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Long live the Netherlands! An analysis of trends in Dutch life expectancy in a European context

Lang leve Nederland! Een analyse van trends in de Nederlandse levensverwachting in een Europese context

Synopsis

In the course of the year 2000 several reports were published that compared public health and health care internationally. A key message that could be derived from these reports for the Netherlands is that the increasing Dutch life expectancy is stagnating compared to life expectancy in surrounding countries. This holds true especially for the life expectancy of women who, over the last fifteen years, dropped from a leading position within the European Union to one in the middle. By means of age-specific death rates it is possible to make a more detailed analysis. Although death rates were generally falling, trends haven't been as positive for elderly Dutch men (80+) as they used to be up to a few years ago. Among women, death rates are levelling off in all age categories. In 1995, mortality in the Netherlands appeared to be higher than the EU-average for men 65 years and older and for women who are between 45 and 70 years old. When age-specific causes of death are considered, the Netherlands turns out to have comparable or slightly better rates for coronary heart disease, stroke and accidental falls. However, six other causes of death lead to higher mortality rates in the Netherlands than in the EU on average. These are breast cancer, prostate cancer, colorectal cancer (younger women), pneumonia, lung cancer (older men, younger women) and asthma/COPD (older men, all women). Determinants are complex for breast cancer, prostate cancer and colorectal cancer but for the latter two, the most dominant risk factor is smoking. It has been clear for some time that, within the EU, prevalence of smoking in the Netherlands is (still) high. Conclusions in this report indicate that the stagnation of increasing life expectancy in the Netherlands can be largely attributed to the single factor smoking. In this respect the Netherlands follows in the footsteps of Denmark. As early as the late eighties, the Danes observed worrying trends with respect to their life expectancy. An analysis pointed towards smoking as the main cause, but also to a complex of factors relating to increased participation on the labour market by women and the adoption of a 'male' lifestyle in general. These developments have resulted in a decreasing gap between life expectancy of men and women. What could be done by policy makers? This analysis again stresses the importance of effective measures against smoking. Furthermore, greater insight is needed in the determinants, prevention and treatment of the cancers that lead to high death rates in the Netherlands relative to the EU. Prevention policy should be long lasting. After all, the seeds of current and future death and disease patterns were sown many years ago.
 

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