Inschatting effecten van openbaar gezondheidsbeleid gericht op roken. Scenario analyses totale bevolking en laag opgeleiden

The Dutch government promotes a healthy lifestyle, and this includes efforts to reduce the number of smokers. Another health policy priority is to decrease socioeconomic health differences. The RIVM was asked to assess the health effects of two theoretical scenarios. In the first scenario, called the 'target scenario', the number of smokers stopping during a 3-year period brings the percentage of smokers down by 2 per cent points. This means that about 250.000 persons quit smoking. In the second scenario, called the 'socioeconomic health differences (SEHD) scenario', the effects on difference in life expectancy between highest and lowest educational levels are estimated as if the prevalence of smokers in all groups were equal to the highest educated population. The effects of the two scenarios were compared to a 'reference scenario' where smoking habits remained equal. The Chronic Disease Model was used, which is a so-called Markov-type multi-state transition model. The effects of the 'target scenario' are that in 2014 total mortality decreases by 0.2%, the number of lung cancer patients by 1.5%, and the number of cardiovascular and COPD patients by 0.5%, compared to the reference situation. In the 'reference scenario' the difference in life expectancy between persons with the lowest and highest level of education amounts to 5.1 years for men and 2.7 years for women. In the 'SEHD' scenario, these differences are reduced to 3.6 years for men and 1.7 years for women. This means that differences in life expectancy between educational levels will be reduced by 35% of maximum. It is emphasized however that the SEHD scenario is not realistic. Since assumptions are made and the situation is simplified, results in the present report should be interpreted as giving an overall indication of total effects. We conclude that a small reduction in the number of smokers results in lower mortality and morbidity in the total population, and that anti-smoking measurements among lower educated persons contributes to decreasing the socioeconomic differences in health.