If you eat healthy and varied, you get all the vitamins and minerals in sufficient numbers within. But in practice, this is often easier said than done. Only a small part of the Dutch eat every day according to the food pyramid. Saves the vast majority do not. In such a case, in the form of a multivitamin supplement can be helpful.
Some groups have always need extra vitamins, how healthy they also eat. For example, pregnant women, as well as seniors and people with dark or tinted skin.

Then there are finally people for whom extra vitamins are recommended because of their lifestyle. For example, smokers, or vegans. But this also applies to people working on the lines are or many sports.

Do here the vitamin test to see if you need a multivitamin.

There are several types of supplements on the market. Where only one or a few vitamins in supplements, but also supplements in which nearly all the vitamins and minerals are: multivitamins.

Multivitamins can complement are on your daily healthy diet. They are available in different forms: tablets, drops, sprays and chewable and effervescent tablets. Vitamin supplements are available without a prescription at drug store, pharmacy and in the supermarket.

All 13 vitamins are in a multivitamin. That's a good thing: they have all 13 different, but important functions in the body. There there are minerals in a multivitamin.

Healthy diet is always the main base to get enough vitamins and minerals. From the food consumption Survey, however, shows that the majority of English people are not healthy eating enough. Multivitamins are that a good addition. They can provide extra energy with fatigue and worry that resistance.

More and more people In England are using extra vitamins and minerals in the form of a multivitamin supplement. Multivitamin supplements or multivitamins are the dietary supplements, they are meant as a supplement to the daily diet, be used for additional energy or for a good resistance.
Here you will find specific information about multivitamins. We explain what a multivitamin is and when your extra vitamins in the form of a multivitamin can use. Also we will address the safety of multivitamins and pronunciations (claims) that on the label. Finally, you'll find here frequently asked questions about multivitamins.

Minerals are substances that the body does not itself to. We need to get them through food. A varied and healthy diet is important for a good mineral supply.

Each product group from the food pyramid provides certain minerals. The overview below gives in alphabetical order a brief explanation about the different minerals and their (natural) sources.

Calcium
Calcium occurs mainly in dairy products such as milk and cheese. Bread, vegetables, pulses and potatoes contain much less calcium than dairy products, but wear though of the total calcium supply.

Below is some important calcium sources for the quantity as a percentage of the recommended daily allowance (RDA). Starting point is the requirement of an adult, namely 1000 mg of calcium a day

Natural food sources% RDA man and woman
Semi-skimmed milk (1 glass) 18
48 + cheese (1 slice) 16
Green beans (cooked 200 grams) 11
Broccoli (cooked, 200 grams) 7
Whole wheat bread (1 slice) 1

Chloride
Because chloride is often in the form of salt is taken in the same foods as sodium chloride comes for. Sodium chloride, and therefore, is present in almost all foods and drinks. Chloride is in the form of salt during the manufacturing process, preparing the meal or added at the table.

There are no general information available about the amount of chloride in foods in Netherlands.

Chrome
Grain products with a high content of bran are high in chromium. It is not clear whether chromium from these products are also good. Advance chrome mainly in Brewer's yeast, whole wheat bread, vegetable, cane molasses, meat and liver. Meat, poultry, and fish contain per serving between 1-2 micrograms of chromium. The content of chromium in fruits and vegetables is very variable.

There are no general information available about the amount of chromium in foods in Netherlands.

Phosphorus
Phosphorus comes almost in all foods. Foods as milk, fish, meat and bread contain relatively much phosphorus. Also phosphorus, as a binding agent, in the form of phosphate salt added to food products.

Below is for some products the quantity as a percentage of the recommended daily allowance (RDA) is displayed. Starting point is a need of 700 milligrams of phosphorus per day. This is the lower limit of the RDA for adults.


Natural dietary sources% RDA man and woman
Chicken breast (75 grams) 36
Semi-skimmed yoghurt (1 dish) 25
Semi-skimmed milk (1 glass) 22
Whole wheat bread (1 slice) 10
White cabbage (cooked, 200 grams) 7

Iron
Iron is found in meat and meat products, potatoes, bread and vegetables. The main suppliers for iron in the Dutch diet are bread and meat (were).

Below is for some products the quantity as a percentage of the recommended daily allowance (RDA) is displayed. Starting point is a need of 9 milligrams of iron per day for men and a need of 15 milligrams of iron per day for women.

Natural food sources% RDA (male)% RDA (female)
Corn salad (raw, 100 grams) 44 27
Apple syrup (1 slice) 25 15
1 Meatball (75 grams) 15 9
Whole wheat bread (1 slice) 8 5
Currants/raisins (1 tablespoon) 3 2

Iodine
Iodine occurs naturally in sea water, in soil and in drinking water. Through these roads is iodine in food as sea fish and vegetables. Milk and milk products also contribute to the iodine intake. In the consumer goods Act stipulates that bread and bread substitutes, meat products and common salt and common salt substitutes may be enriched with iodine.

There are no general data on the amount of iodine in foods in Netherlands.

Potassium
Potassium comes almost in all foods. Major sources of potassium are potatoes, bread, milk and milk products, meat and meat products and vegetables.

When potatoes and vegetables with plenty of water be boiled potassium is lost.

Because there is no recommended daily allowance in Netherlands has been prepared for potassium, there is no percentage of this quantity.

Copper
Copper occurs mainly in organ meats, fish & seafood, nuts and cereal products. Also fruits and vegetables and cocoa products contain copper.

Below is for some products the quantity as a percentage of the recommended daily allowance (RDA) is displayed. Starting point is a need of 1.5 milligrams of copper per day. This is the lower limit of the RDA for adults.

Natural food sources% RDA man and woman
Beef liver (75 grams) 550
Peeled shrimps (75 grams) 36
Cashew nuts (1 tablespoon, 20 g) 23
Sprinkles, pure (1 slice) 20
Whole wheat bread (1 slice) 5

Magnesium
Magnesium found in almost all foods for. The content of magnesium varies by food. Cocoa and dark chocolate, shellfish, shrimp, soybeans and nuts contain more than 100 milligrams of magnesium per 100 grams. Also green vegetables, Brown grains and nuts are rich in magnesium. Drinking water can make an important contribution to the intake of magnesium. This depends on the magnesium content of the drinking water.

Below is for some products the quantity as a percentage of the recommended daily allowance (RDA) is displayed. The calculation is based on a need of 300 milligrams magnesium/day for men and a need of 250 milligrams magnesium/day for women.


Natural food sources% RDA (male)% RDA (female)
Soybeans (cooked, 100 grams) 50 60
Peanuts, unsalted (1 tablespoon) 14 17
Whole wheat bread (1 slice) 8 9
Semi-skimmed milk (1 glass) 6 7
Sprinkles (1 slice) 6 7
Manganese
Manganese is found in cereals, rice, nuts, leafy vegetables, fruit, meat, fish and tea. There are no general information available about the amount of manganese in foods in Netherlands.

Molybdenum
Molybdenum occurs mainly in legumes, grains and nuts. Other good sources of molybdenum are organ meat, milk and eggs. The concentration of molybdenum in plant food depends on the amount of molybdenum in the soil in which the food grow.

There are no general information available about the amount of molybdenum in foods in Netherlands.

Sodium
Sodium is present in almost all foods and drinks. In some foods and drinks sodium comes naturally. Furthermore, sodium in the form of salt during the manufacturing process, preparing the meal or added at the table. Because there is no recommended daily allowance has been established by the Health Council of the Netherlands, are below for several products as a percentage of the amount of the recommended intake of 2.4 grams of sodium (= 6 grams of table salt). There only allow foods to which sodium is added.

Dietary sources% of 2.4 grams of sodium
Salt (1 teaspoon, 3 grams) 49
Sauerkraut (cooked, 200 grams) 25
Whole wheat bread (1 slice) 7
48 + cheese (1 slice) 7
Nuts (1 tablespoon, 15 grams) 6
Selenium
Selenium is present in almost all foods. The content of selenium in plant products depends on the Selenium content of the soil. Grains are generally richer in selenium than vegetables.

Meats such as liver and kidney contains a lot of selenium and the same applies to fish and shellfish.

Below is for some products the quantity as a percentage of the recommended daily allowance (RDA) is displayed. Starting point is a need of 50 micrograms of selenium per day. This is the lower limit of the RDA for adults.

Natural food sources% RDA man and woman
Nice guy (145 grams) 140
Beef liver (1 piece, 75 grams) 59
Tuna, canned in oil (25 grams) 45
Wheat bread (1 slice) 4
Semi-skimmed milk (1 glass) 3

Zinc
Zinc occurs primarily in meat, fish, herring, whole wheat bread, pulses and rice.

For more information about minerals

Most vitamins we get from our diet. People are not able to vitamins to create itself. There are a few exceptions. Vitamin K and D can be created by the body. Vitamin B and A can also make the body itself, but there is the amino acid tryptophan or beta-carotene for need from food.

Who eat sufficient and varied (see the food pyramid), gets all the vitamins within which daily are needed. But not everyone can get enough vitamins from food. A supplement for these groups is desirable.

The following is an overview of the different (pro) vitamins and their natural resources. Per vitamin is for some relevant products the quantity as a percentage of the recommended daily allowance (RDA) is displayed.

Beta-carotene
Beta carotene is found in (dark) green leafy vegetable and carbon species. Carrots also contain a lot of beta-carotene, like mangoes and tangerines. Beta carotene gives the characteristic colour to orange and yellow fruits and vegetables.

Vitamin A
Important sources for vitamin A are liver, fish, (half) whole milk and milk products and butter. Fruits and vegetables contain beta-carotene, which the body is converted to vitamin A as needed. in addition, in Netherlands vitamin A added to margarine, low-fat margarine and cooking products to the level of butter.

Liver contains large amounts of vitamin a. the Health Council Therefore recommends that pregnant women not to eat liver. Example: 75 grams beef liver contains over 27,000 micrograms of vitamin A, nine times as much as the safe upper limit of 3000 micrograms per day!

Vitamin B1
Most foods have a low content of vitamin B1. The main sources of this vitamin are pork and grain products.

Vitamin B2
Important sources of vitamin B2 are milk (products), meat (were), vegetables, fruits and grain products.

Vitamin B3
Vitamin B3 has starred in various foods: meat and fish, cereals, vegetables and fruit. In addition, the body can make vitamin B3 partly from the amino acid tryptophan (a building block of proteins).

Vitamin B5
Vitamin B5 comes in many different foods for meat, fish, eggs, potatoes, milk (products), vegetables and fruit.

Vitamin B6
Good sources of vitamin B6 are meat, eggs, fish, cereals, potatoes and legumes. Vegetables, milk and cheese contain vitamin B6 in smaller quantities.

