was assessed as a dichotomy (‘yes’ or ‘no’). Intermediate options, such as ‘partially’, were
not considered. Compliance and strength of the commitment were combined into a colour score.
Table 2 shows how this scoring mechanism was applied. For example, if the government was found
FCTC Shadow Report 2014
25
not to act in line with an obligation, it was provided with a ‘red score’ regarding that provision. If it
was found to comply, a ‘green score’ was attributed. In case of a suggestion, which is a much weaker
commitment, the government was attributed a ‘light green score’ in case of non-compliance. This is
to indicate that the government cannot be held accountable for not having implemented a provision
which is merely phrased as a suggestion. However, from the perspective of tobacco control and public
health, it would be strongly advisable for the government to take action in this regard.
In order to establish whether or not the government complied with a specific commitment, several
aspects were taken into consideration. Given that the Guidelines are often more far-reaching than the
Convention itself, they were generally not used as a direct benchmark for assessment of compliance
with the Convention provisions. Most sets of Guidelines have the purpose of assisting Parties in
meeting their obligations under a specified FCTC provision. However, in some cases (most notably the
Guidelines on Article 8), the objectives have been defined in broader terms and do set out required
action under the Convention. In these limited instances, the Guidelines have been used to interpret
the related treaty provisions.
Many treaty articles refer to the obligation to take “effective measures”, without specifying this notion
of effectiveness. In these cases, it was considered whether the type of measure should generally be
considered effective. Enforcement of and compliance with the measure were taken into account as
well. Finally, it was assessed to what extent the actions taken by the government were in line with the
current state of scientific knowledge as well as current practices in other countries.
Various provisions contain a conditional phrase, such as “taking into account national circumstances
and priorities”. In such instances, the Dutch context was taken into consideration when assigning
scores. When assessing compliance with provisions that are conditioned by legal requirements (such
as “in accordance with its national law”), it was assumed that there were no legal collisions, unless
there was clear evidence to the contrary (which has not been found).
Finally, in scoring the government’s performance, future actions were not taken into consideration.
However, because the Netherlands is legally required to transpose the revised EU Tobacco Products
Directive (TPD), which contains many predefined conditions, an attempt has been made to point out
for which provisions this transposition (which has to occur by May 2016 at the latest) would likely
make a difference as far as assessed compliance is concerned.
Overall scores for entire treaty articles
Based on the individual scores for the various provisions within a treaty article, an overall score was
created for the entire treaty article. This final score was determined on the basis of the lowest score
on any of the provisions (obligations, recommendations and suggestions) that were identified in
relation to this treaty article. A ‘red score’ does, therefore, not necessarily imply that the government
takes no action in this field. It does, however, indicate that the government does not meet at least one
of its treaty obligations. The tables listing all individual scores, presented at the end of each chapter,
highlight which commitments have to be implemented in order to obtain a better overall score. Not all
treaty articles contain obligations. Article 6 (price and tax measures), for instance, does not include a
“shall”-provision. For these articles it was thus not possible to obtain an overall ‘red score’.
26
Dutch Tobacco Control: Moving Towards the Right Track?
FCTC Article-by-Article Review
Article 5
General Obligations
ARTICLE 5.1
Each Party shall develop, implement, periodically update and review comprehensive
multisectoral national tobacco control strategies, plans and programmes in
accordance with this Convention and the protocols to which it is a Party.
The Dutch government has consistently reported to the World Health Organisation (WHO) that it
has adopted and implemented comprehensive, multisectoral national tobacco control strategies,
plans and programmes8-11. However, there has been no national tobacco control strategy, plan or
programme since the National Programme on Tobacco Control 2006-2010 (which did contain the
ambition of reducing smoking prevalence to 20% in 2010, but lacked a comprehensive and workable
strategic plan as well as agreements between the government
and health organisations on how to achieve the target18) came to
an end. Rather, smoking has come to be included as part of more
general health strategies, plans and programmes.
The Dutch government develops a national health policy document
every four years. In May 2011, the “Health Nearby” (Gezondheid
Alles is
gezondheid…
Het Nationaal Programma Preventie 2014 - 2016
Dichtbij) policy report was presented19. Although smoking was still
identified as one of the priorities, the government had shifted its
www.rijksoverheid.nl
focus to physical activity. In the report, few references were made
to specific tobacco control interventions or measures. In November
2013, the Health Nearby policy was supplemented by the National
Programme on Prevention (NPP) “Everything is Health” (Alles is
Gezondheid)20. The NPP builds upon activities that had already
been initiated and takes the process of shifting responsibility for
preventive health from the government to civil society and citizens
National Programme on Prevention: “Everything is Health”
one step further. Its intention is to link various governmental
and non-governmental (company and civil society) initiatives in order to increase their impact. The
Programme has been explicitly presented as not just a governmental programme. Rather, the central
government is one of many partners. In December 2014, more than 140 organisations had signed
FCTC Shadow Report 2014
27
a pledge, committing them to contribute to the realisation of the objectives of the NPP21. Although
partners from different sectors have been included as part of these initiatives, no mention is made
of the Ministry of Finance, even though this ministry is responsible for taxation of tobacco products,
which is an important measure to reduce tobacco use.
The government has been cautious in formulating concrete targets for tobacco control. Although
the NPP contains specific output targets with regard to policy implementation (such as healthy
schoolyards in all municipalities in 2025 (see the chapter on Article 8)), regarding smoking prevalence
the defined target is not concrete: a “substantial improvement” in comparison to the current trend20,
on the basis of which smoking prevalence is estimated to be at 19% in 2030 (from 23% in 2012)3. At
the same time, the government has indicated to aim at a reduction in the percentage of smokers by
30% in 2025 (in line with the WHO target)22.
Municipalities are expected to play an important role in the area of prevention. Within two years of
the presentation of the national Health Nearby policy, municipalities were required to adopt their
local health programmes. However, of the six national priorities, smoking was among the three topics
that were least often included in the new local health programmes (67%)23. Less than half of the
municipalities (47%) indicated they considered themselves responsible for or in charge of tobacco
control. One of the arguments for not taking control was that many national initiatives were already in
place23. Tobacco control is increasingly included as part of a broader, integrated section on substance
use instead of as an independent theme24. A set of guidelines has been developed by the Centre for
Healthy Living (part of the National Institute for Public Health and the Environment (RIVM)) to support
municipalities in incorporating tobacco control in their local health policies. An integral approach to
tobacco control is encouraged, incorporating environmental factors (e.g. reaching agreements with
school boards to implement smokefree schoolyards), regulation and enforcement (less relevant at
the local level, but municipalities can stimulate compliance), education (e.g. stimulating the use of
intervention at schools), signalling and support (e.g. providing financial means to encourage quit
attempts among poorer segments of the population)25. As of 2015, the Trimbos Institute (Netherlands
Institute for Mental Health and Addiction, which also hosts, since 2013, the National Centre of
Expertise on Tobacco Control (NET)) will support municipalities in developing and implementing local
prevention and enforcement policies26.
ARTICLE 5.2(a)
Each Party shall, in accordance with its capabilities, establish or reinforce and finance
a national coordinating mechanism or focal points for tobacco control.
Primary responsibility for tobacco control lies with the Ministry of Health, Welfare and Sport (hereafter
the Ministry of Health). There is no separate, identifiable unit that is responsible for tobacco control,
although several public servants from the Department of Nutrition, Health Protection and Prevention
work full-time or part-time on issues of tobacco control.
Other ministries also deal with tobacco control issues. For example, excise duties are determined and
implemented by the Ministry of Finance. However, this is generally not done on the basis of a public
health perspective or as part of a wider tobacco control policy (see also the chapter on Article 6).
28
Dutch Tobacco Control: Moving Towards the Right Track?
The 2014 government report to the WHO mentions that one of the civil servants from the Ministry
of Health who works on tobacco control occasionally meets with colleagues from other ministries8.
The wording suggests that these meetings mostly take place on an ad hoc basis (e.g. because certain
topics are discussed in international fora). There does not appear to be an institutionalised, sustainable
coordinating mechanism, such as an inter-ministerial committee, through which civil servants from
different ministries coordinate their tobacco control efforts on a regular and structural basis.
ARTICLE 5.3
In setting and implementing their public health policies with respect to tobacco
control, Parties shall act to protect these policies from commercial and other vested
interests of the tobacco industry in accordance with national law.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 5.3
Parties should interact with the tobacco industry only when and to the extent strictly necessary to
enable them to effectively regulate the tobacco industry and tobacco products. Where interactions
with the tobacco industry are necessary, Parties should ensure that such interactions are conducted
transparently. Whenever possible, interactions should be conducted in public, for example through
public hearings, public notice of interactions, disclosure of records of such interactions to the public.
Article 5.3 is one of the FCTC provisions that has gained more prominence in political debates since
September 2011. This increased attention was prompted by a Dutch television documentary about
the regular contacts between the tobacco industry and the Minister of Health, who was therefore
labelled the “Minister of Tobacco” (October 2011)27. The launch of the website www.tabaknee.nl
(see the chapter on Article 12) further contributed to the rise of Article 5.3 on the Dutch political
agenda. This increasing emphasis on Article 5.3 is also reflected in the Dutch government’s reports
to the WHO. Whereas in 2010 it was reported that no official actions were taken to implement the
Guidelines on Article 5.310, in 2012 and 2014, it was stressed that the government is transparent
regarding tobacco industry contacts, that it only interacts with the industry to the extent strictly
necessary, and that it does not endorse partnerships or other non-binding agreements with the
industry8; 11. In reply to parliamentary questions, members of government repeatedly pointed out that
the Convention does not state that no contacts are allowed between the government and the tobacco
industry28; 29. In fact, in 2012, the Minister of Health even stated that “the Netherlands has only agreed
to the Guidelines, on the condition that interactions between the central government and the tobacco
industry remained possible”30.
Recommendations 2.1 and 2.2 of the Guidelines for implementation of Article 5.3 set out that
contacts with the tobacco industry should only be allowed when they are strictly necessary for
effective regulation and when they are conducted transparently. According to the State Secretary,
contacts with the tobacco industry are only sought when they are considered necessary31. He
has stated that contacts may be deemed necessary if they concern technical issues in relation to
the implementation of legislation and regulation or if they concern the consequences of specific
measures for a factory or industry32. Generally, no information is provided as to why specific
interactions are considered necessary by the government. Due to a lack of transparency (see below), it
is very difficult to establish the contents of such meetings and hence to assess its necessity. Internal
FCTC Shadow Report 2014
29
documents that were made public based on the Dutch Government Information (Public Access) Act
(WOB) showed that there are some examples of the government refusing to meet tobacco industry
representatives: “In your email, you indicate that you would appreciate a meeting, because you do not
agree with a couple of measures included in the new Tobacco Products Directive. We will not accept
your request at this point in time. Not just because we have been informed about your views on several
occasions, but also because the Dutch stance has been determined in consultation with the House of
Representatives – and we are bound by Article 5.3 FCTC” (June 2013)33. However, examples of situations
in which the government did agree to meet the tobacco industry are much more common. In
September 2014, the Youth Smoking Prevention Foundation (Stichting Rookpreventie Jeugd) initiated
legal proceedings against the Dutch government for failure to comply with Article 5.3 FCTC. Their
court summons includes a long list of examples of government-industry interactions, in various stages
of the decision-making process, in the period from 2010 to 201334. At least some of these examples
concern interactions during which legislation or policy that had yet to be presented to parliament
was discussed with the industry. For instance, in April 2012, the State Secretary for Finance sent a
letter to British American Tobacco (BAT): “The Tariff Policy Document for Tobacco and Alcohol Excise
Duties is currently before me and I hope to be able to finalise it soon, so that I can send it to the House of
Representatives. The various elements are addressed in the Tariff Policy Document. You will understand
that I cannot already disclose the contents of the policy document. However, before it will be sent, I would
be happy to discuss the basic ideas in a regular consultation with the tobacco industry”35.
The Dutch government considers itself to be acting in line with the FCTC as far as the Guidelines on
transparency are concerned36. Reference has been made to information that was provided in reaction
to questions raised by members of parliament and following requests under the WOB30; 37. However,
transparency is generally not actively provided by the Dutch government. There are only very few
examples of the government informing the members of parliament about future meetings with the
tobacco industry. Moreover, minutes of meetings are often not available34. The State Secretary for
Health has interpreted Article 5.3 as implying that the government should be able to demonstrate
that the commercial interests of the tobacco industry have had no impact on the development and
implementation of policies29. However, if no minutes are made available of meetings with the tobacco
industry, this cannot (easily) be demonstrated.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 5.3
Parties should formulate, adopt and implement a code of conduct for public officials, prescribing the
standards with which they should comply in their dealings with the tobacco industry.
No official policy document has been developed in which the application of Article 5.3 is specified.
There is no official protocol to be followed when interaction is sought by the tobacco industry. In
2011, the Minister of Health, who was responsible for tobacco control at that time, argued that such
a protocol would not be necessary: “I do not have to draw up a protocol about this. For me, my public
servants are integer, whether they talk to someone from the alcohol industry, with a candy manufacturer or
with someone who wants to prohibit these things. In the end, we transparently consider all options [in the
parliament]”38. Civil servants and government officials are bound by general rules regarding integrity.
They are, for instance, required to report any additional functions held, to prevent conflicts of interest39.
30
Dutch Tobacco Control: Moving Towards the Right Track?
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 5.3
Parties should inform and educate all branches of government and the public about the addictive and
harmful nature of tobacco products, the need to protect public health policies for tobacco control
from commercial and other vested interests of the tobacco industry and the strategies and tactics
used by the tobacco industry to interfere with the setting and implementation of public health
policies with respect to tobacco control.
In political debates, members of government have taken different approaches in defining the position
of the tobacco industry. In March 2012, the Minister of Health stated: “The tobacco industry – let me
make it clear – is a legal industry. I think contacts with legal industries should be possible”40. When
asked about the tobacco industry in relation to other industries, the State Secretary for Health noted
in February 2013: “Exactly because of the nature of the tobacco industry, we have reached international
agreements, which we stick to. It is thus not an industry like any other”28. This position has not been
exploited further. On the contrary, when asked by members of parliament about the ties of various
people and organisations to the tobacco industry, the State Secretary has generally taken a passive
approach. For instance, in relation to investments by pension funds, he emphasised that pension
funds (including the pension fund for employees in the government, public and education sector
(ABP)) are responsible for their own investment policy. He added that the ABP does not invest in
companies that are involved in products or services that are prohibited under Dutch or international
law and that such a prohibition is not in place for tobacco products41. In addition, no public education
campaigns have run about (the uniqueness of) the tobacco industry (stressing the harmful nature of
its products in combination with its strategies to interfere with tobacco control policies). In September
2014, the State Secretary did send a letter to all municipalities and provinces, emphasising that these
levels of government are also bound by the provisions of FCTC, including Article 5.3 (see also the
chapter on Article 13). Although reference was made to the fact that the Convention was established
because tobacco use is the largest preventable cause of death on a global scale, tobacco industry
strategies to interfere with the adoption and implementation of tobacco control policies were not
considered in the letter42.
The central government appears to have been reluctant in entering into partnerships or agreements
with the tobacco industry. For instance, in January 2013, public servants from the Ministry of Health
discussed the government’s proposal to raise the legal age limit for tobacco products from 16 to 18
(see also the chapter on Article 16) with a representative from the Platform Points of Sale of Tobacco
Products (PVT). This representative suggested that the PVT could support in the development of a
campaign strategy. However, one of the public servants indicated that “this is a responsibility of the
government. Collaboration with the tobacco industry, or its allied organisations, is difficult, also in the
light of the FCTC”43.
An important exception to this reluctance relates to the fight against illicit trade. In 2011, a
Memorandum of Understanding was signed between Dutch Customs Administration and tobacco
industry branch organisations44. The contents of this agreement have not been made publicly
available. In the context of the European Union, ‘similar’ agreements have been reached, between
the tobacco industry and the European Commission and between the tobacco industry and other
EU countries. In reaction to questions regarding the compatibility between these agreements and
FCTC Shadow Report 2014
31
the FCTC Guidelines, the responsible EU Commissioner stated that the agreements with the tobacco
industry are binding and enforceable, and therefore in line with FCTC45.
In addition, various partnerships have emerged between local governments (municipalities) and the
tobacco industry, in relation to activities that are closely tied to corporate social responsibility, such
as protection of the environment. Such partnerships are further discussed in the chapter on Article 13.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 5.3
Parties should not grant incentives, privileges or benefits to the tobacco industry to establish or run
their business. Parties should not provide any preferential tax exemption to the tobacco industry.
In April 2014, Philip Morris announced that it would terminate most its production facilities in the
Netherlands (Bergen op Zoom). This termination yielded a significant amount of media and political
attention. One of the topics discussed concerned alleged arrangements between Philip Morris and the
Tax and Customs Administration. In response to parliamentary questions, the State Secretary for Finan­ce
noted that the pledge of secrecy imposed on the Tax and Customs Administration does not allow for
the publication of information regarding individual tax payers (emphasising that the Tax and Customs
Administration only makes deals with tax payers that are not opposed by legislation, policy and jurisprudence)46. This secrecy makes it impossible to assess whether or not preferential treatment has occurred.
Conclusions and recommendations
Several general obligations included in Article 5 are not currently implemented in the Netherlands.
No comprehensive, multisectoral tobacco control strategy, plan or programme has yet been put in
place. An overall ‘red score’ has therefore been attributed to the Dutch government in relation to
Articles 5.1 and 5.2 in the summary table on implementation of FCTC measures in the Netherlands
in 2014 (Table 1b). With regard to Article 5.3, it appears that some actions have been initiated
to eliminate or reduce tobacco industry influence on tobacco control policies. At the same time,
internal documents suggest that these arrangements are not (yet) structurally imbedded within the
entire government. The Dutch government was therefore found not to act in line with the obligation
included in Article 5.3 and was awarded an overall ‘red score’ in the summary table on this treaty
article as well. So far, the government fails to comply with most of the recommendations included in
the Guidelines for implementation of Article 5.3. Based on these conclusions, the Dutch government
is urged to:
• Develop a comprehensive tobacco control strategy, which includes a long-term perspective on
tobacco control.
• Further strengthen and institutionalise coordination of tobacco control measures, to ensure that
the public health perspective on tobacco control is also embedded in ministries other than the
Ministry of Health.
• Develop a clear protocol for all interactions between government officials, representatives and
employees, and the tobacco industry. Current practices should be formalised in a policy document
and should be supplemented by additional procedures, especially in the area of transparency.
Full and comprehensive information on contacts with the tobacco industry should actively be made
available to the public.
32
Dutch Tobacco Control: Moving Towards the Right Track?
• Educate all branches of government and the public about the strategies of the tobacco industry as
well as the need to protect tobacco control policies from the industry’s (commercial) interests, in
line with the Guidelines for implementation of Articles 5.3 and 12.
Scores
FCTC provision
Type of
commitment
Content
Yes/No
5 1
Shall
Develop, implement, periodically update and review
comprehensive multisectoral national tobacco control
strategies, plans and programmes in accordance with
this Convention and the protocols.
No
5 2a
Shall
Establish or reinforce and finance a national coordinating
mechanism or focal points for tobacco control.
Yes
5 3
Shall
In setting and implementing their public health policies
with respect to tobacco control, act to protect these
policies from commercial and other vested interests of
the tobacco industry.
No
5 3 GL 1
Should
Raise awareness about the addictive and harmful
nature of tobacco products and about tobacco industry
interference with Parties’ tobacco control policies.
No
5 3 GL 2
Should
Establish measures to limit interactions with the
tobacco industry and ensure the transparency of those
interactions that occur.
No
5 3 GL 3
Should
Reject partnerships and non-binding or non-enforceable
agreements with the tobacco industry.
No
5 3 GL 4
Should
Avoid conflicts of interest for government officials and
employees.
No
5 3 GL 5
Should
Require that information provided by the tobacco
industry be transparent and accurate.
No
5 3 GL 6
Should
Denormalise and, to the extent possible, regulate
activities described as ‘socially responsible’ by the
tobacco industry, including but not limited to activities
described as ‘corporate social responsibility’.
No
5 3 GL 7
Should
Do not give preferential treatment to the tobacco
industry.
FCTC Shadow Report 2014
?
Score
?
33
Article 6
Price and Tax Measures
Article 6 is based on the recognition “that price
and tax measures are an effective and important
means of reducing tobacco consumption by
http://en.wikipedia.org/wiki/Euro
various segments of the population, in particular
young persons”. Nevertheless, the previous
shadow report established that tobacco price
and tax measures usually serve financial
purposes in the Netherlands. Any reduction
of tobacco consumption as a consequence of
such measures was considered as no more
than a positive side-effect. This situation has
persisted. In 2013, the State Secretary for Finance confirmed that “although excise duties undeniably
play a role in discouraging tobacco use, the primary purpose, as is generally the case for all taxes, is
to generate revenue. The […] planned excise duty increase has therefore been prompted by budgetary
considerations”47. The postponement (September 2013)48 of a previously announced tobacco excise
duty increase49 also demonstrates the sustained primacy of financial objectives. The decision to
postpone was the result of tobacco tax revenues falling short of expectations48. This setback was
considered to be largely due to processes of stockpiling and substitution (issues which are further
discussed below)50. It was expected that another excise duty increase would not (or only marginally)
benefit the Treasury. Any negative health consequences of the delay were barely considered, even
though the government did recognise “that lower revenues due to the fact that fewer people are
smoking can also be a desired result”47.
No (long-term) taxation policy has been developed by the Dutch government. Rather, decisions are
generally made on an annual basis. Although there is a legal requirement stipulating that tobacco
excise taxes must account for at least 60% of the weighted average retail selling price (WAP) for
factory-made cigarettes and 52% of the WAP for roll-your-own tobacco (Act on Excise Duties),
no objectives have been formulated in terms of future targets for excise duty shares or tobacco
consumption reductions. Such a long-term taxation policy would be in line with the newly adopted
Guidelines, which state that “Parties should establish coherent long-term policies on their tobacco
taxation structure and monitor on a regular basis including targets for their tax rates, in order to
achieve their public health and fiscal objectives within a certain period of time”.
Excise duty revenues are currently not being earmarked for tobacco control or other health purposes.
By earmarking (part of) the tobacco tax revenues, the potential of higher taxes as a means to benefit
public health could be further exploited by the Dutch government. Such a decision would also be
in line with paragraph 5 of the new Guidelines. As is illustrated in the chapter on Article 26 FCTC,
the governmental budget for tobacco control has decreased significantly over the past decade. This
complicates implementation of other tobacco control policies.
34
Dutch Tobacco Control: Moving Towards the Right Track?
ARTICLE 6.2a
Without prejudice to the sovereign right of the Parties to determine and establish their
taxation policies, each Party should take account of its national health objectives
concerning tobacco control and adopt or maintain, as appropriate, measures, which
may include implementing tax policies and, where appropriate, price policies, on tobacco
products so as to contribute to the health objectives aimed at reducing tobacco
consumption.
The newly adopted Guidelines recommend Parties to tax all tobacco products in a comparable way,
in particular in those instances where the risk of substitution exists. In the Netherlands, differential
excise duty rates still apply to different tobacco products. A distinction is made between cigarettes,
cigars, other smoking tobacco (including roll-your-own tobacco) and non-smoking tobacco products
(snuff and chewing tobacco).
With regard to the excise duty rates for cigarettes and smoking tobacco, several developments can be
distinguished. Firstly, excise duty rates are adjusted on a yearly basis (generally taking effect on April
1). These annual adjustments are based on changes to the WAP (although downward adjustments
in terms of the absolute amount of excise duties levied are not allowed). Since 2013, the WAP is
calculated on the basis of the retail prices in the preceding period from 1 October to 30 September
instead of from 1 January to 31 December51. Secondly, autonomous tax raises can and have been
implemented. There has been one relatively large tax increase since the publication of the previous
shadow report. In January 2013, the amount of excise duties levied on a pack of 19 cigarettes
was increased by € 0.35 and the amount of excise duties levied on a pack containing 40 grams
smoking tobacco by € 0.60. This excise duty increase, coupled with a general increase in VAT-rates
in November 2012 and additional price rises implemented by the tobacco manufacturers, resulted
in consumer price increases of more than 10% for both factory-made cigarettes (the WAP increasing
from € 264.62 to € 291.91 per 1000 pieces) and smoking tobacco (the WAP increasing from € 126.86
to € 145.09 per 1000 grams)52; 53. The total proportion of excise duties, however, still does not exceed
70% of the retail price, as has been recommended by the World Health Organisation (WHO)54. For
example, in 2014, excise duties amounted to 56% of the retail price for a pack of premium-priced
cigarettes (€ 6.00 per 19 pieces) and to 62% of the retail price for a pack of value-for-money-priced
cigarettes (€ 5.40 per 19 pieces). Another small excise duty increase (€ 0.09 per pack containing 19
cigarettes or 40 grams of roll-your-own tobacco) will come into force on 1 January 2015.
Both cigarettes and smoking tobacco are subject to a mixed system of ad valorem and specific
levels of taxation. Table 3 shows that, over the last couple of years, the share of the specific excise
component as part of the total amount of excise duties has been increased. An advantage of such
a greater reliance on specific excise duties, is that the variability of retail prices is reduced. An
important disadvantage of specific excise duties is that their real value will be eroded if they are
not adjusted in line with inflation54. Such an adjustment system is not currently in place in the
Netherlands. In 2014, the Netherlands is one of the leading EU countries as far as the amount of
specific excise as proportion of the total amount of taxes on factory-made cigarettes (excise duties
and VAT) is concerned59. The share of specific excise duties is smaller for smoking tobacco than it
FCTC Shadow Report 2014
35
is for factory-made cigarettes. Consequently, whereas the risk of substitution to cheaper cigarette
brands can be expected to be relatively low in the Netherlands, this threat of downward substitution
is more likely to play a role in the field of roll-your-own tobacco. Even more importantly, excise
duty rates (and retail prices) are still (much) lower for roll-your-own tobacco than for factory-made
cigarettes. Taking the WAPs in the period from 1 October 2012 to 30 September 2013 (see above) as
a starting point and assuming that 0.75 gram of roll-your-own tobacco is required for one self-rolled
cigarette60, the retail price of one factory-made cigarette (€ 0.29) was more than two-and-a-half times
as high as the retail price of the roll-your-own tobacco required for one self-rolled cigarette (€ 0.11).
Substitution from cigarettes to cheaper roll-your-own tobacco, this way circumventing tax increases,
thus seems a real risk in the Dutch context. The State Secretary for Finance has confirmed that this
process of substitution is actually taking place50.
Table 3
Excise duty levels for cigarettes and roll-your-own (RYO) tobacco in the Netherlands, from 1 July 2011
onwards 52; 53; 55-58
Date of entry
Cigarettes
Smoking tobacco (incl. RYO tobacco)
Ad valorem excise
(% of tax-included
retail selling price)
Specific excise
(€ per 1000 cigarettes)
Ad valorem excise
(% of tax-included
retail selling price)
Specific excise
(€ per 1000 cigarettes)
1 January 2015
0.95
178.71
5.03
78.02
1 April 2014
0.95
173.97
5.03
75.77
1 April 2013
2.36
169.86
7.19
72.64
1 January 2013
3.13
167.84
7.66
72.04
1 April 2012
7.57
138.23
11.97
51.72
1 July 2011
8.59
135.66
13.00
50.45
The risk of substitution to cigars should also be taken into consideration. Cigars have been subject
to the same ad valorem excise rate (5%) since 1997. No legal changes have been implemented in
this area since the previous shadow report. However, recent applications of the definition of cigars
that came into force on 1 January 2011 by Dutch Customs have yielded disputes concerning the
distinction between cigarettes and cigarillos (cigars) for the purposes of taxation. Recently, new cigarlike products have been launched on the Dutch market that resemble regular cigarettes: they are
packed in so-called flip-top boxes, have a similar length and diameter as factory-made cigarette and
contain filters. These products are mainly being differentiated from regular cigarettes on the basis
of their comparatively low pricing. In March 2014, the Amsterdam Court of Appeal ruled that these
products should nevertheless be taxed as cigars, taking into consideration, among other things, that
these products contain an outer wrapper of natural tobacco, have the same colour as cigars and are
not explicitly presented as cigarettes (given the reference to ‘filter cigarillos’ and ‘natural wrapper’ on
the pack)61.
As noted above, effects of excise duty increases may be initially averted if forestalling takes place.
Since 2010, resellers may supply products at the old price (with the old tax stamps) until two months
after the excise duty change62. In July 201263, this transitional period was reduced to one month,
only to be increased again to two months in January 201351. No such time limit applies to tobacco
36
Dutch Tobacco Control: Moving Towards the Right Track?
retailers. As of July 2013, sales of tobacco products are subject to the regular VAT-scheme64. This
implies that retailers only have to pay VAT after they have sold the product to consumers. Because
of the lower cost price, it becomes easier for retailers to increase their stock. Therefore, this measure
appears to have facilitated (in stead of hindered) forestalling by retailers.
ARTICLE 6.2b
Without prejudice to the sovereign right of the Parties to determine and establish their
taxation policies, each Party should take account of its national health objectives
concerning tobacco control and adopt or maintain, as appropriate, measures which
may include prohibiting or restricting, as appropriate, sales to and/or importations by
international travellers of tax- and duty-free tobacco products.
