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Fertility in the Netherlands has never dipped to the extremely low levels observed in some other European countries. The Netherlands has always maintained a total fertility rate (TFR, average number of children per woman) above 1.7. In 2009, the TFR was 1.88. The absence of direct family policies and the fact that the Netherlands is a highly secular society both make the country’s relatively high fertility, in a European context, appear as a paradox. The Dutch government provides substantial welfare benefits, but, given concerns about high population density, no specific policies have been implemented to raise fertility. Dutch society is characterized by a strong value preference for fathers to be the primary breadwinners and mothers to care for children at home. As a result, the Netherlands stands out as having the world’s highest fraction of women in the labor force who are part-time workers. Women tend to work in occupations that allow part-time work and higher work-family reconciliation, resulting in what has been termed unequal work for unequal pay. The state has had a paternalistic role—supporting mothers to work part time and providing child allowances and, until recently, free higher-level education and generous benefits. The Netherlands shows that religion is not necessarily a prerequisite for fertility and that work-life reconciliation and individual control of fertility can sustain moderate fertility levels. The recent financial crisis, however, has called the sustainability of this system into question and has signaled the end of many generous state policies, combined with increased calls for women to become less reliant on their husbands and more economically independent. (Mills 2015)

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Higher education, particularly of women, operates to postpone childbearing and can result in lower fertility overall. Dutch women have made considerable gains in education, and now more women complete university education than men. This appears to have had the expected effect on the timing of childbearing. At an average age of 29.4 years, first time mothers in the Netherlands are among the oldest in the world. Many go on to have a second child soon after the first.(United Nations Department of Economic and Social Affairs)

All primary, secondary, and higher education is provided by either governmental (municipal or state) or private institutions. The latter are, with a few exceptions, run by Protestant and Roman Catholic organizations. All private schools are, when they conform to legally fixed standards, financed from governmental funds on an equal footing with their public (openbare) counterparts. Dutch secondary education is not a comprehensive system (that is, the same for all pupils) but one consisting of several tracks. Among these are the five-year Higher General Education track, the mandatory preparation for institutions of higher education other than the university; and the six-year Preparatory Scientific Secondary Education track, which is mandatory for university admittance.

The system of higher education is a binary one. There are dozens of institutions for Higher Professional Education, and they cover many professional fields complementary to those served by the country’s principal universities. The latter are all publicly financed. A number of the major universities cover a general range of disciplines, including the four state universities—of Leiden (founded 1575), Groningen (1614), Utrecht (1636), and Limburg at Maastricht (1976)—and the (former municipal) University of Amsterdam (1632), the Erasmus University at Rotterdam (1973), the (originally Calvinist) Free University at Amsterdam (1880), the (originally Roman Catholic) Radboud University of Nijmegen (1923), and the University of Tilburg (1927). Other governmental universities are more specialized: the universities of technology at Delft (1842), Eindhoven (1956), and Enschede(Twente University; 1961) and the Agricultural University at Wageningen (1918). In addition, the Open University, established in 1984, provides for both university and vocational education through correspondence courses. (Britannica)

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Historical Trends and the Origin of Immigrants

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Historical Trends and the Origin of Immigrants

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The Netherlands’ history of immigration begins in the 1950’s. After World War II, the country was in ruins and it needed much reconstruction. There was a shortage in the labor market by the 1960’s which led individual companies and the Dutch government to recruit workers from Southern Europe with little qualifications. They were labeled “guest workers” and they returned to the country of origin after a few years. In the 1970’s, the country experienced an oil crisis which led to economic problems and increased unemployment rate. Therefore, the Dutch government introduced the law on family reunification in 1974 which gave the families of the “guest workers” to reunite and live together in the Netherlands. A year later, the Dutch colony, Suriname, gained its independence and thousands of people migrated from Surinam to the Netherlands and became citizens. Since the 1980’s, there has been a wave of asylum seekers fleeing their country of origin and finding refuge in the Netherlands. Many have escaped because of political, humanitarian, or economic reasons (University College London, 2008).

