De effectiviteit van het overheidsbeleid op het gebied van publieke gezondheid : met name op het gebied van overgewicht, voeding en bewegen

Abstract

Obesity is a growing problem. The Dutch government has formulated different objectives in the last decades, aimed at diminishing the problem, but none of these objectives have been reached. Obesity among adults doesn't decline, obesity among children is increasing. Compared with the government policy on alcohol and tobacco, the government has less policy instruments available for the domains nutrition and moving. The emphasis is on stimulating healthy behavior by influencing individual and collective behavior. This influence can be directly or indirectly, by influencing the social and physical environment of the individual. The national government defines a big role for the local government (because of the possibilities on the local level for influencing behavior), but also gives the local authorities a lot of policy freedom. National policy itself is focused on supporting the execution of the policy by local authorities. The policy instruments on national level are used at a suboptimal level, cooperation between departments could me much more intensive. Various projects abroad (Finland, Epode in France) and in the Netherlands (Hartbeat Limburg, Healthy Weight Overvecht) lead to the conclusion that an integrated approach, with strong involvement of the population and a large variety of organizations, can diminish the problem of obesity. In the local public health reports, which each municipality has to formulate once in every four year, the elaboration of such an integrated approach is almost absent. As reasons for this phenomenon a lack of time, staff and budget are mentioned frequently, as well as a lack of commitment from the municipal board and other municipal departments. An important underlying cause seems to be a low sense of urgency by the aldermen, who are responsible for the local policy regarding the problem of overweight. If such a low sense of urgency coincides with other determinants in the theory of Kingdon, such as complex, obdurate solutions, the absence of focusing events and the absence of policy entrepreneurs, effective policy will be absent. Recommendations are therefore formulated for all these aspects.