In the field of tax- and duty-free tobacco products, no additional measures have been taken since
September 2011. This implies that, within certain limits, travellers are exempted from paying Dutch
taxes when bringing in tobacco (for personal use). Dutch Customs rarely prosecutes individuals who
exceed these limits65. The exemption does not apply when tobacco is imported, for instance by
purchasing tobacco through the internet. Tobacco products are confiscated if they do not contain
a valid tax stamp66. Although Dutch Customs generally prioritises large scale seizures, intercepting
illegal internet sales is also considered a focus point65. The issue of internet sales is further discussed
in the chapter on Article 13.
Duty-free sales in duty-free shops (air- and seaports) are also still allowed for travellers with a
destination outside the EU.
Conclusions and recommendations
Progress in the field of the taxation of tobacco products from September 2011 to December 2014
has been slow, although one large increase in the excise duties rates for cigarettes and smoking
tobacco was implemented. In particular, the government still primarily uses the excise duties
on tobacco products to further financial objectives, tax differentials between various tobacco
products have largely remained in place, and no progress has been made with regard to sales and/
or importations of duty-free tobacco products. Article 6 does not contain any obligations and its
recommendation and suggestions are carefully phrased. The Dutch government currently acts in line
with these prudent provisions and has therefore received an overall ‘green score’ in the summary
table on implementation of FCTC measures in the Netherlands in 2014 (Table 1b). This is not to say
that the government is yet taking the most effective measures in the area of taxation. Guidelines for
implementation of Article 6 were adopted by the Conference of the Parties in October 2014. Given
the short period of time between this adoption and the assessment provided in this report, the
Dutch government’s performance has not yet been scored on the basis of the recommendations and
suggestions included in the Guidelines. However, in the upcoming years, the government will have
to take measures to ensure compliance with the recommendations and suggestions included in the
Guidelines. In particular, the Dutch government is urged to:
• Develop a long-term tobacco tax policy. Health objectives should play a central role in the
government’s policy on tobacco excise duties. Significant excise duty increases (at least 5% plus
FCTC Shadow Report 2014
37
inflation) should be implemented on a regular (preferably annual) basis. The Dutch government
should also make an effort to increase tobacco taxes on an EU-wide scale (upward harmonisation).
• Implement higher excise duty increases for roll-your-own tobacco and cigarillos bearing close
resemblance to cigarettes, so that price differences between these products and factory-made
cigarettes are reduced and substitution effects are limited.
• Further restrict the amount of duty-free tobacco products that can be imported by international
travellers, through European cooperation. In addition, duty-free sales of tobacco products should
be prohibited throughout the European Union.
• Consider earmarking (part of) the tobacco tax revenues for public health purposes.
Scores
FCTC provision
Type of
commitment
Content
Yes/No
6 2
Should**
Take account of its national health objectives concerning
tobacco control and adopt or maintain, as appropriate,
measures.
Yes
6 2a
May
Implement tax policies and, where appropriate, price
policies, on tobacco products.
Yes
6 2b
May
Prohibit or restrict, as appropriate, sales to and/or
importations by international travellers of tax- and dutyfree tobacco products.
Yes
Score
** Subject to the following condition: “without prejudice to the sovereign right of the Parties to determine and establish their
taxation policies”.
38
Dutch Tobacco Control: Moving Towards the Right Track?
Article 8
Protection from Exposure to Tobacco Smoke
Article 8 builds upon the recognition “that scientific
evidence has unequivocally established that exposure
to tobacco smoke causes death, disease and health”.
Although the Dutch Tobacco Act is founded on the
consideration “that it is desirable in the interest of public
in particular, to counter nuisances for those who not use
tobacco”, protection against exposure to tobacco smoke
has not always been a decisive factor in the drawing up
of tobacco control policies in the Netherlands. In July
2011, for instance, by reversing part of the smoking ban,
the government chose to increase freedom of choice at
the expense of the health interests of visitors of small
cafes67. However, since the previous shadow report, some
measures have been taken that do again focus on the
http://medimoon.com/2014/03/public-smoking
health to set rules to limit the use of tobacco and, more
protection of non-smokers against exposure to tobacco
smoke.
ARTICLE 8.2
Each party shall adopt and implement in areas of existing national jurisdiction
effective legislative, executive, administrative and/or other measures, providing for
protection from exposure to tobacco smoke in indoor workplaces, public transport,
indoor public places and, as appropriate, other public places.
Smokefree legislation for workplaces was introduced in the Netherlands in 200468. In July 2008,
hospitality venues were also brought within the remit of the smoking ban69. In November 2010, the
newly installed government announced a partial reversal of this smoking ban for hospitality venues70.
As of July 6, 2011, an exception for small cafes has been anchored in regulation67. Since September
2011, two procedures have been initiated to undo this exception, neither of which were, in first
instance, government-driven: a judicial and a legislative trajectory.
The judicial trajectory was initiated by the non-smokers association Clean Air Netherlands (CAN) in
October 2011. CAN claimed that the exception for small cafes ran contrary to Article 8.2 FCTC. In
March 2013, the Court of Appeals of The Hague found that Article 8.2 FCTC is sufficiently clear and
concrete with respect to the results to be achieved through national legislation. The court ruled that
the mere obligation to put a sign on the door indicating that smoking is allowed does not guarantee
effective protection against exposure to tobacco smoke71. The Dutch State lodged an appeal in
cassation against this ruling, in order to gain definitive clarity as to the direct effect of Article 8.2
FCTC72. In October 2014, the Supreme Court sided with the Court of Appeals and concluded that the
FCTC Shadow Report 2014
39
exception for small cafes should be considered non-binding73. Following the ruling by the Supreme
Court, the State Secretary for Health announced on 21 October that the Food and Consumer Product
Safety Authority (NVWA) would immediately start enforcing the smoking ban in all cafes74.
Parallel to the court case, a legislative trajectory was initiated by parliament to re-establish the
smoking ban in all hospitality venues. In February 2013, a majority of the members in the House
of Representatives voted in favour of a motion to create a 100% smokefree hospitality sector75.
To implement this motion, a bill was tabled by the State Secretary for Health in November 2013.
More than before, the smoking ban was presented as a measure to protect those who are visiting
hospitality venues – or the public at large – rather than ‘just’ employees76. The bill was adopted in the
second half of 201477.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 8
Effective measures to provide protection from exposure to tobacco smoke require the total elimination
of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke
free environment. Approaches other than 100% smoke free environments, including ventilation, air
filtration and the use of designated smoking areas (whether with separate ventilation systems or
not), have repeatedly been shown to be ineffective and there is conclusive evidence, scientific and
otherwise, that engineering approaches do not protect against exposure to tobacco smoke.
A limitation of the new legislation is that it allows for the continued existence of designated smoking
rooms. According to the State Secretary for Health, passive smoking by non-smokers does not occur in
enclosed smoking rooms72. The fact that leakage effects may occur was not explicitly addressed. When
asked about the relationship between this exception for designated smoking rooms and the FCTC, the
State Secretary for Health noted: “The FCTC requires the adoption of measures to prevent exposure to
tobacco smoke. […] It should be pointed out that the Convention does not contain the provision that the
environment should be 100% smokefree. […] It is up to the contracting Party to decide on which measures
it takes to prevent exposure to tobacco smoke. […] I am of the opinion that the possibility that exists under
the tobacco legislation for employers to set up smoking rooms, is in accordance with the FCTC”78. However,
this position is not in line with the Guidelines for implementation of Article 8, which emphasise that
approaches other than 100% smoke free environments, including the use of designated smoking
areas, do not protect against exposure to tobacco smoke. Therefore, the Dutch smoking ban still should
not be considered an effective measure within the meaning of Article 8.2 FCTC.
The bill proposing a smoking ban for all hospitality venues initially also included a provision through
which possible alternatives to a smoking ban could become allowed in the future. The explanatory
memorandum set out that “it is not unthinkable that new developments or innovations can give rise
to the consideration to allow for other measures in addition to or instead of a smoking ban”76. Many
questions were asked by members of parliament regarding this exception. In the end, the State
Secretary for Health decided to delete this provision from the bill: “Based on the fact that new
technologies with the same effect as a smoking ban are not to be expected in the foreseeable future, and
on the false idea that emanates from this exception, I will drop the proposed provision”78.
40
Dutch Tobacco Control: Moving Towards the Right Track?
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 8
Raising awareness among the public and opinion leaders about the risks of secondhand tobacco
smoke exposure through ongoing information campaigns is an important role for government
agencies. Key messages should focus on the harm caused by secondhand smoke exposure, the fact
that elimination of smoke indoors is the only science-based solution to ensure complete protection
from exposure, the right of all workers to be equally protected by law and the fact that there is no
trade-off between health and economics, because experience in an increasing number of jurisdictions
shows that smokefree environments benefit both.
No mass media campaigns on exposure to secondhand smoke have been conducted since 2007. Even
the campaign that accompanied the smoking ban in the hospitality sector in 2008 did not include
information on the health effects of passive smoking. The Guidelines for implementation of Article 8
suggest that “only a few prosecutions may be necessary if the [smokefree] legislation is implemented
carefully and active efforts are made to educate businesses and the public”. In the Netherlands, such a
process of self-enforcement has not occurred and enforcement has come to play an important role (see
below). Research has suggested that this lack of compliance might be partially due to the lack of an
accompanying education campaign explaining the health effects of secondhand smoke exposure79.
The State Secretary for Health has indicated that, in 2015, a campaign will be launched to inform the
Dutch population about the changes to the smokefree legislation, confirming that both enforcement
(see below) and education are important for a successful policy. He has indicated that the campaign
will contain “a strong emphasis on the adverse effects of (passive) smoking”80. Such an approach seems
highly appropriate in the Dutch context, given the low levels of knowledge regarding the harms of
secondhand smoke (see also the chapter on Article 12).
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 8
Effective legislation should impose legal responsibilities for compliance on both affected business
establishments and individual smokers, and should provide penalties for violations, which should
apply to business and, possibly, smokers.
The first shadow report identified a trend of decreasing compliance with smokefree legislation. Since
the spring of 2011, there has been a significant increase in the number of bars and clubs in which
no smoking was observed (spring 2014). Compliance increased from 58% to 85%81. Increases were
observed both for bars that have consistently been required to implement a smoking ban (as of July
2008) (from 50% to 77%) and for bars that were (temporarily) exempted from the legal smoking ban
(from July 2011 until October 2014) (from 28% to 41%)81. As shown in Figure 2, overall compliance
levels in the spring of 2014 were similar to the compliance levels that were observed within a year
after implementation of the initial legislation (spring 2009)82.
FCTC Shadow Report 2014
41
Figure 2
Percentage of venues in which no smoking is observed, by type of hospitality venue81; 82
The State Secretary for Health has referred to compliance with the smoking ban in bars and clubs as
one of two tobacco control areas in which compliance lags behind83. To improve compliance, the State
Secretary intensified enforcement activities and proposed to further increase monetary penalties. In
September 2013, he tabled a bill to raise the maximum fine from € 4,500 to €  19,50084. The Bill is
still awaiting parliamentary approval. Non-monetary penalties or monetary penalties for smokers have
not yet been proposed or introduced.
As of January 2014, capacity to enforce the smoking ban has been increased. A team of young
enforcement officers (17 FTE) was added to the existing group responsible for the enforcement of
tobacco control legislation (see also the chapter on Article 16). The State Secretary for Health has
indicated that the number of inspections would increase by 2,000 to a total of 6,000 inspections per
year85. Although the re-introduction of the smoking ban in the all hospitality sectors leads to a larger
number of venues to be inspected, the State Secretary expects that the elimination of the exception
to the smoking ban will also yield significant time savings. After all, enforcement of the smoking ban
with the exception for small hospitality venues was a complex and time-consuming practice, because
the NVWA had to establish the size of the venue as well as whether employees were hired85.
Currently, enforcement of the smoking ban takes place on the basis of sensory perceptions (vision
and odour). To improve enforcement, the NVWA has commissioned a study into enhanced detection
methods for enforcing the smoking ban (by sampling ambient air, to be analysed in the laboratory).
Such detection methods could, for instance, assist in determining whether smoke is leaking from
areas where smoking is allowed. In October 2014, the results of this study were published by
the National Institute for Public Health and the Environment (RIVM)86. It was concluded that the
developed methods and devices could probably be applied in practice shortly as a valuable addition
for enforcement purposes, but that further research is necessary to determine whether the devices
are sufficiently sensitive.
42
Dutch Tobacco Control: Moving Towards the Right Track?
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 8
The language of the treaty requires protective measures not only in all “indoor” public places, but also
in those “other” (that is, outdoor or quasi-outdoor) public places where “appropriate”.
Outdoor smoking bans have not (yet) been implemented in the Netherlands. However, measures
have been initiated to encourage the development of smokefree outdoor areas. In particular, there
has been a focus on realising smokefree schoolyards. This project was initiated by the Dutch Lung
Foundation and has been supported by the Ministry of Health. The Ministry has contributed through
dialogues with other stakeholders, such as the Ministry of Education40, and by commissioning
research into the implementation and effects of smokefree schoolyards29. The State Secretary for
Health has indicated that a national, legal smoking ban does not (currently) appear to be a feasible
option. A local assessment of whether or not to introduce a ban is preferred by stakeholders40. When
asked about his ambition, the State Secretary therefore stated: “I will strongly promote [smokefree
schoolyards], I am a huge proponent of them. But I presume that you are not going to hold to me
accountable for 100% smokefree schoolyards, since I cannot influence that. You can ask me to promote
and to do everything to enable schools to set that standard. I will conduct all consultations necessary
to promote this. That is what I can do. This is really a matter that schools should take up themselves”29.
Smokefree schoolyards are mainly promoted through two trajectories: the Healthy School project
(see the chapter on Article 12) and the Healthy Schoolyards project. Healthy schoolyards are not only
smokefree, but also green and exercise-friendly. The Ministries of Health and Education have provided
budget for the development of healthy schoolyards at 70 schools. These schools are expected to play
an exemplary role for other schools29. The government has set a target of having healthy schoolyards
in all municipalities in 202520. In the autumn of 2013, 34% of secondary schools were reported to
have a smokefree schoolyard, an increase in comparison with 2012 (26%)87.
Conclusions and recommendations
Although there have been some positive developments in the area of protection against exposure to
tobacco smoke (most notably the reversal of the exception to the smoking ban for small hospitality
venues), the Dutch government still does not act in line with its FCTC obligations, given the continued
allowance of designated smoking rooms. The government therefore received an overall ‘red score’ in
the summary table on the implementation of FCTC measures in the Netherlands in 2014 (Table 1b).
Some further room for improvement derives from the Guidelines. The Dutch government is therefore
urged to:
• No longer allow designated smoking rooms.
• Step up its efforts to educate the population about the harms of exposure to tobacco smoke. The
health risks of exposure to secondhand smoke should play a central role in the campaign that will
be run by the government to re-introduce the smoking ban in all hospitality venues.
• Continue to closely monitor compliance with the smoking ban. Enforcement efforts and/or
penalties should be further increased if compliance does not improve.
FCTC Shadow Report 2014
43
Scores
44
FCTC provision
Type of
commitment
Content
Yes/No
8 2
Shall
Adopt and implement effective measures, providing for
protection from exposure to tobacco smoke in indoor
workplaces, public transport, indoor public places and,
as appropriate, other public places.
No
8 GL
Should
Ensure that public education campaigns also target
settings for which legislation may not be feasibly or
appropriate, such as private homes.
Yes
8 GL
Should
Impose legal responsibilities for compliance on both
affected business establishments and individual
smokers.
No
8 GL
Should
Provide penalties for violations, which should apply to
businesses and, possibly, smokers.
Yes
8 GL
Should
Place the responsibility for compliance on the owner,
manager or other person in charge of the premises, and
should clearly identify the actions (s)he is required to
take.
Yes
8 GL
Should
Ensure that the person in charge of the premises
has a duty to post clear signs at entrances and other
appropriate locations indicating that smoking is not
permitted.
Yes
8 GL
Should
Ensure that the person in charge of the premises has a
duty to remove ashtrays from the premises.
Yes
8 GL
Should
Ensure that the person in charge of the premises has a
duty to supervise the observance of rules.
Yes
8 GL
Should
Ensure that the person in charge of the premises has a
duty to take reasonable specified steps to discourage
individuals from smoking on the premises.
Yes
8 GL
Should
Specify fines or other monetary penalties for violations.
Yes
8 GL
May
Allow for administrative sanctions in addition to
monetary penalties, such as the suspension of business
licenses.
No
8 GL
Should
Identify the authority or authorities responsible for
enforcement.
Yes
8 GL
Should
Specify a system both for monitoring compliance and for
prosecuting violators.
Yes
8 GL
Should
Authorise inspectors to enter premises subject to the
law and to collect samples and gather evidence.
Yes
8 GL
Should
Prohibit businesses from obstructing the inspectors in
their work.
Yes
8 GL
Should
Ensure that members of the public may initiate
complaints.
Yes
8 GL
Should
Authorise any person or non-governmental organisation
to initiate action to compel compliance with measures
regulating exposure to secondhand smoke.
Yes
Score
Dutch Tobacco Control: Moving Towards the Right Track?
Articles 9 and 10
Regulation of the Contents of
Tobacco Products and Disclosures
One set of Guidelines has been adopted for
the implementation of Articles 9 and 10. These
provisions are therefore discussed jointly in
efforts have been targeted primarily at the
implementation of Article 10. Actions relating
to the implementation of Article 9 have been
scarce, although the regulation of contents and
emissions is an important part of the revised EU
http://www.zitdaterechtin.nl
this report. Recent Dutch government policy
Tobacco Products Directive (TPD).
ARTICLE 9
Each Party shall adopt and implement effective legislative, executive and administrative
or other measures for testing and measuring the contents and emissions of tobacco
products, and for the regulation these contents and emissions.
GUIDELINES FOR IMPLEMENTATION OF ARTICLEs 9 & 10 (paragraph 3.1.2.2)
(i) Parties should regulate, by prohibiting or restricting, ingredients that may be used to increase
palatability in tobacco products.
(ii) Parties should prohibit or restrict ingredients that have colouring properties in tobacco products.
(iii) Parties should prohibit ingredients in tobacco products that may create the impression that they
have a health benefit.
(iv) Parties should prohibit ingredients associated with energy and vitality in tobacco products.
In relation to Article 9, so far, the government has only established maximum tar, nicotine, and carbon
monoxide yields for cigarettes and a maximum tar yield for roll-your-own tobacco (last adjusted in
May 2002) (Decree on the Maximum Tar, Nicotine and Carbon Monoxide Contents of Cigarettes and RollYour-Own Tobacco). On the issue of further regulation of the contents of tobacco products, the Dutch
government has often taken a conservative position. However, the government’s position has shifted
markedly within the course of one year, following a change in government. In February 2012, the then
responsible Minister of Health stated that she did not intend to reduce or prohibit the use of additives
in tobacco products88. In January 2013, however, in response to the European Commission’s proposal
for the revised TPD, the Dutch government indicated to support the idea of regulating additives. The
government considered such developments to be in line with the FCTC89.
The Guidelines for implementation of Articles 9 and 10 are still of a partial nature. Recommendations
have been developed in relation to the regulation of ingredients to decrease attractiveness, but not
FCTC Shadow Report 2014
45
yet to decrease addictiveness or toxicity, although the Guidelines explicitly list these aspects as
objectives of effective tobacco product regulation as well. The revised TPD largely coincides with
the recommendations included in the Guidelines to decrease attractiveness. A ban on characterising
flavours will, for instance, be implemented. In addition, measures will be taken to ban additives that
increase addictiveness and/or toxicity. Following transposition of the revised TPD, this ban on certain
additives will (initially) only apply to cigarettes and roll-your-own tobacco (and not to other tobacco
products, such as waterpipe tobacco, cigars and cigarillos). An extension of the ban to other tobacco
products will be considered if monitoring points at substantial changes in use patterns. The Dutch
government’s position during the negotiations was to apply the ban to all tobacco products, so as to
prevent the suggestion that certain tobacco products are less harmful than others90.
As a result of the revised TPD, these measures to ban certain additives will have to be accompanied
by further restrictions on the use of misleading labels on tobacco packs, such as labels referring to
the additive free character of tobacco products. This aligns with the FCTC Guidelines as well, which
stress that reductions of attractiveness resulting from removing or reducing certain ingredients are
not to suggest that these products are less harmful.
GUIDELINES FOR IMPLEMENTATION OF ARTICLEs 9 & 10 (paragraph 3.3.2.1)
(i) Parties should require that cigarettes comply with an RIP standard.
(ii) When implementing recommendation (i) of this paragraph, Parties should consider setting a
performance standard that corresponds at a minimum to the current international practice, regarding
the percentage of cigarettes that may not burn their full length when tested according to the method
described in Appendix 4.
Another European initiative that relates to the implementation of Article 9 concerns the entry into
force of regulation on reduced ignition propensity (RIP) cigarettes (Commission Implementing
Decision 2011/496/EU) to reduce the fire risk of cigarettes. As of 17 November 2011, all cigarettes
on the European (and therefore also Dutch) market have to comply with standard EN 16156:2010
‘Cigarettes – Assessment of the ignition propensity’ and standard EN ISO 12863:2010 ‘Standard test
method for assessing the ignition propensity of cigarettes’. This latter standard is one of the standard
test methods mentioned in Appendix 4 of the Guidelines for implementation of Articles 9 and 10. The
Guidelines also refer to the international practice of requiring a not-burn-through rate of no less than
75 percent, the same norm that is included in standard EN 16156:2010 (albeit in combination with a
larger required sample of 40 instead of ten). In 2013, the Dutch Food and Consumer Product Safety
Authority (NVWA) evaluated compliance and found that of 90 sampled cigarettes, only one did not
comply with the norm91.
ARTICLE 10
Each Party shall adopt and implement effective legislative, executive and
administrative or other measures requiring manufacturers and importers of tobacco
products to disclose to governmental authorities information about the contents and
emissions of tobacco products.
46
Dutch Tobacco Control: Moving Towards the Right Track?
The previous shadow report established that the Dutch government’s policy was already largely
in line with the FCTC with respect to requiring tobacco manufacturers (or importers) to disclose
information about the contents and emissions of tobacco products. As of January 2013 (with the entry
into force of the Regulation on the Electronic Notification and Publication of Tobacco Ingredients 2013),
manufacturers are required to report on the contents of their tobacco products through the Electronic
Model Tobacco Control (EMTOC). Although his web application has been available in the Netherlands
since 2010, it was initially used in addition to a less standardised (Excel) format, leaving the choice to
manufacturers as to which format to use. Main advantages of EMTOC include that submitters cannot
change the model, that they are forced to enter values in all mandatory fields and that they have
to select from predefined answers92. By limiting the number of deviating responses, subsequent
analyses by the RIVM and public disclosure of the information are facilitated93.
According to the State Secretary for Health, compliance with the reporting obligations is fairly high. As
of 2010, 9 fines have been imposed for reasons of incomplete, untimely or a complete lack of supply of
information by manufacturers or importers83. The State Secretary is not allowed to make public which
manufacturers have received a fine. However, the database that is accessible via www.tabakinfo.nl (see
below) does contain an indication if information has not been provided in line with the Regulation.
Currently, manufacturers are required to submit, for each brand variant, emissions of tar, nicotine and
carbon monoxide, a list of all ingredients used and the quantities thereof, a declaration of the reason(s)
for including each particular ingredient and any available toxicological data regarding the ingredients.
Some additional reporting obligations will arise based on the revised TPD. For instance, manufacturers
will have to submit studies available to them on market research and preferences of various consumer
groups, executive summaries of market surveys carried out when launching new products and
information on sales volumes. The Dutch government considers such information to be of importance
for effective product regulation and to prevent youth targeting by the tobacco industry89.
ARTICLE 10
Each Party shall adopt and implement effective measures for public disclosure of
information about the toxic constituents of the tobacco products and the emissions
that they may produce.
GUIDELINES FOR IMPLEMENTATION OF ARTICLEs 9 & 10 (paragraph 3.5.2.1)
Parties should consider making information about the toxic constituents and emissions of tobacco
products and other information disclosed to governmental authorities in accordance with these
guidelines publicly accessible (e.g. via the internet) in a meaningful way.
In September 2011, the Dutch government had not yet arranged for any publication of information
on ingredients to the general public. This lack of public disclosure was criticised in the first shadow
report. Since then, the government has taken various actions to promote public access to information
on ingredients. The Dutch government has repeatedly presented itself as one of the frontrunners
in the European Union as far as the public disclosure of tobacco ingredients is concerned89; 94. Two
websites have been launched, one targeted at the general public (www.tabakinfo.nl) and one targeted
specifically at youth (www.watziterintabak.nl). These website primarily focus on the additives in
FCTC Shadow Report 2014
47
tobacco products and their function (e.g. making the smoke less harsh) and effects (e.g. facilitating
smoking uptake). The toxic and addictive nature of tobacco products regardless of additives is only
briefly touched upon, even though knowledge on the harms of smoking is still low in the Netherlands
(see the chapter on Article 12).
Information on the additives in all specific tobacco products has been available since December
2012. The website www.tabakinfo.nl refers to a database in which the following information is
reported for each brand variety: brand name, manufacturer, type of tobacco product, characteristics
of the tobacco product (e.g. pack size), content of tar, nicotine and carbon monoxide (cigarettes
only), additives, quantity of additives, function of additives and the component or material to which
the additives are added. For the 14 most common additives (such as sugars, cacao and menthol),
additional information on harmful health effects and consequences in terms of addiction is provided.
This information has been developed by the RIVM and the German Cancer Research Center (DFKZ)
and was made available in 16 European countries in September 201295.
So far, no comprehensive evaluation of the effects of the website has been published. The Dutch
government has indicated in its reporting instrument to the World Health Organisation (WHO) that
such an evaluation was being executed in early 2014. The RIVM has also expressed its intention
to conduct research to investigate the impact of the information provided on www.tabakinfo.nl on
the public’s smoking behaviour. Some initial figures on the dissemination of the information on the
website to the Dutch public have been made available. The total number of people who accessed
the website in 2012 was estimated at 12,394. The number of visits peaked following media attention
in March 2012 and especially following the publication of the factsheets on the 14 most common
additives in September 2012 and the launch of the database in December 201296.
The website www.watziterintabak.nl was launched in May 2014. The aim of this website is to increase
awareness among youth about the ingredients that manufacturers add to tobacco products and the
health effects of these additives. In an interview during the launch of the campaign, the State Secretary
for Health was quoted as follows: “A key element of our tobacco control policy is to prevent young people
from starting to smoke. Because if you can manage not to smoke as a teenager, the chances are much higher
that you will not become addicted as an adult either. And that is of course much healthier. Our new website
can help young people not to start smoking. With a few clicks, they can see exactly which ingredients are
added to tobacco products by manufacturers, for example, to make smoking taste better. And they can see
that these additives also harm their health, in addition to the harmfulness of tobacco itself”97.
As emphasised in the Guidelines, another goal of collecting information about ingredients (next to
public disclosures) is that it enables the governmental authorities to gain valuable insights “on the
composition of tobacco products, which in turn will assist authorities in developing effective, productappropriate measures”. The RIVM is indeed using the information to assess trends in ingredients
over time. So far, reports have been published on the data collected in 201098 and 201199. In 2011,
additives accounted for, on average, 30% of a cigarette. Once the data from 2012 and 2013 have
been analysed as well, the RIVM will conduct a multi-annual analysis. This analysis will not only focus
on cigarettes and roll-your-own tobacco, but also on other product categories, such as cigarillos, that
will not be covered by the ban on certain additives (as described above in relation to Article 9).
48
Dutch Tobacco Control: Moving Towards the Right Track?
www.watziterintabak.nl
Content from the government’s website on ingredients targeted at youth
GUIDELINES FOR IMPLEMENTATION OF ARTICLEs 9 & 10 (paragraph 2.8)
Civil society has an important role to play in raising public awareness and building support for the
regulation of the contents and emissions of tobacco products, and for the disclosure of information
on these contents and emissions. Civil society should be involved as an active partner.
GUIDELINES FOR IMPLEMENTATION OF ARTICLEs 9 & 10 (paragraph 7.3)
Parties should consider including messages about constituents and emissions of tobacco products in
education, communication, training and other public awareness programmes.
In addition to the youth-targeted website launched by the government (as described above), the
Dutch Lung Foundation has also developed a website to inform youth about the contents of tobacco
products: www.zitdaterechtin.nl (online since February 2012)100. The site lists six videos exposing
some of the ingredients of cigarettes in order to help young people understand what is really in
cigarettes. Rather than merely referring to the official (unknown) names for ingredients, the videos
illustrate some other uses of these substances: nail polish remover (acetone), rat poison (hydrogen
cyanide), insect poison (arsenic), paint thinner (benzene), and a chemical used to preserve bodies
(formaldehyde). These videos are also used in the context of the e-learning on tobacco which forms
part of the Healthy School and Drugs programme (see also the chapter on Article 12)101. The two
websites are complementary and they both contain links to the other website.
