Education And Debate

Socioeconomic inequalities in health in the Netherlands: impact of a five year research programme

BMJ 1994; 309 doi: (Published 03 December 1994) Cite this as: BMJ 1994;309:1487
  1. Johan P Mackenbach, professor of public healtha
  1. a Department of Public Health, Erasmus University, Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands
  • Accepted 7 November 1994

The attention paid to the socioeconomic inequalities in health in the Netherlands has increased greatly in recent years. A national research programme was started in 1989, and among other things, this has increased the yearly number of publications on socioeconomic inequalities in health by about 25%. The programme has increased awareness of inequalities among researchers and policy makers as well as improved the information available on health inequalities and the reasons for them. Cross party agreement on the need to reduce these inequalities has led to a consensus based approach which contrasts with the heavily politicised debate in countries such as the United Kingdom.

The publication of the Black report in 19801 and the inclusion of a reduction of health inequalities among the World Health Organisation's Health for All policy targets in 19852 has increased interest in socioeconomic inequalities in health in many countries. In the Netherlands, socioeconomic inequalities in health were politically a non-issue until the second half of the 1980s. In 1980 the Dutch Society for Social Medicine celebrated its 50th anniversary with a conference on socioeconomic inequalities in health,3 and the results of a thorough study of inequalities between neighbourhoods in Amsterdam were published,4 but neither of these initiatives was given political follow up. The position changed radically, however, after the Dutch government adopted the Health For All policy targets, and in 1986 the ministry of welfare, public health, and cultural affairs included a paragraph on inequalities in health in an important policy document.5

After that, initiatives were taken from inside the ministry to put equity in health on the political agenda.6 In 1987 a conference was organised under the aegis of the prestigious Scientific Council for Government Policy, and widespread press coverage was arranged for the publication of its proceedings. …

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