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The life expectancy of men and women in the Netherlands is growing gradually. Women continue to outpace men in surviving to the next age interval. Although the Dutch health care program has led to significantly improved population health due to reduced numbers of hospitalizations and successful survival rates, which indicates effective care in both primary and secondary sectors, preventable mortality indicators portray long term consequences such as the extended use of tobacco. Daily smokers in presented data above helps paint the picture of sex differences in mortality. With the Dutch Government in early years ignoring the effects of tobacco use, the rising causes of mortality is lung cancer, which is still rising today. The Dutch government is endeavoring to overturn the majority of smokers in the Netherlands by implementing new policies to reduce the spaces in which smokers can smoke. Even with push back from smokers who believe that government intervention in tobacco use is an act against free will, data has shown that men on average are consuming less amounts of tobacco. Gender and class have been shown to induce the likelihood of smoking. Men are described as being more likely than women to engage in risky behaviors such as smoking, therefore, men typically start using these products at an early age. Data has shown that children in the Netherlands are consuming both tobacco products and alcohol as early as 13. The Dutch government as well as committees trying to cease smoking in the Netherlands is addressing both smoking and alcohol consumption in adolescents. The goal for 2040 is that Netherlands becomes a smoke-free environment in which the new generations do not pick up smoking, which will save money for health related issues as well as reduce the leading cause of death for Dutch individuals. The goal consists of reducing tobacco use through “ increasing taxes on tobacco products, limiting marketing of those products, increasing education about the risks of tobacco use and aid more in support for smokers to quit” (Global Report; Ryan). The efforts of the Dutch community have not gone unnoticed. Even comparing the Netherlands to the United States, the Dutch community is surpassing the U.S. in majority if not all of the data that states Dutch men and women are living longer and struggle less with obesity, HIV, Infant mortality, malnutrition etc. The Netherlands is leading the race against America, on top of life expectancy, is tobacco cigarette imports, with the Netherlands being ranked as 22 with 14,250 million of cigarettes compared to American who is ranked 14th with 11,500 million of cigarettes (Nation Master). Thus, indicating that the nation compared to other countries is showing significant growth and improvement with health disparities.

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The Netherlands is a European country located northwest of the continent. This country is geographically popular for its flat land and its rivers, lakes, and canals. All bodies of water have been effectively managed since the medieval times. Some land was drained and reclaimed from the North Sea along the coasts. The North Sea is located north and west of the country. The Netherlands is bounded by the North Sea to the north and west, Germany to the east, and Belgium to the south. If the Netherlands were to lose the protection of its dunes and dikes, the most densely populated part of the country would be inundated. The neighboring countries are Germany to the east and Belgium to the south. Because of its location, the Netherlands is protected by dunes and dikes, and if it were to ever lose that protection, the country would be flooded in its most densely populated area. The highly developed portion of the country covers more than half of the total region of the Netherlands and it lies about three feet above sea level. The other half of the total region lies below sea level. Because of the low elevation and the flat land, building is only possible on rafts and this lower area mainly consists of polders usually surrounded by dikes. Initially, man power and horsepower were used to drain the land, but they were later replaced by windmills, such as the mill network at Kinderdijk-Elshout, now a UNESCO World Heritage Site. The largest water-control schemes were carried out in the second half of the 19th century and in the 20th century, when steam pumps and, later, electric or diesel pumps came into use (Wintle, 2021).

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Birth Control Contraception  and Fertility 

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Birth Control Contraception  and Fertility 