Conclusions and recommendations
Since the previous shadow report, the government has taken various steps to improve
implementation of Article 10 FCTC. In particular, information about the additives in tobacco products
is now disclosed to the public and the reporting system has been tightened. However, in relation
to Article 9, few improvements were observed. In the summary table on implementation of FCTC
measures in the Netherlands in 2014 (Table 1b), a ‘red score’ was assigned to the Dutch government
in relation to Articles 9 and 10. This score solely derives from the government’s failure to comply
with the Article 9 obligation to take effective measures for the regulation of contents and emissions
of tobacco products. Currently, no such measures are in place. The government has only established
maximum tar, nicotine, and carbon monoxide yields for cigarettes and a maximum tar yield for roll-
FCTC Shadow Report 2014
49
your-own tobacco. Full and correct transposition of the revised EU Tobacco Products Directive in
May 2016 at the latest will constitute a major improvement, both in relation to this obligation and to
various recommendations included in the Guidelines. The Dutch government is therefore urged to:
• Correctly transpose the revised EU Tobacco Products Directive and ensure high levels of
compliance.
• Conduct evaluations of www.tabakinfo.nl and www.watziterintabak.nl and make its results publicly
available. Effectiveness of disclosure of information on ingredients to the Dutch public should be
optimised.
Scores
50
FCTC provision
Type of
commitment
Content
Yes/No
9
Shall
Adopt and implement effective measures for testing
and measuring the contents and emissions of tobacco
products.
Yes
9
Shall
Adopt and implement effective measures for the
regu­lation of the contents and emissions of tobacco
products.
No
10
Shall
Adopt and implement effective measures requiring
manufacturers and importers of tobacco products to
disclose to governmental authorities information about
the contents and emissions of tobacco products.
Yes
10
Shall
Adopt and implement effective measures for public
disclosure of information about the toxic constituents of
the tobacco products and the emissions that they may
produce.
Yes
9&10 GL 3.1.1
Should
Require that manufacturers and importers of tobacco
products disclose to governmental authorities
information on the ingredients used in the manufacture
of their tobacco products at specified intervals, by
product type and for each brand within a brand family.
Yes
9&10 GL 3.1.1
Should
Ensure that manufacturers and importers disclose to
governmental authorities the ingredients used in the
manufacture of each of their tobacco products and the
quantities thereof per unit of each tobacco product,
including those ingredients present in the product’s
components, for each brand within a brand family.
Yes
9&10 GL 3.1.1
Should
Require that manufacturers and importers disclose
further infor­mation on the characteristics of the tobacco
leaves they used.
No
9&10 GL 3.1.1
Should
Require that manufacturers and importers notify
governmental authorities of any changes to tobacco
products when the change is made.
Yes
9&10 GL 3.1.1
Should
Require that manufacturers and importers provide
govern­mental authorities with a statement setting out
the purpose of the inclusion of an ingredient in the
tobacco product and other relevant information.
Yes
9&10 GL 3.1.1
Should
Require that manufacturers disclose the name, address
and other contact information of each ingredient’s
supplier.
No
9&10 GL 3.1.2
Should
Regulate, by prohibiting or restricting, ingredients that
may be used to improve the palatability of tobacco
products.
No*
Score
Dutch Tobacco Control: Moving Towards the Right Track?
9&10 GL 3.1.2
Should
Prohibit or restrict ingredients that have colouring
properties in tobacco products.
No*
9&10 GL 3.1.2
Should
Prohibit ingredients in tobacco products that may create
the impression that they have a health benefit.
No*
9&10 GL 3.1.2
Should
Prohibit ingredients associated with energy and vitality
in tobacco products.
No*
9&10 GL 3.3.1
Should
Require that manufacturers and importers of tobacco
products disclose information on design features to
governmental authorities at specified intervals, and as
appropriate, including the results of tests conducted by
the tobacco industry.
No
9&10 GL 3.3.2
Should**
Require that cigarettes comply with an RIP standard.
Yes
9&10 GL 3.3.2
Should consider
Yes
Set a performance standard that corresponds at a
minimum to the current international practice, regarding
the percentage of cigarettes that may not burn their full
length when tested according to the method described
in Appendix 4.
9&10 GL 3.3.2
Should
Not allow any claims to be made suggesting that RIP
cigarettes would be unable to ignite fires.
Yes
9&10 GL 3.4.2
Should
Require that manufacturers and importers of tobacco
products disclose general company information,
including the name, street address and contact
information of the principal place of business and of
each manufacturing and importing facility.
Yes
9&10 GL 3.4.2
Should consider
Require that tobacco manufacturers and importers
disclose, at specified intervals, for each brand within a
brand family, sales volume information in units.
No*
9&10 GL 3.5.2
Should consider
Yes
Make information about the toxic constituents and
emissions of tobacco products and other information
disclosed to governmental authorities in accordance
with these Guidelines publicly accessible in a meaningful
way.
* When the revised EU Tobacco Products Directive is correctly transposed, this assessment (Yes/No) (and the subsequent colour score)
would likely change.
** Subject to the following condition: “taking into account national circumstances and priorities”.
FCTC Shadow Report 2014
51
Article 11
Packaging and Labelling of Tobacco Products
The rules regarding packaging and
labelling of tobacco products are to a
large extent established at the level of
the European Union. The EU Tobacco
Products Directive (TPD) 2001/37/EC
entered into force on 18 July 2001.
Although this Directive contained
several harmonising provisions, in other
instances only minimum standards were
laid down (for example in relation to
the size of health warnings). On 19 May
2014, the revised EU TPD 2014/40/EU
entered into force. Its provisions have
Examples of Dutch health warnings on cigarette packages
yet to be transposed into national law,
and this must be done before 20 May
2016. With regard to the labelling of tobacco products, almost all provisions are of a harmonising
nature (leaving very little discretion to individual member states).
ARTICLE 11.1(b)
Each Party shall adopt and implement effective measures to ensure that each unit
packet and package of tobacco products and outside packaging and labelling of such
products also carry health warnings describing the harmful effects of tobacco use,
and may include other appropriate messages. These warnings and messages: (i) shall be
approved by the competent national authority, (ii) shall be rotating, (iii) shall be large,
clear, visible and legible, (iv) should be 50% or more of the principal display areas but
shall be no less than 30% of the principal display areas, (v) may be in the form of or
include pictures or pictograms.
In the previous shadow report, it was mentioned that the Netherlands was the first EU country to
introduce text health warning labels in accordance with EU Directive 2001/37/EC. However, whereas
several other European countries have made further progress since, there has been a standstill in
the Netherlands. The only significant change that has occurred concerns a recent adjustment to
the additional health warnings used. These texts are defined at the European level. The change to
the 2001 Dutch Labelling Decree for Tobacco Products follows from Directive 2012/9/EU. The new
additional health warnings (see Table 4) have been in place in the Netherlands since 28 March
2014102. However, manufacturers and importers are allowed to market their products with the old
health warnings until 28 March 2016 (i.e. a transition period of two years, the maximum period
allowed by the Directive).
52
Dutch Tobacco Control: Moving Towards the Right Track?
Table 4
Texts of additional health warnings
Old additional health warnings (as of 1 May 2002)
New additional health warnings (as of 28 March 2014)
Smokers die younger
Smoking causes 9 out of 10 lung cancers
Smoking clogs the arteries and causes heart attacks and
strokes
Smoking causes mouth and throat cancer
Smoking causes fatal lung cancer
Smoking damages your lungs
Smoking when pregnant harms your baby
Smoking causes heart attacks
Protect children: don’t make them breathe your smoke
Smoking causes strokes and disability
Your doctor or your pharmacist can help you stop smoking
Smoking clogs your arteries
Smoking is highly addictive, don’t start
Smoking increases the risk of blindness
Stopping smoking reduces the risk of fatal heart and lung
diseases
Smoking damages your teeth and gums
Smoking can cause a slow and painful death
Smoking can kill your unborn child
Get help to stop smoking: 0900-9390 (€ 0.10/min) or
www.stoppen-met-roken.nl or consult your doctor or
pharmacist
Your smoke harms your children, family and friends
Smoking may reduce the blood flow and causes impotence Smokers’ children are more likely to start smoking
Smoking causes ageing of the skin
Quit smoking – stay alive for those close to you:
www.stoppen-met-roken.nl
Smoking can damage the sperm and decreases fertility
Smoking reduces fertility
Smoke contains benzene, nitrosamines, formaldehyde and
hydrogen cyanide
Smoking increases the risk of impotence
In March 2012, a cross-country comparison report on health warnings on tobacco packages was
published, based on data from the International Tobacco Control (ITC) surveys in 19 countries. The
self-perceived effectiveness of health warnings was found to be very low in the Netherlands. The
percentage of smokers who reported to have noticed the health warnings on cigarette packages
‘(very) often’ in the last month was lowest in the Netherlands103. Since 2011, this percentage has
significantly decreased even further to less than 14% in 2014104. The percentage of smokers who
reported that warning labels make them think about the health risks of smoking “a lot” or who
reported that warning labels make them “a lot” more likely to quit smoking was also very low in the
Netherlands in comparison to other countries103. For the Netherlands, these proportions have not
changed significantly from 2011 to 2014, remaining below 2%104.
The 2012 Eurobarometer data (covering the then 27 EU member states) confirmed that the
Netherlands lags behind in the area of health warnings. The Netherlands belongs to the group of
countries in which (ex-)smokers are least likely to report that health warnings have encouraged them
to quit or smoke less and/or that health warnings have increased their awareness of the health effects
of tobacco105.
In the near future, transposition of the revised TPD will make a major contribution to the Dutch
performance in terms of FCTC. Pictorial health warnings covering 65% of the front and back will
be introduced in the Netherlands. The Dutch government has taken a hesitant position towards the
introduction of pictorial health warnings in the past years, focussing on a perceived lack of scientific
evidence in favour of such warnings. In particular, it was found that the long-term effects of pictorial
health warnings had not yet been sufficiently assessed89. However, when discussing the European
FCTC Shadow Report 2014
53
Commission’s proposal for a revised TPD in the House of Representatives, the State Secretary for
Health reasoned: “If it does discourage youth to smoke in the short run, why would you not take this
measure”28? This cautiously favourable stance towards pictorial health warnings appears to deviate
from the position taking in 2011 by the Dutch Minister of Health, who stated that “it would be an illfated undertaking to have the government attempting to force people into a straitjacket through, among
other things, images of damaged lungs on cigarette packages”106.
The Guidelines encourage the Parties to
consider requiring different health warnings
and messages for different tobacco products,
in order to better focus on the specific
health effects related to each product. In the
www.europa.eu
Netherlands (based on European legislation),
different health warnings are required for
smokeless tobacco than for smoked tobacco.
The revised TPD leaves the choice to
member states as to which health warnings
to require for smoked tobacco products
Design of future cigarette packages in the
European Union
other than cigarettes, roll-your-own tobacco
and waterpipe tobacco. Although no official
course of action has been announced, the
Dutch government has indicated that it supports the Commission’s approach of distinguishing
between these different tobacco products for smoking. It is reasoned that the introduction of pictorial
health warnings is targeted primarily at young people, whereas tobacco products for smoking other
than cigarettes, roll-your-own tobacco and waterpipe tobacco are currently mainly used by older
people90. This approach might, however, suggest that these other products are less harmful, whilst
this is not the case.
ARTICLE 11.2
Each unit packet and package of tobacco products and any outside packaging and
labelling of such products shall contain information on relevant constituents and
emissions of tobacco products.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 11
The provision of advice on cessation and specific sources for cessation help on tobacco packaging,
such as a web site address or a toll-free telephone ‘quit-line’ number, can be important in helping
tobacco users to change their behaviour.
Currently, tobacco packages sold in the Netherlands only contain a general and additional health
warning. These are placed at the bottom of the pack. Although a limited number of these additional
health warnings provides some information on the composition of tobacco smoke or on smoking
cessation (see Table 4), in most instances such information is lacking. Following transposition of the
revised TPD, the new combined health warnings will have to be placed at the top of the package.
Moreover, additional messages on the emissions of tobacco products (“Tobacco smoke contains over
54
Dutch Tobacco Control: Moving Towards the Right Track?
70 substances known to cause cancer”) and on smoking cessation information will be required on all
packages. The rules on rotation of health warnings will also be adjusted. Currently, the Dutch Labelling
Decree for Tobacco Products only specifies that warnings should alternate in such a way that they
appear regularly. In line with the FCTC Guidelines, the revised TPD introduces an additional rotation
scheme by establishing three sets of health warnings that are to alternate on an annual basis.
ARTICLE 11.1(a)
Each Party shall adopt and implement effective measures to ensure that tobacco
product packaging and labelling do not promote a tobacco product by any means that
are false, misleading, deceptive or likely to create an erroneous impression about its
characteristics, health effects, hazards or emissions, including any term, descriptor,
trademark, figurative or any other sign that directly or indirectly creates the false
impression that a particular tobacco product is less harmful than other tobacco
products.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 11
Parties should not require quantitative or qualitative statements on tobacco product packaging and
labelling about tobacco constituents and emissions that might imply that one brand is less harmful
than another, such as the tar, nicotine and carbon monoxide figures.
The Dutch Tobacco Act contains a prohibition on the use of misleading texts, names, trademarks and
figurative or other signs about the harmfulness of a tobacco product. This prohibition covers the use
of terms such as ‘light’ and ‘low-tar’. Following transposition of the revised TPD, the interpretation of
this prohibition will have to be widened. Labels may, for instance, no longer suggest that a particular
tobacco product has vitalising, energetic, healing, rejuvenating, natural or organic properties or other
health or lifestyle benefits.
The current obligation for tobacco manufacturers to place tar, nicotine and carbon monoxide (TNCO)
figures on cigarette packages is based on the 2001 TPD. This obligation runs contrary to the FCTC
Guidelines for implementation of Article 11, which state that such information should not be on
packaging, because of its misleading or deceptive nature. The Dutch government is bound by EU
legislation and hence has not been in a position to remove the requirement to place TNCO figures on
cigarette packages unilaterally. The revised 2014 TPD is in line with the FCTC Guidelines. It explicitly
states that “labels shall not include any information about the nicotine, tar or carbon monoxide
content of the tobacco product”, because such information might promote a tobacco product or
encourage its consumption by creating erroneous impressions of relative safety.
The TPD leaves the decision on whether or not to implement plain packaging to the member states.
This position of the Dutch government in relation to plain packaging is further discussed in the
chapter on Article 13.
FCTC Shadow Report 2014
55
Conclusions and recommendations
With the exception of providing support for the revised Tobacco Products Directive (suggesting
future developments), few actions have been taken in the area of packaging and labelling of tobacco
products since September 2011. The Dutch government was found not to act in compliance with one
of the obligations included in Article 11 (requiring the display of information on relevant constituents
and emissions of tobacco products on tobacco packages). It was therefore awarded a ‘red score’ in
the summary table on implementation of FCTC measures in the Netherlands in 2014 (Table 1b). The
government has not yet implemented various recommendations and suggestions included in the
Convention and its Guidelines either. Transposition of the revised TPD (which covers a large number of
the requirements, recommendations and suggestions related to Article 11) will allow for a major step
in the right direction with regard to the implementation of this article. Some additional measures could
enhance the performance of the government even further. The Dutch government is therefore urged to:
• Correctly and promptly transpose the revised EU Tobacco Products Directive. The government
should inform the public about the new health warnings (and other changes) and set out the
(health) reasons for introducing these new warnings (and other changes).
• Opt to introduce combined health warnings for smoking tobacco products other than cigarettes,
roll-your-own tobacco and waterpipe tobacco as well.
• Consider implementing plain packaging, in line with the Guidelines for implementation of Articles
11 and 13.
• Consider innovative ways of conveying health warnings and messages, for instance through pack
inserts with information on smoking cessation or through labels on smoking accessories.
Scores
56
FCTC provision
Type of
commitment
Content
Yes/No
11 1a
Shall
Adopt and implement effective measures to ensure
that tobacco product packaging and labelling do not
promote a tobacco product by any means that are false,
misleading, deceptive or likely to create an erroneous
impression about its characteristics, health effects,
hazards or emissions, including any term, descriptor,
trademark, figurative or any other sign that directly or
indirectly creates the false impression that a particular
tobacco product is less harmful than other tobacco
products.
Yes
11 1b
Shall
Adopt and implement effective measures to ensure
that each unit packet and package of tobacco products
and outside packaging and labelling of such products
carry health warnings describing the harmful effects of
tobacco use.
Yes
11 1b
May
Include other appropriate messages.
Yes
11 1b(i)
Shall
Require that warnings and messages are approved by
the competent national authority.
Yes
11 1b(ii)
Shall
Require that warnings and messages be rotating.
Yes
11 1b(iii)
Shall
Require that warnings and messages be large, clear,
visible and legible.
Yes
11 1b(iv)
Should
Require that warnings and messages be 50% or more of
the principal display areas.
No*
Score
Dutch Tobacco Control: Moving Towards the Right Track?
11 1b(iv)
Shall
Require that warnings and messages be no less than
30% of the principal display areas.
Yes
11 1b(v)
May
Require warnings and messages to be in the form of or
include pictures or pictograms.
No*
11 2
Shall
Require that each unit packet and package of tobacco
products and any outside packaging and labelling of such
products contains information on relevant constituents
and emissions of tobacco products as defined by
national authorities.
No*
11 3
Shall
Require that the warnings and other textual information
will appear on each unit packet and package of tobacco
products and any outside packaging and labelling of
such products in its principle language.
Yes
11 GL
Should
Require that health warnings and messages be
positioned on both the front and back (or on all main
faces if there are more than two) of each unit packet
and package, rather than on just one side, to ensure that
health warning and messages are highly visible.
Yes
11 GL
Should
Require that health warnings and messages be positioned
on principal display areas and, in particular, at the top of
the principal display areas rather than at the bottom to
increase visibility.
No*
11 GL
Should
Require that health warnings and messages be positioned
in such a way that normal opening of the package does
not perma­nently damage or conceal the text or image of
the health warning.
Yes
11 GL
Should consider
Require further health warnings and messages on all
sides of a package, as well as on package inserts and
onserts.
No*
11 GL
Should
Ensure that health warnings and messages are not
obstructed by other required packaging and labelling
markings or by commercial inserts and onserts.
Yes
11 GL
Should
Ensure that other markings, such as tax stamps and
markings as per the requirements of Article 15 of the
Convention, do not obstruct any part of the health
warnings and messages.
Yes
11 GL
Should consider
Introduce other innovate measures regarding location,
including, but not limited to, requiring health warnings and
messages to be printed on the filter overwrap of cigarettes
and/or on other related materials such as packages
of cigarette tubes, filters and papers as well as other
instruments, such as those used for water pipe smoking.
No
11 GL
Should consider
Exclude the space dedicated to framing health warnings
and messages from the size of the health warning or
message itself when calculating the percentage of
display area occupied by them.
No*
11 GL
Should
Select contrasting colours for the background of the text in
order to enhance noticeability and maximise the legibility
of text-based elements of health warnings and messages.
Yes
11 GL
Should
Specify the number of health warnings and messages
that are to appear concurrently.
Yes
11 GL
Should
Require that health warnings and messages in a
specified series be printed so that each appears on an
equal number of retail packages, not just for each brand
family but also for each brand within the brand family
for each package size and type.
Yes
11 GL
Should consider
Establish two or more sets of health warnings and
messages, specified from the outset, to alternate after a
specified period.
No*
FCTC Shadow Report 2014
57
11 GL
Should
Ensure that health warnings and messages to address
different issues related to tobacco use, in addition to
harmful health effects and the impact of exposure
to tobacco smoke, such as advice on cessation, the
addictive nature of tobacco, adverse economic and
social outcomes and the impact of tobacco use on
significant others.
Yes
11 GL
Should consider
Innovative content for other messages, such as adverse
environmental outcomes and tobacco industry practices.
No
11 GL
Should
Ensure that health warnings and messages to be
presented in simple, clear and concise language that is
culturally appropriate.
Yes
11 GL
Should
Require that relevant qualitative statements be
displayed on each unit packet or package about the
emissions of the tobacco product.
No*
11 GL
Should
Not require quantitative or qualitative statements on
tobacco product packaging and labelling about tobacco
constituents and emissions that might imply that one
brand is less harmful than another, such as the tar,
nicotine and carbon monoxide figures.
No*
11 GL
Should consider
Require different health warnings and messages for
different tobacco products, in order to better focus on
the specific health effects related to each product.
Yes
11 GL
Should
Have a comprehensive understanding of the many
different types of tobacco product packaging found within
their jurisdic­tion, and should indicate how the proposed
health warnings and messages will apply to each type and
shape of packaging.
No*
11 GL
Should consider
Designing warnings that target subgroups and adapting
the number of health warnings and their rotation
accordingly.
Yes
11 GL
Should consider
Pre-marketing testing to assess the effectiveness of
the health warnings and messages on the intended
population.
Yes
11 GL
Should
Inform the public of proposals to introduce new health
warnings and messages.
No
11 GL
Should
Prohibit terms such as ‘extra’, ‘ultra’ and similar terms in
any language that might mislead consumers.
No
11 GL
Should
Prohibit the display of figures for emission yields (such
as tar, nicotine and carbon monoxide) on packaging and
labelling, including when used as part of a brand name
or trademark.
No*
11 GL
Should
Prevent the display of expiry dates on tobacco packaging
and labelling where this misleads or deceives consumers
into con­clu­ding that tobacco products are safe to be
consumed at any time.
Yes
11 GL
Should consider
Adopt measures to restrict or prohibit the use of logos,
colours, brand images or promotional information
on packaging other than brand names and product
names displayed in standard colour and font style (plain
packaging).
No
* When the revised EU Tobacco Products Directive is correctly transposed, this assessment (Yes/No) (and the subsequent colour score)
would likely change.
58
Dutch Tobacco Control: Moving Towards the Right Track?
Article 12
Education, Communication, Training
and Public Awareness
The previous shadow report highlighted the fact that public awareness of harms caused by smoking
to both smokers and non-smokers was significantly lower in the Netherlands compared to many
other countries. For instance, only 61% of Dutch smokers reported to agree with the statement
that secondhand smoke is dangerous to non-smokers (data derived in 2010)107. Based on these
results, the Minister of Health stated that, in this area, health gains could be achieved through better
information108. In 2014, however, the proportion of smokers reporting to agree with the above
statement had not changed significantly104.
ARTICLE 12
Each Party shall adopt and implement effective legislative, executive, administrative or
other measures to promote:
(a) broad access to effective and comprehensive educational and public awareness
programmes on the health risks including the addictive characteristics of tobacco
consumption and exposure to tobacco smoke;
(b) public awareness about the health risks of tobacco consumption and exposure to
tobacco smoke, and about the benefits of the cessation of tobacco use and tobacco-free lifestyles;
(c) public access to a wide range of information on the tobacco industry; […] and
(f) public awareness of and access to information regarding the adverse health,
economic, and environmental consequences of tobacco production and consumption.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 12
In tobacco control, communication is essential to change attitudes about tobacco production,
manufacture, marketing, consumption and exposure to tobacco smoke, discourage tobacco use, curb
smoking initiation, and encourage cessation, as well as being necessary for effective community
mobilisation towards providing enabling environments and achieving sustainable social change.
The importance of education and communication, as part as of a comprehensive tobacco control
policy, has been recognised repeatedly by the State Secretary for Health80. When discussing the
introduction of an increased legal age limit for tobacco sales (see also the chapter on Article 16),
the State Secretary noted: “Of course, enforcement has to improve […] but it is much more important to
educate people well, to convince them of the fact that smoking is unhealthy, especially at a younger age,
and to ensure that this campaign to prevent a new generation from starting to smoke, is more important
than surveillance”29.
In July 2011, the then responsible Minister of Health announced a different approach to discourage
smoking. In particular, she chose to no longer use untargeted mass-media campaigns to change
FCTC Shadow Report 2014
59
unhealthy behaviour such as tobacco use, but instead to rely on educational programmes in
schools and on direct communication through health professionals (such as general practitioners,
obstetricians and medical specialists)109. Therefore, no mass media campaigns were run by the
government from the end of 2011 to the end of 2013. However, following a change of government
and the transfer of responsibility for tobacco control policies to the State Secretary for Health in
November 2012, mass media campaigns have been initiated or supported by the government since
late 2013. These mass media initiatives are the NIX18 campaign (to introduce the increased legal age
limit, see below) and Stoptober (to stimulate smokers to quit smoking for 28 days in October 2014,
see also the chapter on Article 14). It has also been announced that a campaign will be launched to
explain the re-introduction of the smoking ban in all hospitality venues. It has been communicated
that the rationale underlying such a smoking ban – the health risks associated with passive smoking
– will also be addressed in the campaign80. If so, it would be the first mass media campaign in about
a decade that highlights the harms caused by (passive) smoking. The campaign is expected to start in
early 2015110.
Article 12 also contains the requirement to provide public access to a wide range of information on
the tobacco industry. This has not been done by the government, with the exception of information
on the ingredients of tobacco products (see the chapter on Articles 9 and 10). The topic has, however,
been put on the agenda by civil society. In March 2013, the website www.tabaknee.nl was launched
by the Youth Smoking Prevention Foundation (Stichting Rookpreventie Jeugd). This website unmasks
tobacco industry strategies and practices, and identifies Dutch allies of the tobacco industry
(including members of government and parliament).
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 12
Infrastructure to raise public awareness refers to the organisational structures and capacity needed
to ensure sustained education, communication and training programmes. It provides the means and
resources needed to gather knowledge, translate research results and good practices into useful and
understandable messages for individual target groups, communicate the relevant messages, and then
monitor the effects of these messages on knowledge, attitude and behavioural outcomes.
Parties should establish an infrastructure to support education, communication and training and
ensure that they are used effectively to raise public awareness and promote social change, in order to
prevent, reduce or eliminate tobacco consumption and exposure to tobacco smoke.
As of January 2013, responsibility for prevention of tobacco use (including the task of informing and
educating the general public) has been transferred from STIVORO, the former Dutch expert centre
on tobacco control, to the Trimbos Institute111. This decision was motivated by reasons of efficiency
and the government’s aim for a more integrated approach to prevention (in the field of addictive
substances)40; 112. This reallocation of tasks has been criticised by the international tobacco control
community113. In parliament, fears were expressed that (a large) part of the knowledge base on tobacco
control would be lost114; 115. In 2012, a one-off subsidy was provided to the Trimbos Institute in order
to prepare itself for its new task as national centre of expertise on tobacco control, by acquiring and
safeguarding (existing) knowledge and expertise111. The decision to transfer responsibilities was
challenged by STIVORO in the Dutch courts. STIVORO claimed that the decision was not in line with
various FCTC-provisions, such as Article 12. In the end, the Council of State ruled that, because of the
60
Dutch Tobacco Control: Moving Towards the Right Track?
Minister’s discretion in relation to cutting or terminating subsidies, the Minister was allowed to end all
subsidies to STIVORO. It added that a court should only marginally asses such decisions. The Council
reasoned: “The fact that the Trimbos Institute will not execute all programmes that STIVORO is committed
to and will, presumably, have less employees to carry out the subsidised activities, does not give rise to a
different conclusion. It is not implausible that these restrictions are associated with the […] announced
cuts on tobacco control activities of 25% in 2013 and 50% in 2014. However, these cuts do not concern
STIVORO but the Trimbos Institute and fall outside the scope of this proceeding”116.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 12
In tobacco control, education comprises a continuum of teaching and learning about tobacco which
empowers people to make voluntary decisions, modify their behavior and change social conditions in
ways that enhance health.
School education is considered an important channel for raising
awareness about (the harms of) smoking and for stimulating healthy
lifestyles117. Various initiatives have started to encourage such
education and to improve the available materials, including an
www.gezondeschool.nl
increased budget118. The Ministries of Health and of Education
contribute financially to the “Healthy School” (Gezonde School)
project20. Within this project, schools can apply for a vignette, allow­
ing them to raise their profile as a school that emphasises health and
wellbeing. Since September 2014, such vignettes are available for
both primary and (more recently) secondary education institutions, as
well as for secondary vocational schools119. To qualify for the Healthy
School vignette, schools have to obtain at least one of the predefined
Healthy School vignette
theme certificates. One of these theme certificates focuses on smoking
(and other substance uses). Requirements for the attainment of this certificate include smokefree
schoolyards, structural education on tobacco use, communication with parents regarding smoking,
and more120. In December 2014, the theme certificate “Smoking and alcohol” had been allocated
to six primary schools121 and the theme certificate “Smoking, alcohol and drugs prevention” to one
secondary school122; 123. The government aims for all schools to be healthy in 203020. In 2016, 850
schools (out of 8,000) are supposed to have successfully applied for the Healthy School vignette20.
One of the education programmes on smoking available to schools is the “Healthy School and Drugs”
(DGSG) programme (developed by the Trimbos Institute). For instance, e-learning programmes have
been developed for secondary schools and for secondary vocational schools. The DGSG programme
encourages an integral approach that also includes parental involvement, establishing a policy on
substance use and signalling substance use124. Various studies have been conducted to measure the
effectiveness of the DGSG programme. Recent publications suggested that the DGSG programme did
not significantly impact tobacco use, causing the authors to conclude that the programme was either
ineffective or implemented inadequately125; 126. These results have prompted the Trimbos Institute
to update the materials. For instance, the role of parents has been incorporated more strongly127; 128.
