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BMJ. 2007 June 23; 334(7607): 1292–1293.
PMCID: PMC1895692

Netherlands bans smoking in enclosed public places but allows closed smoking rooms

Smoking is to be banned in all Dutch cafes, restaurants, hotels, and sports facilities from July 2008, when the Netherlands' government axes the previous unsuccessful policy of industry self regulation.

Ministers rejected the hospitality industry's proposal to phase out smoking gradually by 2011, provoking a furious response from the industry's umbrella body, Royal Dutch Horeca, which accused the government of being unreliable.

Doctors welcomed the ban while calling for tougher government action on a range of unhealthy lifestyles. National opinion polls show that 64% of the public support an immediate ban.

The government, formed this year, has sought a new approach, with the health minister, Ab Klink, calling for a total ban from January 2008. The cabinet chose July to allow the tobacco industry time to adjust.

Mr Klink told MPs that an evaluation of the current self regulation showed that areas reserved for non-smokers mostly accounted for less than a quarter of the total places accessible to the public. Most cafes and restaurants had a maximum of five tables. Self regulation, he concluded, would clearly not protect employees.

A blanket ban was chosen to offer all employees the same health protection as in other industries. Cafes, restaurants, and hotels that fear a loss of trade can choose to set up separate closed smoking rooms, but staff will not serve customers in these areas. MPs had asked whether the ban should apply to so called coffee shops, where cannabis smoking is permitted. The government's solution is to require cannabis to be sold in an area separate from a closed smoking area so that employees of the coffee shop maintain their legal right to a smoke-free workplace and customers can buy cannabis without having to enter a room in which people are smoking.

Data from the European Commission show that the Netherlands' strong tradition of smoking is changing. It has a relatively low proportion of people who have never smoked, 40%, but also the highest proportion of former smokers, at 30% (www.ec.europa.eu/health).

Doctors say that smoking is the main cause of ill health in the Netherlands. Lung cancer accounts for about 8000 deaths a year, the second greatest cause of death among men, with rates rising significantly among women. Nico van Zandwijk, head of thoracic oncology at the Dutch Cancer Institute, says that smoking is a serious problem and remains popular among young people who visit cafes. “I believe the ban will have a large influence. We will gradually see more and more people quitting,” he said.

The Dutch Medical Association is urging the government to tackle all unhealthy lifestyles with a sharper and more powerful prevention policy. Its report, Public Health and Prevention, warns that if such a policy is not adopted then the average number of years of healthy living will begin to decline. Its author, Han Willems, says that the association can apply pressure but “only the government can regulate . . . it has the key to public health; if it can't, or won't, act little can be achieved.”


Articles from The BMJ are provided here courtesy of BMJ Publishing Group