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At the beginning of the 1960s, the Netherlands was basically a conservative society, in which there was little public discussion of birth control or of any sex-related topic. Then, beginning in the 1960s, a series of revolutionary changes in attitudes transformed the Netherlands. The pill was introduced in 1964, and within four years, four out of 10 Dutch women between the ages of 21 and 34 had used it. In 1971, the pill and sterilization were both made available free of charge through the national health insurance plan. By 1974, three-quarters of currently married women 20-42 years of age had ever used the pill, and by 1981, more than 700,000 men and women of reproductive age had had voluntary sterilizations, so that approximately 20 percent of all Dutch couples of reproductive age were protected from pregnancy by sterilization. As might be expected, the wide use of effective contraceptive methods during the late 1960s and the 1970s produced an unprecedented fertility downturn in the Netherlands: The crude birthrate fell from about 20 births per 1,000 population in 1965 to 13 per 1,000 in 1975; the total fertility rate fell from 3.1 births per woman in 1960 to 1.7 in 1975. The birthrate and the abortion rate among teenagers both declined during the 1970s; since sexual activity among teenagers was far more common at the end of the decade than at the start of it, the decline suggests that teenagers used modern contraceptive methods, especially the pill, effectively. At present, contraceptives are widely available, usually at no cost, throughout the Netherlands. (National Library of Medicine)

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When the Netherlands started recruiting “guest workers” in the 1960’s, they were coming from Spain and Italy. However, most of them returned to their homes. In the 1970’s with the family reunification law, most “guest workers” came from Morocco and Turkey and they resided with their families in the Netherlands thereafter. As mentioned, many migrants from Dutch colonies came from Suriname but they also came from the Netherlands Antilles. Refugees in the 1980’s came from Iraq, Somalia, and Afghanistan. More recently, refugees have been coming from Syria (University College London, 2008).

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As already discussed, the Netherlands has been pulling in a great amount of people and integrating them into the country. One of these pull factors is employment opportunities. When the Dutch economy was in ruins after World War II, they knew that there must be a rebuilding of the labor market. Ever since then, employment chances have been a major factor in attracting people to come to the Netherlands. The wages of these jobs and their security kept “guest workers” coming in. Another pull factor is having a good education. Even though most of the immigrants that come to the Netherlands speak a different language, the educational system in the country helps students rise and set them up to have a good career and a better life (Federica, 2020). Migration data below shows there is not a substantial out migration rate from the Netherlands. Any push factors that may make a person wish to leave the country is not significant enough to be a national shared experience. Some leave for higher education and some leave for a greater job opportunity. However, these are personal decisions, and they are not caused by a specific factor that pushes these individuals out of the country.

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According to the Migration Data Portal, the net migration in the Netherlands by the year 2020 complied from the 5 years prior to 2019 was 80 thousand (Global Migration Data Portal, 2021). The net migration number represents the number of immigrants minus the number of emigrants in the country. That is, the number of people coming into the country minus the people leaving it. The graph for this measure shows how net migration numbers have decreased over the years. In 1995, it reached its peak with the rate being 186.4 thousand. The lowest number was in 2015 at 62.7 thousand (Global Migration Data Portal, 2021). This measure is important because it clearly reflects the historical migration trends in the Netherlands that were discussed above. It also reflects the times in which push and pull factors were relevant enough to create major flows of immigration and emigration.

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There is not a substantial out migration rate in the Netherlands, as mentioned above. The total numbers of emigrants half way through 2020 was 970.4 thousand. This is relatively small compared to the total number of international migrants which was 2.4 million people (Global Migration Data Portal, 2021). It is important to note that these numbers reflect the prevalence of each category. This means that they tell the proportion of the people in the population at a specified point in time. Comparing these numbers, it is clear that the ratio of immigration is higher compared to that of emigrants. The Netherlands receives many more people than those leaving.

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The 3 countries neighboring the Netherlands are Germany, Belgium, and the UK. Ranking all 4 nations based on their net migration rate, the Netherlands would be fourth and last. The country with the highest net migration rate is Germany, which had a rate of 2.7 million in 2020. This makes Germany the second country with highest net migration value worldwide. The United States is number one. The UK is second between all 4 countries and it had a rate of 1.3 million. Belgium has a higher rate than the Netherlands as well. Its net migration rate in 2020 was 240 thousand (Global Migration Data Portal, 2021). Even though Dutch history has brought in many immigrants and it did not push away many others, the net migration rate is relatively lower compared to its neighboring countries. It seems that the pull factors in the Netherlands may not be as strong as the pull factors nearby in the region.