As of the school year 2014-2015, the “Prevention of Alcohol Use among Students” (PAS) intervention
also covers smoking. Hence it has been renamed the “Student and Parent Intervention Alcohol and
FCTC Shadow Report 2014
61
Smoking”. It builds on the finding that parents should be educated simultaneously with their children,
so that they can be clear about substance use at home129. Previous research has established the
effectiveness of the PAS intervention and has shown that these effects originate in particular from the
addition of parental involvement130.
Monitoring data on education on smoking in secondary education has suggested that the percentage
of secondary schools paying attention to smoking in at least one grade significantly decreased
between 2008 (96%) and 2011 (82%)131. No recent figures have been published. The share of
secondary schools using the DGSG programme has remained at 70% from 2011132 to 2014133. It is
unclear to what extent these schools (also) use the tobacco e-learning as part of the programme.
Youth and their parents are also targeted through the “Growing Up Smokefree” (Rookvrij Opgroeien)
programme118. This programme has been implemented through the Youth Health Care (JGZ) system.
Since 2012, the Growing Up Smokefree programme is no longer solely targeted at (the parents of)
children aged 0 to 3, but also at youth aged 4 years or older. This is in line with the observation that,
in 2011, exposure to secondhand smoke at home was (much) higher among school children (ages
4-18), than among babies and very young children (ages 0-3). Whereas 5% of adults reported to
smoke inside their homes in the presence of their youngest child aged 0-3, 18% reported to do so in
the presence of their youngest child aged 4-12 and 27% in the presence of their youngest child aged
13-18134. The new training for Youth Health Care workers in relation to older children also includes
elements of smoking prevention among these children135.
General information on smoking (cessation) is currently provided rather passively in the Netherlands.
Although reliable information on smoking (cessation) can be accessed through the Trimbos Institute’s
website for tobacco control public education (www.rokeninfo.nl) and/or its Smoking Information Line,
these channels are not (yet) actively promoted through mass media (see also the chapter on Article 14).
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 12
It is essential to change social, environmental and cultural norms and perceptions regarding the
acceptability of the consumption of tobacco products, exposure to tobacco smoke, and aspects of the
growing, manufacturing, marketing and sale of tobacco and tobacco products.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 12
Outreach can be increased by encouraging and supporting non-governmental organisations and other
members of civil society active in the field of tobacco control, and not affiliated with the tobacco
industry, to complement governmental programmes through joint and/or independent educational
activities and communication campaigns.
The Netherlands is not only lagging behind internationally with regard to knowledge of the health
risks of (passive) smoking, but also in relation to the (perceived) denormalisation of smoking.
Comparative research has shown that, in the Netherlands, the group of smokers who agreed that
society disapproves of smoking was relatively small in comparison to other countries136; 137. The
percentage of smokers who agrees that society disapproves of smoking has significantly increased
from 53.1% in 2011 to 62.2% in 2014104, but this is still well below the levels that were previously
62
Dutch Tobacco Control: Moving Towards the Right Track?
found in Germany (70%), France (74%)136, the UK (77%), the USA (78%), Australia (82%), and
Canada (88%)137. The percentage of smokers whose overall opinion of smoking is (very) negative has
also significantly increased from 17.4% in 2011 to 21.2% in 2014104. Again, this still is a relatively
small proportion in comparison to other countries107. Another positive trend is that parents take
an increasingly negative stance towards smoking by their children138. In 2013, 9 out of 10 parents
reported to believe that occasional smoking is harmful for children under the age of 16 and 9 out of
10 parents reported to support the norm of no smoking at all among children under the age of 16138.
The State Secretary for Health has recognised the importance of
social norms in relation to tobacco use. The NIX18 campaign was
designed to play a role in this regard and help establish the norm
that smoking is not normal (especially among those aged under
18)29. Various television and radio commercials were broadcast
and social media were used to target youth87. An early evaluation
showed that the NIX18 campaign contributed to higher levels
of knowledge among parents, minors and the general public
about the new legal age limit and to increased communication
about smoking (and drinking) before children turn 18. Effects on
www.trimbos.nl
attitude (such as perceived normality of no smoking before the
age of 18) and behaviour (such as no smoking among minors)
are expected by the government in the longer term139. The State
Secretary has indicated that the campaign has, so far, been
associated primarily with ‘no alcohol’ and less with ‘no smoking’.
In the development of new campaign materials, more emphasis
Example of NIX18 campaign
materials
will therefore be placed on tobacco87.
The State Secretary has pointed out that the denormalisation of smoking can only be achieved
through cooperation with as many social partners as possible. Examples mentioned are the promotion
of smokefree schoolyards (see the chapter on Article 8) and the organisation of a national smoking
cessation month (Stoptober)22. The government does not play an active, initiating role in these
initiatives, but mainly supports these campaigns financially. A denormalisation campaign (“Smoking is
sooo…”) was also run by the Dutch Cancer Society (KWF). According to the State Secretary, the NIX18
campaigns and the KWF campaign should be considered complementary. For example, whereas the
KWF campaign was targeted at young adults, the governmental NIX18 campaign has been directed
primarily at the social environment of youth22.
ARTICLE 12
Each Party shall adopt and implement effective legislative, executive, administrative
or other measures to promote effective and appropriate training or sensitisation and
awareness programmes on tobacco control addressed to persons such as health
workers, community workers, social workers, media professionals, educators, decisionmakers, administrators and other concerned persons.
FCTC Shadow Report 2014
63
Training provided by the Trimbos Institute is targeted primarily at school teachers (DGSG) and at
midwives, maternity assistants and JGZ professionals (Growing Up Smokefree). Training for smoking
cessation service providers is delivered through a broad range of organisations. These organisations
include the Netherlands School of Public and Occupational Health (NSPOH), but also several
specialised smoking cessation entities. High-quality training can be accredited through the Quality
Register on Smoking Cessation (see also the chapter on Article 14). In 2013, the Trimbos Institute
concluded that coordination was lacking regarding the training for smoking cessation service
providers. This caused uncertainties in the field and discouraged the (re)training of service providers.
In order to remove these bottlenecks in the field of training, the Trimbos Institute has requested
further subsidies from the Ministry of Health140. These subsidies should support the Trimbos Institute
in ensuring that professionals are being adequately informed, that training materials remain available
and that training for professionals is guaranteed.
Conclusions and recommendations
Government policy in the area of education, communication and training has changed throughout
the past years. For example, whereas initially a stop on all mass media campaigns was declared, some
mass media initiatives have been implemented or announced since late 2013. However, from an
international perspective, awareness of the health risks of smoking is still very low and smoking is still
considered to be relatively normal behaviour in the Dutch society. The government is not acting in
compliance with various of the obligations included in Article 12 (see the scoring table below). A ‘red
score’ was therefore assigned in the summary table on the implementation of FCTC measures in the
Netherlands in 2014 (Table 1b). The lack of compliance with some of the recommendations included
in the Guidelines also illustrates that there still is much room for improvement. Further measures are
therefore essential. Most notably, the Dutch government is urged to:
• Implement further measures, such as mass media campaigns, to increase awareness of the
harmfulness of (passive) smoking. The government should also initiate communication on other
topics, such as the strategies of the tobacco industry. Appropriate (financial) resources should be
provided.
• Ensure that appropriate training and awareness programmes on tobacco control are not only
available for health workers, but also for professionals in other relevant sectors, such as social
workers, media professionals and decision-makers.
Scores
64
FCTC provision
Type of
commitment
Content
Yes/No
12 a
Shall
Adopt and implement effective measures to promote
broad access to effective and compre­hen­sive
educational and public awareness programmes on the
health risks including the addictive characteristics of
tobacco consumption and exposure to tobacco smoke.
No
12 b
Shall
Adopt and implement effective measures to promote
public awareness about the health risks of tobacco
consumption and exposure to tobacco smoke, and
about the benefits of the cessation of tobacco use and
tobacco-free lifestyles.
No
Score
Dutch Tobacco Control: Moving Towards the Right Track?
12 c
Shall
Adopt and implement effective to promote public access
to a wide range of information on the tobacco industry
(as relevant to the objective of this Convention).
No
12 d
Shall
Adopt and implement effective measures to promote
effective and appropriate training or sensitisation and
awareness programmes on tobacco control addressed
to persons such as health workers, community workers,
social workers, media professionals, educators, decisionmakers, administrators and other concerned persons.
Yes
12 e
Shall
Adopt and implement effective measures to promote
awareness and participation of public and private
agencies and nongovernmental organisations not
affiliated with the tobacco industry in developing and
implementing intersectoral programmes and strategies
for tobacco control.
Yes
12 f
Shall
Adopt and implement effective measures to promote
public awareness and access to information regarding
the adverse health, economic, and environmental
consequences of tobacco production and consumption.
No
12 GL
Should
Establish an infrastructure to support education,
communication and training and ensure that they are
used effectively to raise public awareness and promote
social change, in order to prevent, reduce or eliminate
tobacco consumption and exposure to tobacco smoke.
Yes
12 GL
Should
Use all available means to raise awareness, provide
enabling environments and facilitate behavioural
and social change through sustained education,
communication and training.
No
12 GL
Should
Actively involve members of civil society, in different
phases such as planning, developing, implementing,
monitoring and evaluating education, communication
and training programmes.
Yes
12 GL
Should
Restrict their collaboration to members of civil society
not affiliated with the tobacco industry
Yes
12 GL
Should
Ensure that the public has free and universal access to
accurate and truthful information on the strategies and
activities of the tobacco industry and its products, as
appropriate.
No
12 GL
Should
Ensure that education, communication, training and
public awareness programmes include a wide range of
information on the tobacco industry.
No
12 GL
Should
Monitor, evaluate and revise their communication,
education and training measures to meet their
obligations under the Convention.
Yes
FCTC Shadow Report 2014
65
Article 13
Tobacco Advertising, Promotion and Sponsorship
Article 13 is based on the recognition that a
comprehensive ban on advertising, promotion and
sponsorship would reduce the consumption of tobacco
products. The Guidelines underline that such a ban
is effective only if it has a broad scope. The effect of
a partial ban is limited. The previous shadow report
established that the ban on tobacco advertising,
promotion and sponsorship was not comprehensive
enough. Nevertheless, since 2011, few developments
have been initiated by the Dutch government to improve
its performance. In line with this lack of more stringent
measures, the percentage of smokers that reported to
have noticed the promotion of smoking (very) often in
the past six months has remained at similar levels from
Tobacco advertising outside specialised
tobacco shops
2011 to 2014 (around 14%)104.
ARTICLE 13.2
Each Party shall, in accordance with its Constitution or constitutional principles,
undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship.
ARTICLE 13.4
As a minimum, and in accordance with its Constitution and constitutional principles,
each Party shall:
(a) prohibit all forms of tobacco advertising, promotion and sponsorship that promote
a tobacco product by any means that are false, misleading or deceptive or likely to
create an erroneous impression about its characteristics, health effects, hazards or
emissions;
(b) require that health or other appropriate warnings or messages accompany all
tobacco advertising and, as appropriate, promotion and sponsorship;
(c) restrict the use of direct or indirect incentives that encourage the purchase of
tobacco products by the public;
(d) require, if it does not have a comprehensive ban, the disclosure to relevant
governmental authorities of expenditures by the tobacco industry on advertising,
promotion and sponsorship not prohibited;
(e) undertake a comprehensive ban of tobacco advertising, promotion and sponsorship
on radio, television, print media and, as appropriate, other media, such as the internet,
within a period of five years; and
(f) prohibit tobacco sponsorship of international events, activities and/or participants
therein.
66
Dutch Tobacco Control: Moving Towards the Right Track?
There have been no legal changes in the area of tobacco advertising, promotion and sponsorship
since 2011. This implies that there still is no comprehensive ban on all tobacco advertising,
promotion and sponsorship. Although Article 5.1 of the Dutch Tobacco Act contains a general ban
on all advertising and sponsorship of tobacco products, several exceptions are identified in the
subsequent paragraphs. The Dutch government acknowledged the lack of a comprehensive ban
in its FCTC progress reports to the World Health Organisation (WHO)8; 10; 11. A comprehensive ban
on advertising, promotion and sponsorship is required by the FCTC, unless a Party is precluded
from adopting such a ban on the basis of its Constitution or constitutional principles. The Dutch
government has reported that it is not prevented from undertaking a comprehensive ban by the
Dutch Constitution or constitutional principles8; 10; 11. In terms of the FCTC, it therefore has no valid
reason for not having implemented a comprehensive ban on advertising, promotion and smoking. For
those countries that have not yet implemented a comprehensive ban, Article 13.4 sets out a number
of minimum requirements. The Dutch government still does not fulfil these minimum requirements
either. In particular, it fails to demand the disclosure of expenditures on advertising, promotion and
sponsorship by the tobacco industry.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 13
To ensure that points of sale of tobacco products do not have any promotional element, Parties
should introduce a total ban on any display and on the visibility of tobacco products at points of sale.
Tobacco sales are still allowed at many venues. Only
a couple of categories of institutions are excluded
from selling tobacco, such as educational facilities.
For the purposes of the ban on advertising, a
distinction is made between specialised tobacco
shops and other tobacco retailers. In specialised
tobacco shops (about 1,500)141, advertising is still
permitted (albeit within certain boundaries). These
shops are also allowed to display advertising (of
maximum 2 m²) on the outside of their shops.
The display of tobacco packages, on the other
hand, is allowed at all tobacco points of sale. In
Display of tobacco packages at points of sale
of tobacco
October 2013, motions were tabled by members of
parliament to introduce a display ban in the Netherlands and to limit the number of tobacco points
of sale29. The motions were not supported by a majority in the House of Representatives142. Based
on these debates, the State Secretary for Health did commission a review of the evidence on the
effectiveness of restricting the number of tobacco points of sale and of introducing a display ban
in terms of reducing smoking prevalence. This review was published in July 2014. It was concluded
that, whereas the evidence in support of a reduction of points of sale was still relatively weak,
studies on display bans did suggest that such a ban would contribute to reduced tobacco use in the
population143. On request of the State Secretary, the economic effects of reducing the number of
points of sale (measured by changes in revenue and employment) were also mapped144. The State
Secretary has not yet announced a course of action on the basis of these publications110.
FCTC Shadow Report 2014
67
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 13
Packaging and product design are important elements of advertising and promotion. Parties should
consider adopting plain packaging requirements to eliminate the effects of advertising or promotion
on packaging. Packaging, individual cigarettes or other tobacco products should carry no advertising
or promotion, including design features that make products attractive.
The packaging of tobacco products is an
important exception to the ban on advertising.
When the ban was proposed by the government
in 2001, it was reasoned that the packaging
of tobacco products, as such, fell within the
definition of advertising, but that it could not
be the intention to prohibit these packages145.
An explicit exception was therefore formulated.
This exception has remained in place. Although
no legal changes occurred, some developments
have taken place in the area of ‘package’ design
that have prompted the authorities to further
Example of inserts in cigarette packages
delineate the boundaries of the exception. The
increased use of so-called pack inserts by the tobacco industry is an example of such developments.
For the tobacco industry, such inserts are a cost-effective way of introducing new brand features or
changes to the brand portfolio146. The question has arisen whether or not these inserts should be
seen as part of the packaging and are therefore also exempted from the ban on advertising. In August
2013, the Dutch Food and Consumer Product Safety Authority (NVWA) fined British American Tobacco
(BAT) for violating the Tobacco Act by adding inserts to the packaging of several tobacco products.
In February 2014, the District Court of The Hague ruled that this decision of the NVWA could not be
regarded as manifestly erroneous. The fact that the inserts are added to the packaging, does not make
them part of the packaging: they are not used to pack the product147.
The FCTC Guidelines on the implementation of Article 13 suggest the adoption of plain packaging.
The revised EU Tobacco Products Directive (TPD) leaves the choice of implementing plain packaging
to individual member states. Ireland and France have already indicated that they intend to introduce
plain packaging when transposing the revised TPD. Although the Dutch government has not openly
objected to these plans (as some other EU member states have done)148, so far, it has taken a cautious
position towards the implementation of plain packaging in the Netherlands. Although the State
Secretary for Health closely monitors the developments in the area of plain packaging, he argues that
such a measure should be extensively evaluated first, especially as far as its effects on health and
intellectual property are concerned149. He considers the current evidence base to be insufficient28.
The State Secretary is, therefore, not (yet) prepared to propose the adoption of plain packaging85.
If plain packaging is not mandated, the Guidelines recommend to restrict as many design features
as possible. Currently, only the use of texts, (brand) names and figures or other signs that suggest
that one tobacco product is less harmful than others is prohibited (in line with Article 13.4(a) FCTC).
Following transposition of the revised TPD, there will also be a ban on very small packages (such as
the so-called lipstick packs) and there will be further restrictions regarding the shape and opening
68
Dutch Tobacco Control: Moving Towards the Right Track?
mechanisms of tobacco packs. However, many other promotional elements, such as coloured cigarette
papers and special edition designs, will still be allowed (if plain packaging is not introduced).
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 13
The Parties should ban contributions from tobacco companies to any other entity for ‘socially
responsible clauses’, as this is a form of sponsorship. Publicity given to ‘socially responsible’ business
practices of the tobacco industry should be banned, as it constitutes advertising and promotion.
In the context of corporate social responsibility, the previous
shadow report pointed at a partnership between Japan Tobacco
International (JTI), the Keep Holland Tidy Foundation (Stichting
Nederland Schoon) and the municipality of Zandvoort. Goal
of this partnership was to reduce cigarette litter on beaches.
Similar partnerships were established in the subsequent years.
Every year a different location is selected for launch of the
project. As part of the campaign “Don’t leave your fag alone”,
beach-goers are provided with disposable ashtrays. These
ashtrays, as well as other campaign materials, contain the JTIwww.perssupport.nl
logo and hence could be considered to constitute corporate
promotion. The Guidelines for implementation of Article 13
indicate that such promotion of tobacco companies themselves
is a form of promotion of tobacco products or tobacco use as
well. In response to questions asked by members of parliament,
the State Secretary for Health stated that he had no reasons
to assume that this initiative should be considered a violation
Poster “Don’t leave your fag alone”
campaign
of the Convention, emphasising that the campaign did not
derive from local tobacco control policies150. The State Secretary sent a letter to all municipalities and
provinces to emphasise that these lower levels of government are also bound by the FCTC. Although
the Guidelines for implementation of the Convention were briefly mentioned, it was stressed that
these Guidelines are of a non-binding nature42.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 13
Internet sales of tobacco should be banned as they inherently involve tobacco advertising and
promotion.
There is no ban on internet sales of tobacco products in the Netherlands. Although the government
has acknowledged that “internet sales are practically impossible without violating the ban on
advertising”89, the issue of internet sales is considered primarily as part of the discussion on
compliance with the legal age limit. It is, therefore, further discussed in the chapter on Article 16.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 13
Parties should introduce and apply effective, proportionate and dissuasive penalties. Parties should
designate a competent, independent authority to monitor and enforce the law and entrust it with the
necessary powers and resources.
FCTC Shadow Report 2014
69
Since 2010, 101 fines have been imposed because of a violation of the ban on tobacco advertising
and sponsorship. In three instances, the maximum fine of € 450,000 has been levied. Violations have,
for instance, been observed at events and festivals83.
Conclusions and recommendations
There have been few new government initiatives to prevent tobacco advertising, promotion and
sponsorship since September 2011. Although various studies were commissioned, so far no
concrete measures have been implemented. The Dutch government does not act in line with the
FCTC obligations in relation to Article 13. A comprehensive ban on tobacco advertising, promotion
and sponsorship has not been implemented and the minimum requirements listed in Article 13.4
are currently not all fulfilled. It was therefore awarded a ‘red score’ in the summary table on the
implementation of FCTC measures in the Netherlands in 2014. The recommendations and suggestions
included in the Guidelines offer many possibilities for future enhancement as well. The Dutch
government is particularly urged to:
• Ban advertising outside and inside all tobacco points of sale and no longer allow for any
exemptions for certain points of sale. In addition, the government should ban the display and
visibility of tobacco products at all point of sales.
• Ban the sale of tobacco through vending machines. A ban on internet sales should also be
considered.
• Take measures to limit (the visibility of) ‘socially responsible’ business practices by the tobacco
industry. As an absolute minimum, in line with the Guidelines for implementation of Article
5.3, governmental officials and public servants should not be able to endorse, support, form
partnerships with or participate in corporate social responsibility initiatives of the tobacco industry.
• Consider implementing plain packaging, in line with the Guidelines for implementation of Articles
11 and 13.
• Implement a ban on more indirect forms of tobacco promotion, such as advertising for smoking
accessories.
Scores
70
FCTC provision
Type of
commitment
Content
Yes/No
13 2
Shall
Undertake a comprehensive ban of all tobacco
advertising, promotion and sponsorship.
No
13 4a
Shall
Prohibit all forms of tobacco advertising, promotion and
sponsorship that promote a tobacco product by any
means that are false, misleading or deceptive or likely to
create an erroneous impression about its characteristics,
health effects, hazards or emissions.
Yes
13 4b
Shall
Require that health or other appropriate warnings or
messages accompany all tobacco advertising and, as
appropriate, promotion and sponsorship.
Yes
13 4c
Shall
Restrict the use of direct or indirect incentives that
encourage the purchase of tobacco products by the
public.
Yes
Score
Dutch Tobacco Control: Moving Towards the Right Track?
13 4d
Shall
Require the disclosure to relevant governmental
authorities of expenditure by the tobacco industry
on advertising, promotion and sponsorship not yet
prohibited.
No
13 4e
Shall
Undertake a comprehensive ban on tobacco advertising,
promotion and sponsorship on radio, television, print
media and, as appropriate, other media, such as the
internet.
Yes
13 4f
Shall
Prohibit tobacco sponsorship of international events,
activities and/or participants therein.
Yes
13 GL
Should
Ban advertising and promotion of tobacco brand names
and all corporate promotion.
No
13 GL
Should
Ban display and visibility of tobacco products at points
of sale.
No
13 GL
Should
Ban vending machines.
No
13 GL
Should consider
Adopt plain packaging requirements.
No
13 GL
Should
Ban internet sales.
No
13 GL
Should
Ban ‘brand stretching’ and ‘brand sharing’.
No
13 GL
Should
Ban contributions from tobacco companies to any other
entity for ‘socially responsible’ business practices.
No
13 GL
Should
Ban publicity given to ‘socially responsible’ business
practices of the tobacco industry.
No
13 GL
Should
Take measures to prevent the use of journalistic, artistic
or academic expression or social or political commentary
for the promotion of tobacco use or tobacco products.
Yes
13 GL
Should
Take particular measures concerning the depiction of
tobacco in entertainment media products, including
requiring certification that no benefits have been
received for any tobacco depictions, prohibiting the use
of identifiable tobacco brands or imagery, requiring antitobacco advertisements and implementing a ratings or
classification system that takes tobacco depictions into
account.
No
13 GL
Should
Define and apply strictly any exception to a
comprehensive ban on advertising, promotion and
sponsorship to allow communication with the tobacco
trade.
Yes
13 GL
Should
Take effective actions to limit or prevent any crossborder tobacco advertising, promotion and sponsorship
entering their country.
Yes
13 GL
Should
Define the entities responsible for tobacco advertising,
promotion and sponsorship widely, and have the way in
which they are held responsible depend on their role.
Yes
13 GL
Should
Ensure that primary responsibility lies with the
initiator of advertising, promotion or sponsorship,
usually tobacco manufacturers, wholesale distributors,
importers, retailers and their agents and associations.
Yes
13 GL
Should
Ban persons or entities that produce or publish media
content from including tobacco advertising, promotion
and sponsorship in the content they produce or publish.
Yes
13 GL
Should
Ban persons or entities (such as events organisers,
sportspeople and celebrities) from engaging in tobacco
advertising, promotion and sponsorship.
Yes
FCTC Shadow Report 2014
71
72
13 GL
Should
Apply particular obligations, for example, to remove
content to other entities involved in analogue or digital
media after they have been made aware of the tobacco
advertising, promotion and sponsorship.
Yes
13 GL
Should
Introduce and apply effective, proportionate and
dissuasive penalties.
Yes
13 GL
Should
Ensure that civil society is involved in the monitoring and
enforcement of the law and have access to justice.
Yes
13 GL
Should
Designate a competent, independent authority to
monitor and enforce the law and entrust it with the
necessary powers and resources.
Yes
13 GL
Should
Promote and strengthen, in all sectors of society, public
awareness of the need to eliminate tobacco advertising,
promotion and sponsorship, the laws against it, and
the ways in which members of the public can act on
breaches of these laws.
No
Dutch Tobacco Control: Moving Towards the Right Track?
Article 14
Tobacco Dependence and Cessation
ARTICLE 14.1
Parties shall develop and disseminate appropriate, comprehensive and integrated guidelines
based on scientific evidence and best practices.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 14
These guidelines should include two major components: (1) a national cessation strategy, to promote
tobacco cessation and provide tobacco dependence treatment, aimed principally at those responsible
for funding and implementing policies and programmes; and (2) national treatment guidelines aimed
principally at those who will develop, manage and provide cessation support to tobacco users.
In the Netherlands, a clinical Guideline for the Treatment of Tobacco Dependence has been in place
since 2004151. This Guideline summarises scientific evidence with regard to the effectiveness of smoking
cessation treatments. It has emerged from the Partnership on Smoking Cessation, a public-private
platform in which various healthcare-related organisations collaborate that was initiated by the Ministry
of Health in the early 2000s. The Guideline was last updated in 2009152. A new update is currently being
considered. The Ministry of Health will provide a small amount of financial support to this end140.
In 2009, the Partnership on Smoking Cessation established the Standard of Care on Smoking Cessation153,
to translate the Guideline into practice. This Standard of Care describes the norms for high-quality
smoking cessation care. Among other things, it is used to facilitate agreements between health insurers
and service providers regarding the eligibility of smoking cessation treatments for reimbursement154.
ARTICLE 14
Parties maintain or consider creating an up-to-date, easily accessible information system on
available tobacco cessation services and qualified service providers for tobacco users.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 14
Both health-care workers and those outside health-care settings who deliver intensive specialised
supports should be trained to the highest possible standard and receive continuous education.
Various initiatives have been taken to disclose information on available tobacco cessation services
and qualified service providers to smokers. Since September 2011, the Quality Register for Smoking
Cessation has been online (www.kwaliteitsregisterstoppenmetroken.nl). This Register was developed
by the Partnership on Smoking Cessation and builds upon the Standard of Care on Smoking Cessation.
It lists health care professionals who have been trained to provide evidence-based, effective
intensive behavioural cessation support. Professionals have to re-register every five years. To ensure
that knowledge and experience remain up-to-date, re-registration is conditional upon having acquired
a minimum amount of counselling hours (100) and continuing education accreditation points (15) in
the past five years. The overview of all registered service providers is publicly available.
FCTC Shadow Report 2014
73
To improve accessibility of information on the availability
of effective smoking cessation support to tobacco users,
on request of the Ministry of Health, a so-called social map
has been developed155. Until December 2012, this map
was available at the website of STIVORO. Since September
2013, this social map is included as part of www.rokeninfo.
nl, the Trimbos Institute’s website for public education on
smoking156 (see the chapter on Article 12). Through this map,
individuals can locate smoking cessation services nearby
www.rokeninfo.nl
their home address. Only organisations that offer evidencebased, effective intensive behavioural cessation support
are incorporated. The website also contains some general
information on the different types of effective smoking
cessation therapies that are available. Additionally, in
December 2011, a patient-targeted folder of the Standard of
Social map on effective smoking
cessation services
Care on Smoking Cessation was published by the Partnership
on Smoking Cessation, focussing on the questions of what and who can help people quit smoking157.
This folder has been uploaded on www.stoppen-met-roken.nl, the website that is referred to in one of
the additional health warning labels on tobacco packages.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 14
Brief advice should be integrated into all health-care systems. All health-care workers should be trained
to ask about tobacco use, record it in the notes, give brief advice on stopping, and direct tobacco users
to the most appropriate and effective treatment available locally. Brief advice should be implemented
as an essential part of standard practice and its implementation should be monitored.
The clinical Guideline for the Treatment of Tobacco Dependence stresses the importance of having
health-care workers ask (new) patients about tobacco use and advise smoking patients to quit152.
The Guideline on smoking cessation put forward by the Dutch College of General Practitioners
(NHG) recommends that general practitioners (GPs) provide all smokers with the advice to stop using
tobacco158. Nevertheless, research suggests that brief advice is not yet sufficiently integrated in the
Dutch health-care system. In 2010-2011, smokers in the Netherlands were less than half as likely as
English smokers to report having received advice to quit from their GP during a consultation (22.6%
vs. 58.9%)159. Longitudinal data from the Dutch Continuous Survey of Smoking Habits show that, in
2013, only 21% of smokers who visited their GP in the last year had received advice to quit smoking.
This proportion exceeded the percentage measured in 2001 (18%), but was lower than the level
found in 2011 (25%)160. There has been an upward trend in directing tobacco users to treatment. The
percentage of smokers reporting that their GP recommended them to use behavioural support to quit
smoking increased from 4% in 2005 to 10% in 2013160.
Using the health-care system to promote smoking cessation among pregnant women has received
special attention in the past few years. In 2010, the Dutch Health Inspectorate (IGZ) found that
smoking cessation support was not yet structurally embedded in most midwifery practices (primary
health-care facilities). In many cases, a policy on providing smoking cessation support was lacking.