Vitamin B8
Vitamin B8 comes in many different foods, including eggs, milk, soy products, nuts and peanuts.

Folic acid (vitamin B11)
Folic acid is found in green vegetables, fruit, whole grain products and to a lesser extent in milk and milk products.


Vitamin B12
Vitamin B12 occurs only in foods of animal origin. Vegetarians, vegans, but surely there should be extra careful that this vitamin is present enough in their diet. If not, are supplements necessary.

Vitamin C
The main sources of vitamin C are vegetables, fruit and potatoes.

Vitamin C in food is sensitive to heat. The vitamin C is declining as a result of (long-term) cooking and during storage at a relatively high temperature. After opening a bottle or Pack sap takes the vitamin C content. For acid juices (such as orange juice) continues the decline limited to about two percent per day. By shaking more vitamin C can also be lost.

Vitamin D
The main source for vitamin D is sunlight. At large exposure to sunlight makes the body for most adults enough vitamin D in the skin. Children under four years of age need extra vitamin D needed.
Vitamin D occurs naturally only in foods of animal origin. These foods contain, however, generally very little vitamin d. a exception is oily fish (such as salmon and mackerel); they contain slightly more vitamin d. In Netherlands is vitamin D to margarine, low-fat margarine and cooking products added.


Vitamin E
Vitamin E is found in vegetable oils and in plant products such as cereals, nuts, seeds, vegetables and fruits. Animal products are relatively low in vitamin e.

Vitamin K
The body is itself able to make vitamin K to. In addition we also get vitamin K from food. Vitamin K occurs mainly in spinach, broccoli and oils.

Body
Most vitamins we need to ingest through food. But there are two that our body can make itself.
These are vitamin D and vitamin k. vitamin D is synthesized in the skin, under the influence of the Sun. For that it is important to every day a quarter of an hour to come out with hands and face uncovered. Vitamin K is made by bacteria in the intestine. Only babies can this yet (enough) and have therefore a supplement needed.

We make itself vitamins
In addition, the body also make vitamin A and vitamin B3, but other substances from the power supply, the so-called pro-vitamins. For vitamin A is this beta carotene, vitamin B3 for the amino acid tryptophan.

The body of man is not able to make vitamin C itself. Also great apes and Guinea Pigs cannot. All other animals can make vitamin C does itself.

Minerals we can not create itself. There are no exceptions. We must therefore all minerals from our diet.

The body as pantry
The body can store vitamins in the body. The fat-soluble vitamins, vitamins A, D, E and K are stored to a limited extent in the body. The rest is excreted through the urine or bile. The water soluble vitamins (B vitamins and vitamin C) may, with the exception of vitamin B12, also only in small quantities are stored. The rest will be excreted through the urine. Fat-soluble vitamins and water soluble vitamins are stored in the body at different places. For example, vitamin A is stored in adipose tissue, vitamin B12 in the liver.

Because we most vitamins no large stock can moor, it is important that we get them daily through our diet. Minerals are stored in various places in the body. Examples include calcium, magnesium and zinc. Calcium can be found in bones, magnesium in muscles and zinc in the hair and skin.

Vitamins come not only from food. The body can make some vitamins themselves.
Many people use supplements. That contain extra vitamins and minerals, in addition to the power supply. But what supplements are there, what do you really need and how to make a responsible choice? Also on those questions can be found in this chapter the answers.

For the composition of supplements, for adding vitamins and minerals to foods and for the mention of the composition, for example on the label, apply laws and rules. The most important we have.

The ' recommended daily allowance (RDA) "may vary by age group and by gender.
The RDA covers the average need of the English population, with still a wide margin to take account of the distribution of the need in the population. According to the definition would the RDA the need of 97.5% of the population have to cover. 2.5% of the population has so need more than the RDA, but on the other hand, most of the population to less even though sufficient.

If someone structural (more than a few weeks) ingest less than the RDA vitamins, does not automatically mean that there is a deficit. Chances are that this person is in the 97.5% of the population under less even though sufficient. Therefore, never be shown without a deficit in the body to measure how much of a vitamin is available to the normal functions of the organs and tissues to take place. Such a study is vitamin status search.

Sometimes is not the Adequate Intake (AI), but the RDA. The AI is a level of intake that is sufficient for (almost) the entire population. There is insufficient information available to determine the average need.

In this chapter stand for different population groups in Netherlands (children, adults, seniors and other population groups) the Rdas per vitamin and mineral. In addition to a number of groups given an explanation when supplements are desired and why.

Diabetes Mellitus
Diabetes mellitus is a chronic metabolic disease. Approximately 600,000 people In England have diabetes, of which about 85% type 2 diabetes.
In people with diabetes can the body's carbohydrates (glucose) from the power supply does not handle well. That's because there is too little or no insulin is created. Or the insulin cannot do more good. The hormone insulin is necessary for the transport of glucose from the blood to the body tissues. If there is too little insulin, or when the insulin does not work properly, the glucose levels in the blood, the so-called glucose levels, much too high. Besides those problems with glucose metabolism is often also the fat metabolism out of balance. These metabolic disorders are unhealthy and even dangerous. Therefore, always be treated diabetes.


Types of diabetes
There are different types of diabetes. The most common are type 1 and type 2.

Type 1
Normally, insulin is created by groups of cells in the pancreas called islets of Langerhans. In people with type 1 diabetes these cells are destroyed by the immune system. The pancreas makes insulin so no more. Because insulin is necessary for glucose from the blood to the body cells, you need with this form of diabetes inject insulin every day. Otherwise, the glucose level in the blood is too high. Type 1 diabetes occurs in short time and usually in people under 30 years. Therefore it was called type 1 diabetes once called ' juvenile diabetes '. About 15% of people with diabetes has this form.

Type 2
In type 2 diabetes the insulin works less well and makes the body increasingly less insulin. There is then insufficient glucose from the blood. In addition, the fat metabolism and blood pressure often disrupted. Type 2 diabetes is usually treated with medications, plus nutritional and exercise advice. Sometimes it's over time also needed to inject insulin to go. Especially people who were older than sixty got used to type 2 diabetes. Therefore, one spoke of "aging sugar". But that term is obsolete, because type 2 diabetes is nowadays also often in younger people. Even in children. About 85% of people with diabetes has this form.

Vitamins and diabetes
The recommendations for vitamins and minerals are in principle similar to that of healthy persons. The basis for this is a healthy and varied diet. There is, however, a number of concerns.

Vitamin B12
The absorption of vitamin B12 can be disrupted in patients who use the drug metformin. This medication is frequently prescribed to people with type 2 diabetes. If there is inadequate absorption of vitamin B12, can be decided until the use of supplements. The use must take place in consultation with the attending physician.

Folic acid (vitamin B11)
Cardiovascular diseases are a complication of diabetes. Homocysteine, a substance that occurs in the metabolism of protein, is a predictor of heart disease. An increased homocysteine levels in the blood is a risk factor for heart disease and stroke. At the same time is well known: the higher the folic acid levels in the body, the lower homocysteine levels. Or the use of folic acid supplements also reduces the risk of heart disease is not proven. For the time being is therefore no additional folic acid for the prevention of heart disease is recommended. Because the folic acid dietary intake in Netherlands on the tight side, is a supplement according to the vitamin information Office worth consideration.

Magnesium
There is evidence that in people with diabetes are more likely to have a magnesium deficiency than in healthy people. Symptoms of this are lethargy, muscle weakness and pain, heart function disorder. A magnesium deficiency is related to diabetes complications such as heart disease and eye disorders. If a magnesium deficiency has been detected, is a magnesium supplement desirable. The use must take place in consultation with the attending physician.

Chrome
Chromium plays a role in the action of insulin in the body. It improves insulin sensitivity. More and more studies indicate a beneficial effect of the use of chromium supplements in diabetes (both type 1 and type 2). People with poorly controlled diabetes may, in consultation with the attending physician, passing on the use of chromium supplements.

General starting point when giving advice to diabetic patients is a healthy and varied diet, which contains enough vitamins and minerals. If the power supply for long periods of time to be desired, then the use of a multivitamin worth considering.

Heart and blood vessels
Heart disease is a collective name of a number of disorders. Some are harmless, other life-threatening.

The most known are disorders in which the blood supply to the heart is not good, but there are even more heart disease. Cardiovascular diseases are the number one cause of death in women and number two cause of death in men in England. Forty percent of all deaths is caused by diseases of heart and blood vessels.

Risk Factors
Heart disease have a lot to do with the way of life. Risk factors for heart disease include smoking, lack of exercise, poor diet, high blood pressure and stress. Sometimes play also hereditary factors, such as high cholesterol, a role.

Prevention
The risk of getting heart disease can be reduced by quitting smoking, to eat healthy and get enough exercise. In addition, it is important to avoid stress as much as possible and seek a healthy body weight.

Diet and heart disease
There is a link between diet and heart disease. For example, an excess of saturated fats raises cholesterol levels in the blood and thus the risk of cardiovascular problems.Sodium (salt) can increase blood pressure. And high blood pressure increases the risk of a stroke. That are so adverse influences.

Good influences are there too. Healthy eating lowers blood cholesterol levels and thereby helps the arteries to keep clean. In addition, health food (varied, and not too much) the body weight within limits and can help prevent high blood pressure.

Vitamins, minerals and heart disease
Vitamins can also make a positive contribution to the prevention of heart disease.

So is there a significant relationship between the B vitamins and heart disease. B vitamins decrease homocysteine levels in the blood. Homocysteine is a substance that occurs in the metabolism of proteins. An increased homocysteine levels in the blood is a risk factor for heart disease and stroke. How homocysteine leads to heart disease is not yet clear. Folic acid (vitamin B11) lowers homocysteine levels by an average of 25%, an extra dose of vitamin B12 (0.5 mg per day) provides an additional decrease of 7%. Vitamin B6 also plays a role, albeit to a somewhat lesser degree.

Also the antioxidant vitamins beta carotene, vitamin E and vitamin C are often associated with lowering the risk of heart disease. But investigations in this area give much different results.

Previously it was assumed that there was a link between the amount of iron in the body and reduce the risk of heart disease. From more recent and more reliable research shows no correlation between the amount of iron in the diet, the iron stores in the body and heart disease. Well there are some indications that a higher consumption of products with heme iron the risk of heart disease increases. Real evidence for this is however not yet delivered.

Research shows extra calcium (1000-2000 milligrams per day) in individuals with high blood pressure, systolic blood pressure slightly reduce. For magnesium is not proven an effect on blood pressure.