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One lesson we can learn regarding fertility in the Netherlands is that social norms, values and family policy contribute to the rates of fertility. The Dutch government provides substantial welfare benefits, but, given concerns about high population density, no specific policies have been implemented to raise fertility. Dutch society is characterized by a strong value preference for fathers to be the primary breadwinners and mothers to care for children at home. As a result, the Netherlands stands out as having the world’s highest fraction of women in the labor force who are part-time workers. Women tend to work in occupations that allow part-time work and higher work-family reconciliation, resulting in what has been termed unequal work for unequal pay. The state has had a paternalistic role—supporting mothers to work part time and providing child allowances and, until recently, free higher-level education and generous benefits. The Netherlands shows that religion is not necessarily a prerequisite for fertility and that work-life reconciliation and individual control of fertility can sustain moderate fertility levels. The recent financial crisis, however, has called the sustainability of this system into question and has signaled the end of many generous state policies, combined with increased calls for women to become less reliant on their husbands and more economically independent.  (Research Gate). Thus we may see in the future a change in fertility due to the uncertainty of many with the changes in state policies.

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In the Netherlands, the religious divide between Protestants and Catholics is even further pronounced. As part of the pillarization system, which prevailed from the end of the nineteenth century to the mid-twentieth century, members of each denomination, or unaffiliated people, belonged to separate social, educational and political institutions (van Poppel 1985). However, the pillarization system has dissolved since the 1960s, as secularization accelerated and the proportion of disaffiliated people has increased rapidly (Knippenberg 1998; van Rooden 2003). Today, Catholics constitute around 30 percent of the population in the Netherlands, while Protestants constitute about a fifth (Berghammer 2012).

The demographic history of the Netherlands in the nineteenth and twentieth century, while firmly rooted in the pattern of the development in Western Europe, has as one its most distinctive characteristics the relatively late and gentle decline in fertility. As a consequence of the slow fall of the birth rate, from around 1910 Dutch fertility stood out well above the level in other European countries. Only in the mid-1960s fertility levels had been reduced to the then existing European standard (Festy, 1971, 2).

The reasons for this anomalous position have been the subject for extensive discussion from the mid-1950s on (Van Heek, 1956; Petersen, 1960; Hofstee, 1968, 1985; Buissink, 1971; Boonstra & Van der Woude, 1984; Van Poppel, 1985). From the beginning, the rather high fertility of Dutch Catholics was considered as one of the factors responsible for the late Dutch fertility decline. Census data on the number of children ever born showed that Dutch Catholics were later in adopting fertility control than other religious groups

As can be seen in Figure 1, already among women married before 1900 there was an important difference between the fertility of Roman Catholics and that of other denominations. Catholic women had on average two children more than women with no religious denomination up to and including the 1934-38 cohort. Catholic women married in the period 1950-54 still had, on average, the same number of children as women of no denomination, married forty years earlier. From the 1940s on, Catholic fertility was lower than that of Calvinists

When around 1965 a new stage in Europe’s demographic history started and fertility rates declined, the differences in fertility between religious groups almost completely disappeared. Figure 2 shows that the number of children of Catholics was lower than that of Calvinists from cohorts married in 1950-54 Fertility of Catholics even became lower than that of Dutch Reformed in cohorts married in the period 1965-69; from then on Catholics had on average almost the same number of children as women without religion. (Figure 2)The change in the fertility of Dutch Catholics position—a very slow decline during the first transition, a very steep and fast decline during the recent period—can only be understood in the wider context of the massive changes that occurred within international and Dutch Catholicism after World War II.

Until the 1950s, official Roman Catholic teaching on birth control was clear and almost unchallenged within the Catholic community (Burch & Shea, 1971). Reproduction was considered the main objective of marriage, and the use of methods preventing conception was not permissible. Birth control was considered a violation of the law of God and nature and a grave and mortal flaw. Only in the thirties the "Casti Connubii" encyclical, while repeating that depriving intercourse of its ‘natural power of procreating life’ was a violation of the law of God and nature, provided the first indications that—under certain conditions—periodic abstinence was considered allowable. Such kinds of intercourse were lawful provided ‘the intrinsic nature of the act is preserved’ (Noonan, 1965, 442-443). The large family remained the Catholic ideal though it was no longer a question of fundamental inflexibility. Public debates among priests, theologians and interested laymen were limited to such questions as the conditions under which a couple might morally limit their family size or the relative merits of different arguments aimed at proving the validity of Church teaching. There was no direct public challenge to Church teaching from anyone who considered himself or wished to be considered a Catholic in good standing.