74
Dutch Tobacco Control: Moving Towards the Right Track?
Also, the evidence-based Minimum Intervention Strategy for smoking cessation counselling of
pregnant women (V-MIS) was only partially implemented161. Based on this assessment, the IGZ
declared that all midwifery practices were expected to comply with professional standards as of
January 2012. Following announcement of this deadline, and encouraged through increased support
from the Royal Dutch Organisation of Midwives (KNOV) and STIVORO, the proportion of practices
reporting to use V-MIS increased from 28% to 80%162. More recently, the IGZ’s focus has shifted
towards secondary health-care providers (such as gynaecologists) and the coordination between
primary and secondary health services in Perinatal Care Partnerships (VSVs). A lack of coherent
policies in relation to smoking cessation was detected163. Subsequently, the IGZ has requested all
VSVs to develop a comprehensive policy on smoking cessation support before January 2015164. In
November 2014, the Trimbos Institute, KNOV and the Dutch Society of Obstetrics and Gynaecology
(NVOG) presented a handbook to support VSVs in formulating such a comprehensive policy. In
addition, an updated version of the V-MIS manual was published, with more attention for the
application of the intervention in secondary health care165.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 14
Tobacco users who need cessation support should be offered intensive specialised support, delivered
by specially trained practitioners. Such services should offer behavioural support, and where
appropriate, medications or advice on the provision of medications. These services can be delivered
in a wide variety of settings and should be easily accessible to tobacco users. Where possible they
should be provided free or at an affordable cost. Medications that have been clearly shown by
scientific evidence to increase the chances of tobacco cessation should be made available to tobacco
users wanting to quit and where possible be provided free or at an affordable cost. Some medications
can also be made available populationwide, with fewer restrictions to access.
Comparative research has shown that the use of evidence-based smoking cessations aids is lower
in the Netherlands than in several other countries, such as the United Kingdom and Canada166.
These low levels of use may be (partially) explained by Dutch smokers’ limited levels of knowledge
regarding the evidence base of smoking cessation aids. An analysis of data from 2010 suggested that
what Dutch smokers perceive to be proven effective smoking cessation aids is unrelated to the actual
evidence base for these aids167.
There have been various changes to the health insurance coverage of smoking cessation. Since 2008,
brief and intensive behavioural cessation interventions are covered by the Dutch Health Insurance
Act (as part of the mandatory basic insurance)168. In 2011, evidence-based pharmacotherapy for
smoking cessation became reimbursable as well, but only when used in combination with behavioural
counselling169. This reimbursement of pharmacotherapy was withdrawn in 2012170, to be re-introduced
in 2013171. It continued in 2014 and will also be available in 2015. For each smoker, one smoking
cessation programme is covered per year. In practice, the treatment is only (fully) reimbursed by the
health insurer if the mandatory policy excess has already been spent on healthcare costs. This mandatory
policy excess has increased from € 170 in 2011172 to € 360 in 2014173. Health insurers are allowed to
exclude certain care from the mandatory policy excess. In 2014, only 2% of insured adults (18 years or
older) were subject to such an exemption for smoking cessation programmes174. Some health insurers
demand completion of the programme to qualify for exemption from the mandatory policy excess.
FCTC Shadow Report 2014
75
Although reimbursement of pharmacotherapy has now been continued for three years in a row, the
government has not established a long-term view or strategy on tobacco dependence treatment.
Rather, the decision to reimburse pharmacotherapy for smoking cessation is taken on an annual
basis. Each year, the Dutch National Health Care Institute (previously known as the Health Care
Insurance Board (CVZ)) advises the Minister of Health on the content and scope of the basic health
insurance package. In the end, the Minister decides what is to be included. The government has
expressed its intention to attribute a decisive role to the criterion of necessity when deciding what
care should be covered by the basic health insurance49. The National Health Care Institute has
indicated that such a one-dimensional approach is not the most desirable approach. With regard
to the health insurance coverage of smoking cessation, the Institute has argued that, although the
costs of such an intervention can generally be borne by the quitter – especially considering that
quitters can realise large savings because they no longer have to buy tobacco products –, coverage
of the intervention may lead to a larger number of quitters. This way, health gains for society would
be larger than when smoking cessation programmes are not included as part of the basic health
insurance175. A survey among adult insureds has found that a majority does not support the inclusion
of tobacco dependence treatment as part of the basic health insurance package. This position seems
to be fuelled by the assumption that such care can be traced back to decisions made by patients
themselves (own choice, own responsibility)176. Such a perspective does not seem to coincide with
the FCTC Guidelines’ underlying consideration that tobacco use is highly addictive.
Dutch research highlights the importance of reimbursing a comprehensive package of smoking
cessation interventions. One study illustrates that the number of enrolments for telephone
counselling increased distinctively (more than 10-fold) following the change to the reimbursement
scheme in January 2011. This number dramatically decreased again following reversal of the policy
in 2012 (even below the 2010 levels)177. Another study shows that there was a steep increase in the
number of (dispensed) prescriptions of stop-smoking medication in 2011, again to be followed by a
significant decrease in 2012. Moreover, a statistically significant decrease in smoking prevalence was
found178. Further research suggests that this decrease was due to both an increase in quit attempts
(among moderate-to-heavy smokers) and an increase in quit success (among all smokers). It appears
that these increases can be (partly) attributed to media coverage of the policy change, most notably in
the form of a mass media campaign179. Such a campaign has not been aired when pharmacotherapy
became reimbursable again in 2013. This aligned with the 2011 announcement of the Minister of
Health that she no longer wanted to invest in mass media campaigns (see the chapter on Article 12).
ARTICLE 14.1
Parties shall take effective measures to promote cessation of tobacco use and adequate
treatment for tobacco dependence.
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 14
Parties should ensure that the population is well informed about the availability and accessibility of
tobacco dependence treatment services and encourage them to make use of them.
Concerns have been expressed by civil society about the absence of active communication with
regard to smoking cessation and the lack of a comprehensive strategy to stimulate and support
76
Dutch Tobacco Control: Moving Towards the Right Track?
smokers to quit smoking180. The FCTC Guidelines for implementation of Article 14 define promotion
of tobacco cessation as populationwide measures and approaches that contribute to stopping
tobacco use. Three channels are distinguished: mass communication, brief advice and quitlines. In
principle, all three channels are available in the Netherlands. However, their use is not (yet) optimised.
As of January 2013, the Trimbos Institute has been responsible for public information on tobacco
use and cessation (see also the chapter on Article 12). From that moment onwards, the national
smoking information telephone service has been operated by the Trimbos Institute as well. Whereas
in 2012, STIVORO employees processed almost 5,000 calls to the quitline115, in 2013, the number of
contacts via the Smoking Information Line amounted to less than 1,700 (a decrease of approximately
two-thirds)181. Contrary to the STIVORO era, there no longer is a direct link between the reactive
information line (answering ad hoc questions) and proactive telephone counselling.
The transferral of tasks from STIVORO to the Trimbos Institute has not been accompanied by a large
media campaign. Moreover, explicit references to the new Smoking Information Line number have
been scarce. For instance, the quitline number that features on one of the additional health warning
labels on cigarette packs is the old STIVORO telephone number (although callers can opt to be
forwarded to the Smoking Information Line).
GUIDELINES FOR IMPLEMENTATION OF ARTICLE 14
Mass communication campaigns and education programmes are essential for encouraging tobacco
cessation, promoting support for tobacco cessation, and encouraging tobacco users to draw on this
support.
One nationwide smoking cessation campaign has been conducted since the previous shadow report:
Stoptober 2014. This campaign was a collaboration of various health organisations, among which the
Ministry of Health (see also the chapter on Article 12). It stimulated smokers to quit smoking for 28
days in October, so as to increase the odds of permanent smoking cessation. Tools made available
to support the participants included an app, social media support and communities, a website (with
links to smoking cessation service providers) and
a phone number. Materials targeted at health-care
professionals were also developed182.
The concept of Stoptober originated in the United
Kingdom. In the UK, the campaign has been
shown to have contributed to a 50% increase in
quitting in October183. The results of the Dutch
variant of Stoptober have not yet been properly
evaluated. Based on the number of subscriptions
via the website, the number of participants has
www.trimbos.nl
been estimated at almost 40,000. In a first survey,
over 70% of participants indicated to have
successfully quitted for 28 days184. It has been
announced that there will be another Stoptober
campaign in 2015185.
FCTC Shadow Report 2014
Example of Stoptober campaign materials
77
Conclusions and recommendations
There have been various changes regarding tobacco dependence and cessation since the previous
shadow report. Quality of smoking cessation support seems warranted in the Netherlands. Recent
initiatives have contributed to a further embedment of quality standards. With regard to the
promotion of smoking cessation, various opposing developments have been observed. This applies,
for instance, to the fluctuations in reimbursement for pharmacotherapy. Another example is the
development of a social map to improve accessibility to effective smoke cessation aids, that is now
published on a webpage that has not been widely communicated to the Dutch population. The Dutch
government is currently acting in line with the obligations included in Article 14. Compliance with
various recommendations is, however, still lacking (see the scoring table below). An ‘orange score’ was
therefore assigned in the summary table on implementation of FCTC measures in the Netherlands in
2014 (Table 1b). To further improve its performance, the Dutch government is particularly urged to:
• Invest in the implementation of the Guideline for the Treatment of Tobacco Dependence.
• Continue to reimburse efficacious tobacco cessation treatments. This decision should no longer
be made on an annual basis. Rather, reimbursement of these treatments should be included as
part of a long-term strategy to help smokers quit smoking. Health insurers should be requested to
maintain a balanced and clear purchasing policy.
• Increase awareness among smokers about the support that is available for tobacco cessation and
about the effectiveness of using such support. All smokers should be proactively informed about
where to find efficacious support to help them quit smoking and be provided with easy access to it.
Scores
78
FCTC provision
Type of
commitment
Content
Yes/No
14 1
Shall**
Develop and disseminate appropriate, comprehen­sive
and integrated guidelines based on scientific evidence
and best practices
Yes
14 1
Shall
Take effective measures to promote cessation of tobacco
use and adequate treatment for tobacco dependence.
Yes
14 2a
Shall endeavour
Design and implement effective programmes aimed
at promoting the cessation of tobacco use, in such
locations as educational institutions, health care
facilities, workplaces and sporting environments.
No
14 2b
Shall endeavour
Include diagnosis and treatment of tobacco dependence
and counselling services on cessation of tobacco use
in national health and education programmes, plans
and strategies, with the participation of health workers,
community workers and social workers as appropriate.
Yes
14 2c
Shall endeavour
Establish in health care facilities and rehabilitation
centres programmes for diagnosing, counselling,
preventing and treating tobacco dependence.
Yes
14 GL
Should**
Conduct a national situation analysis.
No
14 GL
Should**
Create or strengthen national coordination.
Yes
14 GL
Should**
Develop and disseminate comprehensive guidelines.
Yes
14 GL
Should**
Address tobacco use by health-care workers and others
involved in tobacco cessation.
Yes
Score
Dutch Tobacco Control: Moving Towards the Right Track?
14 GL
Should**
Develop training capacity.
No
14 GL
Should**
Use existing infrastructure and resources to ensure the
greatest possible access to services.
No
14 GL
Should**
Make the recording of tobacco use in medical notes
mandatory.
No
14 GL
Should**
Encourage collaborative working.
Yes
14 GL
Should**
Establish a sustainable source of funding for cessation
help.
Yes
14 GL
Should
Provide cessation support and treatment in all healthcare settings and by all health-care providers.
No
14 GL
Should consider
Provide cessation support and treatment in non-healthcare settings and by suitably trained non-health-care
providers, especially where scientific evidence suggests
that some populations of tobacco users may be better
served in this way.
Yes
14 GL
Should**
Establish population-level approaches.
Yes
14 GL
Should**
Establish more intensive individual approaches .
Yes
14 GL
Should**
Make medications available.
Yes
14 GL
Should**
Consider emerging research evidence and novel
approaches and media.
Yes
14 GL
Should
Monitor and evaluate all tobacco cessation and tobacco
treatment strategies and programmes, including process
and outcome measures, to observe trends.
No
** Subject to the following condition: “taking into account national circumstances and priorities”.
FCTC Shadow Report 2014
79
Article 15
Illicit Trade in Tobacco Products
http://az.trend.az/business/economy/2114688.html
Article 15 builds upon the recognition that
the elimination of all forms of illicit trade in
tobacco products is an essential component
of tobacco control. To the extent that illicit
trade is considered a serious problem by the
Dutch government, it is primarily considered an
economic problem. Combatting illicit trade in
tobacco products is not explicitly recognised as
an integral component of the tobacco control
policy. In its 2012 report on combating alcohol
and tobacco duty fraud, the Dutch Court of
Audit concluded that the fight against tobacco
duty fraud is not a high priority in the Netherlands. Among other things, it was found that there were
no concrete targets for combatting duty fraud and that there had been a reduction in the capacity
to trace illegal tobacco products186. Some changes have been implemented since the publication of
this report. For instance, a national Excise Fraud Team has been put place in January 2013187. Specific
targets were set for this team. They have to generate a minimum number of fraud cases and risk
signals. For the Fiscal Intelligence and Investigation Service (FIOD), additional capacity has been made
available as well186.
Cooperation with other countries is necessary to combat the problem of illicit tobacco trade. Since
the previous shadow report, various international and European developments have been initiated
to strengthen the fight against illicit trade in tobacco products. In November 2012, the Protocol to
Eliminate Illicit Trade in Tobacco Products was adopted by the Conference of the Parties (COP) to the
FCTC. This Protocol is primarily targeted at securing the supply chain of tobacco products and it sets
out requirements for the development of a (global) tracking and tracing system. The Netherlands has
signed (6 January 2014), but not yet ratified the Protocol. In March 2014, the Dutch parliament was
informed that the government expected to table the Protocol for parliamentary approval in 2014188.
However, by December 2014, no progress on this matter had been made.
Two important developments at the EU level are the adoption of the revised Tobacco Products
Directive (TPD), which also contains provisions on tracking and tracing, and the presentation of
a comprehensive EU Strategy and Action Plan on the fight against cigarette smuggling and other
forms of illicit trade in tobacco products by the European Commission in June 2013189. The Dutch
government has voted in favour of the TPD (as a whole) and has indicated to have a positive stance
towards most of the elements in the EU Strategy and Action Plan, acknowledging the importance of an
EU-wide approach in this regard190.
80
Dutch Tobacco Control: Moving Towards the Right Track?
ARTICLE 15.2
Each Party shall adopt and implement effective legislative, executive, administrative or
other measures to ensure that all unit packets and packages of tobacco products and
any outside packaging of such products are marked to assist Parties in determining the
origin of tobacco products. In addition, each Party shall:
(a) require that unit packets and packages of tobacco products for retail and
wholesale use that are sold on its domestic market carry the statement: “Sales only
allowed in the Netherlands” or carry any other effective marking indicating the final
destination or which would assist authorities in determining whether the product is
legally for sale on the domestic market; and
(b) consider, as appropriate, developing a practical tracking and tracing regime that would
further secure the distribution system and assist in the investigation of illicit trade.
In line with European legislation (Directive 2001/37/EC), the Dutch Labelling Decree for Tobacco
Products requires that all tobacco products are marked in any appropriate manner, by batch
numbering or equivalent, on the unit packet enabling the place and time (i.e. origin) of manufacture
to be determined, as required by Article 15.2. The European Commission has not adopted technical
measures to guide the application of this requirement191 and it is unclear to what extent the Dutch
government has taken measures to ensure effective implementation.
Tobacco products that are to be sold legally on the Dutch market have to be provided with Dutch
health warnings and a tax stamp. This stamp assists authorities in determining whether the product
is legally for sale on the Dutch market, as required by Article 15.2(a). It contains information on the
number of tobacco products or amount of tobacco included in the package as well as the retail price
of the product. The statement “Sales only allowed in the Netherlands” is not required. Tax stamps
can only be acquired by permit holders. Such tax stamp permits are being awarded by the Customs
Administration. A comprehensive administration regarding the tax stamps is an important prerequisite
that has to be fulfilled in order to qualify for the permit192. To decrease illicit trade incentives193, the
permit holder is, as of June 2012, financially liable for all lost tax revenues (both excise duties and
VAT) if the tax stamps go missing63.
Based on the revised TPD, all tobacco packs will have to “carry a tamper proof
security feature, composed of visible and invisible elements [… and which is]
irremovably printed or affixed, indelible and not hidden or interrupted in any
form” (Article 16). The Dutch government has stated not to be convinced by
the added value of such an additional security feature, in comparison with the
current tax stamps194.
There is no national tracking and tracing regime currently in place in the
Netherlands. The European Commission has stressed that, regardless of the
settlement agreements that have been reached with some of the tobacco
manufacturers, in the EU countries, “there is […] no general legal obligation in
place for producers or importers to monitor the movement of cigarettes and
Dutch tax stamp
other tobacco products through their supply chain (tracking). In the absence
FCTC Shadow Report 2014
81
of such measures, it is very difficult (even impossible) for the authorities to determine at which
point a product was diverted into the illicit trade (tracing)”189. Thus, the revised TPD contains several
requirements regarding the traceability of tobacco products. For cigarettes and roll-your-own tobacco,
the tracking and tracing system will have to be implemented by May 2019.
In October 2013, the European Parliament voted in favour of adding the following condition to
the TPD’s provisions on tracking and tracing: “The technology used for tracking and tracing should
belong to and be operated by economic entities without any legal or commercial link to the tobacco
industry”195. The Dutch government expressed its concerns regarding this additional requirement,
because “this would imply that we cannot build on existing systems”196. In drawing up a compromise
agreement between the European Parliament and the Council of Ministers, this requirement has
been removed from the Directive. One of the existing systems that the Dutch government might have
been referring to is the Codentify system which is developed by Philip Morris. This system has been
criticised for various technical reasons and for the fact that it would bring about “the very real danger
of regulatory capture by the tobacco industry in the area of illicit trade”197.
ARTICLE 15.4(a)
Each Party shall monitor and collect data on cross-border trade in tobacco products,
including illicit trade.
In its reporting instrument to the World Health Organisation (WHO), the government indicated that
it monitors and collects data on cross-border trade in tobacco products, including illicit trade. One
of the sources relied upon by the Dutch authorities in their reporting instrument to the WHO, is the
KMPG Star report, which was commissioned by Philip Morris. This report has been heavily criticised
for several reasons, including the lack of transparency regarding the methodologies that were
used198. The WHO FCTC Indicator Compendium also stresses that such tobacco industry “information
needs to be viewed with caution, because the aim of the tobacco industry is to promote its interests
and agenda, and there is a fundamental and irreconcilable conflict between the tobacco industry’s
interests and public health policy interests. The industry promotes such information with a view to
interfering with the development of public health policies with respect to tobacco control”199. The
Dutch authorities have conducted several empty pack surveys themselves as well186, although the
results have not been distributed widely. The latest pack survey (2011) found that approximately 1 in
10 cigarette packs had not been taxed according to the Dutch tobacco excise duty scheme. However,
these packs should not necessarily be considered illegal. The State Secretary for Finance has argued
that it is difficult, if not impossible, to determine whether foreign cigarettes have been imported
legally. Such claims can only be made in relation to counterfeit cigarettes. Based on the 2011 pack
survey, this category was estimated at less than 1%31.
In addition, the Dutch government monitors the number of tobacco products that are confiscated
by the Tax and Customs Administration each year. The quantity of cigarettes and amount of fine-cut
tobacco seized, as well as the total number of seizures, vary significantly between years (see Figure
3) and no clear trends can be detected. Because the quantity of cigarettes and amount of fine-cut
tobacco seized are generally derived on the basis of a very small number of seizures (about 10 to 20),
these data may be skewed and should be interpreted with caution65.
82
Dutch Tobacco Control: Moving Towards the Right Track?
Figure 3
Confiscated cigarettes and fine-cut tobacco in the Netherlands from 2005 to 2013200; 201
Over the past few years there has been a shift from seaside to inland seizures (from 35% in 2011 to
70% in 2013)200 and an increased share of cheap ‘whites’ as part of the total number of cigarettes
seized (from 60% in 2011186 to 83% in 201365). The Netherlands is still primarily considered a
so-called transit country65. Both the presumed origin and destination of a large majority of seized
tobacco products is located outside the Netherlands. In 2013, 6% of seized cigarettes was destined
for the Dutch market200.
Conclusions and recommendations
Recently, various measures have been initiated at the international and European level in an attempt
to combat the illicit trade in tobacco products. Although the Dutch government seems to intend to
act in line with these measures, few new concrete actions have yet been taken at the national level to
tackle the problem of illicit trade. Such actions are, however, highly desirable, especially in relation to
FCTC Shadow Report 2014
83
the establishment of a well-functioning tracking and tracing system. Currently, the Dutch government
is acting in compliance with most of the obligations, recommendations and suggestions included in
Article 15. Because a tracking and tracing has not yet been broadly implemented by the government,
it was awarded a ‘light green score’ in the summary table on implementation of FCTC measures in the
Netherlands in 2014 (Table 1b), To further improve its performance, the Dutch government is urged to:
• Acknowledge that the fight against illicit trade in tobacco products is part of a comprehensive
tobacco control policy. By taking action to prevent illegal tobacco products from being marketed,
the effectiveness of other tobacco control measures can be optimised.
• Ratify the Protocol to eliminate illicit trade in tobacco products as soon as possible and adjust
national legislation, regulation and policies accordingly, including the implementation of an
independent tracking and tracing system for tobacco products.
• Limit its relations with the tobacco industry, in accordance with Article 5.3 FCTC, in relation to the
fight against illicit trade as well. The government should not rely on data or systems provided or
developed by the industry (or its contractors), because these systems are most likely to be in the
interest of the industry itself rather than in the interest of public health.
• Improve monitoring of illicit trade. The government should consider using additional methods of
monitoring, such as consumer surveys. It should map the position of the Netherlands in relation to
illicit trade, as a transit or destination country.
Scores
84
FCTC provision
Type of
commitment
Content
Yes/No
15 2
Shall
Adopt and implement effective measures to ensure that
all unit packets and packages of tobacco products and any
outside packaging of such products are marked to assist
Parties in determining the origin of tobacco products.
Yes
15 2a
Shall
Require that unit packets and packages of tobacco
products for retail and wholesale use that are sold
on its domestic market carry the statement: “Sales
only allowed in [the Netherlands]” or carry any other
effective marking indicating the final destination or
which would assist authorities in determining whether
the product is legally for sale on the domestic market.
Yes
15 2b
Shall consider
Develop, as appropriate, a practical tracking and tracing
regime that would further secure the distribution system
and assist in the investigation of illicit trade.
No*
15 3
Shall
Require that the packaging information or marking
specified in paragraph 2 shall be presented in legible
form and/or appear in its principal language.
Yes
15 4a
Shall
Monitor and collect data on cross-border trade in
tobacco products, including illicit trade.
Yes
15 4b
Shall
Enact or strengthen legislation, with appropriate penalties
and remedies, against illicit trade in tobacco products,
including counterfeit and contraband cigarettes.
Yes
15 4c
Shall
Take appropriate steps to ensure that all confiscated
manufacturing equipment, counterfeit and contraband
cigarettes and other tobacco products are destroyed,
using environmentally-friendly methods where feasible,
or disposed of.
Yes
Score
Dutch Tobacco Control: Moving Towards the Right Track?
15 4d
Shall
Adopt and implement measures to monitor, document
and control the storage and distribution of tobacco
products held or moving under suspension of taxes or
duties within its jurisdiction.
Yes
15 4e
Shall
Adopt measures as appropriate to enable the
confiscation of proceeds derived from the illicit trade in
tobacco products.
Yes
15 7
Shall endeavour
Adopt and implement further measures including
licensing, where appropriate, to control or regulate the
production and distribution of tobacco products in order
to prevent illicit trade.
Yes
* TPD: When the revised EU Tobacco Products Directive is correctly transposed, this assessment (Yes/No) (and the subsequent colour
score) might/will change.
FCTC Shadow Report 2014
85
Article 16
Sales to and by Minors
The protection of youth against the risks of smoking plays a central part in the current approach to
tobacco control by the Dutch government28; 29. Since September 2011, various measures have been
taken to discourage tobacco sales to minors.
ARTICLE 16.1
Each Party shall adopt and implement effective legislative, executive, administrative
or other measures to prohibit the sales of tobacco products under the age set by
domestic law, national law or 18.
On 1 January 2014, the minimum age for purchasing tobacco products in the Netherlands was raised
to 18 years. A multiannual campaign (NIX18) was developed by the government to inform the public
about this legal change. The NIX18 campaign is targeted at the denormalisation of tobacco (and
alcohol) use. In particular, its aim is to encourage parents to reach an agreement with their children
about the use of tobacco (and alcohol): “The agreement is nothing. No smoking, no drinking under the
age 18”202 (see also the chapter on Article 12).
ARTICLE 16.1(a)
Measures may include: requiring that all sellers of tobacco products place a clear and
prominent indicator inside their point of sale about the prohibition of tobacco sales to
minors and, in case of doubt, request that each tobacco purchaser provide appropriate
evidence of having reached full legal age.
The requirement that all tobacco retail outlets provide a
clear and legible sign indicating that tobacco is not sold
to underage minors, has remained in place. Previously, no
national sign existed for these purposes. Branch organisations
therefore designed their own indicators. In the framework of
the NIX18 campaign, various standardised resources (such
as door stickers) have been developed to support retailers
in complying with their obligations regarding legal age limit.
www.huisstijlvannix.nl
Although retailers are not obliged to use these materials,
most tobacco retailers (such as those represented by the
branch organisations for tobacco retailers (NSO)203 and food
retailers (CBL)204) have opted to use the NIX18 resources.
It is encouraged that retailers ask for proof of age from all
youngsters under the age of 25. Retailers can be sanctioned if
they are caught selling tobacco to people who have reached
the age of 18, but who could not (objectively) have been
Example of NIX18 campaign
materials
considered a person who has clearly reached the age of 18205.
86
Dutch Tobacco Control: Moving Towards the Right Track?
ARTICLE 16.6
Each Party shall adopt and implement effective legislative, executive, administrative
or other measures, including penalties against sellers and distributors, in order to
ensure compliance with the obligations.
Enforcement of the legal age limit still falls under the responsibility of the Dutch Food and Consumer
Product Safety Authority (NVWA). In the past years, a relatively limited number of inspections has been
carried out to check compliance. Whereas in 2010, 8,746 inspections were completed, in 2012 this
number was reduced to 900206, following prioritisation of the enforcement of smokefree legislation,
increased levels of aggression with which enforcement officers were confronted and preparations for
the decentralisation of the enforcement of the legal age limit for tobacco sales207. The number of fines
that were given out for a violation of provisions on the legal age limit for selling tobacco seems very low
as well. In 2012, for instance, only 13 measures (including fines) were imposed on retailers206. This does
not align with reports by minors. In 2013, 50% of cigarette purchasing youth aged under 16 reported
that they were (almost) never asked for proof of age when purchasing cigarettes208.
In the previous shadow report, reference was made to the results from a 2009 survey on compliance
with the legal age limit for sales of tobacco products. Underage minors (13-15) reported very high
levels (93-100%) of success when trying to purchase tobacco209. Similar studies have not been
published since then. However, the State Secretary for Health has indicated that research based on
mystery shopping to measure compliance with the new legal age limit would take place at the end of
201422. Budget for this purpose has also been made available for 2015/201687.
The legal age limit for purchasing tobacco has been referred to by the State Secretary for Health as
one of two tobacco control areas in which compliance is still insufficient83. Several measures have
been taken and/or proposed to increase compliance, both with regard to enforcement capacity and
the range of penalties available. As of January 2014, retailers selling tobacco to minors can no longer
only be sanctioned through monetary fines but also by having their right to sell tobacco products
temporarily revoked (up to a period of 12 weeks). Tobacco sales may only be closed down when a
retailer is found to have acted contrary to the legal age limit at least three times within a period of 12
months (the three-strikes-and-you’re-out principle). The length of the suspension is dependent on
the number of violations and the type of company. Additionally, in May 2014 a bill was tabled by the
State Secretary for Health to allow for increased monetary fines (up to € 19,500)210.
Enforcement efforts have been intensified as of January 1, 2014. A team of young enforcement officers
(17 FTE) was added to the existing group responsible for the enforcement of tobacco control legislation
(see also the chapter on Article 8). The State Secretary has indicated that this additional capacity should
allow for a doubling of the number of inspections in relation to the legal age limit (which ranged from
2,000 to 4,000 in the preceding years)29. The young enforcement officers fulfil an important signalling
task, being unobtrusive observers76. They are not employed as mystery shoppers. In the Netherlands,
mystery shoppers are only being used for research purposes (see above) and not for enforcement, as
this would constitute a criminal offence (provocation). Enforcement is complicated by the fact that no
license or registration is required for selling tobacco in the Netherlands. The exact number of retailers is,
therefore, unknown. Estimates of the number of tobacco retailers vary from 30,000 to 60,000141.
