The successes of prevention in the Netherlands.

On March 11, the department of Public Health of Erasmus University Medical Center celebrated its 40 anniversary with a symposium on the success of prevention in the Netherlands, in the period of 1970-2010. The symposium was well attended by almost all experts in the field, as well as representatives of policy and practice organisations.


The head of the department, Prof Johan Mackenbach provided an overview of the success of prevention. This overview is more extensively documented and described in the book that he edited on the topic (see the picture), and illustrated in a short documentary.

Mackenbach argued in his presentation that the successes of prevention are often rather unnoticed, because, indeed successful prevention prevents ill health or mortality, i.e. it prevents an event from happening. This relative invisibility of the success of prevention may be one of the important reasons why policy makers have less attention for prevention and are often less willing to invest in prevention (only a few percent of the national health care budget is invested in prevention).

The successes presented by Mackenbach were identified based on the following criteria:

1. The effectiveness of the preventive action, policy or intervention should be scientifically well-documented

2. The effect of the preventive intervention should have clearly caused a reduction in mortality or morbidity because of the disease that the intervention was aiming to prevent

The team that did the analyses came up with 5 fields of prevention, i.e. prevention regarding pregnancy and youth care, prevention regarding work & health, prevention of accidents and injuries, promoting health lifestyles, and medical preventative interventions.

In terms of prevention of deaths, the antismoking efforts were by far the most successful prevention intervention in the last 40 years, with more than 6900 deaths prevented per year. Other important successes are the removal of trans fatty acids from foodstuffs (1500 deaths per year avoided), the screening on and treatment of high blood pressure (3000 per year), and traffic safety measures (2000).

Writing papers for the energy project

The last few days I spend in Ghent. Part of the team of the Energy project met there to write a series of scientific papers on overweight, obesity and energy balance behaviors in European schoolchildren. Papers were prepared on the validity of the questionnaires used for data collection in the project, on sedentary behaviors among the children and the relation with metabolic function, and on mediators and moderators of dietary, physical activity and sedentary behaviors. All these papers are prepared to further inform obesity prevention efforts in this important target group.

Bregje Onwuteaka Philipsen inaugurated

Today prof. Bregje Onwuteaka Philipsen accepted her chair in End of Life Research. In the Netherlands about 135,000 people die annually. For about 90,000 of these people, their end of life is something they foresee and something they and their important others can prepare for in this phase of end of life care. Bregje Onwuteaka Philipsen, a recent 'Vici laureat', i.e. she received one of the most prestigious personal research grants available in the Netherlands, has conducted and will conduct and lead important research to inform and improve end of life care. In her inaugural address she provided an overview of work accomplished and work to be done.

Active transportation, e.g. walking or cycling to school or work, may contribute to energy balance, i.e. preventing unwanted weight gain, and prevent becoming overweight. Some studies have been conducted looking at the association between  active commuting to school and weight status among youth, but no clear conlusion can be drawn. Some recent studies suggest that cycling to school may make a bigger difference than walking to school. The purpose of our study, recently published in the Scandinavian Journal of Medicine and Science in Sport, (with Dr. Elling Bere as first author) was to assess the association between cycling to school and weight status in two cities, Rotterdam and Kristiansand, i.e. in the Netherlands and Norway, two countries where cycling to school remains common. Data from two studies, ENDORSE (Rotterdam) and Youth in Balance (Kristiansand), were used including, respectively, 1361 and 1197 adolescents around 14 years old. The adolescents were categorized as cyclist or non-cyclist based on questionnaires asking them about their usual mode of transportation to school. Twenty-five and 18% were categorized as overweight, and 35% and 31% were categorized as cyclists, in Rotterdam and Kristiansand, respectively. Further analyses showed that youth who cycled to school were about half as likely to be overweight than their peers who did not, after adjusting for a range of other possible 'reasons' for being overweight. These results thus suggest that cycling to school may 'protect' against overweight, but more rigorous research is necessary.

The protocol of the ENERGY cross sectional study now published

ENERGY stands for European Energy balance Research to prevent excessive weight gain among youth, and is a European Commission funded project aiming to study important dietary, physical activity and sedentary behaviors among youth aged 10-12 across Europe. ENERGY also investigates determinants of engaging in such behaviors and develops and tests an intervention scheme to promote more healthful energy-balance behavior in schoolchildren. The protocol paper of the cross-sectional ENERGY study, describing the methods, procedures and measures of the study, and with Dr. Maartje van Stralen as first author, has now been published in BMC Public Health.

Research concerning elderly populations at EMGO+

Last Tuesday we show cased our research concerning elderly populations. The focus was especially on research conducted by the departments of General Practice, Nursing Home Medicine, Public & Occupational Health and Medical Humanities, i.e. the 'extramural' departments of the VU University Medical Center. Professor Guy Widdershoven chaired the afternoon symposium. Professor Dorly Deeg provided an overview of the history and scope of research among the elderly at the VU University and its medical center; Professor Henriette van der Horst shared her thoughts on the future of such research. A panel of project leaders provided their reactions to these introductions, which gave input for a general discussion with the audiende. Finally, more than 50 posters on relevant recent research were presented and discussed. 

Farewell address by Prof. Martijn Katan

Yesterday Professor Martijn Katan gave his farewell address as professor of nutrition at the department of health sciences and the EMGO Institute for health and care research. Before Martijn Katan's lecture there was a short symposium with two distinghuised invited speakers: Professors Jan Vandenbroucke and Marion Nestle. Marion Nestle presented her work on food politics and the relation between nutrition researcher, nutrtion researchers and food policies of governments and food industry. Vandenboucke and Katan himself spoke about the problems nutrition researchers face in establishing evidence-based practice. Martijn Katan used examples from his own research career - his world famous research on transfats and cafestol- to urge the future generation of nutrition researchers to go back to the reductionist approach, focussing in nutrients rather than foods or food patterns. I myself have argued that a focus on food patterns may be more fruitful; see for example the paper I wrote with Elling Bere on the Nordic Diet. However, Katan certainly has a point that internally valid research on the potential health promoting effects of food patterns is very difficult (Katan would claim it to be impossible, I think...).