Fig. 1 ( First Graph)

Average number of children per marriage, by period of marriage and religious denomination of the woman (marriages with durations of 20 years or more, contracted before the woman was aged 25)

Fig. 2 ( Second Graph)
Average number of children born or ultimately expected in first marriages, by period of marriage and religious denomination of woman (surviving marriages only) (Angelo Somers, Frans Van Poppel 1935-1970)

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The Netherlands was officially established as the United Kingdom of the Netherlands in 1815. At that time, it included modern day Belgium and Luxembourg. The population for that entire region was about two million people. Once established, the Netherlands grew economically, and it modernized itself into a higher quality of life. However, there was some religious conflict between the Catholics in the south and the Protestants in the north. Because of these tensions, the kingdom split into Belgium, Luxembourg, and the Netherlands in 1839. By 1900, the Netherlands population was over five million people. Halfway through the 20th century, the population doubled into ten million. This was due to further economic expansion in the Dutch region and in the Dutch colonies as well. During the second world war, the population size continued to grow because the Netherlands did not have terrible number of casualties compared to other countries nearby. After the war, population growth was on the rise and uninterrupted. However, in the 1970s, there was a slow growth because of economic recession and high unemployment. When the Dutch economy recovered in the 1990s, the growing population resumed its course. It continued to grow into the 21st century. In 2020, the Netherlands was home to a population 17 million people. The small size of the region and its population size makes it one of the most densely populated countries worldwide. The graph shows the population size of the Netherlands since the beginning of its time. It shows a positive increase in the number of people in millions. It displays how in each century and period there was an increase in population till our modern day. It is included to show that the Netherlands has had a steady growth in its population without decreasing (O’Neill, 2020).

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Migration in the Netherlands has a rich history beginning in the 1950’s. When the economy was struggling, the Dutch needed as much help as they could get. Foreigners began migrating to the country as “guest workers” in the 1960’s and 1970’s. They came from Spain, Italy, Turkey, and Morocco. Some immigrants also came from the Dutch colonies like Suriname. From the 1980’s and until now, many refugees have been seeking asylum in the Netherlands and they have come from Iraq, Somalia, Afghanistan, and from Syria. Many move to this country because of its pull factors. These are some of the reasons that immigrants are attracted to the Netherlands. The country has employment opportunities for the workers who come in seeking economic benefits. The country also has a good education system for those workers who move with their families and children. The country has had a reputation of being stable and successful. Therefore, there is not many push factors that drive out the Dutch people from their land. Because of such factors, the number of immigrants in 2020 was 2.4 million while the number of emigrants was 970.4 thousand.  Net migration data from the 5 previous years to 2019 indicates that the net migration number is 80 thousand. This rate is lower than previous years in Dutch history. Additionally, compared to the neighboring countries, this is a low net migration number. Germany, Belgium, and the UK all have a much higher number of net migrations; with Germany being the second highest in the world. The history, the diversity of immigrants, and the net migration rate shows that the Netherlands does attract a good number of newcomers, even if it is not as much as the nearby countries.

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The population pyramid in the year of 2020 in the Netherlands, with the population coming in at 17,134,873, is shaped like a ball point pen. Meaning that the mortality rate was significantly similar amongst men and women for much of the age cohorts, until the early 60s, when the growth rate of mortality was increased by .8 from 2.9% to 3.7%. This pyramid additionally indicates that men are slightly less likely than women to make it to the next year of life. This is shown in the graph because at each age cohort from 0-4 to 55-59, men have a higher mortality rate. As women age however, women tend to have a higher mortality rate. Starting from the age cohort of  60-65 the rate of mortality for women is 3.3% with 562,550 deaths  whereas men’s mortality rate is 3.3% with 562,407 deaths, according to Population Pyramids of the World from 1950 to 2100. As the age cohort begins to increase closer to 100, the mortality rate of men decreases resulting in 471 deaths and the mortality rate of women increases with 2,492 deaths. The population graph shows that population is increasing in numbers, meaning mortality for both men and women are being addressed. Life expectancy gains are reported due to the result of the Dutch health care system, which is further discussed in the mortality section.
Source CBS site  (StatLine - Levensverwachting; geslacht, leeftijd (per jaar en periode van vijf jaren) (cbs.nl))