FCTC Shadow Report 2014
87
In addition to mass media interventions and enforcement, other methods of increasing compliance
are being considered, such as systems of remote age verification. So far, the government has been
hesitant to create specific obligations in this regard, stating that decisions on the age verification
system should be left to the retailers29. At the same time, some local franchisees are being prevented
from using more advanced systems of age verification by their franchisers211. Following requests by
members of parliament, the government has commissioned research to set out the current practices
on preventing sales of tobacco products to minors and to assess the effectiveness of various systems
of age verification. Two studies were published in July 2014212; 213. The State Secretary for Health has
not yet announced what measures he intends to take on the basis of these results110.
ARTICLE 16.7
Each Party should, as appropriate, adopt and implement effective legislative, executive,
administrative or other measures to prohibit the sales of tobacco products by persons
under the age set by domestic law, national law or 18.
There are no specific age restrictions for those who sell tobacco, although those aged under 16 are
not allowed to operate the cash register regardless of the product on sale (Working Hours Act and
Specific Child Labour Regulation). This implies that there has been a discrepancy between the age
required for purchasing and selling tobacco products since entry into force of the increased legal age
limit for purchasing tobacco on 1 January 2014.
ARTICLE 16.1(b)(c)(d)
Measures may include: banning the sale of tobacco products in any manner by which
they are directly accessible, such as store shelves; prohibiting the manufacture and
sale of sweets, snacks, toys or any other objects in the form of tobacco products
which appeal to minors; and ensuring that tobacco vending machines do not promote
the sale of tobacco products to minors.
The Convention contains several suggestions for preventing sales to minors. No legal prohibition on the
manufacture and sale of sweets, snacks, toys or any other objects in the form of tobacco products which
appeal to minors has been implemented in the Netherlands. However, the topic has gained prominence
in recent political discussions, following the appearance on the market of the so-called shisha pens (and
reports on their use by young children)214 and subsequent discussions in relation to the contents of the
revised EU Tobacco Products Directive (TPD). The Dutch government has indicated not to be in favour of
such a general (Europeanwide) prohibition196, but it did express an intention to implement a minimum
age limit for purchasing electronic cigarettes, similar to the age limit that applies to tobacco products215.
The State Secretary for Health has also stressed the importance of closely monitoring the use of such
products among minors as well as its relation to uptake of smoking216; 217.
As has been noted in the chapter on Article 13, currently there is no ban on the sale of tobacco products
through vending machines either. However, some restrictions are in place. It is legally required that
these machines are placed in the line of sight of the personnel or owner and can only be unlocked by
those aged 18 or older. Despite these restrictions, in 2013 almost 10% of smokers under the legal age
limit (16 years) indicated to (sometimes) get their tobacco products through vending machines208. In
88
Dutch Tobacco Control: Moving Towards the Right Track?
October 2013, a motion to enact a full ban on sales
through vending machines was rejected by a large
majority of the House of Representatives142. The State
Secretary for Health did, however, pledge to include
vending machines in his research application for
studying the effectiveness of limiting the number of
points of sale for tobacco products. Reports on the
current state of scientific evidence on the effectiveness
of such measures as well as their economic
consequences were published in July 2014143; 144.
The State Secretary has not yet announced a course of
action based on these publications110.
Tobacco vending machine
Although the issue of internet sales is not explicitly mentioned in Article 16, the Guidelines for
implementation of Article 13 do stress that internet sales are also problematic from the perspective
of sales to minors. It appears that only few Dutch smokers purchase their tobacco products through
the internet143. Nevertheless, research in the area of alcohol has shown that compliance with the legal
age limit has been extremely low in cases of home delivery (0% in 2013)218.
The State Secretary for Health has acknowledged that internet sales can potentially undermine many
policies219. Concrete measures have not yet been implemented. However, the government is working
on the development of a system of electronic identification (eID). This system should also contribute to
higher levels of compliance with age verification when tobacco is sold through the internet220. Based
on the revised TPD, cross-border internet sales will have to be regulated more tightly. Member states
may either prohibit these cross-border internet sales or implement a registration scheme, coupled with
an obligation to provide a description of the details and functioning of the age verification system
used. During the negotiations, the Dutch government has questioned the enforceability of a complete
ban194. It has advocated the inclusion of an effective system of age verification221.
ARTICLE 16.2
Each Party shall prohibit or promote the prohibition of the distribution of free
tobacco products to the public and especially minors.
ARTICLE 16.3
Each Party shall endeavour to prohibit the sale of cigarettes individually or in small
packets which increase the affordability of such products to minors.
The Dutch Tobacco Act contains a prohibition on the distribution of free tobacco. In addition, tobacco
products can only be sold at the price that is printed on the tax stamps (Excise Duty Act). This implies
that price promotion (for instance, through coupons) is not allowed. The ban on sales of packs
containing fewer than 19 cigarettes (Tobacco Act) or less than 10 grams of roll-your-own tobacco
(Excise Duty Implementing Regulation) has also remained. Transposition of the revised TPD will further
decrease affordability of tobacco products. Cigarette packs will be required to contain at least 20
cigarettes and a minimum of 30 grams will be set for roll-your-own tobacco.
FCTC Shadow Report 2014
89
Conclusions and recommendations
The prevention of smoking uptake among youth is a key objective guiding current actions by the
government in the field of tobacco control. Measures have been taken to increase the legal age limit,
to strengthen enforcement efforts and to allow for more stringent penalties. The Dutch government
currently acts in line with all FCTC obligations (“shall”-provisions) in relation to Article 16. Because
it does not comply with the recommendation on prohibiting sales by minors (Article 16.7), it was
awarded an overall ‘orange score’ in the summary table on the implementation of FCTC measures in
the Netherlands in 2014 (Table 1b). The suggestions included in the treaty article offer further room
for improvement. In particular, the Dutch government is urged to:
• Monitor compliance with the legal age limit more closely. Enforcement efforts should be intensified
as long as unsatisfactory levels of compliance are reported. The government should also consider
establishing additional requirements with regard to age verification systems.
• Ban the sale of tobacco through vending machines (in line with the Guidelines for implementation
of Article 13 FCTC). Tighter regulation or bans of other types of distance sales (such as internet
sales) should also be considered.
• Take measures to prohibit the sales of tobacco products by persons under the age of 18.
Scores
90
FCTC provision
Type of
commitment
Content
Yes/No
16 1
Shall
Adopt and implement effective measures to prohibit the
sales of tobacco products to persons under the age set
by national law or 18.
Yes
16 1a
May
Require that all sellers of tobacco products place a clear
and prominent indicator inside their point of sale about
the prohibition of tobacco sales to minors.
Yes
16 1a
May
Require that all sellers of tobacco products, in case of
doubt, request that each tobacco purchaser provide
appropriate evidence of having reached full legal age.
Yes
16 1b
May
Ban the sale of tobacco products in any manner by which
they are directly accessible, such as store shelves.
No
16 1c
May
Prohibit the manufacture and sale of sweets, snacks,
toys or any other objects in the form of tobacco
products which appeal to minors.
No
16 1d
May
Ensure that tobacco vending machines under its
jurisdiction are not accessible to minors and do not
promote the sale of tobacco products to minors.
No
16 2
Shall
Prohibit or promote the prohibition of the distribution of
free tobacco products to the public and especially minors.
Yes
16 3
Shall
Endeavour to prohibit the sale of cigarettes individually
or in small packets which increase the affordability of
such products to minors.
Yes
16 6
Shall
Adopt and implement effective measures, including
penalties against sellers and distributors, in order to
ensure compliance with the obligations.
Yes
16 7
Should
Adopt and implement effective measures to prohibit the
sales of tobacco products by persons under the age set
by national law or 18.
No
Score
Dutch Tobacco Control: Moving Towards the Right Track?
Article 20
Research and Surveillance
ARTICLE 20.1
The Parties undertake to develop and promote national research in the field of
tobacco control. Towards this end, each Party shall: (a) initiate and cooperate in
the conduct of research and scientific assessments, and in so doing promote and
encourage research that addresses the determinants and consequences of tobacco
consumption and exposure to tobacco smoke; and (b) promote and strengthen training
and support for all those engaged in tobacco control activities, including research,
implementation and evaluation.
In relation to Article 20.1, which requires the Parties to develop and coordinate a research programme
in the field of tobacco control, no major changes have taken place since the first shadow report. There
is no separate fund for tobacco control-related research. The coordination of government-sponsored
scientific research in the area of prevention is allocated to the Netherlands Organisation for Health
Research and Development (ZonMw), which receives targets and guidelines from the Ministry of
Health. In ZonMw’s Fourth Prevention Programme, covering the period 2010-2014 and a total budget
of €  47.8 million, few explicit references to tobacco research were included222. It was possible to
submit research applications in the area of tobacco control, especially when the research would
contribute to the development or implementation of evidence-based educational interventions (for
use in local settings), or address the social and physical determinants of smoking behaviour. Research
on the cost-effectiveness of existing tobacco prevention interventions was also eligible for subsidies.
However, research addressing the determinants or consequences of (passive) smoking was not. The
Ministry does regularly commission the National Institute for Public Health and the Environment
(RIVM) to conduct research regarding the health consequences of smoking.
In June 2014, ZonMw published the Fifth Prevention Programme223. This new research programme,
which will run until 2018, supports the Ministry of Health’s new national prevention policy “Everything
is Health” (Alles is Gezondheid) (see also the chapter on Article 5). Although tobacco use is one
of the policy’s priorities, no tobacco-specific research priorities have been identified in the new
programme and the possibilities to submit applications for tobacco control research have been
severely restricted. The focus is on youth and only research that addresses interventions that can be
implemented at the local level is eligible for subsidy. These restrictions are detrimental to research
aimed at national measures and the adult population of smokers, an important target group of FCTC
measures. The previous shadow report recommended that the government should set out a new study
to identify and establish priorities for tobacco control research. The previous priority assessment,
which was drawn up in 2007, is now outdated224. However, such an initiative has not yet been
considered or realised by the government.
FCTC Shadow Report 2014
91
ARTICLE 20.2
The Parties shall establish, as appropriate, programmes for national, regional and
global surveillance of the magnitude, patterns, determinants and consequences of
tobacco consumption and exposure to tobacco smoke.
ARTICLE 20.3
Each Party shall endeavour to establish progressively a national system for the
epidemiological surveillance of tobacco consumption and related social, economic
and health indicators
The previous shadow report applauded the Dutch government for its surveillance programmes in the
area of tobacco control. In particular, the Continuous Survey of Smoking Habits (COR) and the Smoking
Youth Monitor (RJM) were considered to be of a very high quality. However, by now the government
has decided to discontinue both monitors. This decision does not fit well with the Convention’s
encouragement to progressively establish a national system for the epidemiological surveillance
of tobacco consumption. ‘Progressively’ implies that Parties work to improve their surveillance and
monitoring systems. In the Netherlands we see a deterioration. The ramifications of the decision to
discontinue these monitors are profound. With regard to the surveillance of tobacco consumption
among adults, there will be much less flexibility and a lower number of respondents. As part of
the Statistics Netherlands (CBS) Health Survey, a limited number of key variables will be measured
once every year (instead of once every quarter), and additional questions will be asked only once
every two years55. Consequently, there will be less data available to monitor important topics such
as exposure to secondhand smoke at home, the use of smoking cessation aids by smokers, and the
smoking cessation advice and support given by health professionals to smokers225. Moreover, given
the smaller number of respondents, it will be much harder to draw conclusions in terms of annual
trends in smoking prevalence. A 1% decrease in observed smoking prevalence will no longer suffice
to conclude that there has been a (significant) decrease in smoking prevalence in the population.
This way, the surveillance data can no longer be used to assess the consequences of policies and, if
necessary, adjust policies accordingly115.
The changes also have substantial consequences for the surveillance of tobacco use among youth.
The smoking behaviour of youth will no longer be measured on an annual basis. There will be a
youth-targeted survey every two years: once every four years the Health Behaviour of School aged
Children (HSBC) Study and once every four years the Dutch National School Survey on Substance
Use (Peilstationsonderzoek). Whereas the former only includes children up to the age of 16, the
latter only collects data from (secondary) schoolchildren225. Although the State Secretary for Health
has announced that he intends to add school drop-outs to the sample226, the lack of coverage in
comparison to the now defunct Smoking Youth Monitor (in time, and across age groups and education
levels) remains remarkable, especially given the government’s focus on prevention of smoking among
youth (see also the chapter on Article 16).
92
Dutch Tobacco Control: Moving Towards the Right Track?
Conclusions and recommendations
The first Dutch FCTC shadow report established that only in the area of surveillance the Netherlands
was performing in excess of its FCTC commitments. In December 2014, surveillance of tobacco
consumption is the sole area in which an obvious backward trend has been observed since the
previous shadow report. With regard to the promotion of scientific research, no improvements have
been observed either. If anything, it appears to have become more difficult to obtain government
subsidies for tobacco control research. In the summary table on implementation of the FCTC measures
in the Netherlands in 2014 (Table 1b), the Dutch government received an overall ‘red score’ in relation
to Article 20, because of its failure to comply with one of the obligations regarding research (see the
scoring table below). Room for improvement also stems from the lack of compliance with one of the
recommendations in relation to surveillance, which encourages progressive rather than regressive
developments. The Dutch government is therefore urged to:
• Prioritise tobacco control research and take on a more pro-active role, by promoting and
strengthening the training of people working in tobacco control and stimulating tobacco control
research that supports the implementation of the FCTC measures in the Netherlands. A new study
should be initiated to identify research priorities in the field of tobacco control.
• Re-consider its position to discontinue the COR and RJM.
Scores
FCTC provision
Type of
commitment
Content
20 1a
Shall
Initiate and cooperate in the conduct of research and
scientific assessments, and in so doing promote and
encourage research that addresses the determinants
and consequences of tobacco consumption and
exposure to tobacco smoke.
Yes
20 1b
Shall
Promote and strengthen training and support for all
those engaged in tobacco control activities, including
research, implementation and evaluation.
No
20 2
Shall
Establish, as appropriate, programmes for national,
regional and global surveillance of the magnitude,
patterns, determinants and consequences of tobacco
consumption and exposure to tobacco smoke.
Yes
20 2
Should
Integrate tobacco surveillance programmes into national,
regional and global health surveillance programmes so
that data are comparable and can be analysed at the
regional and international levels, as appropriate.
Yes
20 3a
Shall endeavour
Establish progressively a national system for the
epidemiological surveillance of tobacco consumption
and related social, economic and health indicators.
No
FCTC Shadow Report 2014
Yes/No
Score
93
Article 26
Financial Resources
http://www.bredavandaag.nl/fotoalbums/
breda/koffertje-prinsjesdag
Article 26 builds upon the recognition that financial
resources play an important role in achieving the
Convention’s objective. Budgetary concerns seem to
have been guiding the Dutch government’s decisions
regarding the adoption of tobacco control policies, rather
than that the government has committed itself to finding
appropriate financial resources to support implementation
of all substantive measures required by the FCTC. In 2011,
when the Health Nearby policy was introduced (see the
chapter on Article 5), the authorities spoke of a “period of thorough reprioritisation in public tasks and
expenditure”227. Prevention of tobacco use was not considered a priority in this context. Rather, a
reduction of tasks and increased levels of efficiency were deemed necessary, resulting, for instance,
in the (temporary) halt of subsidies for (mass media) public education campaigns (see the chapter on
Article 12).
ARTICLE 26.2
Each Party shall provide financial support in respect of its national activities intended
to achieve the objective of the Convention, in accordance with its national plans,
priorities and programmes.
The previous shadow report identified a decreasing budget for tobacco control from 2003 to 2009.
This trend has continued (see Table 5). In 2012, the Netherlands already scored low on the Tobacco
Control Scale with regard to public funding. Since then, the available budget appears to have been cut
even further. The budget available to the Trimbos Institute for tobacco control was estimated at € 1.77
million for 2013 and € 1.36 for 2014. The Chairman of the Board of Director of the Trimbos Institute
referred to a “significantly lower budget for tobacco control” for 2013 and 2014228.
Table 5
Tobacco control budget per capita over the years in the Netherlands5; 6; 229-231
Year
Population (x 1,000)
Tobacco control budget (€)
Tobacco control budget per
capita (€)
2003
16,193
15,000,000
0.93
2004
16,258
8,500,000
0.52
2006
16,334
8,800,000
0.54
2009
16,485
4,050,000
0.25
2012
16,730
2,076,000
0.12
These figures include national government funding for mass communication campaigns, tobacco control projects,
educational programmes and support for nongovernmental organisations.
94
Dutch Tobacco Control: Moving Towards the Right Track?
The assessment of the available budget is complicated by the Dutch government’s increased reliance
on an integrated approach to prevention. The government has repeatedly confirmed that this process
of integration makes it impossible to identify a specific tobacco control budget87; 232. The NIX18
campaign (with a budget of approximately € 0.5 to 1 million in 2014 and subsequent years)233 and
the programmes on healthy schools and healthy schoolyards (on which more than € 2 million is spent
on an annual basis20) are examples of this integrated approach.
Not included in the budget as reported in the framework of the Tobacco Control Scale, are those
resources related to the enforcement of tobacco control policies and reimbursement of smoking
cessation interventions. The estimated annual costs for the reimbursement of pharmacotherapy for
smoking cessation, used in combination with behavioural counselling, amount to € 20 million171. In
2011, 2013, and 2014, the government allocated this budget to smoking cessation reimbursement.
With regard to enforcement of tobacco control legislation, there have also been some issues that
complicate comparisons of the budget over time. In 2011, € 8.2 million was provided to the Dutch
Food and Consumer Product Safety Authority (NVWA) for enforcing provisions on tobacco and alcohol.
The government has not been able to report an exact breakdown of the amount of money allocated
to tobacco and to alcohol234. As of January 2013, enforcement of the legal age limit for alcohol has
been decentralised, alleviating the NVWA of most of its enforcement activities in relation to alcohol.
Nevertheless, the budget available for tobacco and alcohol has decreased only slightly. The budget
for 2014 is estimated at € 7.1 million235.
Conclusions and recommendations
FCTC obligations with regard to financial resources for national purposes are rather limited, as the
Convention merely states that the Parties should provide financial means supporting national tobacco
control activities. Because the Dutch government acts in line with the sole obligation included in
Article 26, an overall ‘green score’ was assigned in the summary table on the implementation of
FCTC measures in the Netherlands in 2014 (Table 1b). However, concluding that the government is
technically acting in line with the budgetary obligations does not imply that it is acting desirably
from the perspective of public health. Two issues are of particular concern: (a) the decreasing trend
with regard to the amount of financial resources allocated specifically to tobacco control and (b) the
tendency that the implementation of tobacco control policies appears to be driven by budgetary
concerns. The Dutch governments is therefore urged to:
• Reverse the trend of decreased tobacco control spending and increase the annual budget. The budget
should be supportive of a comprehensive tobacco control policy.
• Consider earmarking tobacco tax revenues as a means to obtain and increase a dedicated budget
for tobacco control (in line with the newly adopted Guidelines for implementation of Article 6).
Scores
FCTC provision
Type of
commitment
Content
Yes/
No
26 2
Shall
Provide financial support in respect of its national activities
intended to achieve the objective of the Convention, in
accordance with its national plans, priorities and programmes.
Yes
FCTC Shadow Report 2014
Score
95
Conclusions
‘Moving towards the right track?’ is the title of this second FCTC shadow report. In the research period
covered by the previous shadow report, the government clearly went astray by dismantling tobacco
control in the various ways that were meticulously recorded in that report. Since then, the proportion
of smokers in the population did not decline and it is clear that more needs to be done to bring down
smoking rates. In the current shadow report we conclude that no major improvements have been
made, although a few positive signs were detected. The downward movement that was apparent from
the previous report seems to have come to a halt, but it is yet unclear if the government is indeed
moving towards the right track that will lead to a full implementation of the Framework Convention on
Tobacco Control (FCTC). For this reason, we added a question mark to the title of the report.
Being a Party to an international agreement such as the FCTC cannot be considered an open-ended
commitment. By signing the FCTC, the government has dedicated itself to implementing the tobacco
control measures included in the Convention in order to continually and substantially reduce
smoking prevalence and exposure to tobacco smoke. The mandatory character of the Convention has
also been stressed by the Dutch government: “The [FCTC] is a treaty with legally binding framework
provisions that has been ratified by the Dutch government. This implies that the Netherlands commits
itself to compliance with the treaty in its entirety”234.
The report assesses the performance of the Dutch government with regard to its implementation of
the FCTC. It is not an assessment of how effective the government’s tobacco policy currently is, nor
is it an assessment of what the government does and could do more to reduce the death toll from
smoking. Compliance with FCTC obligations is the central focus. FCTC constitutes an evidence-based
set of measures, which – when implemented properly – will substantially drive down smoking rates.
The conclusions and recommendations in this report relate to the FCTC obligations. When the FCTC
measures were developed, electronic cigarettes were not yet on the market, and measures to reduce
the appeal of these novel products are therefore not included. However, this does not imply that this
is not an important topic for the government and it is imperative that policy measures are developed
and implemented to assure that these products are not marketed at young people and that they do
not renormalise smoking.
Some caution is required in drawing conclusions concerning changes in compliance with FCTC
between the first and the second report. The results from the two reports cannot be compared
one-on-one. In the previous report we summarised the main results in a table, where we assigned
colour codes to each FCTC Article. In the new shadow report, we again use a colour code system
to summarise our findings. However, we extended the scoring system, now using four colours
instead of three. This allows for a more detailed assessment and more precise recommendations for
96
Dutch Tobacco Control: Moving Towards the Right Track?
improvement. Further, we improved the criteria for assigning a colour. In the present report we strictly
look at the wording of the Convention Articles and associated Guidelines, with some measures being
phrased as obligations (indicated by a “shall”), while other measures are recommendations or merely
suggestions. Only when the national tobacco policy did not fully oblige to a “shall”-provision, the
colour ‘red’ was assigned. This was the case for Articles 5.1 and 5.2, 5.3, 8, 9 and 10, 11, 12, 13, and 20.
With the change of government in November 2012, responsibility for tobacco control was handed
over from the Minister of Health Edith Schippers to the State Secretary for Health Martin van Rijn.
Since then several positive developments occurred, which are noted in our report. First, the extension
of smokefree environments by implementing a ban on smoking in small bars. However, this constitutes
a relative small improvement, and leaves open the major omission of still allowing smoking rooms in
hospitality settings, and in workplaces in general. For this reason, the Dutch government is still not
fully acting in accordance with the obligation in Article 8 FCTC to protect its citizens from exposure to
secondhand smoke. A second positive development was that State Secretary for Health has increased
the age limit for the sale of tobacco products from 16 to 18 (Article 16). Some further measures
were taken to improve enforcement of the age limit, and additional measures are currently being
considered as the level of compliance is still not optimal. Additional small signs of improvement
include initiatives taken by the government to conduct campaigns, where there was a full stop on mass
media campaigning some years ago, and the reinstatement of financial reimbursement for efficacious
smoking cessation support through the national health care insurance system.
Based on the findings in this report, we identify three main areas for improvement for the government
that, when implemented, will make the largest improvement in complying with FCTC.
First, the government has to develop a clear comprehensive tobacco policy (Article 5.1) and allocate
sufficient dedicated budget. The report shows that the government continues to dilute its focus
on tobacco by integrating tobacco control within a broader lifestyle prevention approach so that
tobacco does not get the attention it deserves. The amount of money that is spent on tobacco
control has consistently been reduced over the past decade, instead of dedicating more budget and
resources. The government should develop a comprehensive integrated tobacco control strategy,
with clear quantitative and measurable targets, and with sufficient budget for health education and
communication.
Related to the need for a national tobacco control strategy is the concern over industry interference.
The tobacco industry continues, through many ways, to influence tobacco policy. It is therefore good
that the awareness of the obligation of the government to take measures to protect their tobacco
policy from the tobacco industry (as stated in relation to Article 5.3) has increased. However, this has
not yet resulted in a concrete protocol on how to deal with tobacco industry interference. Such a
protocol should be structurally implemented at all levels and sectors of government.
Second, it is particularly worrisome that the government is reluctant to conduct public awareness
campaigns of the health risks of smoking in the general population (Article 12), resulting in the very low
level of awareness in the adult population regarding the harms from tobacco use and subsequent low
general support for further tobacco control measures. Further steps in tobacco control policy should
FCTC Shadow Report 2014
97
go hand in hand with targeted efforts to educate the general public about the devastating effects of
tobacco smoking for individuals and society. This will denormalise smoking in society and will help to
generate public support for further restrictions on tobacco. In order to better comply with Article 12,
the government should thus implement comprehensive public awareness programmes on the health
risks of smoking including the addictive characteristics of tobacco use and exposure to tobacco smoke.
Currently, there are no signs that the government is prepared to take this necessary step.
Third, Article 13 requires governments to have a comprehensive ban of all tobacco advertising,
promotion and sponsorship. Such a comprehensive ban is currently not in place in the Netherlands.
Although the government commissioned studies to examine the effects of a tobacco display ban
and a reduction of the number of points of sale for tobacco products including a ban on tobacco
vending machines, these measures have not yet been taken, resulting in a negative evaluation of the
implementation of Article 13. Promotion of tobacco products in shops, supermarkets and in petrol
stations is still present everywhere in the Netherlands. An increasing number of European countries
has already banned point-of-sale promotion or is in the process of doing so.
In many instances, the Guidelines to the FCTC are more far-reaching than the treaty articles
themselves. In such cases, it is possible for the government to fulfil its obligations under the
Convention, while failing to comply with recommendations and suggestions in the Guidelines. For
example, by transposing the new revised Tobacco Products Directive (TPD), the government will fulfil
its obligations under Article 11, while ignoring the recommendations from the Guidelines to Articles
11 and 13, to implement plain packaging. These recommendations are based on a strong rationale
and an increasing body of scientific knowledge regarding the appeal of tobacco products to youth.
The Dutch government is therefore urged to continue to explore the option of plain packaging, by
examining emerging research data, for example from Australia, which introduced plain packaging
in December 2012, and closely monitor developments in European countries, notably France and
Ireland. The implementation of the TPD regarding pictorial health warnings in 2016, is a good
opportunity to introduce plain packaging.
Another area in which the government formally complies with FCTC, but which has substantial room
for improvement is taxation of tobacco products. The Dutch government should develop a long-term
tobacco tax policy based on public health considerations, as recommended by the newly adopted
Guidelines. The government is recommended to significantly increase tax levels yearly, reduce the
tax difference between factory-made cigarettes and roll-your-owns and dedicate part of the revenues
to tobacco control. This will both reduce tobacco consumption and support increased spending on
effective tobacco control measures.
The Dutch government supported the adoption of a strong revised EU TPD. When this Directive is
implemented in the Netherlands in 2016, this will mean that the government will by then comply with
important obligations on the regulation of additives in tobacco products as required in Article 9, and
Article 11 on packaging and labelling. But this is not yet the case, and therefore in the present report
the government is still assigned the colour ‘red’ for Articles 9 and 10, and 11. It is important that civil
society closely monitors the correct and prompt transposition of the revised EU TPD into national law,
and assures that this process is not disturbed by the tobacco industry.
98
Dutch Tobacco Control: Moving Towards the Right Track?
To summarise, several positive improvements in tobacco control policy have occurred since the
previous shadow report, and the government seems to be moving towards the right track. However,
it still has a long distance to cover before a full implementation of the FCTC is realised and, as a
consequence, a significant reduction of the devastating effects of smoking to public health.
FCTC Shadow Report 2014
99
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
100
Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (n.d.). Volksgezondheid en zorg: Sterfte en verloren
levensjaren door roken. Retrieved December 22, 2014, from https://www.volksgezondheidenzorg.info/
onderwerp/roken/cijfers-context/gezondheidsgevolgen#!node-sterfte-en-verloren-levensjaren-door-roken
Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (n.d.). Volksgezondheid en zorg: Gezondheidsgevolgen
van passief roken. Retrieved December 22, 2014, from https://www.volksgezondheidenzorg.info/
onderwerp/roken/cijfers-context/gezondheidsgevolgen#!node-gezondheidsgevolgen-van-passief-roken
Hoeymans, N., Van Loon, A. J. M., Van den Berg, M., Harbers, M. M., Hilderink, H. B. M., Van Oers, J. A. M., &
Schoemaker, C. G. (2014). Een gezonder Nederland: Kernboodschappen van de Volksgezondheid Toekomst
Verkenning 2014. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM). Retrieved from http://
www.rivm.nl/dsresource?objectid=rivmp:251654&type=org&disposition=inline&ns_nc=1
Van Laar, M. W., & Van Ooyen-Houben, M. M. J. (2014). Nationale drug monitor: Jaarbericht 2013/2014.
