The importance and significance of health and health care for the individual and for the community can be viewed and interpreted in various ways. In the previous chapter, the now well-established PHSF model (see subsection 1.3 and the introduction to chapter 2) was used as a basis for examination of the facts, statistics, analyses and associations pertaining to Dutch public health. In this chapter, health, health care, preventive action and health policy in the Netherlands are considered from other angles and perspectives.

The previous chapter focused mainly on public health in the Netherlands as a whole. However, considerable health diversity exists within the Netherlands. This chapter therefore begins by describing this diversity in more detail and analysing its nature. First, the temporal dimension of diversity is considered, by looking at health in relation to phase of life (subsection 3.1). Illness, health and care consumption differ considerably according to phase of life, and patterns of life are increasingly diverse. We then move on to look at health deprivation (subsection 3.2). Health deprivation is evident in various vulnerable groups, such as people of lower socio-economic status and ethnic minorities; this is the social dimension of diversity in health. Because vulnerable groups are not evenly distributed across regions and neighbourhoods, socio-economic and ethnic health differences create geographical differences: the spatial dimension of diversity.

In connection with the (new) epidemic-related risk to and vulnerability of the Netherlands, an update of the situation with regard to infectious disease in the Netherlands is presented in subsection 3.3. The amount of attention given to this topic may seem disproportionate, in view of the modest contribution that infectious disease presently makes to morbidity and mortality in the Netherlands. However, the level of public disquiet seen whenever there is even a threat of an outbreak (as with SARS or avian influenza) suggests that the significance of infectious disease cannot be judged solely in terms of the quantitative effects on public health, as defined in the context of the PHSF model. The potentially catastrophic implications of a pandemic, and the disruptive effect of loss of confidence in everyday social institutions, such as the postal service (because of, for example, anthrax letters), indicate that other perceptions of illness and the risk of illness – associated with factors such as controllability, consent and fairness – have a major influence on the way that infectious disease is viewed by society.

Public health and preventive action are placed in a European context in subsection 3.4. What happens in the Netherlands is increasingly closely linked to what is happening on the international stage, particularly within Europe; this is certainly the case where public health, preventive action, health care and health policy are concerned. First, the public health situation in the Netherlands is compared with that which prevails elsewhere in the European Union (we assess how well the Netherlands is doing) in order to add further detail to the geographical dimension of health diversity. We then consider what the Netherlands can learn from the public health policies pursued in other countries that face many of the same health problems and policy challenges. Finally, consideration is given to the often-underestimated influence of Europe on public health in the Netherlands.

Subsection 3.5 looks into the future. One the main drivers of future developments in health and care will be the demographic makeup of the population. In 2010, the first of the ‘baby boomers’ will reach the age of sixty-five, and the wave of people entering old age will continue to get higher until about 2040. Because illness is concentrated within the elderly population, increasing average age will mean higher levels of disease burden and care consumption. Alongside such demographic determinants, other factors, which can more readily be influenced by policy, will influence the nation’s health. In order to shed light on the effect of these factors, two strongly contrasting scenarios for the future are briefly explored and used as a basis for the examination of certain dilemmas and political and policy tradeoffs.

This chapter concludes with a look at the economics of health care (subsection 3.6). Many people are inclined to think of care as a cost item. However, care is in fact a component of prosperity. Not only has increasing prosperity led to better health, but also improved health has contributed to growing prosperity. This subsection compares the costs and benefits of care and seeks to quantify the ‘yield' of health care.