Neoliberalismo e Historia Una apuesta metodológica: de la perspectiva de la

ARTICLE 20.1

THE PARTIES UNDERTAKE TO DEVELOP AND PROMOTE NATIONAL RESEARCH IN THE FIELD OF TOBACCO CONTROL. TOWARDS THIS END, EACH PARTY SHALL: (A) INITIATE AND COOPERATE IN THE CONDUCT OF RESEARCH AND SCIENTIFIC ASSESSMENTS, AND IN SO DOING PROMOTE AND ENCOURAGE RESEARCH THAT ADDRESSES THE DETERMINANTS AND CONSEQUENCES OF TOBACCO CONSUMPTION AND ExPOSURE TO TOBACCO SMOKE; AND (B) PROMOTE AND STRENGTHEN TRAINING AND SUPPORT FOR ALL THOSE ENGAGED IN TOBACCO CONTROL ACTIVITIES, INCLUDING RESEARCH, IMPLEMENTATION AND EVALUATION.

In relation to Article 20.1, which requires the Parties to develop and coordinate a research programme in the field of tobacco control, no major changes have taken place since the first shadow report. There is no separate fund for tobacco control-related research. The coordination of government-sponsored scientific research in the area of prevention is allocated to the Netherlands Organisation for Health Research and Development (ZonMw), which receives targets and guidelines from the Ministry of Health. In ZonMw’s Fourth Prevention Programme, covering the period 2010-2014 and a total budget of €  47.8 million, few explicit references to tobacco research were included222_{. It was possible to}

submit research applications in the area of tobacco control, especially when the research would contribute to the development or implementation of evidence-based educational interventions (for use in local settings), or address the social and physical determinants of smoking behaviour. Research on the cost-effectiveness of existing tobacco prevention interventions was also eligible for subsidies. However, research addressing the determinants or consequences of (passive) smoking was not. The Ministry does regularly commission the National Institute for Public Health and the Environment (RIVM) to conduct research regarding the health consequences of smoking.

In June 2014, ZonMw published the Fifth Prevention Programme223_{. This new research programme,}

which will run until 2018, supports the Ministry of Health’s new national prevention policy “Everything is Health” (Alles is Gezondheid) (see also the chapter on Article 5). Although tobacco use is one of the policy’s priorities, no tobacco-specific research priorities have been identified in the new programme and the possibilities to submit applications for tobacco control research have been severely restricted. The focus is on youth and only research that addresses interventions that can be implemented at the local level is eligible for subsidy. These restrictions are detrimental to research aimed at national measures and the adult population of smokers, an important target group of FCTC measures. The previous shadow report recommended that the government should set out a new study to identify and establish priorities for tobacco control research. The previous priority assessment, which was drawn up in 2007, is now outdated224_{. However, such an initiative has not yet been}

ARTICLE 20.2

THE PARTIES SHALL ESTABLISH, AS APPROPRIATE, PROGRAMMES FOR NATIONAL, REGIONAL AND GLOBAL SURVEILLANCE OF THE MAGNITUDE, PATTERNS, DETERMINANTS AND CONSEQUENCES OF TOBACCO CONSUMPTION AND ExPOSURE TO TOBACCO SMOKE.

ARTICLE 20.3

EACH PARTY SHALL ENDEAVOUR TO ESTABLISH PROGRESSIVELY A NATIONAL SYSTEM FOR THE EPIDEMIOLOGICAL SURVEILLANCE OF TOBACCO CONSUMPTION AND RELATED SOCIAL, ECONOMIC AND HEALTH INDICATORS

The previous shadow report applauded the Dutch government for its surveillance programmes in the area of tobacco control. In particular, the Continuous Survey of Smoking Habits (COR) and the Smoking Youth Monitor (RJM) were considered to be of a very high quality. However, by now the government has decided to discontinue both monitors. This decision does not fit well with the Convention’s encouragement to progressively establish a national system for the epidemiological surveillance of tobacco consumption. ‘Progressively’ implies that Parties work to improve their surveillance and monitoring systems. In the Netherlands we see a deterioration. The ramifications of the decision to discontinue these monitors are profound. With regard to the surveillance of tobacco consumption among adults, there will be much less flexibility and a lower number of respondents. As part of the Statistics Netherlands (CBS) Health Survey, a limited number of key variables will be measured once every year (instead of once every quarter), and additional questions will be asked only once every two years55_{. Consequently, there will be less data available to monitor important topics such}

as exposure to secondhand smoke at home, the use of smoking cessation aids by smokers, and the smoking cessation advice and support given by health professionals to smokers225_{. Moreover, given}

the smaller number of respondents, it will be much harder to draw conclusions in terms of annual trends in smoking prevalence. A 1% decrease in observed smoking prevalence will no longer suffice to conclude that there has been a (significant) decrease in smoking prevalence in the population. This way, the surveillance data can no longer be used to assess the consequences of policies and, if necessary, adjust policies accordingly115_.

The changes also have substantial consequences for the surveillance of tobacco use among youth. The smoking behaviour of youth will no longer be measured on an annual basis. There will be a youth-targeted survey every two years: once every four years the Health Behaviour of School aged Children (HSBC) Study and once every four years the Dutch National School Survey on Substance Use (Peilstationsonderzoek). Whereas the former only includes children up to the age of 16, the latter only collects data from (secondary) schoolchildren225_{. Although the State Secretary for Health}

has announced that he intends to add school drop-outs to the sample226_{, the lack of coverage in}

comparison to the now defunct Smoking Youth Monitor (in time, and across age groups and education levels) remains remarkable, especially given the government’s focus on prevention of smoking among youth (see also the chapter on Article 16).

Conclusions and recommendations

The first Dutch FCTC shadow report established that only in the area of surveillance the Netherlands was performing in excess of its FCTC commitments. In December 2014, surveillance of tobacco consumption is the sole area in which an obvious backward trend has been observed since the previous shadow report. With regard to the promotion of scientific research, no improvements have been observed either. If anything, it appears to have become more difficult to obtain government subsidies for tobacco control research. In the summary table on implementation of the FCTC measures in the Netherlands in 2014 (Table 1b), the Dutch government received an overall ‘red score’ in relation to Article 20, because of its failure to comply with one of the obligations regarding research (see the scoring table below). Room for improvement also stems from the lack of compliance with one of the recommendations in relation to surveillance, which encourages progressive rather than regressive developments. The Dutch government is therefore urged to:

• Prioritise tobacco control research and take on a more pro-active role, by promoting and

strengthening the training of people working in tobacco control and stimulating tobacco control research that supports the implementation of the FCTC measures in the Netherlands. A new study should be initiated to identify research priorities in the field of tobacco control.

• Re-consider its position to discontinue the CoR and RJm.

Scores

FCTC provision Type of

commitment

Content Yes/No Score

20 1a Shall Initiate and cooperate in the conduct of research and

scientific assessments, and in so doing promote and encourage research that addresses the determinants and consequences of tobacco consumption and exposure to tobacco smoke.

Yes

20 1b Shall Promote and strengthen training and support for all

those engaged in tobacco control activities, including research, implementation and evaluation.

No

20 2 Shall Establish, as appropriate, programmes for national,

regional and global surveillance of the magnitude, patterns, determinants and consequences of tobacco consumption and exposure to tobacco smoke.

Yes

20 2 Should Integrate tobacco surveillance programmes into national,

regional and global health surveillance programmes so that data are comparable and can be analysed at the regional and international levels, as appropriate.

Yes

20 3a Shall endeavour Establish progressively a national system for the

epidemiological surveillance of tobacco consumption and related social, economic and health indicators.

Article 26