Ultimately, people still ingest more energy than we consume. Resulting in an increase in our weight.
Healthy nutrition and supplements
For people who want to fall off a responsible diet advice must always work on the basis of the guidelines for a healthy diet. These are for the consumer have been worked out in the food pyramid. A diet that is prepared according to this directive contains all the vitamins and minerals needed. For example, it is important to provide enough bread and grain products to eat: If someone eats less than four slices of bread, is the intake of vitamin B1 is lower than recommended. Also the intake of iron (Fe) can then be at risk.

It is not necessary to recommend a standard multivitamin supplement for overweight people who follow a diet because they often eat healthier already. This makes the intake of vitamins and minerals in the diet sometimes even higher than before. If a diet is followed that does not meet the ' food pyramid ' then it can be considered a supplement. For example, it is wise to pay attention to the amount of vitamins and the sustainability of the supplements.

Vitamin deficiency in obesity
Obesity also is a vitamin deficiency. Food with a lot of energy not necessarily contains more vitamins. A power supply with lots of carbohydrates, proteins or fats and low in vitamins, such as candy and snacks, you can make overweight and lead to vitamin deficiencies.

Diets
The energy requirement for adult women with sedentary work and little movement in the spare time is around 2000 kcal (8400 kJ). For adult men with the same movement pattern is this need about 2500 kcal (10500 kJ). The energy requirement depends on several factors: age, gender, weight, amount of movement and the intensity and duration of these. If you want to lose weight you'll have to consume more energy than you consume through your food and drinks. If you're on a diet you can choose different types of diets.

Atkins, doctor Frank, Montignac, the diet guru or the Cambridge diet. A random selection of the many diets out there. Who follows this type diets long-term, runs a risk of shortages of certain vitamins or minerals. What these are entirely depends on the type of diet. Is better to follow a diet according to the guidelines for a healthy diet. Such a diet not only delivers enough vitamins and minerals, but also, for example, provides plenty of fiber, protein and fats.

In addition, there are also low-energy diet power supplies and meal replacements. To this diet requirements in relation to the power supplies are amount of vitamins and minerals that they should contain. These products contain at least one Per Day times the recommended daily amount of vitamins and minerals.

We all want to be healthy. Healthy starts with healthy life. Nutrition and exercise are important parts of. But what is healthy food and how much you need per day? More on that in this chapter.

Good nutrition will ensure that we ingest enough nutrients. There are vitamins and minerals; they are important to function well and to maintain good health. Without these micro-nutrients, there is no life. But vitamins and minerals can also help to prevent certain diseases. Examples include vitamin D and calcium in relation to bone loss (osteoporosis). This chapter therefore also much information about vitamins and minerals in relation to certain diseases.

Avoidable burden of disease results in additional pressure on our health care. More than 70 percent of the
expenditure in healthcare goes to people with chronic illness. The RIVM has calculated that the
next 20 years (2005-2025) significantly increases the number of people with a chronic condition.
This is mainly because of the ageing of the population, but also unhealthy behavior plays a
important role. Many of these chronic diseases are caused or exacerbated by an unhealthy
lifestyle including smoking, lack of exercise, unhealthy eating. Often there is also a stacking on
of chronic conditions, the so-called multi-morbidity.

as the number of people who are overweight continues to increase at the same rate, diabetes with over
70 percent will rise to 940 in 2025. By 2025 we expect 540,000 people with COPD
(chronic obstructive pulmonary disease): an increase of 12 percent in men and as many as 30
percent in women. For the risk groups, it is first of all important that the condition is not
get, or only later in life. If someone does get the condition then it is important that those
person can count on a good secondary and tertiary prevention.
Chronic diseases lowering the quality and length of life and cause
social costs because a job needs to be done on care and informal care, and a
lower labour productivity. Help the prevention and behaviour
personal and social consequences of chronic diseases.
differences in health
While England in European perspective to be seen is a village in the middle bracket,
are also significant differences in regional and local health and the occurrence of
risk factors for disease and death. So is the difference between regions with the highest and lowest
healthy life expectancy 15 years. The health of people with a low socio-economic
status is on almost all fronts worse than those of the Englishmen with a high socio-economic
status. They experience their health often less well and they have more often
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
12
chronic conditions and restrictions. Also immigrants constitute a sensitive group when it comes to
Health goes. That is demonstrated, for example, the above average percentage of persons with
overweight and a higher mortality risk among immigrant children.
The analysis of the National Institute for public health and the environment (RIVM) is clear: socio-economic
and ethnic health backlogs have persistent
proven. In addition, they are inseparably bound up with backlogs in other areas.
Health inequalities are greatest at the level of neighborhoods and districts. A ' cheap ' neighborhood
with poor quality housing, less favourable environmental characteristics and defective
facilities, especially the underprivileged, while promising citizens precisely select leave. Also the
poor quality of housing and the local environment itself have an unfavourable influence on the
health. In addition, prevailing social standards for (UN) healthy behaviour and dealing with
Health hit each other in the neighborhood. Bad example does follow.
Key Points
• Health is an important core value that requires constant attention and action.
• Health and care sectors provide a positive contribution to society. Healthy
citizens contribute to the vitality of society. Health care in broad sense
maintains and produces human talent.
• Health in England can be much better. England lags behind other European countries.
• Differences in health between groups are very large.
• Stay Alert on old and new health threats is necessary.
• Diseases that nowadays many premature death and cause loss of quality of life,
often hang together with the lifestyle earlier in the life course. There is especially a profit yet
by healthy behaviour.
• Prevention is also needed to prevent the unnecessary care in the future.
Good use of scarce resources (finance and human resources) is important for a
sustainable solidarity with sick people. Prevention can contribute to flattening of the
staff shortages.

We all want to be healthy and remain healthy'. Young and old. During the consecutive
life stages will get this wish a different face and other priorities. In the early years is it going to be
a healthy start, health education, healthy growing up. Adults, in the power of the
life, should set the example and invest in their own health. During the
old age is important to cherish what is there. For people with chronic conditions
It goes to optimize the quality of life. In short: health is for every individual
a key value. Delivers return on investment in health, namely working longer and
life in good health. Healthy living for a booming economy is also an important
building block. Or as the English say, ' health is wealth '.

1. introduction
Health in England is not like other develpoped countries. The figures are eloquent.
England lags behind other countries and the differences in health between population groups
remain unchanged in size.

This is a vision: a
clear picture of the current situation, to achieve a clear vision of the situation and
directions for the way there.
In 2006, the Cabinet note ' opt for healthy living ' as part of the legal
Prevention cycle. This note focused mainly on health promotion. On the basis of a
thorough analysis of the problems, the following priorities have been identified: smoking, problematic
alcohol consumption, obesity, diabetes and depression. These priorities remain in full force and effect.
At the same time, the note that new strategies, sometimes of new actors and parties,
necessary to the health problems of the 21st century. That is what this
document in particular. It sets long-term lines and mental models that the Ministry, but
above all, its partners, will develop strategies and action plans for a healthy Britain.
Where next to ' sick care ' also the literal meaning of the word ' health care ' will apply and
where health is a legitimate interest between other legitimate interests.

2. health in England
2.1 Introduction
Health in England can do much better. Although the life expectancy for an average of light increases,
This virtually stagnant for women. England lags behind other European countries and there are
persistently large differences between population groups. In this chapter, the interest of
Health sketched. It also gives a picture of the health in
our country and what the future prospects for 20071.
2.2 health: a social core value
Health is important for people to be able to live and to work. It is a
prerequisite for the functioning of our society and the preservation and development of
our prosperity. Healthy and staying healthy is not automatic and requires constant
attention and permanent action. Health is usually by people as the most important aspect of
their life called. In practice, people often choose, consciously or unconsciously, for unhealthy
behavior. The result too often is that people have to deal with preventable diseases, sometimes
of chronic nature. That is damaging to the individual, but also for third parties, such as the family or the
post. The charge also healthcare. Resources for care are scarce. We get
In addition, to do with scarcity on the labour market and perhaps too few nurses. 2 Also
There is a reason to actually prevent avoidable damage to health. We must of
aftercare to for care. Increasingly, it is recognized that health and care sectors
also make a positive contribution to society. Healthy citizens contribute to the vitality
of society. Health care maintains and produces in a broad sense, as well as the
education, human talent. Health care costs not just money; It has also many society
to offer.
Definition health
Health is a State of complete physical, mental and social well-being and not merely the
absence of diseases or other physical defects.
Preamble To Constitution, World Health Organisation (WHO)
Estimates indicate that at a constant labour productivity the required extra fittings of the
healthcare sector amounts to 500,000 and thus far exceeding the expected growth of the active
labor force in all of Netherlands (250,000 employees). Limiting the growth of the demand for care by
prevention is an important entry point for policy. If recourse is limited by 10%, AWBZ care
provides that a saving of ± 90,000 jobs.
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
10
2.3 health in England
Numerous new threats or old well known risks to health in our society
present. The dangers were formerly predominantly ' from outside ', nowadays there are also many
health threats that people, usually unintentionally, create yourself.

Diseases that nowadays many premature death and cause loss of quality of life,
often hang together with the lifestyle earlier in the life course. There are paradoxical relationships between
increased prosperity and health arise: by "everyone" prosperity is unhealthy living
afford, such as smoking, excessive eating or drinking. The current behavior determines in part the
health of the future. And that behavior is not entirely favorable, especially the youth often makes
to a bad start.
So is obesity a rapidly growing problem. Also among children the number of serious
cases steadily. The combination of fewer and fewer move in everyday life and more and
unhealthier food brings us conditions ' on sight ' closer. Overweight is linked
with type 2 diabetes, an increased risk of heart disease and premature death. Children
In addition, more likely with obesity walk on psychosocial issues. Bullying, a negative self-image
and school failure are more common in children with obesity. The difference in life expectancy
between a person with obesity and someone with a healthy weight is 4 ½ years. The cost of the
overweight health care, are approximately £ 1.2 billion. The economic
damage due to overweight and obesity by absence and disability shall not
less than about € 2 billion per year.
Also some alcohol consumption and smoking, Brits are worried. While english
adults to the biggest smokers in Europe, may our youth turned to the heavy drinkers
count. One in three people aged 15 or older smoke, nearly twice as much as countries like
Canada, the United States and Sweden. Within the OECD countries is only in Luxembourg,
Hungary and Greece more non-smoking. Absolute leader we are even with the tobacco consumption in
pounds per capita. Smoking people live, on average, seven years shorter than non-smokers.
The health care costs associated with smoking are about 2½ billion £ per year.
In the area of alcohol consumption by young people occupied Englands a questionable first
place. With alcohol as such do not need anything to be wrong. Excessive drinking has not, however, rarely
far-reaching, harmful consequences, for young people and for public order. Nearly two-thirds of
the twelve year olds has already drunk alcohol. Apart from the health damage that, certainly in young
children, then also much nuisance. Estimates indicate that at least 40 percent of
Police action in the weekends to do with drinking. Over 27% of all
violent crimes goes hand in hand with alcohol. More than five percent of the citizens has nuisance of
drunk people on the streets. In addition, 25 – 30% of road deaths due to
alcohol.
Also the society as a whole will suffer consequences of unhealthy behavior. Rising
medical expenses, an extra tax of the scarce medical disciplines and of the scarce capacity to
workers in this sector, but also an increasing work loss and investment in
adjustments of daily facilities (of seats in public transport to
hospital beds) are the prospect.