Utrecht: Trimbos-instituut. Retrieved from http://www.trimbos.nl/~/media/files/gratis%20downloads/
AF1316%20NDM%20Jaarbericht%202013-2014.pdf
Joossens, L., & Raw, M. (2014). The Tobacco Control Scale 2013 in Europe. Brussels: Association of European
Cancer Leagues. Retrieved from http://www.europeancancerleagues.org/images/TobaccoControl/
TCS_2013_in_Europe_13-03-14_final_1.pdf
Joossens, L., & Raw, M. (2011). The Tobacco Control Scale 2010 in Europe. Brussels: Association of European
Cancer Leagues. Retrieved from http://www.europeancancerleagues.org/images/stories/The_TCS_2010_in_
Europe_Final_4.pdf
World Health Organization (WHO). (2014). WHO FCTC - Status of reporting 4 November 2014 (Parties in
alphabetical order). Retrieved from http://www.who.int/fctc/reporting/ReportingStatus20141104.pdf
World Health Organization (WHO). (2014). Reporting instrument of the WHO Framework Convention on
Tobacco Control: The Netherlands, 2014. Retrieved from http://apps.who.int/fctc/implementation/database/
sites/implementation/files/documents/reports/netherlands_2014_report.pdf
World Health Organization (WHO). (2008). Reporting instrument of the WHO Framework Convention on
Tobacco Control: The Netherlands, 2008. Retrieved from http://apps.who.int/fctc/implementation/database/
sites/implementation/files/documents/reports/netherlands_report.pdf
World Health Organization (WHO). (2010). Reporting instrument of the WHO Framework Convention on
Tobacco Control: The Netherlands, 2010. Retrieved from http://apps.who.int/fctc/implementation/database/
sites/implementation/files/documents/reports/Netherlands_5y_report_v2_final.pdf
World Health Organization (WHO). (2012). Reporting instrument of the WHO Framework Convention on
Tobacco Control: The Netherlands, 2012. Retrieved from http://apps.who.int/fctc/implementation/database/
sites/implementation/files/documents/reports/netherlands_2012_report_final.pdf
Convention Secretariat, Conference of the Parties to the World Health Organization (WHO) Framework
Convention on Tobacco Control. (2014). Reporting arrangements under the WHO FCTC: Establishment of a
mechanism to facilitaite review of Parties’ reports (FCTC/COP/6/17). Retrieved from http://apps.who.int/gb/
fctc/PDF/cop6/FCTC_COP6_17-en.pdf
Tweede Kamer. (2011-2012). 32 793, nr. 41. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-41.html
Tweede Kamer. (2011-2012). Handelingen 62, 24. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20112012-62-24.html
Mamudu, H. M., Hammond, R., & Glantz, S. A. (2011). International trade versus public health during the
FCTC negotiations, 1999-2003. Tobacco control, 20(1), e3.
Besluit van 24 november 2014, houdende tijdelijke regels met betrekking tot de elektronische sigaret
(Tijdelijk warenwetbesluit elektronische sigaret). Staatsblad 2014, 456. Retrieved from https://zoek.
officielebekendmakingen.nl/stb-2014-456.html
Rennen, E., & Willemsen, M. C. (2012). Dutch tobacco control: Out of control? Amsterdam: KWF
Kankerbestrijding.
Dutch Tobacco Control: Moving Towards the Right Track?
18. Van Emst, A. J. (Willemsen, M C). Naar een nieuwe structuur voor tabaksontmoediging in Nederland. Verslag
van een inspirational conference. Den Haag: STIVORO voor een rookvrije toekomst. Retrieved from
http://stivoro.nl/wp-content/uploads/2012/docs/rapporten/diversen/Naar%20een%20nieuwe%20
structuur%20voor%20tabaksontmoediging%20in%20Nederland.pdf
19. Tweede Kamer. (2010-2011). 32 793, nr. 2. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-2.html
20. Tweede Kamer. (2013-2014). 32 793, nr. 102, bijlage 256288. Retrieved from https://zoek.
officielebekendmakingen.nl/blg-256288.pdf
21. Alles is Gezondheid. (n.d.). Wie hebben er al getekend? Retrieved December 18, 2014, from http://www.
allesisgezondheid.nl/Doe_mee_en_teken_een_pledge/Wie_hebben_er_al_getekend
22. Tweede Kamer. (2013-2014). 32 793, nr. 114. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-114.html
23. Van den Broek, M., & Koornstra, A. (2013). Gezondheidsbeleid in de groei: Scan van gemeentelijke
gezondheidsnota’s 2013. Utrecht: Gemeentelijke Gezondheidsdient (GGD) Nederland. Retrieved from http://
www.ggdkennisnet.nl/?file=16799&m=1392651200&action=file.download
24. Huijsman, F., van der Meer, R. M., de Beer, M. A., van Emst, A. J., & Willemsen, M. C. (2013). Decentralisatie
van tabaksontmoediging: rookbeleid tussen wal en schip? Tijdschrift voor gezondheidswetenschappen, 91(1),
52-59.
25. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (2013). Handreiking Gezonde Gemeente: roken.
Bilthoven: RIVM. Retrieved from http://www.loketgezondleven.nl/object_binary/o17215_Factsheet-Rokenjuli-2013.pdf
26. Trimbos-instituut. (2014, December 10). Trimbos-instituut ondersteunt gemeenten bij alcohol-, drugs- en
tabaksbeleid. Retrieved December 22, 2014, from http://www.trimbos.nl/nieuws/trimbos-nieuws/trimbosinstituut-ondersteunt-gemeenten-bij-alcohol--drugs--en-tabaksbeleid
27. Zembla. (2011, October 21). Minister van Tabak [video]. Retrieved December 22, 2014, from http://zembla.
vara.nl/seizoenen/2011/afleveringen/21-10-2011
28. Tweede Kamer. (2012-2013). 33 522, nr. 4. Retrieved from https://zoek.officielebekendmakingen.nl/kst33522-4.html
29. Tweede Kamer. (2013-2014). Handelingen 8, 6. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20132014-8-6.html
30. Tweede Kamer. (2011-2012). Aanhangsel 1683. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20112012-1683.html
31. Tweede Kamer. (2013-2014). Aanhangsel 192. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-192.html
32. Tweede Kamer. (2013-2014). Aanhangsel 135. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-135.html
33. Ministry of Health. (2013, June 6). RE: Verzoek tot overleg in kader tabaksrichtlijn (Ph.Morris) [email to
Philip Morris]. Retrieved from http://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/wobverzoeken/2013/12/18/bijlage-1-wob-besluit-contacten-tabaksindustrie-februari-september-2013/
bijlage-1-wob-besluit-contacten-tabaksindustrie-februari-september-2013.pdf
34. Stichting Rookpreventie Jeugd. (2014, September 8). Dagvaarding Stichting Rookpreventie Jeugd vs.
de Staat der Nederlanden. Retrieved from http://www.stichtingrookpreventiejeugd.nl/wp-content/
uploads/2014/09/08-09-2014-Dagvaarding-Stichting-Rookpreventie-Jeugd-v.-Staat-der-Nederlanden.pdf
35. Weekers, F. H. H. [State Secretary for Finance]. (2012, April 6). Reactie op uw brief van 5 maart [letter
to British American Tobacco]. Retrieved from http://www.rijksoverheid.nl/bestanden/documenten-enpublicaties/wob-verzoeken/2013/12/18/bijlage-1-wob-besluit-contacten-tabaksindustrie-februariseptember-2013/bijlage-1-wob-besluit-contacten-tabaksindustrie-februari-september-2013.pdf
36. Tweede Kamer. (2011-2012). Aanhangsel 1362. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20112012-1362.html
37. Tweede Kamer. (2012-2013). Aanhangsel 3127. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20122013-3127.html
38. Tweede Kamer. (2011-2012). Handelingen 14, 5. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20112012-14-5.html
39. Rijksoverheid. (n.d.). Integriteit overheid. Retrieved December 22, 2014, from http://www.rijksoverheid.nl/
onderwerpen/kwaliteit-en-integriteit-overheidsinstanties/integriteit-overheid
40. Tweede Kamer. (2011-2012). 32 793, nr. 43. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-43.html
41. Tweede Kamer. (2013-2014). Aanhangsel 1011. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-1011.html
FCTC Shadow Report 2014
101
42. Van Rijn, M. [State Secretary for Health]. (2014, September 1). Informatievoorziening over WHO-Kaderverdrag
inzake tabaksontmoediging en tabaksreclamebeleid [letter to municipalities]. Retrieved from http://www.
rijksoverheid.nl/bestanden/documenten-en-publicaties/brieven/2014/09/04/brief-aan-gemeenten-overfctc-verdrag-en-tabaksreclameverbod/brief-aan-gemeenten-over-fctc-verdrag-en-tabaksreclameverbod.pdf
43. Ministry of Health. (2013, January 31). Verhoging leeftijdgrens verkoop tabak naar 18 jaar [minutes of
meeting Ministry of Health and Platform Points of Sale of Tobacco Products]. Retrieved from http://
www.rijksoverheid.nl/bestanden/documenten-en-publicaties/wob-verzoeken/2013/12/18/bijlage-1wob-besluit-contacten-tabaksindustrie-februari-september-2013/bijlage-1-wob-besluit-contactentabaksindustrie-februari-september-2013.pdf
44. Rijksoverheid. (2011, June 16). Afspraken aanpak smokkel en illegale handel in tabaksproducten. Retrieved
December 22, 2014, from http://www.rijksoverheid.nl/nieuws/2011/06/16/afspraken-aanpak-smokkel-enillegale-handel-in-tabaksproducten.html
45. European Parliament. (2014). E-008123/2014. Retrieved from http://www.europarl.europa.eu/sides/
getAllAnswers.do?reference=E-2014-008123&language=EN
46. Tweede Kamer. (2013-2014). Aanhangsel 1911. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-1911.html
47. Tweede Kamer. (2013-2014). 33 752, nr. 11. Retrieved from http://zoek.officielebekendmakingen.nl/kst33752-11.html
48. Tweede Kamer. (2013-2014). 33 752, nr. 3. Retrieved from http://zoek.officielebekendmakingen.nl/kst33752-3.html
49. Tweede Kamer. (2012-2013). 33 410, nr. 15. Retrieved from https://zoek.officielebekendmakingen.nl/kst33410-15.html
50. Tweede Kamer. (2013-2014). 33 752, nr. 7, bijlage 252177. Retrieved from https://zoek.
officielebekendmakingen.nl/blg-252177.pdf
51. Wet van 20 december 2012 tot wijziging van enkele belastingwetten en enige andere wetten (Overige fiscale
maatregelen 2013). Staatsblad 2012, 669. Retrieved from https://zoek.officielebekendmakingen.nl/stb2012-669.html
52. Besluit van de Staatssecretaris van Financiën van 21 december 2012, nr. DV 2012/509M tot wijziging van de
Wet op de accijns en de Algemene douaneregeling. Staatscourant 2013, 425. Retrieved from https://zoek.
officielebekendmakingen.nl/stcrt-2013-425.html
53. Regeling van de Staatssecretaris van Financiën van 30 december 2013, nr. DV 2013/559M tot wijziging van de
Wet op de accijns en de Algemene douaneregeling. Staatscourant 2013, 36471. Retrieved from https://zoek.
officielebekendmakingen.nl/stcrt-2013-36471.html
54. World Health Organization (WHO). (2010). WHO technical manual on tobacco tax administration. Geneva:
WHO. Retrieved from http://whqlibdoc.who.int/publications/2010/9789241563994_eng.pdf?ua=1
55. Wijziging van de Wet op de accijns en Algemene douaneregeling, Nr. DV/2011/185. Staatscourant 2011,
7490. Retrieved from https://zoek.officielebekendmakingen.nl/stcrt-2011-7490.html
56. Wijziging van de Wet op de accijns en Algemene douaneregeling, Nr. DV 2012/47M. Staatscourant 2012,
3856. Retrieved from https://zoek.officielebekendmakingen.nl/stcrt-2012-3856.html
57. Wet van 12 juli 2012 tot wijziging van enkele belastingwetten en enige andere wetten (Wet uitwerking
fiscale maatregelen Begrotingsakkoord 2013). Staatsblad 2012, 321. Retrieved from https://zoek.
officielebekendmakingen.nl/stb-2012-321.html
58. Wet van 18 december 2013 tot wijziging van enkele belastingwetten en enige andere wetten (Belastingplan
2014). Staatsblad 2013, 565. Retrieved from https://zoek.officielebekendmakingen.nl/stb-2013-565.html.
59. European Commission. (2014). Excise duty tables. Part III - Manufactured tobacco. Shows the situation as at 1
July 2014 (Ref 1041). Retrieved from http://ec.europa.eu/taxation_customs/resources/documents/taxation/
excise_duties/tobacco_products/rates/excise_duties-part_iii_tobacco_en.pdf
60. Gallus, S., Lugo, A., Ghislandi, S., La Vecchia, C., & Gilmore, A. B. (2014). Roll-your-own cigarettes in Europe:
use, weight and implications for fiscal policies. European Journal of Cancer Prevention, 23(3), 186-192.
61. Gerechtshof Amsterdam. (2014, March 13). ECLI 2014, 744. Retrieved from http://uitspraken.rechtspraak.nl/
inziendocument?id=ECLI:NL:GHAMS:2014:744
62. Wet van 23 december 2009 tot wijziging van enkele belastingwetten en enige andere wetten (Overige fiscale
maatregelen 2010). Staatsblad 2009, 610. Retrieved from https://zoek.officielebekendmakingen.nl/stb2009-610.html
63. Wet van 22 december 2011 houdende wijziging van enkele belastingwetten en enige andere wetten
(Belastingplan 2012). Staatsblad 2011, 639. Retrieved from https://zoek.officielebekendmakingen.nl/stb2011-639.html
64. Wet van 20 december 2012 tot wijziging van enkele belastingwetten en enige andere wetten (Belastingplan
2013). Staatsblad 2012, 668. Retrieved from https://zoek.officielebekendmakingen.nl/stb-2012-668.html
102
Dutch Tobacco Control: Moving Towards the Right Track?
65. Loubeau, P. (forthcoming). An exploratory review of illicit tobacco trade in the Netherlands.
66. Douane. (n.d.). Koopt u tabaksproducten op internet? Retrieved December 22, 2014, from http://www.
belastingdienst.nl/wps/wcm/connect/bldcontentnl/belastingdienst/prive/douane/goederen_ontvangen_
uit_het_buitenland/van_organisaties_en_bedrijven/koopt_u_tabaksproducten_op_internet
67. Besluit van 14 juni 2011, houdende wijziging van het Besluit uitvoering rookvrije werkplek, horeca en andere
ruimten. Staatsblad 2011, 337. Retrieved from https://zoek.officielebekendmakingen.nl/stb-2011-337.html
68. Wet van 18 april 2002 tot wijziging van de Tabakswet. Staatsblad 2002, 201. Retrieved from https://zoek.
officielebekendmakingen.nl/stb-2002-201.html
69. Besluit van 4 april 2008, houdende een aantal nadere voorschriften ter uitvoering van de Tabakswet.
Staatsblad 2008, 122. Retrieved from https://zoek.officielebekendmakingen.nl/stb-2008-122.html
70. Rijksoverheid. (2010, November 3). Versoepeling rookverbod kleine cafés. Retrieved December 22, 2014,
from http://www.rijksoverheid.nl/nieuws/2010/11/03/versoepeling-rookverbod-kleine-cafes.html
71. Gerechtshof Den Haag. (2013, March 26). LJN BZ4871. Retrieved from http://uitspraken.rechtspraak.nl/inzie
ndocument?id=ECLI:NL:GHDHA:2013:BZ4871
72. Tweede Kamer. (2012-2013). 32 011, nr. 24. Retrieved from https://zoek.officielebekendmakingen.nl/kst32011-24.html
73. Hoge Raad. (2014, October 10). ECLI 2014, 2928. Retrieved from http://uitspraken.rechtspraak.nl/inziendoc
ument?id=ECLI:NL:HR:2014:2928
74. Rijksoverheid. (2014, October 21). Rookverbod geldt per direct in alle cafés. Retrieved December 22, 2014,
from http://www.rijksoverheid.nl/nieuws/2014/10/21/rookverbod-geldt-per-direct-in-alle-cafes.html
75. Tweede Kamer. (2012-2013). Handelingen 51, 12. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20122013-51-12.html
76. Tweede Kamer. (2013-2014). 33 791, nr. 3. Retrieved from https://zoek.officielebekendmakingen.nl/kst33791-3.html
77. Wet van 5 november 2014, houdende verduidelijking van de rookverboden in de Tabakswet, met inbegrip
van een algemeen rookverbod in de horeca. Staatsblad 2014, 447. Retrieved from https://zoek.
officielebekendmakingen.nl/stb-2014-447.html
78. Tweede Kamer. (2013-2014). 33 791, nr. 5. Retrieved from https://zoek.officielebekendmakingen.nl/kst33791-5.html
79. Nagelhout, G. E., Mons, U., Allwright, S., Guignard, R., Beck, F., Fong, G. T., de Vries, H., & Willemsen, M. C.
(2011). Prevalence and predictors of smoking in “smokefree” bars. Findings from the International Tobacco
Control (ITC) Europe Surveys. Social science & medicine, 72(10), 1643-1651.
80. Eerste Kamer. (2014-2015). 33 791, nr. D. Retrieved from https://zoek.officielebekendmakingen.nl/kst33791-D.html
81. Intraval, & Nederlandse Voedsel- en Warenautoriteit (NVWA). (2014). Inventarisatie naleefniveau rookvrije
horeca voorjaar 2014. Groningen: Intraval. Retrieved from http://www.vwa.nl/txmpub/files/?p_file_
id=2207165
82. Intraval, & Nederlandse Voedsel- en Warenautoriteit (NVWA). (2012). Inventarisatie naleefniveau rookvrije
horeca voorjaar 2012. Retrieved from http://www.vwa.nl/txmpub/files/?p_file_id=2202401
83. Tweede Kamer. (2013-2014). 33 738, nr. 6. Retrieved from https://zoek.officielebekendmakingen.nl/kst33738-6.html
84. Tweede Kamer. (2013-2014). 33 738, nr. 2. Retrieved from https://zoek.officielebekendmakingen.nl/kst33738-2.html
85. Tweede Kamer. (2013-2014). 33 791, nr. 8. Retrieved from https://zoek.officielebekendmakingen.nl/kst33791-8.html
86. Van de Nobelen, S., Cremers, H., Ramlal, R., & Talhout, R. (2014). Detectiemethoden ter ondersteuning bij
de handhaving van het rookverbod (RIVM Briefrapport 090071001/2014). Bilthoven: Rijksinstituut voor
Volksgezondheid en Milieu (RIVM). Retrieved from http://www.rivm.nl/dsresource?objectid=rivmp:263982&
type=org&disposition=inline&ns_nc=1
87. Tweede Kamer. (2014-2015). 34 000 XVI, nr. 33. Retrieved from https://zoek.officielebekendmakingen.nl/
kst-34000-XVI-33.html
88. Tweede Kamer. (2011-2012). Aanhangsel 1557. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20112012-1557.html
89. Tweede Kamer. (2012-2013). 33 522, nr. 2. Retrieved from https://zoek.officielebekendmakingen.nl/kst33522-2.html
90. Eerste Kamer. (2013-2014). 33 522, nr. A. Retrieved from https://zoek.officielebekendmakingen.nl/kst33522-A.html
91. Colijn, M. W. (2013). ‘Reduced Ignition Paper’ sigaretten: Screening van de markt. Utrecht: Nederlandse
Voedsel- en Warenautoriteit (NVWA). Retrieved from http://www.vwa.nl/txmpub/files/?p_file_id=2204680
FCTC Shadow Report 2014
103
92. Talhout, R. (2012). Rapportage en regelgeving van tabaksingrediënten: Een vergelijking van Nederland met
andere landen (RIVM briefrapport 340610004/2012). Bilthoven: Rijksinstituut voor Volksgezondheid en
Milieu (RIVM). Retrieved from http://www.rivm.nl/dsresource?objectid=rivmp:191867&type=org&dispositio
n=inline&ns_nc=1
93. Regeling van 24 oktober 2012, houdende vaststelling van de Regeling elektronische melding en
publicatie tabaksingrediënten 2013. Staatscourant 2012, 22107. Retrieved from https://zoek.
officielebekendmakingen.nl/stcrt-2012-22107.html.
94. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (2012, December 20). RIVM publiceert toegevoegde
stoffen aan tabak. Retrieved December 22, 2014, from http://www.rivm.nl/Documenten_en_publicaties/
Algemeen_Actueel/Nieuwsberichten/2012/RIVM_publiceert_toegevoegde_stoffen_aan_tabak
95. Wychgel, H. [Rijksinstituut voor Volksgezondheid en Milieu (RIVM)]. (2012, September 13). Europese
instituten geven informatie over gezondheidseffecten van additieven in sigaretten. Retrieved December 22,
2014, from http://www.rivm.nl/Documenten_en_publicaties/Algemeen_Actueel/Nieuwsberichten/2012/
Europese_instituten_geven_informatie_over_gezondheidseffecten_van_additieven_in_sigaretten
96. Kienhuis, A., Schenk, E., & Talhout, R. (2013). Publieksinformatie over additieven in tabaksproducten: The right
to know (RIVM briefrapport 050057001/2013). Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu
(RIVM). Retrieved from http://www.rivm.nl/dsresource?objectid=rivmp:207392&type=org&disposition=inli
ne&ns_nc=1
97. Rijksoverheid. (2014, May 14). Staatssecretaris Van Rijn lanceert jongerenwebsite over toevoegingen tabak.
Retrieved December 22, 2014, from http://www.rijksoverheid.nl/nieuws/2014/05/14/staatssecretaris-vanrijn-lanceert-jongerenwebsite-over-toevoegingen-tabak.html
98. Talhout, R., & Schenk, E. (2012). Additieven in Nederlandse tabaksproducten: Analyse van de gegevens over
2010 (RIVM briefrapport 340610005/2012). Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu (RIVM).
Retrieved from http://www.rivm.nl/dsresource?objectid=rivmp:233569&type=org&disposition=inline&ns_
nc=1
99. Schenk, E., Kienhuis, A., & Talhout, R. (2013). Additieven in Nederlandse tabaksproducten: Analyse van de
gegevens over 2011 (RIVM briefrapport 050057002/2013). Bilthoven: Rijksinstituut voor Volksgezondheid
en Milieu (RIVM). Retrieved from http://www.rivm.nl/dsresource?objectid=rivmp:233569&type=org&dispos
ition=inline&ns_nc=1
100. Longfonds. (2012, February 21). Consument onwetend over sigaret. Retrieved December 22, 2014, from
https://www.longfonds.nl/nieuws/consument-onwetend-over-sigaret
101. Hilderink, I. (2014). E-learning roken: Docentenhandleiding. Utrecht: Trimbos-institute. Retrieved from http://
www.trimbos.nl/webwinkel/productoverzicht-webwinkel/alcohol-en-drugs/pf/~/media/files/gratis%20
downloads/pfg55164%20docentenhandleiding%20leren%20over%20roken.pdf
102. Besluit van 29 oktober 2012, houdende wijziging van het Aanduidingenbesluit tabaksproducten
ter implementatie van richtlijn 2012/9/EU. Staatsblad 2012, 548. Retrieved from https://zoek.
officielebekendmakingen.nl/stb-2012-548.html.
103. International Tobacco Control (ITC) Project. (2012). Health warnings on tobacco packages: ITC cross-country
comparison report. Waterloo: University of Waterloo. Retrieved from http://itcproject.org/files/ITC_CrossCountry_Report_-_Warning_Labels-Final.pdf
104. International Tobacco Control (ITC) Netherlands Survey. (2014). Wave 8, unpublished data [personal
communication with G.E. Nagelhout].
105. European Commission. (2012). Special Eurobarometer 385: Attitudes of Europeans towards tobacco. Brussels:
European Commission. Retrieved from http://ec.europa.eu/health/tobacco/docs/eurobaro_attitudes_
towards_tobacco_2012_en.pdf
106. Tweede Kamer. (2010-2011). Handelingen 15, 13. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20102011-15-13.html
107. International Tobacco Control (ITC) Project. (2011). ITC Netherlands Survey: Report on smokers’ awareness of the
health risks of smoking and exposure to second-hand smoke. Waterloo: University of Waterloo. Retrieved from
http://www.itcproject.org/files/Report_Publications/National_Summary/itcnetherlandsknowledgefinal.pdf
108. Tweede Kamer. (2011-2012). Aanhangsel 830. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20112012-830.html
109. Tweede Kamer. (2010-2011). Aanhangsel 3130. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20102011-3130.html
110. Tweede Kamer. (2014-2015). 2014D48214. Retrieved from http://www.tweedekamer.nl/kamerstukken/deta
il?id=2014D48214&did=2014D48214
111. Tweede Kamer. (2011-2012). 32 793, nr. 56. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-56.html
104
Dutch Tobacco Control: Moving Towards the Right Track?
112. Tweede Kamer. (2012-2013). 33 400 XVI, nr. 119. Retrieved from https://zoek.officielebekendmakingen.nl/
kst-33400-XVI-119.html
113. Arnott, D., Berteletti, F., Britton, J., Cardone, A., Clancy, L., Craig, L., Fong, G. T., Glantz, S. A., Joossens, L., &
Rudolphie, M. T. (2012). Can the Dutch Government really be abandoning smokers to their fate? The Lancet,
379(9811), 121-122.
114. Tweede Kamer. (2011-2012). 32 793, nr. 59. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-59.html
115. STIVORO voor een rookvrije toekomst. (2013). Jaarverslag 2012: Vallen en opstaan. Den Haag: STIVORO voor
een rookvrije toekomst. Retrieved from http://stivoro.nl/wp-content/uploads/jaarverslagen/20130607%20
STIVORO%20jaarverslag%202012.pdf
116. Raad van State. (2013, January 16). LJN BY8520. Retrieved from http://uitspraken.rechtspraak.nl/inziendocu
ment?id=ECLI:NL:RVS:2013:BY8520
117. Tweede Kamer. (2012-2013). 33 400 XVI, nr. 2. Retrieved from https://zoek.officielebekendmakingen.nl/kst33400-XVI-2.html
118. Tweede Kamer. (2011-2012). 33 240 XVI, nr. 6. Retrieved from https://zoek.officielebekendmakingen.nl/kst33240-XVI-6.html
119. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (2014, September 2). Ook middelbare scholen
kunnen nu vignet Gezonde School aanvragen. Retrieved December 22, 2014, from http://www.rivm.nl/
Documenten_en_publicaties/Algemeen_Actueel/Nieuwsberichten/2014/Ook_middelbare_scholen_
kunnen_nu_vignet_Gezonde_School_aanvragen
120. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (2014, December 23). Gezonde school (voortgezet
onderwijs): Criteria themacertificaat Roken, alcohol en drugs [versie 1.5]. Retrieved December 24, 2014,
from http://www.gezondeschool.nl/voortgezet-onderwijs/vignet-gezonde-school/themacertificaten-vignet/
themacertificaat-roken-alcohol-en-drugs/
121. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (2014). Overzicht vignetscholen per themacertificaat
vignet Gezonde School po. Versie 10 december 2014. Retrieved from http://www.gezondeschool.nl/object_
binary/o21130_20141210%20overzicht%20vignetscholen%20per%20themacertificaat%20vignet%20
GS%20po.pdf
122. Rijksinstituut voor Volksgezondheid en Milieu (RIVM). (2014, December 23). Gezonde school (voortgezet
onderwijs): Vignetscholen [versie 1.5]. Retrieved December 24, 2014, from http://www.gezondeschool.nl/
voortgezet-onderwijs/vignet-gezonde-school/vignetscholen/
123. Trimbos-instituut. (2014, November 14). Eerste vignet Gezonde School VO voor preventie roken, alcohol,
drugsgebruik. Retrieved December 22, 2014, from http://www.trimbos.nl/nieuws/trimbos-nieuws/eerstevignet-gezonde-school-vo
124. De Gezonde School en Genotmiddelen (DGSG). (n.d.). Onderdelen DGSG. Retrieved December 22, 2014,
from http://www.dgsg.nl/de-gezonde-school-en-genotmiddelen/onderdelen-dgsg
125. Malmberg, M., Kleinjan, M., Overbeek, G., Vermulst, A., Lammers, J., Monshouwer, K., Vollebergh, W. A., &
Engels, R. C. (2015). Substance use outcomes in the Healthy School and Drugs program: Results from a
latent growth curve approach. Addictive behaviors, 42, 194-202.
126. Malmberg, M., Kleinjan, M., Overbeek, G., Vermulst, A., Monshouwer, K., Lammers, J., Vollebergh, W. A., &
Engels, R. C. (2014). Effectiveness of the ‘Healthy School and Drugs’ prevention programme on adolescents’
substance use: a randomized clustered trial. Addiction, 109(6), 1031-1040.
127. Tweede Kamer. (2012-2013). 33 400 XIII, nr. 137. Retrieved from https://zoek.officielebekendmakingen.nl/
kst-33400-VIII-137.html
128. Trimbos-instituut. (2014, January 27). De gezonde school en genotmiddelen: Blik op de toekomst.
Retrieved December 22, 2014, from http://www.trimbos.nl/nieuws/trimbos-nieuws/de-gezonde-school-engenotmiddelen-blik-op-de-toekomst
129. De Gezonde School en Genotmiddelen (DGSG). (n.d.). Leerling- en ouderinterventie alcohol en roken.
Retrieved December 22, 2014, from http://www.dgsg.nl/scholen/dgsg-vo/leerling-en-ouders---alcohol-enroken
130. Koning, I. M., Van den Eijnden, R. J., Verdurmen, J. E., Engels, R. C., & Vollebergh, W. A. (2011). Long-term
effects of a parent and student intervention on alcohol use in adolescents: A cluster randomized controlled
trial. American journal of preventive medicine, 40(5), 541-547.