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Morality refers to death rate, or the number of deaths in a certain group of people in a certain period of time. Mortality may be reported for people who have a certain disease, live in one area of the country, or who are of a certain gender, age, or ethnic group. According to Statline, the life expectancy in the Netherlands, or the average number of years that a person is expected to live if current mortality rates continue to apply is at the rate of 82.05 years for both men and women combined at the age period of 0-4 in 2019.  As the age periods of five continue to increase, the life expectancy of both sexes decrease. At 20 years the life expectancy decreases to 62.99 in 2019. At 65 years of life the life expectancy decreases further to 20.52. At the age interval of 80 years, the life expectancy is 9.38. The likelihood of reaching the next age interval begins to decrease substantially as each individual ages, this is particularly  true for men.  This data shows that women on average live longer than men, and that the discrepancy only grew in the course of time. Although women tend to live longer than men according to the graph, both men and women have significantly increased their life expectancy rates over the years. In the 1950s, the likelihood of reaching the age of 75 was significantly lower in possibility compared to the year 2019, where both men and women have surpassed the year 75 and lived even longer than generations before them. The reason for men and women having longer life expectancies than recent years can be argued that it is due to the Dutch Health care system.
Source CBS: (StatLine - Levensverwachting; geslacht, leeftijd (per jaar en periode van vijf jaren) (cbs.nl))

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In 1941, the Netherlands implemented a national health insurance program that would allow for both public and private health insurance depending on individuals income, which would grant universal health care for all. (Tikkanen).  In 2006, the health insurance act took over the two programs and merged them into one, making insurance a mandatory coverage (Kroneman). All Dutch individuals who paid taxes were required to purchase health insurance from any private insurer, allowing them to choose their provider given the option. Children under this program until the age of 18 were covered. According to the International Health Care system Profiles, “at the end of 2016, 23,000 people less than 0.2% of the population remained uninsured” (Tikkanen) meaning that because health insurance was based on income and personal choice of provider, most individuals felt that is was not only necessary but financially forgiving due to its cost.  Essential healthcare services are within easy reach for almost the entire population, and waiting times for most services have been decreasing and in most cases meet national standards for reasonable waiting times ( Hilderink). Although health care is available and accessible, there are many health disparities that continue to raise the mortality rate for both men and women.

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Causes of death in the Netherlands in 2019

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Causes of death in the Netherlands in 2019

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According to Statista Data, the total fertility rate in a specific year is defined as the total number of children that would be born to each woman if she were to live to the end of her child-bearing years and give birth to children in alignment with the prevailing age-specific fertility rates. It is calculated by totalling the age-specific fertility rates as defined over five-year intervals. Assuming no net migration and unchanged mortality, a total fertility rate of 1.59 children per woman ensures a broadly stable population. Together with mortality and migration, fertility is an element of population growth, reflecting both the causes and effects of economic and social developments. The reasons for the dramatic decline in birth rates during the past few decades include postponed family formation and child-bearing and a decrease in desired family sizes. This indicator is measured in children per woman.

This graph shows the number of children born per mother between the years of 2008- 2018. I selected this graph because it demonstrates a clear representation of the range between the 10 years when a lot happened within society such as policy changes, political stances, and financial crisis within this time. I overall feel this graph is important in understanding how outside factors such as religion, education, and historical events affect fertility.