The downside of all this is that health care is a huge contribution towards
society, both preventive and curative.



2.4

3. interests, responsibilities and forms of prevention
3.1 Introduction
Invest in health can improve the quality of life, increase labour productivity and
bring us back to the European Summit. The Ministry of health considers delivering a
contribution to society as part of his mission. In today's complex society
There are various actors who have their interests and responsibilities. People themselves
of course have an interest in their own health. But also others-family and relatives, the
direct living and working environment, the Government and the health care sector-are major parties to health
of individuals and of society as a whole. In reality, the relationships complex and
walk through each other responsibilities and interests, sometimes even in opposite directions. This
Chapter also describes briefly the various forms of prevention, which, together with the analysis of
stakeholders form the basis for the next chapters.
3.2 analysis of interests and responsibilities
The person
Important: everyone benefits from a healthy or live as healthy as possible. A long life in which a
man as many years as healthy experiences, is often the basis for happiness, independence and
can join and contribute to society. That does not diminish the meaningfulness of
a life with restrictions and it also doesn't mean that in it no luck or independence can
be found. People determine the own quality of life, among other things, by the way
they deal with setbacks. However, health and wellbeing important
are.
Responsibility: people are primarily responsible for their health and
for dealing with impaired health. They are generally familiar with behavioral and
risk factors. In many cases people can influence or health problems
and whether existing problems worse. Everyone should realize that the way they with their
(UN) health deal, may have direct influence on others and thus appeals to their
solidarity. That is especially true for relatives.
Family and relatives
Interest: family and friends have an interest in health and healthy behaviour of their loved ones. It is
part of their happiness and quality of life. Parents have an interest in healthy children,
children in healthy parents. Illness gives uncertainty and provide for family and friends.
Ill health and disease in the immediate environment can be very stressful and even long term
pathetic.
Responsibility: the importance that a man has at the health of his or her relatives,
also means that he or she has responsibility for the own health. In the first place
applies to parents. They are responsible for the welfare of their children and for a
healthy education. They are also responsible for their own health, so they the education
well in hand.
The immediate vicinity
The living environment of people outside a circle of family and relatives – the ' settings '-are the
places where people a (sometimes large) spend part of their time, such as a residential area,
workplace, school or sports club.
Interest: not just people from the direct heating circuit, but also others benefit from the health of
a person. The healthier individuals are and the more risks they are taking with their

health, is partly determines the livability and quality of districts and neighborhoods. Employers
in turn have interest in healthy, productive employees and low absenteeism.
Healthy staff contributes to a healthy company, higher labour productivity and
profitability of enterprises. Entrepreneurs and business sectors (for example, the diet and
alcohol industry, Saha etc.) important to have reputation damage. A healthy
image, both for the product if the company, begins to become an increasingly important concept.
Teachers want to see fit, well-rested and sober pupils in their class. That gives easier
les, but also comes the school performance.
Responsibility: also here are interests connected with responsibilities. Everyone has
a certain responsibility for the health of other people in the same environment. A
teacher should appeal to parents or pupils can on fatigue or risky behavior
among pupils. Employers have a big influence on employees ' welfare, for example by the
design of the building and the workplace, but also by an organizational structure and facilities
available that focus on health. With the new working conditions act of
2007 is the primary responsibility for working conditions at the enterprises.
Employers and employees have more opportunities to fill in the policy together.
Health aspects can be part of this. Employers can workers relatively
Easy boost by a healthy catering, the opportunity to play sports or by
a bike fee. The occupational physician plays an important role in identifying
stress, obesity and occupational diseases. The way in which large employers and employers in the
small and medium-sized enterprises meet prevention differs.
The Government
Importance: the Government is the guardian of the collective interests and role conditions
create a vital and just society, with a sound economic basis.
Optimal health of people and optimal health conditions are important
determinants of. Unnecessary loss of health, sick leave and an unnecessary increase in the
zorgkosten4 are unwanted types of welfare loss. Especially now partly as a result of the
Aging care cost rising and shortage on the labour market is going to sign off, it is
important be careful with the use of scarce resources and taking care not to unnecessarily
taxing. Also this is why prevention is important.
Responsibility: it is the core task of the Government to take responsibility in that
cases where different interests are not necessarily equal. The Government assumes
that people themselves are best placed to make choices in line with own preferences
and based on what the market offers. This also applies to the lifestyle. The market affects the
choices that people make and the physical and social environment often determines the bandwidth
within which people choose healthy behaviour. The décor and game rules in that environment get rid
often collective tasks of the Government. People can suffer from the choices of others
(external effects). Sometimes people, for example children or sometimes addicts, the ' best '
choice (yet) make (information provision for the citizen). Also the Government takes from
point of view of justice sometimes a particular responsibility for people who
worst off in society (normative considerations). The interdepartmental
policy research (IBO) prevention of June 2007, which focuses on the effectiveness of
4 it should be said to save on health care costs by prevention especially related to the
medium term. In the short and long term costs of prevention, as with life-prolonging curative
interventions, money. In the short term related to the expenditures for prevention policy and in the long term
for example, the extra consumption of care and longer use of the AOW. The relationship is complex
because there are also other indications. The Government wants to also clear about the fact that the
the health benefits here, alongside an improved quality of life, which if the intrinsic value and benefit of
Prevention has to be seen and that investing in prevention worthwhile.

health promotion, provides a guide. The report differentiates three different motives
for public interventions in relation to the lifestyle of people:
1) external effects: these are effects of unhealthy behavior that precipitate at others;
2) information deficit: the fact that people have insufficient information to make a good
trade off;
3) normative considerations: the Government may believe that the behavior of people not in
their own interest (paternalism) or that it has a special responsibility for
people in disadvantaged situations (solidarity).
Business
Importance: the first importance of business lies in business continuity and thus profitability.
That is sometimes seen as opposed importance of health, especially in sectors that much with
(UN) health associated, such as the agricultural sector, food and foodstuffs, the soft drinks
alcohol industry and the catering industry. These interests are also not always parallel. But entrepreneurs and
business sectors also have an interest in a healthy population and want to of course reputation damage
occur. A healthy image, both for product and company, is becoming an increasingly important concept.
Responsibility: right from the point of view of a good image and in the light of
corporate social responsibility, taking entrepreneurs and businesses their responsibility for
health.
The health care sectors
Important: the purpose of the sector is not only caring for the sick, but achieving optimal
health. Public health care (OGZ), the cure, the care and the health insurance companies have
a common interest in preventing health loss. The sector has because of its scarce
means an interest in prevention, for care instead of aftercare.
Responsibility: from their code of ethics and professional conviction alone have
health care providers and health professionals to a special responsibility as much as possible
health gains. Health insurance companies have from their own business continuity and their
the task of social responsibility to promote health, including
preventive activities. Parties must endeavour to maintain solidarity to by
to work effectively and efficiently, the quality, accessibility and affordability.
Prevention will be more and more a village, also in the care itself.
3.3 preserved parallelism of legitimate interests and cooperation
The interests and responsibilities of these parties for health with each other
entwined. Sometimes, health is the starting point, but there are also where health interests
support is an essential prerequisite to or. The Government actively seeks where interests
of all those partners running in parallel. Not only their health but also their interests at
other legitimate objectives, such as economic or social interests or
responsibilities arising from the nature and mission of organisations and actors. The importance
of health does not always paramount and can often be supportive to other
interests or responsibilities of an organization or person. Breaking of unfavourable
trends in healthy behavior requires customization, collaboration, persistence, and so a long
breath.

New connections
On the basis of the above analysis and assuming the societal benefit that prevention can provide, are
lots of new connections. Examples of this are:
• Employers and entrepreneurs have an interest in preventive measures that reduce sickness absence and
loss prevention and at the same time, the health of workers. Healthy staff
contributes to a healthy company, higher labour productivity and profitability.
• Entrepreneurs and business sectors want to avoid reputational damage. Producers of food and drink
thus have a own legitimate interest in healthier foods, moderate use of alcohol, etc.
• A healthy image (both for product and company) begins to become an increasingly important concept. Also
There are points of reference for a common agenda.
• There is a clear relationship between excessive alcohol consumption and pollution and public order. Municipalities,
Police and hotel and catering industry, have, each from its own perspective, important to these problems
offer. An effective approach to provide health gains on this nuisance.
• There are growing evidence of the link between school performance and school failure on the one hand and
alcohol and drug use on the other. The evidence for a positive correlation between fitness and move
on the one hand and on the other hand, cognitive performance, amongst others from German and American research, is
getting stronger. Schools that overuse and misuse of alcohol and other stimulants
combat, are partners in prevention and in combating unhealthy behavior. This also applies to sports organizations, and, above all, parents!
• At the municipalities are much chances to health from various disciplines. To
These include education, the environment, spatial planning and housing. Based on the law
collective prevention public health (Wcpv, 2002) are municipalities required to an integral
health policy. In recent years the attention that municipalities spend on the
health consequences of decisions in other policy areas such as environment, Economic Affairs and
social work, increased. Yet many opportunities still untapped. There is a task for the
integrated policy to stimulate local and national Government to Mayor and aldermen serve in turn
opportunities to pick.
• By enough hiking and cycling trails and outdoor play areas move is encouraged.
Poverty reduction and youth health care can reinforce each other. Aldermen education, youth and
for example, joint the theme sports recreation & overweight picking up. Good examples
are the projects ' delicious Fit! ' and ' custom ' at school (lengthening the school week as municipal and
local initiative) in Rotterdam.
3.4 types of prevention
Prevention is the total of measures, both in and out of health care, which aims
to monitor health by illness and health problems. There are several
ways to further define prevention: to the extent to which the activity (on) asked, whether the
a on the collective or on the individual-oriented activity, the extent to which prevention focuses on
healthy or sick people. There can look at the stage of disease, to the extent to which
people on their individual behavior are addressed or to the type of activity.
The widely used classification divides prevention in primary stage of disease (disease causes,
risk factors and exposure, reducing or eliminating), secondary (risk factors and
predispositions detection and treatment) and tertiary (monitors and preventing complications and
effects of existing disease).
A more recent classification, which is also used in the opinion of the College for
Health care Insurance Board (CVZ) of June 2007 is especially based on the structure and financing of the
care and distinguishes between universal, selective, indicated. In Addition
prevention is also often used in connection with the occurrence of sickness absence and
work loss. Here is also a reciprocal relationship with health. This form of prevention runs in
fact by the different layouts of prevention such as the health care that is often uses
back.