131. STIVORO voor een rookvrije toekomst. (2011). Factsheet Rookvrije scholen 2011, voortgezet onderwijs. Den
Haag: STIVORO voor een rookvrije toekomst. Retrieved from http://www.alliantienederlandrookvrij.nl/
wp-content/uploads/2014/01/Factsheet-de-rookvrije-school-2011_voortgezet-onderwijs.pdf
132. Tweede Kamer. (2011-2012). Handelingen 890. Retrieved from https://zoek.officielebekendmakingen.nl/
dossier/33358/ah-tk-20112012-890.html
FCTC Shadow Report 2014
105
133. Tweede Kamer. (2014-2015). 27 565, nr. 130. Retrieved from https://zoek.officielebekendmakingen.nl/kst27565-130.html
134. Nagelhout, G. E., Van den Burg, I., Crone, M. R., Zeegers, T. M. C., & Willemsen, M. C. (2012). Themapublicatie
Meeroken bij kinderen van 0 tot en met 18 jaar, 2008-2011. Den Haag: STIVORO voor een rookvrije
toekomst. Retrieved from http://www.alliantienederlandrookvrij.nl/wp-content/uploads/themapublicaties/
meerokenkinderen0-18/Themapublicatie%20meeroken%20bij%20kinderen%20van%200%20tm%20
18%20jaar.pdf
135. STIVORO voor een rookvrije toekomst. (2013). Rookvrij opgroeien, 4-19 jaar. Den Haag: STIVORO voor een
rookvrije toekomst. Retrieved from http://www.trimbos.nl/webwinkel/productoverzicht-webwinkel/alcoholen-drugs/s/~/media/files/inkijkexemplaren/sr0303%20handreiking%20rookvrij%20opgroeien%20
jgz%204-19%20jaar.pdf
136. Rennen, E., Nagelhout, G. E., van den Putte, B., Janssen, E., Mons, U., Guignard, R., Beck, F., de Vries, H.,
Thrasher, J. F., & Willemsen, M. C. (2014). Associations between tobacco control policy awareness, social
acceptability of smoking and smoking cessation. Findings from the International Tobacco Control (ITC)
Europe Surveys. Health education research, 29(1), 72-82.
137. Hammond, D., Fong, G. T., Zanna, M. P., Thrasher, J. F., & Borland, R. (2006). Tobacco denormalization and
industry beliefs among smokers from four countries. American journal of preventive medicine, 31(3), 225232.
138. De Looze, M., Van Dorsselaer, S., De Roos, S., Verdurmen, J., Stevens, G., Gommans, R., Van Bon-Martens,
M., Ter Bogt, T., & Vollebergh, W. (2014). HBSC 2013: Gezondheid, welzijn en opvoeding van jongeren in
Nederland. Utrecht: Universiteit Utrecht. Retrieved from http://www.trimbos.nl/~/media/files/gratis%20
downloads/af1327%20hbsc%202013.pdf
139. Tweede Kamer. (2013-2014). 33 750 III, nr. 7, bijlage 331896. Retrieved from https://zoek.
officielebekendmakingen.nl/blg-331896
140. Nationaal Expertisecentrum Tabaksontmoediging (NET). (2013). Werkplan Aanvullende activiteiten
2014 [attachment to letter from the Director of Operations of the Trimbos Institute to the Ministry
of Health]. Retrieved from http://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/wobverzoeken/2014/11/14/bijlagen-bij-wob-besluit-over-tabaksbeleid/bijlagen-bij-wob-besluit-overtabaksbeleid.pdf
141. Tweede Kamer. (2013-2014). Handelingen 7, 19. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20132014-7-19.html
142. Tweede Kamer. (2013-2014). Handelingen 12, 15. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20132014-12-15.html
143. Monshouwer, K., Verdurmen, J., Ketelaars, T., & van Laar, M. W. (2014). Point of sale of tobacco products:
Synthesis of scientific and practice-based knowledge on the impact of reducing the number of points of sale
and restrictions on tobacco product displays. Utrecht: Trimbos-instituut.
144. Gerritsen, M., Van der Voort, J., Rougoor, W., Smits, T., & Huizer, S. (2014). Economische effecten beperken
verkooppunten tabak: Omzet- en werkgelegenheidseffecten verkooppunten als gevolg van verbod
tabaksverkoop. Amsterdam: SEO Economisch Onderzoek. Retrieved from http://www.seo.nl/uploads/
media/2014-30_Economisch_effecten_beperken_verkooppunten_tabak.pdf
145. Tweede Kamer. (2000-2001). 26 472, nr. 7. Retrieved from https://zoek.officielebekendmakingen.nl/kst26472-7.html
146. Moodie, C., Stead, M., Bauld, L., McNeill, A., Angus, K., Hinds, K., Kwan, I., Thomas, J., Hastings, G., & O’MaraEves, A. (2012). Plain tobacco packaging: a systematic review. Stirling: University of Stirling. Retrieved from
http://eprints.ioe.ac.uk/16381/1/Moodie_et_al._2012._Plain_Tobacco_Packaging._A_Systematic_Review.
pdf
147. Rechtbank Den Haag. (2014, February 5). ECLI 2014, 1365. Retrieved from http://uitspraken.rechtspraak.nl/
inziendocument?id=ECLI:NL:RBDHA:2014:1365
148. Lyons, T. (2014, September 19). Italy joins EU states objecting to Irish plan for plain cigarette packs. The Irish
Times. Retrieved from http://www.irishtimes.com/business/health-pharma/italy-joins-eu-states-objectingto-irish-plan-for-plain-cigarette-packs-1.1933916
149. Tweede Kamer. (2013-2014). Aanhangsel 1150. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-1150.html
150. Tweede Kamer. (2013-2014). Aanhangsel 2919. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-2919.html
151. Kwaliteitsinstituut voor de Gezondheidszorg CBO. (2004). Richtlijn Behandeling van tabaksverslaving.
Utrecht: CBO. Retrieved from http://www.partnershipstopmetroken.nl/wp-content/uploads/2013/01/
RichtlijnTabaksverslaving2004_000.pdf
106
Dutch Tobacco Control: Moving Towards the Right Track?
152. Partnership Stop met Roken. (2009). Richtlijn Behandeling van tabaksverslaving, herziening 2009. Den
Haag: Partnership Stop met Roken. Retrieved from http://www.partnershipstopmetroken.nl/wp-content/
uploads/2013/05/RichtlijnTabaksverslavingActualisatie2009definitief.pdf
153. Willems, E. (2009). Zorgmodule Stoppen met roken. Den Haag: Partnership Stop met Roken. Retrieved from
http://www.partnershipstopmetroken.nl/wp-content/uploads/2013/01/ZorgmoduleStoppenmetRoken_
PartnershipStopmetRoken_2009.pdf
154. Stoppen-met-rokenprogramma, Regeling NR/CU-713. Staatscourant 2013, 701. Retrieved from https://zoek.
officielebekendmakingen.nl/stcrt-2013-701.html.
155. Pieterse, H. (2013, January). Sociale kaart. In Feite de Professional, 11(20), p. 19. Retrieved from http://
stivoro.nl/wp-content/uploads/nieuwsbrieven/In%20Feite/infeiteprofessional0113_3.pdf
156. Trimbos-instituut. (2013, September 13). Nieuwe wegwijzer Stoppen met roken online. Retrieved December
22, 2014, from http://www.trimbos.nl/nieuws/trimbos-nieuws/sociale-kaart-roken-online
157. Willems, E., & Van Dongen, T. (2011). Hulp nodig bij stoppen met roken? Den Haag: Partnership Stop
met Roken. Retrieved from http://www.partnershipstopmetroken.nl/wp-content/uploads/2013/01/
FolderHulpnodigbijStoppenmetRoken_000.pdf
158. Chavannes, N. H., Kaper, J., Frijling, B. D., Van der Laan, J. R., Jansen, P. M. W., Guerrouj, S., Drenthen, A. J. M.,
Bax, W., & Wind, L. A. (2007). NHG-Standaard Stoppen met roken. Huisarts Wet, 50(7), 306-314.
159. Kotz, D., Willemsen, M. C., Brown, J., & West, R. (2013). Light smokers are less likely to receive advice to quit
from their GP than moderate-to-heavy smokers: A comparison of national survey data from the Netherlands
and England. European Journal of General Practice, 19(2), 99-105.
160. Van den Berg, M. J., De Boer, D., Gijsen, R., Heijink, R., Limburg, L. C. M., & Zwakhals, S. L. N. (2014).
Zorgbalans 2014: De prestaties van de Nederlandse gezondheidszorg (RIVM Rapport 2014-0038). Bilthoven:
Rijksinstituut voor Volksgezondheid en Milieu (RIVM). Retrieved from http://www.rivm.nl/dsresource?objecti
d=rivmp:262269&type=org&disposition=inline&ns_nc=1
161. Inspectie voor de Gezondheidszorg (IGZ). (2012). Staat van de gezondheidszorg 2012. Preventie in de
curatieve en langdurige zorg: noodzaak voor kwetsbare groepen. Utrecht: IGZ. Retrieved from http://www.igz.
nl/zoeken/download.aspx?download=Staat+van+de+Gezondheidszorg+(SGZ)+2012.pdf
162. Oude Wesselink, S. F., Lingsma, H. F., Reulings, P. G. J., Wentzel, H. R., Erasmus, V., Robben, P. B. M., &
Mackenbach, J. P. (2014). Does Government Supervision Improve Stop-Smoking Counseling in Midwifery
Practices? Nicotine & Tobacco Research. Advance online publication. doi:10.1093/ntr/ntu190
163. Inspectie voor de Gezondheidszorg (IGZ). (2014). Verloskundige samenwerkingsverbanden: acute zorg
veiliger, preventie is blijven liggen. Utrecht: IGZ. Retrieved from http://www.igz.nl/Images/2014-06%20
Verloskundige%20samenwerkingsverbanden_tcm294-351518.pdf
164. Tweede Kamer. (2014-2015). Aanhangsel 229. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20142015-229.html
165. Trimbos-instituut. (2014, November 12). Nieuwe materialen ondersteuning rokende zwangeren.
Retrieved December 22, 2014, from http://www.trimbos.nl/nieuws/trimbos-nieuws/nieuwe-materialenondersteuning-rokende-zwangeren
166. Borland, R., Li, L., Driezen, P., Wilson, N., Hammond, D., Thompson, M. E., Fong, G. T., Mons, U., Willemsen,
M. C., & McNeill, A. (2012). Cessation assistance reported by smokers in 15 countries participating in the
International Tobacco Control (ITC) policy evaluation surveys. Addiction, 107(1), 197-205.
167. Willems, R. A., Willemsen, M. C., Smit, E. S., Nagelhout, G. E., Janssen, E., & De Vries, H. (2013). Which smoking
cessation aids are proven effective according to smokers who want to quit smoking? A report from the
Netherlands. Tobacco control. Advance online publication. doi:10.1136/tobaccocontrol-2013-051076
168. Kroes, M. E. (2008). Begeleiding bij stoppen met roken: verzekerde zorg? Diemen: College voor
zorgverzekeringen (CVZ). Retrieved from http://www.zorginstituutnederland.nl/binaries/content/
documents/zinl-www/documenten/publicaties/rapporten-en-standpunten/2008/0806-begeleiding-bijstoppen-met-roken-verzekerde-zorg/Begeleiding+bij+stoppen+met+roken%3A+verzekerde+zorg.pdf
169. Besluit van 7 juli 2010 tot vaststelling van het tijdstip van inwerkingtreding van de onderdelen B, C en D
van artikel I, voor zover het betreft zorg bij stoppen-met-rokenprogramma, van het koninklijk besluit van 31
augustus 2009, houdende wijziging van het Besluit zorgverzekering in verband met aanpassingen in de te
verzekeren prestaties en in de regels voor het eigen risico per 1 januari 2010. Staatsblad 2010, 303. Retrieved
from https://zoek.officielebekendmakingen.nl/stb-2010-303.html.
170. Besluit van 30 september 2011, houdende wijziging van het Besluit zorgverzekering in verband met wijziging
van de te verzekeren prestaties Zorgverzekeringswet per 2012 en de eigen bijdragen daarvoor en wijziging van
dat besluit en het Besluit zorgaanspraken AWBZ in verband met stringent pakketbeheer en wijziging van het
Besluit tegemoetkoming chronisch zieken en gehandicapten. Staatsblad 2011, 467. Retrieved from https://
zoek.officielebekendmakingen.nl/stb-2011-467.html.
FCTC Shadow Report 2014
107
171. Besluit van 13 oktober 2012, houdende wijziging van onder meer het Besluit zorgverzekering en het Besluit
zorgaanspraken AWBZ in verband met maatregelen 2013 in het zorgpakket. Staatsblad 2012, 512. Retrieved
from https://zoek.officielebekendmakingen.nl/stb-2012-512.html.
172. Regeling van de Minister van Volksgezondheid, Welzijn en Sport van 17 november 2010, Z/VU-3032705,
houdende vaststelling van het maximumbedrag aan eigen risico 2011, wijziging van de Regeling
zorgverzekering in verband met indexering van een eigen bijdragebedrag en wijzing van de Regeling van 14 juli
2010 (Stcrt. 11513). Staatscourant 2010, 18501. Retrieved from https://zoek.officielebekendmakingen.nl/
stcrt-2010-18501.html.
173.Regeling van de Minister van Volksgezondheid, Welzijn en Sport van 26 november 2013, kenmerk Z-167189112798, houdende vaststelling van het maximumbedrag aan eigen risico 2014. Staatscourant 2013, 33835.
Retrieved from https://zoek.officielebekendmakingen.nl/stcrt-2013-33835.html
174. Nederlandse Zorgautoriteit (NZA). (2014). Rapportage Evaluatie aspecten verplicht eigen risico 2012 en
2013. Utrecht: NZA. Retrieved from http://www.nza.nl/104107/138040/Rapport_Betalingsregelingen_en_
Sturing_verplicht_eigen_risico_2012_2013.pdf
175. Moerkamp, A. [Chairman Board of Directors National Health Care Institute]. (2014, April 4). Toepassing
pakketcriterium noodzakelijkheid en afbakening domein gezondheidszorg [letter to the Minister of Health].
Retrieved from http://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/brieven/2014/05/13/
brief-toepassing-pakketcriterium-noodzakelijkheid-en-afbakening-domein-gezondheidszorg/brieftoepassing-pakketcriterium-noodzakelijkheid-en-afbakening-domein-gezondheidszorg.pdf
176. Bes, R., Kerpershoek, E., Brabers, A., Reitsma-van Rooijen, M., Curfs, E., & De Jong, J. (2014). Wat hoort er in
het basispakket volgens verzekerden? Utrecht: NIVEL. Retrieved from http://www.nivel.nl/sites/default/files/
bestanden/Rapport-wat-hoort-bij-basispakket-volgens-verzekerden.pdf
177. Willemsen, M. C., Segaar, D., & Schayck, O. C. (2013). Population impact of reimbursement for smoking
cessation: a natural experiment in the Netherlands. Addiction, 108(3), 602-604.
178. Verbiest, M. E., Chavannes, N. H., Crone, M. R., Nielen, M. M., Segaar, D., Korevaar, J. C., & Assendelft, W. J.
(2013). An increase in primary care prescriptions of stop-smoking medication as a result of health insurance
coverage in the Netherlands: population based study. Addiction, 108(12), 2183-2192.
179. Nagelhout, G. E., Willemsen, M. C., Van den Putte, B., De Vries, H., Willems, R. A., & Segaar, D. (2014).
Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation
treatment and on smoking cessation: a real-world study in the Netherlands. Tobacco control. Advance online
publication. doi:10.1136/tobaccocontrol-2013-051430
180. Lotterman, L. (2013, January). STIVORO gaat voor een effectief nationaal tabaksontmoedigingsbeleid. In
Feite de Professional, 11(20), pp. 4-6. Retrieved from http://stivoro.nl/wp-content/uploads/nieuwsbrieven/
In%20Feite/infeiteprofessional0113_3.pdf
181. Goossens, F. (2014). Jaarbericht 2013: Publieksinformatie. Utrecht: Trimbos-instituut. Retrieved from http://
www.trimbos.nl/webwinkel/productoverzicht-webwinkel/alcohol-en-drugs/af/~/media/files/gratis%20
downloads/af1276%20jaarbericht%20publieksinformatie%202013.pdf
182. Stoptober. (2014). Toelichting professionals Stoptober. Retrieved from http://www.trimbos.nl/webwinkel/~/
media/files/gratis%20downloads/pfg81046_toelichting%20professionals%20stoptober.pdf
183. Brown, J., Kotz, D., Michie, S., Stapleton, J., Walmsley, M., & West, R. (2014). How effective and cost-effective was
the national mass media smoking cessation campaign ‘Stoptober’? Drug and alcohol dependence, 135, 52-58.
184. Centrum voor jeugd en gezin Zuidplas. (n.d.). Eerste Stoptober succes! Retrieved December 22, 2014, from
http://www.cjgzuidplas.nl/shownews.asp?nws_id=3077
185. Marketing Tribune. (2014, November 27). Terugblik op eerste Stoptober in Nederland. Retrieved December
22, 2014, from http://www.marketingtribune.nl/zorg/nieuws/2014/11/terugblik-op-eerste-stoptober-innederland/index.xml
186. Algemene Rekenkamer. (2012). Bestrijding van accijnsfraude bij alcohol en tabak. EU-beleid: naleving en
effecten. Den Haag: Algemene Rekenkamer. Retrieved from http://www.rekenkamer.nl/dsresource?objectid=
3435&type=org
187. Tweede Kamer. (2013-2014). 33 930 IX, nr. 7. Retrieved from https://zoek.officielebekendmakingen.nl/kst33930-IX-7.html
188. Tweede Kamer. (2013-2014). 33 750 V, nr. 62, bijlage 302399. Retrieved from https://zoek.
officielebekendmakingen.nl/blg-302399.pdf
189. European Commission. (2013). Stepping up the fight against cigarette smuggling and other forms of illicit
trade in tobacco products - A comprehensive EU Strategy [COM(2013) 324 final]. Retrieved from http://
ec.europa.eu/anti_fraud/documents/2013-cigarette-communication/communication_en.pdf
190. Tweede Kamer. (2012-2013). 22112, nr. 1660. Retrieved from https://zoek.officielebekendmakingen.nl/kst22112-1660.html
108
Dutch Tobacco Control: Moving Towards the Right Track?
191. European Commission. (2012). Impact assessment accompanying the document Proposal for a directive of
the European Parlaiment and of the Council on the approximation of the laws, regulations and administrative
provisions of the member states concerning the manufacture, presentation and sale of tobacco and related
products [SWD(2012) 452 final, Part 1]. Retrieved from http://ec.europa.eu/health/tobacco/docs/
com_2012_788_ia_en.pdf
192. Douane. (2013). Procedure accijnszegels. Retrieved from http://download.belastingdienst.nl/douane/docs/
brochure_aanvragen_accijnszegels_acc0241z3fd.pdf
193. Tweede Kamer. (2011-2012). 33 003, nr. 3. Retrieved from https://zoek.officielebekendmakingen.nl/kst33003-3.html
194. Tweede Kamer. (2012-2013). 33 522, nr. 6. Retrieved from https://zoek.officielebekendmakingen.nl/kst33522-6.html
195. European Parliament. (2013). P7_TA(2013)0398. Retrieved from http://www.europarl.europa.eu/sides/
getDoc.do?type=TA&language=EN&reference=P7-TA-2013-398
196. Tweede Kamer. (2013-2014). 33 522, nr. 7. Retrieved from https://zoek.officielebekendmakingen.nl/kst33522-7.html
197. Joossens, L., & Gilmore, A. B. (2014). The transnational tobacco companies’ strategy to promote Codentify,
their inadequate tracking and tracing standard. Tobacco control, 23(e1), e3-e6.
198. Gilmore, A. B., Rowell, A., Gallus, S., Lugo, A., Joossens, L., & Sims, M. (2013). Towards a greater understanding
of the illicit tobacco trade in Europe: a review of the PMI funded ‘Project Star’report. Tobacco control,
tobaccocontrol-2013-051240.
199. World Health Organization (WHO). (2013). WHO FCTC Indicator Compendium (1st edition). Retrieved from
http://www.who.int/fctc/reporting/who_fctc_indicator_compendium_first_edition.pdf
200. Rijksoverheid. (2014). Sigarettenvangsten in Nederland 2011-2013. Retrieved from http://www.
rijksoverheid.nl/bestanden/documenten-en-publicaties/rapporten/2014/04/24/sigarettenvangsten-innederland-2011-2013/sigarettenvangsten-in-nederland-tm-2013.pdf
201. Rijksoverheid. (2011). Sigarettenvangsten in Nederland tot 2011.
202. Rijksoverheid. (2013, November 18). NIX18 campagne afgetrapt door staatssecretaris Van Rijn en Ronald
Koeman [video clip]. Retrieved December 22, 2014, from http://www.rijksoverheid.nl/nieuws/2013/11/18/
nix18-campagne-afgetrapt-door-staatssecretaris-van-rijn-en-ronald-koeman.html
203. NSO [Branch organisation for tobacco retailers]. (2013, November 27). Tabaksverkopers vragen jongeren
tot 25 jaar legitimatie te laten zien! Retrieved December 22, 2014, from http://www.tabaksdetailhandel.nl/
actueel/news/344/Tabaksverkopers+vragen+jongeren+tot+25+jaar+legitimatie+te+laten+zien!
204. Centraal Bureau Levensmiddelenhandel (CBL). (n.d.). Leeftijdsgrens naar 18 jaar. Retrieved December 22,
2014, from http://www.cbl.nl/activiteiten/lobby-en-wetgeving/alcohol-en-tabak/leeftijdsgrens-naar-18-jaar/
205. Rechtbank Rotterdam. (2008, July 3). LJN BD9146. Retrieved from http://uitspraken.rechtspraak.nl/inziendo
cument?id=ECLI:NL:RBROT:2008:BD9146
206. Tweede Kamer. (2012-2013). Aanhangsel 2379, bijlage. Retrieved from http://www.rijksoverheid.nl/
bestanden/documenten-en-publicaties/rapporten/2013/05/27/overzicht-handhavingsinspectiesleeftijdsgrenzen-verkoop-tabak-2003-2012/overzicht-handhavingsinspecties-leeftijdsgrenzen-verkooptabak-2003-2012.pdf
207. Tweede Kamer. (2012-2013). Aanhangsel 2379. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20122013-2379.html
208. Verdurmen, J., Monshouwer, K., & Van Laar, M. (2014). Factsheet Roken Jeugd Monitor 2013. Utrecht:
Trimbos-instituut. Retrieved from http://www.trimbos.nl/~/media/files/gratis%20downloads/af1266%20
factsheet%20roken%20jeugd%20monitor%202013.pdf
209. Bieleman, B., Kruize, A., & Zimmerman, C. (2010). Monitor tabaksverstrekking jongeren 2009. Naleving
leeftijdsgrens 16 jaar: Tweejaarlijkse metingen 1999-2009. Groningen: Intraval. Retrieved from http://www.
intraval.nl/pdf/MTN09.pdf
210. Tweede Kamer. (2013-2014). 33 738, nr. 7. Retrieved from https://zoek.officielebekendmakingen.nl/kst33738-7.html
211. Rechtbank Noord-Holland. (2014, September 11). ECLI 2014, 9474. Retrieved from http://uitspraken.
rechtspraak.nl/inziendocument?id=ECLI:NL:RBNHO:2014:9474
212. Buisman, R. S. M., Mulder, J., & Van Laar, M. W. (2014). Leeftijdsverificatie in het vizier: Een explorerend
onderzoek naar leeftijdsverificatiehulpmiddelen en -systemen voor de verkoop van tabak. Utrecht:
Trimbos-instituut. Retrieved from http://www.trimbos.nl/~/media/files/gratis%20downloads/af1303_
rapportageleeftijdsverificatie%20in%20het%20vizier%20def.pdf
213. Oostdijk, A., Van den Nieuwenhuizen, D., & Van Noort, M. (2014). De toepassing van (elektronische) leeftijds­
verificatie­hulpmiddelen & -systemen bij alcohol- en tabaksverkoop: Uitkomsten van een praktijkinventarisatie.
Utrecht: Berenschot. Retrieved from https://zoek.officielebekendmakingen.nl/blg-355945.pdf
FCTC Shadow Report 2014
109
214. Tweede Kamer. (2012-2013). Aanhangsel 2049. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20122013-2049.html
215. Tweede Kamer. (2013-2014). Aanhangsel 784. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20132014-784.html
216. Tweede Kamer. (2012-2013). 32 793, nr. 100. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-100.html
217. Tweede Kamer. (2014-2015). Aanhangsel 796. Retrieved from https://zoek.officielebekendmakingen.nl/
ah-tk-20142015-796.html
218. Roodbeen, R., Lie, K. J., & Schelleman-Offermans, K. (2014). Alcoholverkoop aan jongeren 2013: Ontwikkeling
in de landelijke naleving van de leeftijdsgrenzen. Nijmegen: Nuchter, Kenniscentrum leeftijdsgrenzen.
Retrieved from http://nuchter.nl/wp-content/uploads/2014/01/AlcoholverkoopAanJongeren2013_
NUCHTER.pdf
219. Tweede Kamer. (2013-2014). Handelingen 98, 13. Retrieved from https://zoek.officielebekendmakingen.
nl/h-tk-20132014-98-13.html
220. Tweede Kamer. (2013-2014). 26 643, 299. Retrieved from https://zoek.officielebekendmakingen.nl/kst26643-299.html
221. Tweede Kamer. (2012-2013). 33 522, nr. 5. Retrieved from https://zoek.officielebekendmakingen.nl/kst33522-5.html
222. ZonMw. (2009). Vierde programma Preventie 2010-2014: Vernieuwing voor Langer Gezond Leven. Den
Haag: ZonMw. Retrieved from http://www.zonmw.nl/uploads/tx_vipublicaties/Programmatekst_PP4_18_
mei_2009_definitief1.pdf
223. ZonMw. (2014). 5e Programma Preventie 2010-2014: Preventie op koers. Den Haag: ZonMw. Retrieved from
http://www.zonmw.nl/uploads/tx_vipublicaties/PP5_Programmatekst_PP5_01.pdf
224. Bouwens, J., Kleinjan, M., Peters, L., & Van den Eijnden, R. (2007). Aanbevelingen onderzoek en
implementatie op het terrein van de aanpak van roken - Adviesdocument. Adviesdocument in het kader van de
Programeerstudie Roken in opdracht van ZonMw. Woerden: Nationaal Instituut voor Gezondheidsbevordering
en Ziektepreventie (NIGZ).
225. Trimbos-instituut [Chairman Board of Directors]. (2013, April 22). Rokenmonitors 2014 [letter to Ministry
of Health]. Retrieved from https://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/wobverzoeken/2014/11/14/bijlagen-bij-wob-besluit-over-tabaksbeleid/bijlagen-bij-wob-besluit-overtabaksbeleid.pdf
226. Tweede Kamer. (2014-2015). 32 793, nr. 161. Retrieved from https://zoek.officielebekendmakingen.nl/kst32793-161.html
227. Huijts, P. H. A. M. [Director-general for Public Health]. (2011, May 25). Gevolgen voor uw instelling van
beleid ‘Gezondheid dichtbij’ [letter to STIVORO]. Retrieved from http://www.rijksoverheid.nl/bestanden/
documenten-en-publicaties/wob-verzoeken/2013/04/05/documenten-99-106-bij-wob-verzoekcontacten-vws-met-tabaksindustrie/deel-11-openbaargemaakte-doc-99-106.pdf
228. Walburg, J. A. [Chairman Board of Directors Trimbos Institute]. (2012, November 27). Nationaal
Expertisecentrum Tabaksontmoediging van start per 1 januari 2013 [letter to State Secretary for
Health]. Retrieved from http://www.rijksoverheid.nl/bestanden/documenten-en-publicaties/wobverzoeken/2013/04/05/documenten-107-110-bij-wob-verzoek-contacten-vws-met-tabaksindustrie/deel12-openbaargemaakte-doc-107-110.pdf
229. Joossens, L., & Raw, M. (2007). Progress in tobacco control in 30 European countries, 2005 to 2007. Berne:
Swiss Cancer League. Retrieved from http://old.ensp.org/files/30_european_countries_text_final.pdf
230. Joossens, L., & Raw, M. (2006). The Tobacco Control Scale: a new scale to measure country activity [webonly figure]. Tobacco control, 15(3), 247-253.
231. Joossens, L. (2004). Effective tobacco control policies in 28 European countries. Brussels: European Network
for Smoking Prevention (ENSP). Retrieved from http://old.ensp.org/files/effectivefinal2.pdf
232. Tweede Kamer. (2013-2014). 33 750 XVI, nr. 13. Retrieved from https://zoek.officielebekendmakingen.nl/
kst-33750-XVI-13.html
233. Tweede Kamer. (2014-2015). 34 000 XVI, nr. 2. Retrieved from https://zoek.officielebekendmakingen.nl/kst34000-XVI-2.html
234. Tweede Kamer. (2012-2013). 33 400 XVI, nr. 12. Retrieved from https://zoek.officielebekendmakingen.nl/
kst-33400-XVI-12.html
235. Tweede Kamer. (2013-2014). 33 750 XVI, nr. 2. Retrieved from https://zoek.officielebekendmakingen.nl/kst33750-XVI-2.html
110
Dutch Tobacco Control: Moving Towards the Right Track?