Municipal Tobacco Control in the Netherlands: A Quantitative Content Analysis of Health Policies

Abstract Background A smoke-free society by 2040 is a target for Dutch municipalities, mandated by law. Smoking remains a significant public health issue in Northern Netherlands. This study evaluates the content of municipal health policies concerning tobacco control and their correlation with provincial smoking rates. Methods We utilised the Dutch Public Health Act to analyse and score municipal health policies. We built our scoring model based on the logic of events theory, which determines policy impact according to four categories: Obligations, Goals, Opportunities, and Resources. We examined provincial differences and correlations in health policy scores, smoking prevalence, and municipal-level factors, including socioeconomic status. We created an interactive health policy map to visualise results. Results Groningen scored the highest variability among its municipalities in total health policy score, with a median ± (IQR) of 22.50±14.50, and Opportunities significantly varied among provinces (p = 0.01). Groningen showed the highest smoking prevalence (24.68%) compared to Drenthe (20.51%) and Friesland (22.49%), and the lowest socioeconomic status (-0.104) compared to Drenthe (0.095) and Friesland (0.005). We found negative correlations between socioeconomic status and total health policy score (r=-0.38, p = 0.02), Opportunities (r=-0.36, p = 0.02), and Resources (r =-0.33, p = 0.04). Additionally, we found Resources correlated with both Obligations (r = 0.51, p < 0.001) and Opportunities (r = 0.58, p < 0.001). Obligations also correlated with Goals (r = 0.35, p = 0.03). Conclusions We developed a scoring model and an interactive map to quantitatively examine municipal health policy content in Northern Netherlands, particularly regarding tobacco control. Given a smoking prevalence higher than the national average, despite high policy scores, inadequate tobacco control suggests socioeconomic factors, governance, and financial planning as barriers to implementing policies. Key messages • Quantitative content analysis and evaluation of health policy using a newly developed and reproducible policy surveillance scoring model utilising nationally available datasets. • Barriers to smoke-free society include inadequate municipal financial planning and limited national legislative authority over municipalities, leading to reluctance to enforce tobacco control.