All formats go out of other dimensions and are therefore difficult, while comparable
There are also large overlaps. Because this vision is the reason, especially from the action
breakdown by activity: health protection, disease prevention and
health promotion, such as also included in box below. Where in this view there is
of prevention of work loss or sick leave, is that named as such.

Health protection: improving the sewerage system and the drinking water supply,
safer working conditions, safer food products and improving road safety
are among the great achievements of the 20th century. This applies to health protection in
classical sense. These things are the heart of the permanent monitoring of our health,
together with the following activities.
Disease prevention: other measures more directly to specific diseases or early
tracks, preventing many deaths every year and the sick. Examples are the national immunization programme
and flu vaccination, early detection of breast cancer and cervical cancer through
population research and of metabolic disorders by the newborn screening. Also in the curative care is
disease prevention incorporated, for example from cardiovascular disease by medication against high
blood pressure or cholesterol and recent efforts to integrated care for diabetes.
Health promotion: the current disease pattern in the Western world gives more than adequate
occasion to focus attention on the life styles of people. Activities that a healthy
lifestyle and which help to prevent unnecessary health loss people belong to
health promotion. This includes, for example, information campaigns and courses that
aim the individual behavior of people and the social norm to influence (for example, the BOB
campaigns against the use of alcohol in traffic and stop smoking courses).
Finally, it is important to indicate that health is determined by determinants from
four dimensions as the Canadian Minister Lalonde in 1974 in a still prevalent model has
put.

This vision does not deal with the first of the four groups above determinants
called: the genetic and biological properties tied to the individuals. That
We regard as a given. ' Lifestyle ' runs through the entire vision back and is a determining
factor for achieving health gains in the Western world. Chapter 4 of the vision goes into
on the role of the physical and social environment on the behaviour of people, and with it on their
lifestyle. Chapter 5 looks at the relationship between health care (such as that among other things in
primary care practices and hospitals is given) and the preventive care such as local health authorities
that at the local level.
This model forms the lock of the analysis in chapters 2 and 3. On this basis in the
following chapters set out the vision of prevention and health.
The Canadian Minister Lalonde
in the early 1970s suggested a
model, health Central
in the midst of four groups
determinants: (1) endogenous
or personal
properties, (2) lifestyle,
(3) the physical and social
environment and (4) the
health care (including
Prevention). The below
VTV-model, coming from
' Care for health ', is
based on this. The
health status is in
the VTV-model understood as the
outcome of a process that
different causes and
determinants.
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
19
Key Points
• People themselves have an interest in their own health. But also family and relatives, the direct
living and working environment, the Government and the health care sector are the main parties to health
of individuals and of society as a whole.
• The interests and responsibilities of these parties in respect of health,
but also in other areas, are intertwined. The Government is actively looking
to where that different legitimate interests of all those partners running in parallel and
reinforce each other, so as to work United to the contribution of the health sector to
the society can provide.
• On the basis of which various legitimate interests and assuming the social
income that can deliver prevention, are plenty of new connections.
• The importance of health doesn't always prevail, in that the support can
to other interests or responsibilities that an organization or person has.
• In this vision means the total of prevention measures, HEALTH, WELFARE and SPORT under both inside and outside
health care, which aim to monitor and promote health by disease
and to prevent health problems.

4. connection between behavior and environment
4.1 Introduction
The Brit population can be longer and more years in good health, according to the
Public health Future explorations of 2006 (VTV 2006). Correct by strengthening
healthy behaviour is still a lot to achieve health gains. This applies both to people in full
Health (chronic) as for people who are sick. The ' only ' that people have to do is good
take care of themselves: unhealthy eating, more exercise, not smoking and drinking less. That
choices for healthy behaviour, incidentally, find place in a social and physical environment that a
strong influence on those choices. The family where you grow up, the school where you enjoy education,
the company you work for and the neighborhood where you live, sports or recreates. Also design and dynamics
of that environment are determining factors. The Government also has an important right here
responsibility. An important key in achieving health gains lies therefore in the
connection between the individual behavior and living, living, learning and working environment. The Government
has historically been the task and responsibility often collective and programmatic
to take measures that protect health and prevent diseases. These are measures that
because of their inherent nature, never on individual level can be taken. That is why this chapter
there first on in.
4.2 cherish health protection and disease prevention
Health protection and disease prevention are forms of prevention which, because of their scale,
complexity or allocation of responsibility almost always taken on collective level
be. This makes the tasks for the rural or municipal government. They can rightly
the ' deep ' monitoring of our health. They are also tasks, especially where the
health protection, which in the present time often outside the sphere of health care
fall.
The construction of sewage and drinking water supply —
is still the most effective measure for the health. That was so in 1900 in England and
is still as in 2007, in Africa and England. The Government Had at that time only in the England
emphasizes individual responsibility, then one would have been sufficient with the advice to
regular hand washing. For the control of infectious diseases was more needed than just
a change in behaviour, namely an infrastructure focused on health, including the establishment of
the national vaccination programme. In addition to the persuasiveness of the hygienists and the administrative
daring of visionary leaders, there was for the construction of more than a hundred years ago, sewer
Another important factor is present. Large industrialists saw in that investing in healthier
employees also in their interest. A comparison with the present intrudes on.
 Crisis management, preparations for a flu pandemic, food and product safety,
population studies and the national vaccination programme are matters that must always be there and and
those people not at an individual level. As with the ' real ' VC security, are
they are largely out of sight, but the society needs this hidden pearls of
cherish her health care! Alone from its responsibility for public safety
the Government must remain alert to new threats in these areas (for example, bio-defense,

new forms of flu and drug-resistant tuberculosis). It must also keep good eye on changing
conditions, and in the field of health protection and disease prevention, keep looking
to innovations and efficiency and work with, and learn from foreign countries. So give new
techniques from the bio-genetics possibilities for other vaccinations and new forms of
Diagnostics. This is true for both diseases which already screened as for new diseases.
Screenings are also possible combinations of the next item or improvement of logistics and the
attendance. New technology also makes possible new forms of nutrition, with
(health) benefits and possible also with risks which will need to be ensured.
4.3 individual behaviour
Chapter 2 gave all that in addition to the protective measures of the Government, the
State of health of the population and the burden of disease in part determined by the behaviour
of people. Of course every person primarily responsible for and accountable for its own
behavior. People playing a large role in their own health and in preventing diseases.
The weakest link at dental care is so to speak not the toothbrush or toothpaste,
but the teeth PAL itself. Large groups of people are already very aware with their health and
It grows in the society the interest in health items (for example,
magazines and tv shows) and health products (for example, fruit shots, enriched
milk products, but also health checks). There is also a growing interest for the understanding
' wellness '. The Government is going better seek membership of that trend and the way
people experience their health. The emphasis may lie on the fact that (also) enjoy health
means and not at odds with the ' good life ', but that health contributes to firmly correct that
good life. The concept of self-care should therefore important.
Apart from the individual responsibility and the increasing extent to which healthy behaviour to
health gains can lead, still much disease burden is something that happens to people just outside
their reach and responsibility. At most of the chronically ill and people
living with a limitation of their disease or limitation has little, if anything, do with their
lifestyle. In addition, it is difficult or impossible for many people to for healthy behavior
choose (children, forms of addiction) or this to sustain. Many people benefit from
support in it. And coming back to the imagery of the teeth shine boy: it has maybe
more sense to help someone learn to fill teeth shine than ever holes.
Above all also by the large time difference between cause and effect realize many people are
not enough that the current behavior until ill health may provide in the future. Some
populations exhibit relatively unhealthy behavior. They also often have a
In addition, hardly sensitive to public health is lagging behind and turn out messages.
In addition, the Government budget for healthy messages out of all proportion to the
marketing budgets in business. It is therefore necessary that the Government with
health messages is more in line with the experience of people. Say that something is good
(positive message through temptation), works better than say people something no longer
may. But it also means customization: specialized for specific measures
target groups.

4.4 environmental factors
There are general features that make the environment health. In addition, there are also
specific measures in the environment that can effectively influence healthy behaviour. To
understand is awareness required that behavior affects is embedded and context: the family, the
quarter, the workplace, the school, the store, the public space or the Green, or for example the
health care. Even without believing in the historical materialism (or the malleable
to see if human society) and simple product of his environment, it is clear that there is a
great interaction between behavior and environment. Just try to 15 modern food
outlets on the station without pull.
The environment can and must encourage healthy behaviour: invite up to cycling or walking, more leefgroen
instead of look green, entice people to buy and eat healthy products, people
smoke-free environment. Central State so the healthy choice the easy, and sometimes
even the only choice. Some important environments now come separately to bid, especially
as an example, and without the illusion be exhaustive.
The healthy environment
It is clear that there is a great interaction between behavior and environment. To the man on
to encourage a positive way (sometimes unconscious) more with healthy behaviour to be busy, the
environment to optimally there invite. As already stated in Chapter 3, the people who
responsible in that specific environment there also self-interest. Examples of a
healthy environment are:
From their responsibility for bringing up watching parents in a healthy family out that
children eat well, get enough exercise, not too much and prefer to snack on healthy, for example
fruit. For a small trip is not necessarily the car getting caught.
Improves the quality of life as a healthy quarter good amenities within walking distance, good
maintained cycle paths, pedestrian zones and accessible and accessible ' DIY green ' has, or
Green that invites people for hiking, cycling or sports.
Employers like to have healthy workers and have thus benefit from a healthy workplace. They
offer opportunities to play sports and serving healthy meals in the restaurant.
Because the school is teaching more enjoyable performance and spends a healthy
school much attention to sports, exercise and a healthy lifestyle and has a healthy properties in the
canteen.

