Intended for healthcare professionals

Education And Debate

A strategy for tackling health inequalities in the Netherlands

BMJ 2002; 325 doi: (Published 02 November 2002) Cite this as: BMJ 2002;325:1029
  1. Johan P Mackenbach (, professora,
  2. Karien Stronks, associate professorb
  1. a Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands
  2. b Department of Social Medicine, Academic Medical Centre/University of Amsterdam, Netherlands
  1. Correspondence to: J P Mackenbach

    The Netherlands ministry of health has undertaken systematic research into inequalities in health. Twelve different interventions have been tried and evaluated, and from the results an independent advisory committee has devised a strategy to reduce inequalities by 2020

    Socioeconomic inequalities in health are a major challenge for health policy worldwide,1 and several countries are struggling to develop realistic and effective programmes for reducing them. In Britain the Acheson committee2 and in Sweden the National Public Health Committee have developed recommendations and policy targets that are intended to reduce inequalities in health.3 In this article we describe the approach followed in the Netherlands.

    The Dutch ministry of health has over the past 10 years commissioned systematic research into the problem. An initial five year research programme mapped the nature and determinants of socioeconomic inequalities in health in the Netherlands,4 and some of the key findings are presented in the table.510 Health inequalities and their explanation in the Netherlands are largely similar to those in other countries in western Europe. 6 8 11 A second, six year, programme was launched in 1994 to gain systematic experience with interventions and policies designed to reduce health inequalities.

    Summary points

    The Netherlands has pursued a systematic, research based approach to develop a strategy for reducing socioeconomic inequalities in health

    Twelve evaluation studies were conducted to study the effectiveness of different interventions

    A government advisory committee developed a strategy covering four different entry points for reducing socioeconomic inequalities in health, containing 26 specific recommendations and 11 quantitative policy targets

    We need international exchange of experiences with developing and implementing interventions and policies to reduce socioeconomic inequalities in health in order to increase learning speed in this field


    The main focus of the programme was on developing and evaluating interventions and policies, …

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