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Sex variation in health related behaviors and or lifestyles has been proven to impact sex differences in mortality. Socioeconomic differences in mortality is apparent in both gender and education in the Netherlands when looking at health related smoking consequences. In the journal, The Adoption of Smoking and Its Effect on the Mortality Gender gap in Netherlands, author Fanny Janssen illustrates that “The size of the gender gap in the adoption of risky behavior varies as a function of a culture’s restrictiveness, the norms for appropriate gender role behavior” (Janssen). The way women and men were brought up, and the working conditions that dictated a certain area, mirrors the outside factors that lead men to increase activities that were deemed risky. Women who were excluded from the workforce did not have the same stress and availability to risky behaviors until women integrated into the labor market. Janssen argues that “Smoking-related cancer mortality contributed most to the increase in the sex difference” (Janssen). The percentage of men who engaged in smoking decreased to 27% in 2012, while the percentage of women gradually reduced to 25% after being at a high rate of 42% in the 1970s( Janssen). The reason for the trend of women smoking is due to the marketing of tobacco products years prior, that made the assumption that women who are intelligent and strong smoke. According to the Netherlands Expertise Centre for Tobacco Control, “Fewer women than men smoke (19.2% versus 27.0%) as well as Daily smoking [being] less common among women than among men (14.5% versus 19.9%)” (Trimbos institute). Gender is an important factor in the likelihood of risk factors, as well as education attainment. Lower education is linked to higher rates or smoking with the rate of 25.7%(Trimbos Institute). Thus, low educated men are at risk of more respiratory diseases and cancer due to smoking being a cheaper way to release stress from outside factors such as working conditions. Women who are non-smokers are becoming more sick, with diseases and cancers such as breast related, however, men have a higher chance of mortality. This graph is important because it indicates that men actively participate in smoking more than women. In addition, class becomes a role in health related consequences that factor into mortality and life expectancy rates in both men and women.

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The health challenges that Dutch individuals face are those categorized as lifestyle preventable causes of morbidity and mortality in health related behaviors such as high degrees of smoking and alcohol use. The related morbidities are liver diseases, respiratory diseases, cancer in the liver or breasts, and accidents. According to the Health Reviews of Netherlands, “Discouraging smoking has been a priority in the Netherlands since 2004, when a law came into force that guaranteed every citizen a smoke-free work environment” (Kroneman 10). This is due to “an estimated four in ten premature deaths [which was ] attributed to smoking in the Netherlands”(Van).  This is why the government felt the need to push further for a smoke-free environment outside of the work environment as well. In 2008, the Netherlands government initiated a smoking ban in cafes, pubs, and restaurants in order to cease smoking habits that have increased the mortality rate in many individuals (Kroneman). Along with the smoking ban, the Dutch government also introduced a “financial reimbursement” for individuals that underwent smoking cessation treatment, which was noted in the Global Report, A Dutch Dilemma (Ryan). The reason that smoking is still a prevalent issue today for the Dutch government is due to many Dutch members banding together in revolt against government interference on individual responsibility. On the other hand, children as young at 13 are participating in smoking which raises the risk of respiratory and health related risks at a younger age thus decreasing life expectancy (Global report; Ryan). Another issue that the Dutch government wanted to disband was alcohol consumption among young adults such as teenagers. The government made a new age requirement to legally buy alcohol in an attempt to reduce young adults from purchasing at a much younger age, in which the new age would be “raised from 16 to 18” (Kroneman 10). Cancer is the predominant cause of death amongst smokers. This is shown in the main causes of death data provided by the WHO Regional office for Europe in 2015. According to the public health journal, The Current and Future Burden of Diseases in the Netherland, “almost the entire burden of disease [in the case of lung cancer] is due to premature death” (Hilderink). This is important because smoking has increased the chances of more Dutch individuals risks of being diagnosed with cancer. Life expectancy for these smokers are continuously reducing. In fact,   "In 2019, just over 150,000 people passed away in the Netherlands. The most common causes of death were neoplasms, diseases of the circulatory system as well as diseases of the respiratory system", which was published by the Statista Research Department (• Netherlands: causes of death 2019 | Statista). This data is also important to note because since the data in 2012, respiratory disease and cancer has only increased, meaning the push for a smoke-free environment in the Netherlands has not been entirely successful.