District Design
The establishment of districts can greatly affect health. With good bike-and
pedestrian facilities can be stimulated the daily move. This also applies to
good range of facilities, especially shops. Stairs and playing fields and green-and
residential neighbourhood facilities promote the outdoor play, one of the most effective measures
against childhood obesity. Living conditions, diversity and atmosphere in the District have large
influence on feelings of security and, therefore, on the quality of life. The presence of
good social and health facilities carry this sense of loneliness. Also the accessibility and
accessibility of green spaces in the city, but have an important
impact on health. At a good décor is involvement in and control of people
the most important thing about their own environment. The Ministry of health, welfare and sport goes with VROM/WWI and
LNV discuss how health can stand at the service of a good neighbourhood development and design and
vice versa.
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
24
Nature and health
According to the report, "nature and health" of the Health Council of the England from 2004 let various
investigations show that the environment indeed affect the duration and intensity of moving.
Research shows that a green environment has a positive effect. Evaluations of
programs for stimulating point out moreover that an attractive, green
environment close to home and work most impetus for hiking and cycling. People turn out the
move in a natural setting to appreciate also higher and keeping it thereby also longer
full. However, Recent research by NIVEL that Brit General practitioners rarely to the
' green ' by regularly recommend to refer to — for example, in the park or nature
go hiking. In England already have years of experience with it on medical advice more often move, under
more in nature. The Forestry Commission, the British equivalent of the Forestry Commission, put in
cooperation with the insurers, volunteers in to groups of people under guidance to let
hiking. The Forestry Commission in England also explores possibilities for such activities.
The healthy workplace
Employers can as part of their total health management the work environment and the individual
workplace as a way that this be an incentive for the employee's health and healthy behavior
promote. This requires investment, but also delivers much less loss, lower absenteeism and higher
labour productivity on. for example:
• good equipment and equipment so that work-related symptoms do not or hardly occur.
• good working atmosphere, in which opportunities and confidence-building on mental and stress-related
conditions are minimal and workers also smoothly.
• provisions that workers ' force ' to also exercise regularly during the work.
• sports facilities at work or in the vicinity.
• catering facilities with a varied and healthy offerings.
4.5 the working environment and the labour factor
Employers have an interest in healthy and productive employees, employees have an interest in
a healthy environment. Employees need to be healthy to get their pension and also after their
active life staying healthy and not adversely affected by previous labour. It is
known to work, whether or not paid, contributes significantly to making sense and with it to the
quality of life. Good working conditions are part of a good personnel policy and
a prerequisite for (maintaining) healthy staff. They have a positive effect on the
reducing absenteeism and incapacity for work. This is in the interests of the individual
employee (including income, less chance of additional disorders), the employer (e.g. higher
labour productivity, lower wages sick) and society (e.g. fewer benefits
and health care expenditures). In a recent study by Mackenbach (see VTV 2006) it is shown that
people who are in good health, eight months working time per person extra have at
over others. With the new working conditions act of 2007 is the
responsibility for the overall working conditions policy lies primarily with the enterprises.
Employers and employees are jointly responsible for that policy. The Government has an eye and
ear for obstacles or bottlenecks on system level.

4.6 long winded and action on several fronts
It is an illusion to think simple interventions can affect behavior or undesirable conduct
can change. Complex and persistent health problems require more and long-term
interventions. Successful examples where large groups of people change their behavior, such as
in road safety and smoking, show that a full package of measures on many levels
and over a long series of years get the most results. The comparison is needed with
large infrastructure projects, where the investment from the four-year political cycle go above.
Promoting healthy behavior requires time and continuity and the will to
collaborative approaches that are not always obvious. The Government must be to a
much more pragmatic approach.
The Council for public health and care (RVZ) advised recently to this type of complex
problems a lot of customization and a problem-oriented approach to use. The Ministry of health, welfare and sport
examines how this can be put into practice in the coming years. For addressing many current
complex health problems work insufficient existing methods. Health Policy
must be wide cabinet policy, about departmental borders. The common goal is
a healthy population, and that purpose is also about structures, laws and regulations.
Important sectors to work with are spatial planning, environment, management of the
public space, security, economy, education, green facilities, media, finance, sports and
Social Affairs. Leading actors where the Central and local Government can work are
health experts, schools, companies, institutions, Ward and community centers and advocacy groups
as local residents, patients and consumer organisations and nature organisations.
Key Points
• Healthy behaviour is not in itself, but shows a strong correlation with the social and
physical environment where people are born, grow up and live. Action should therefore above all
take place in the direct living environment.
• Our society increasingly invites to unhealthy choices. The Government can help by the
healthy choice the easy and obvious choice. By audience calls
its own approach.
• People living in an environment. Also that environment has a legitimate interest in their
health. The Government should look for in its policy with force the merger of
interests and those smarter and more consistently go connect.
• The Ministry of health, welfare and sport goes hand in hand with other partners are looking for ways to
to strengthen existing measures and methods and to expand and to new and
innovative methods to encourage people to healthy behavior as normal group standard
consider.
• The environment is complex and dynamic. Multiple measures are necessary to conduct
affect and standards change. That is a task of many and lengthy process.





5. connection between prevention and care
5.1 Introduction
The previous chapter shall establish a better connection between behavior and environment. There are still two
areas to a more consistent connection questions. Sometimes it seems like our country two
kent health systems one joint goal of good health for all
Brit People. This chapter deals with the functioning of the public health system (OGZ),
more and more often called Public health care. The Ministry of Health wants to help
those two worlds are connected and work together. Matching side note that prevention in
the care is wider than just treating disease in order to prevent worse. More and more often goes
identifying and addressing the risk to diseases.
5.2 care to the regular prevention
The area of prevention and care is characterized by a large number of players which contributes
to the health of Brit. The role of some actors such as the insurers, the
business, or new occupations in the first line, as the nurse practitioner, it changes greatly.
More on that later. The municipal health services have always had many ' traditional '
preventive tasks. They have various – often legally defined – features, such as combating
infectious diseases, consultation and crisis management tasks.
The dynamics in the public health system is changing and not always as in other sectors in
health care, where people focus on performance, transparency and innovation. Of course
happening in the OGZ much good. Attention is paid to the certification of the functions of the law
Collective Prevention public health and with the academic collaborative centres one works on
renewal. But there is also fragmentation and lack of coordination. There is to be gained,
for example, by reviewing the infrastructure, showing steering and funding and further
professional development through certification, reporting and quality processes.
5.3 prevention in the regular care
Prevention in the first line
The Ministry of Health wants to make prevention a more natural part of the regular
caregiving. Thus, preventive activities in chronic diseases already increasingly
part of the care chain. For these and many other forms of prevention is the first line
Moreover, the logical entry point for the connection to the curative care. After all, a large
part of the people comes annually at the GP or other health care providers in the first line. The
first line early warning lends itself well to people with a particular risk profile
who (have to) come into consideration for preventive measures. Finally, the first line close
to the people, which are sensitive turn out for health advice, for example, general practitioners or
nurses. Both the KNMG if the NPCF sees an important role for the wide first-line
to play in the connection between the curative and preventive health care. Also in European
related advises the European Observatory, a collaboration among other things the
World Health Organisation and the London School of Economics a leading role for the
primary care.

A lot is happening in the field of prevention in the first line. In varying degree is prevention
part of the treatment, care and guidance. There is still a lot of profit, especially on
the area of standardization, references, spreading good examples and by
financieringstromen on each other. By delivering the right information to people
There may be a demand for optimal prevention. There is also a role for patients and
consumer organisations. Finally, there are opportunities for the first line by more or better
collaboration with other healthcare providers, such as public health care,
occupational health care, social work and visiting nurses.
Prevention in primary care by general practitioners
In an average general practice is already done a number of things to prevention. In the basistaken package
family practices are specific preventive tasks appointed and in many standards in family medicine and
laws, the necessary attention to prevention. More than eighty of the current standards of the Brit
Family practices Fellowship (NHG), ten have almost completely covers prevention. The training requirements of
family doctors provide much general knowledge for this, but the courses are still primarily focused on the
medical model of disease treatment. There is little focus on specific preventive interventions and the
role of labour and the social environment. Here seems to be still a lot of room for improvement. The GP does
drug treatment often itself and he refers for lifestyle advice and other activities often to
other health workers in the first line, such as physiotherapist, dietitian, nurse practitioner,
primary care psychologist.
More cooperation between the curative and public health care
There are financial, organisational and mental barriers whereby both
health systems their own dynamics. The bridge function does not or only difficult to
stand. This is not only inefficient, but it also means possible missed
Health revenues. To reach a broad and integrated first line actually is
a better connection between the current first line (General practitioners, health centres) and the authorities
who are more concerned with public health, such as municipalities, local health authorities and
home care agencies, necessary and possible. To contribute to ' healthy quarters ',
all these partners focused on ward or neighbourhood level must work together.
Prevention activities should be determined locally, depending on the health problems in the
District. As indicated in the previous chapter, find the area-oriented impulses of this cabinet
opportunities for health centers and community centers in the area as a bridge. Also schools and
Centers for youth and families (CJG) – in some parts of the country parent-and-Kindcentra (OKC)
– can be instrumental. They can take the lead because of the
link to the WCPV and the social support Act (WMO). Also the national
Sports action plan offers new opportunities.

Prevention in second and third line
A major challenge for the health care is providing insight into the quality of the
care. If it is clear that certain health professionals deliver better products and services, and they
a reward (more patients and/or higher price), it is the health
for the better. A on balance, improves care quality-oriented competition. Prevention in the second
and third line may refer to preventing medical errors and increasing the
patient safety.
More and more often indicative prevention also within the guidance of patients with chronic conditions.
More serious symptoms often can be prevented and the quality of life
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
29
increased. More attention to the problem of malnutrition in the second and third line, and after a
treatment can prevent a lot of unnecessary burden of disease. Also on the more general area of
preventive work and rehabilitation are developments which that return or renewed action
of diseases occur. These things are often an integral part of the care chain
and for a number of diseases included in standards and guidelines. Here too, however,
that there is still progress to be made.
On the way to integrated care
To prevention-prevention primary prevention, but also in both the second and third line-
actually part of the care for chronically ill people, is a broad
programmatic approach, according to the concept of ' disease management ', are required. This approach provides
a chain of prevention, as many closing early detection, self management and good care.
The patient with the chronic condition is central. Patients receive customized care
offered by a multifunctional care team. The care team in consultation with the patient makes a
treatment program that is based on the standard of care of that condition. Doing so will the patient
also efforts to achieve good results and thus the highest possible
quality of life. In the future situation will be prevention-oriented part of the
standard of care of the patient in the treatment program and be included. The chain care
on the basis of the standard of care is offered will continuously on quality and effectiveness
be assessed by patient organisations, health care providers and insurers. The health insurance companies
will the care standards purchases for their insured and, if necessary, selective contracting at
favor of institutions and teams that make the difference in qualitative terms. Of course with
respecting the efficiency, but that is often in line with quality.
This broad programmatic approach with quality indicators and standards as the norm with care
for proper care, can ensure that market forces and competition on quality actually on
Gets going, especially in the treatment of chronic diseases. Within the Diabetes Care is
currently experience gained with the broad programmatic approach. Health care providers, insurers
and the patient organisation supports this development.

