Opkomst en neergang van ziekten in Nederland: Succes en falen van de publieke gezondheidszorg in langetermijnperspectief

The increase in life expectancy at birth is the result of the rise and fall of mortality from a large number of separate diseases. The fact that so many diseases show a pattern of rise-and-fall is due to the fact that both rise and fall are often a direct or indirect consequence of socio-economic developments. These lead on the one hand to exposure to new health risks, on the other hand to more possibilities to combat health risks, in the form of public health or medical care. This paradoxical phenomenon is illustrated with historical European examples, and then the question is raised of how Dutch experiences in this area relate to those of other countries, in particular Sweden, which has long been one of the most successful countries in the field of preventive health policy. Only around the middle of the twentieth century did the Netherlands surpass Sweden, in particular in terms of reducing infant mortality, but since then the Netherlands has fallen back into a European ‘sub-top’, partly due to a lack of decisive anti-smoking policy. This indicates that public health in the Netherlands can do better, by looking for a success formula that fits the health problems of the twenty-first century.