Our children are the replacements for the 19,000 smokers who die each year

It is shocking to note that in the Netherlands we are not succeeding in preventing children from starting to smoke. Every adult smoker who dies is still replaced by a young smoker. What is missing from the Prevention Agreement is a sense of urgency for measures to prevent young people from starting to smoke. A generation-specific sales ban is a desirable supplement to the measures already taken from the Prevention Agreement.

The ambitions of the national prevention agreement ‘Towards a smoke-free generation’ are high: Less than 5% of adults and 0% of young people will still smoke in 2040. But four years after the start of the prevention agreement, the number of smokers has only slightly and sadly fallen. One in three young adults (20 to 24 years old) smoke, and in the group of 16-20 year olds, a slight increase in smoking behavior can be seen, thanks to the popularity of steam cleaners and dampers: 8% of this group now smoke daily.1

Every day, 40 children under the age of 18 start smoking

I find it alarming that around 40 children under the age of 18 start smoking every day.2 Two of the three young people eventually become addicted.3 And thus the tobacco industry deprives our children of 10 years of their lives, while they also experience around thirteen less healthy years of life.4 Smoking has a huge impact on healthcare. Of the total disease burden in the Netherlands, 9.4% is caused by smoking, leading to 2.4 billion euros in healthcare costs annually.5 If nobody smokes anymore, the number of cancer cases will drop by 20 to 30 percent and we will save 19,000 lives a year.4 Far-reaching preventive measures are necessary to achieve this.

The question is why the politicians do not feel that they are in a hurry and are lagging behind in implementing important measures. Various anti-smoking measures have been shelved. A pack of cigarettes would increase in price by ten percent every year. But excise duty was most recently increased in April 2020, and the ban on flavorings in e-cigarettes comes far too late for me. Because in the meantime someone in the Netherlands dies every half hour from the consequences of a smoking addiction.

Vaping, snuff and nicotine pouches

Alternative smoking products such as e-cigarettes, snuff and nicotine pouches are promoted as healthy alternatives to tobacco. But all these variants release toxic and carcinogenic substances. In addition, the risk of vaping is that it is a stepping stone to smoking nicotine-containing cigarettes. The production of e-cigarettes and refills with flavorings will be banned from 1 January 2023, and snuff and nicotine pouches are already banned for young people under 18. My proposal is to treat ‘vaping’ and ‘snus’ in the same way as tobacco. This means, among other things, neutral packaging and the collection of consumption tax.

We will have to remain extremely sharp, the tobacco industry will no doubt come back with new products on the market. Because the industry is constantly looking for ‘replacement smokers’. Children and young people must replace the 19,000 smokers who die every year in the Netherlands from the consequences of their addiction. The documentary ‘The Replacements’ gives a picture of the meticulous tobacco industry. Young people are an instrument to make money. If we don’t ban alternative smoking products early, the smoke-free generation will soon be back at square one.

Smoke-free generation in 2035 with the intergenerational sales ban

I am following with great interest the generational sales ban that has been proposed in New Zealand. Such regulation could be a nice supplementary measure for the Netherlands to achieve the smoke-free generation faster. New Zealand’s law will ensure that young people who are now 14 years old can never buy tobacco again. If we start now with such a generational ban on the purchase of tobacco, for everyone born from 2017 we can reach the smoke-free generation in 2035. That is five years earlier than agreed in the national prevention agreement. It saves pain, grief, life and money.

Why wait?

Hundreds of children a week, about 14,600 a year, start smoking or vaping, resulting in a deadly addiction. And half of these children will eventually die from the consequences of their addiction. The sooner we start with the start of a smoke-free generation, the better. Every child should have the opportunity to grow up smoke-free, and non-smoking should become the new norm. Together we can influence the future now and all be part of history in the making. We will start with that today.

René Héman, chairman of the KNMG medical association

1 Overweight, smoking and alcohol consumption have hardly decreased since 2018 (cbs.nl)
2 Towards a smoke-free generation: “Are we there yet?” – Trimbo’s Institute
3 Children and smoking: facts at a glance – Trimbos Institute
4 Figures smoke – Trimbo’s Institute
5 Home | Public health perspective



More columns by René Héman


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