Porter: health gains in the care chain
Michael Porter, a leading Professor at the Harvard Business School, is known internationally because of its
strategic models. According to Porter, the patient should, more than is currently the case, really central. Then
the Organization of care automatically in a chain around the medical condition. By diagnosis
and treatment to focus on the causes instead of symptoms, the care
more effective and cheaper. Better coordination and integration throughout the care cycle and better management of
chronic diseases improve the results.
Implementation by various parties
Preventive interventions can be performed by various care providers. From the point of view
of market forces, there is no reason to submit to this exclusive one group. For example, the
Minimal intervention strategy (MIS) smoking offered by family doctors (or their
practice support staff), obstetricians, lifestyle advisors, whether or not employed by local health authorities or
home care organizations, primary psychologists and others. Condition is that they are experts in
the basis of their basic training refresher courses are about.

Default prevention, care and social security
Has already been referred to the importance of the working environment on health. The occurrence of
loss and the fast re-integrating workers after illness or loss has a positive effect on
health and is in the interests of employee and employer. In terms of legislation and regulations close
the social security systems and take good care on each other and there is a comprehensive chain of
failure prevention and reintegration. It is now up to the responsible parties to the policy
(advance) translate to company level. Here is also a responsibility and an interest for
insurers. The Government is monitoring the development, guarded the interests of vulnerable
groups and provides information through the health & safety portal, a digital information about
working conditions, prevention, absenteeism and reintegration. A better connection between the
occupational health care and the first line here will also have a positive effect on both
health as preventing loss from employment.
5.4 measures, framework conditions and innovation
Less fragmentation and more structure
People often do not naturally in movement. Citizens, health professionals and other parties
have (financial) incentives need making them notice if they perform well and if they are less
performing well. A bonus or a discount: provide the right motivation and the right incentives
Thus for more dynamics, also in prevention. So it lacks at this time to the right
Organization and the right incentives to the alert of risk groups to follow in the
form of systematic guidance. In many places are pilots and projects initiated in
to provide this guidance. The total gives a rather fragmented picture, in which the ' not-invented
here ' syndrome often rears its head. The projects often have an ad hoc approach and a
short duration, which also is not always clear if they work on the basis of experiments or just
with unproven effective interventions. Monitoring and evaluation are not always good
organized, whereby also the effectiveness is difficult to determine. There is, in short, too few
learned from each other.
Creating the desired (financing) structure and continuity should be a combination of
the Fund preventive health care provider, reimbursement from the health insurance and/or
national arrangements and the emergence of insurers actively looking
for high quality integrated care. Prevention is thus also integral part
of the care chain.

Claims in the health insurance act or AWBZ
Accepted and effective prevention would be a natural part of care
are supposed to be. It should be as part of the usual care in principle for compensation in
qualifying, depending on budgetary considerations and the regular decision-making
about that. The College voor Zorgverzekeringen (CVZ) has in July 2007 opinion on
prevention in health insurance. The concept of prevention is tangent to the social
responsibility of the health care provider. Main message is to ensure prevention
When there is a high risk of disease. Adding a separate claim ' on preventive
care ' in the health insurance act or AWBZ is probably not necessary, but may be a
adjustment of the decision claims Health Insurance Act. Condition is that the preventive
intervention in question sufficient (cost) effective. Sometimes it will be difficult in advance
scientific evidence for preventive interventions in the regular care. In those cases
can pilots help with proper monitoring the proof Express. Since the
introduction of the health insurance is the synergy with absenteeism and reintegration policy of
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
31
enterprises lagged behind expectations. An important explanation may be that the time
simple yet has been too short to expect. The next time will have to prove
or insurers and employers here new paths.
Prevention and quantify meaning product
It is necessary that such preventive measures defined and delineated loose
be that the recognizable services or products, that can be charged. At
the exploration the Ministry of health would like to give priority to measures which are in line with
the five priorities from the prevention note. A ' recipe ' move would not only in writing, but
also in the implementation in the same way should be seen as a recipe for a medicinal
bloeddrukverlager. In the exploration of possibilities for this are the cost, of course, an
relevant aspect. Also preventive interventions cost money.
Lifestyle and other risk mitigation medicines
Medicines are widely used for preventive purposes. The best known are
of course, blood-pressure and cholesterol, which in 2003 was about 600 million to
issued. Large parts of prevention by medications are historically part of the insured
care. Often are other interventions possible. Walking, lose weight or quit smoking can
an alternative to blood pressure and lower blood cholesterol, a afslankpil or an anti rookpil. The
discussion about this is still ongoing, as is also evident from the aforementioned CVZ-report. In
some cases, the combination of vaccines or medicines with lifestyle advice ensure
optimal results.
Strengthening incentives in the insurance system
Parallel to the exploration how parties can embed in better care, prevention must
explore the Ministry or as a matter of priority and what adjustments in there to care insurance
can contribute that insurers get a stronger incentive to support prevention efforts.
Research shows that financial incentives also work well for the more difficult to achieve
target groups.

Under the Health Insurance Act, the cost of insurers between prevention and curation
currently still at a disadvantage too fast out of prevention. The reason is that the cost of prevention
mainly be made in the first line. Insurers carry the risk of these costs for
100 percent in contrast to the cost of the curative costs of hospital care; that
be shared with other insurers. The same happens with profits that an insurer on the
curative care gained by more to prevention. The policy is aimed at the
risicodragendheid of insurers to increase for hospital care in connection with a
further adjustment of the hospital meeting of costs. That will benefit the preventive
care. 5
Another incentive for prevention can come via the submitted at the second Room
Bill for the compulsory excess. In it is recorded that in order in
Administration (General administrative order) forms of care or other services can be designated which
health care provider may provide that such fall outside the compulsory excess and under what
conditions. Can be examined or insurers with it discounts can start giving
for example, to insured persons take part in prevention programmes by which they go healthier
life and less medical expenses. It should in any case be avoided that,
nsurers about their clients the information they get, this will go in hands will
use to risk selection.
Innovation, ICT and E-health
New ideas may arise from the chemistry of combining. By people from the care
together with people from other sectors (business, education, ICT, philosophers,
trend watchers, artists, etc.) is created an environment where innovations can arise.
Something similar happens with the academic collaborative centres. Networks and alliances are also in
the health domain rule rather than exception.
There appear new products on the market and the application areas of existing products
wider at high speed. Big profit lies with process-driven innovation in the health care, often by a
better use of ICT capabilities. Innovations can be developed faster and better targeted and
more effective and earlier.
In the field of prevention are important innovations the remote monitoring,
patient compliance by, for example, medication reminders by e-mail or by sms and specially developed
disease-management programs at certain conditions. In addition, innovation and
possible to achieve individualized communication that connects to the personal
people's circumstances.
Prevention and treatment over the internet is another emerging development. Especially in the mental
health care (ggz) experiments find place and there is a shift from treatment to
Prevention and clinical care to self-help. There are already internet interventions for things like
obesity, depression, stress disorder, sleep problems and substance use such as smoking and drinking.
Key Points
• The public health system is characterized by fragmentation and small size.
Infrastructure and attention to showing steering and-financing is needed.
• Also in public health care to be gained through innovation and further
professionalisation.
• The first line does all the necessary in the field of prevention, but there are large mutual
differences and more is possible.
• There should be more connections between the first line and the public health system. All
parties need to work together to the financial, organisational and mental barriers that
between these systems are observed.
• Creating the desired (financing) structure and continuity should, in time, a good
interplay of the Fund preventive care provider and reimbursement from
the medical insurance and national arrangements on the other. There must be separate decisions to be
taken. A broad programmatic approach with care with quality indicators and standards
as standard for good care, can ensure that market forces and competition on quality
actually gets going, making a ' zorginkoopmarkt ' is created which insurers
actively searching for high-quality integrated care.
• Two explorations are needed. With priority should be explored which adjustments in the
health insurance insurers more to excite to prevention efforts.
You will then need to be explored how innovations (medicines, ICT-related and other
products) can be used to achieve health gains.

6. connect, collaborate and modernize Administrative environment:
6.1 Introduction
Chapter three gave to which parties have an interest in improving the health and what
It is everyone's responsibility. In Chapter 4 and 5 are those interests into two main lines,
know behavior and environment and prevention and care, connected to each other. Also outlines the Ministry
in those chapters which avenues towards a new prevention policy
come.
For the Government is that responsibility even in the Constitution. Therefore, HEALTH, WELFARE and SPORT in
This chapter a picture of what is within the domain of the Government needs to be done to the
to improve administrative context where it can refresh and where it should be. That all things in the
realize that the time is over all that is centrally controlled. Better health also remains mainly a
case of people themselves and can, also where the support and guidance from the Government, the
best in consultation and in short lines with them. That also means a strong emphasis on the
local level and an Apple on municipalities for a powerful health policy. Of a
public health policy on the way to a healthy public policy!
6.2 Prevention cycle
In the Collective public health Prevention Law in 2002, is the ratio between rural and
Local Government recorded in a four-year prevention cycle. The Central Government sets priorities and put
frameworks within which municipalities are responsible for the implementation of local policies. In the
WCPV are also the supervisory task of the health care Inspectorate (IGZ) and the
analyserol of the Center for public health Future Explorations (VTV) of the RIVM
included. The prevention cycle is only young and municipalities are in 2007 apply to their
second note local health policy. The Ministry of health will go long-term cycle
use as a basis for policy. The push button function of the inspection plays a crucial role.

6.3 local policies
At municipalities takes an increasingly important place in health policy, that there are still improvements
possible showed off a report of the Inspection in 2005 which showed that many municipalities
problems in the implementation of planned activities: a (large) number of municipalities
knew the local health situation still insufficiently to the right priorities
can fix. The inspection concluded that there is insufficient use is made of
proven effective measures. In the implementation of the local administration play the local health authorities, where
municipalities – whether or not jointly – owner of his, an important role. Also
home care organizations, traditionally mainly charged with care of the elderly, have increasingly
a task. HEALTH, WELFARE and SPORT notes that many municipalities their responsibility for local
health policy will pick it up and wants to see that they continue this with force and translate into further
effective policies, both within their statutory duties as on other policies
with health. Also at the local level can go to cooperation and the
merger of interests wanted and municipalities have an important direction-and aanjaagrol.
There are also good examples, such as the aforementioned ' delicious Fit! ' program in Rotterdam.
6.4 modernisation of public health care
Public health care is in many cases characterized by small scale and
fragmentation. To counter this, the national Government goes through with the development of
field congruence between MUNICIPAL HEALTH SERVICE regions and those of the medical aid in case of accidents and
Disasters (GHOR). The so-called 25-5-1 formula: 25 local health authorities, 5 lands as a contact point for
the Ministry of health. The Center gets further formation of the RIVM form. Also the Government
continue with the modernisation of the national vaccination programme and of the population surveys.
It will keep a watchful eye for the independent responsibilities of all stakeholders and
the powers of the various levels of Government. But it is clear to all that there
given the fragmentation the necessary to achieve efficiency gains.

The Ministry of health is going to encourage their local health authorities quality policies and training requirements for
their people to the next level in the way that also still further in
the curative care. Instruments as guidelines, accreditation and certification will be much attention
get.
6.5 Better knowledge management as part of the national Government directing function
As part of its management function has the Central Government a responsibility for a
efficient knowledge policy. This is especially true in a usable way also for the provision of
that knowledge and the resulting applications. The Ministry of health, welfare and sport does that by the
granting contracts to health-promoting institutes to tools and
information material that actually can work in practice. In the coming years there will be
in the research more attention for the social benefits of health and prevention in
the research, as for example the relationship between school performance and health.
ZonMw has the task to discover new things and try out. It is up to the
RIVM to know how the flag blowing and substantive direction. The national Government goes into
its responsibility for the knowledge policy invest and the commissioning
strengthen.
HEALTH, WELFARE and SPORT a vision of health and prevention, september 2007
35
Healthy Living Centre
At the RIVM is a Center healthy life style. This brings supply and demand of knowledge
about health together, run directed about the offer of framing methods and provides
above all for better cooperation between the existing health-promoting and rural
Working organizations. By a better organisation of the available knowledge, the
professionals within local health authorities, schools, work environments etc. focus on a good quality
implementation and customization of that knowledge for their work. That prevents the accumulation
small projects and the constantly re-inventing the wheel. Local innovations that
on the other hand, are promising, must fast as an oil spill may spread.

increasing the knowledge about prevention and prevention
measures. The program focuses on the emergence and application of effective measures,
efficiency, effectiveness and implementation. The gaps in existing knowledge about prevention in image
brought in cooperation with RGO, EUR/MGZ and TNO. Other participants in the field by ZonMw are the
home care organizations, health-promoting institutions and local health authorities. The program runs from 1997 to
2014, divided into three installments with different sub-projects.
6.6 knowledge about cost effectiveness
Following on the need for better management function in knowledge management, as mentioned in para.
6.4, the Government notes that little is known about the cost-effectiveness of measures. That
makes the formulation of an optimal package of measures difficult. Often only a
part of the cost, revenue, and limited effects taken into account in the evaluation, is not known
What impact on the measures for specific target groups (such as low SES, young people) and is
often further research needed to determine the conditions under which large-scale introduction of
an experiment will be successful. Tests with proven effective interventions will additional
knowledge about profitable investments in prevention. At the research programming will
Cabinet focus on knowledge about cost-effectiveness in the broad sense of the word in
connection to this vision. In particular the program described above in the box by ZonMw will
play a role in the coming years.
6.7 Health as a condition for and results of join
With the social support act of 2007, municipalities still an instrument in
hands for an effective health policy. Purpose of this law is to promote
people "take part" in society. Promoting participation in social life
and promoting health are closely related. There is no linear relationship: health
and participation reinforce each other. If you're not healthy, you can take part more difficult, while you feel more
feels like you take part in elections. As the aging population increases, the number of chronically ill rises and there
more and more people with mental or intellectual disabilities in society,
more attention for the quality of life. With the new law the municipalities the
attention to quality of life. Municipalities have great opportunities with the law on the
improving living conditions so that problems can be prevented and people are in
health to live. The aforementioned merger of interests of different sectors
also plays here emphatically. Municipalities can improve the physical infrastructure with accessible
and accessible facilities, but also the poverty policy and youth care in the frame
of their approach to problem areas. The Ministry of health will also the local administration possible

by knowledge, by comparative examination and by
to organize meetings between municipal services.
6.8 Centers for youth and families
As already indicated in the programme ' All opportunities for children ' by the Ministry of youth and
Family takes the Cabinet the emergence of Centers for youth and families with power.
These centers are for parents, children and young people (of at least 9 months to 23 years) a clear and
easily accessible central point for growth and educational questions, adequate and appropriate help, and
coordination of that aid. The centers are there for all parents, children and young people, and not only for
problem families. Base is the youth health care: this is with a range of more than 95 percent
particularly low threshold. The centres are also a central point for professionals for early
signaling. The centres bring together various bodies and functionalities that are still too much along
each other work.
4.3 improvement of enforcement and supervision
One of the most important measures in reducing the drinking of alcohol by young people is the
better maintaining existing age limits for the sale of alcohol. To which enforcement at
alcohol sales and supervision of the non-smoking hospitality as possible is there for extra budget in 2008
the VWA. In addition, in consultation with the INTERIOR and KINGDOM RELATIONS will start in 2008 pilots with municipal supervision
the drink – and catering regulations. At success of these projects will be in concert with the INTERIOR and KINGDOM RELATIONS to see how
the municipal supervision can be further rolled out and what the role of the VWA.
6.10 exploit international cooperation and international contacts
On the other side of the England is only part of a geographical spectrum quickly
globalizing world. In the area of health protection is international cooperation
a requirement, such as in preventing the outbreak of large-scale infectious diseases. Furthermore,
large social trends almost universally as, for example the obesity epidemic. Other
social actors, such as business, are internationally organized. ICT
applications and developments are pretty much not restricted to a particular area.
For legal regulation is the national Government increasingly dependent on international and
European agreements and regulations. On the one hand, the regulation of the European Union (EU) impact
on the Brit situation, on the other hand, the EU England sometimes also necessary for an effective
approach. Will the national Government should focus on more and more global or European agreements.
The Ministry of health will draw up proactive and involved in the creation of those
appointments.
International organisations such as the EU, the Organisation for economic co-operation and
Development (OECD), the World Health Organisation (WHO) and the world bank, can a wealth
of knowledge. The Ministry of health is going to better use the knowledge of those organizations,
especially on the two main features of this vision, behavior relate to environment and prevention and care
connect with each other.

Also from experiences in other similar countries and maintaining contacts can VWS
learn. The Ministry should use international comparisons to improve themselves and sharp
to keep. In the field of integral public policies, modernisation of public
health care and innovative prevention concepts is a lot to learn from the United Kingdom,
the Scandinavian countries and some Anglo-saxon countries such as Canada, Australia and new –
Zeeland.
In the field of health, WELFARE and SPORT the experiences in those countries better use than to
present is done. England can also sometimes just next, instead of ' guide land '.
In addition, knowledge not without knowledge. There is a lot of interest abroad
for the changes in the Brit healthcare system and the connection between prevention and
curation. HEALTH, WELFARE and SPORT will also actively promote the Brit knowledge.
Key Points
• The prevention cycle is still young, but municipalities begin their responsibility
for health policy. A clear division of labour with local health authorities and the curative health care
is needed to more health gains.
• Municipalities are ideally find and work place of cooperation and therefore the right place to
understanding ' preserved parallelism of interests ' to operationalize.
• The Government will improve the knowledge management as part of its management function and to this end
among other things the Center for healthy living.
• The Ministry of health will anticipate to other departments and a
solution-oriented attitude with an eye for the interests which those departments
represent.
• The reciprocity between health and participating is evident. The Ministry of health encourages
municipalities to seek synergy between local health policy and the social
Support.
• Improve enforcement and monitoring of compliance with age limits in alcohol sales.
• Overseas is a source of inspiration. Strengthen international cooperation and exploited
international contacts better.

7. final
The analysis from the previous chapters makes it clear that the current policy and implementation
of tasks often remains free, fragmented and not enough health benefits. The
importance of a good health policy, including prevention, however, is not only in
health gains. Increasingly recognised that health and care sectors also a
positive contribution to society. Can also contribute to the sustainability of prevention
the health care system itself, because it can have a positive influence on the batter on scarce resources
as labour.
An approach to the most current public health problems and prevention
actually make it contribute to society and the sustainability of the health care system asks
to adjustments of policies and directions for new policy. HEALTH, WELFARE and SPORT has it that policy development in
four themes:
1. nurture and innovate
2. coherent and health in all policies
3. prevention in the care
4. connect work and modernise administrative environment:
The further development of the themes will, in consultation with parties as a follow-up to this vision happen.
Together with the Minister for youth and families will be the Minister of health, welfare and sport as a follow-up to this
Prevention vision also getting started with the axes letter about alcohol policy, the amendment
Beverage and hospitality policy, and a policy document for addressing obesity.
The coming year comes VWS with a Public Health Bill, a nutrition note, a
drug prevention plan and a tobacco action plan. Further stimulates VWS ' move on ' and stop recipe
smoking-support via the care. In addition, in consultation with the RIVM, ZonMw
and the Health Council shall review existing programs may be how the Ministry advice
use for setting up a good monitoring and evaluation system of the implementation and
effects of the prevention policy.
Across these four themes and the two main features of the vision stand around at which take effect the
following principles central.
• Preserved parallelism of interests: the Government sees health as a social core value, but
above all, if legitimate interest between other legitimate interests. Actively looking
go to where those interests reinforce each other or where health can be at the service to
other interests provides important synergy.
• Effectiveness as standard: stop, promising preventive interventions that do not work
investigations on interventions (cost) effectiveness. Proven (cost) effective interventions should
basically in the insured parcel, or relevant national arrangements to the AWBZ included
Depending on budgetary considerations.
• The healthy choice the easy or the only choice for people as:
and offer the products in such a way that people choose "automatic" for health.
• Innovative communicate: make better use of old and new media and
marketing strategies and health messages from different environments that are on display
connecting.
• Learning from foreign countries and other sectors: not everything myself inventing, share successes and
make applicable to achieve health gains.
• Interest in the youth at the forefront of prevention: prevention policy specific attention on
measures that benefit to the youth. After all, young taught are done. The lifestyle
those is largely determined by the education.

The Cabinet calls on all its partners in prevention with parallel interests – and, above all, outside the
health sector – on to contribute and to cooperate in realizing this agenda for
change and strengthen our prevention policy. But the Cabinet calls not only on. We will,
precisely with an eye on the issue of alcohol, drugs and obesity, deepen cooperation
and institutionalizing. We will also create conditions for the public. Also do
we call on our partners to prevention in the own a clearer policy.
Hand in hand toward a healthier England!