The Dutch public policy on fighting Covid-19 will inevitably lead to major public health issues and sky-high medical costs in the near future. It is a paradox of fighting a disease but getting even sicker. It is time to break this downward spiral.
The Dutch public policy for fighting Covid-19 is primarily developed from a medical point of view, with the number of ICU beds and positive tests as indicators for policy effectiveness. That by itself is an interesting topic for discussion. For one because it is well known that public policy can only be effective if it is developed from a multi perspective point of view with corresponding indicators.
The issue we want to address here is the following: The current Dutch public policy on fighting Covid-19 will inevitably lead to major public health issues and sky-high medical costs in the near future. The governmental Covid-19 restrictions create huge barriers for living a healthy lifestyle,which under ‘normal’ circumstances is already a challenge for more than half of the Dutch population, let alone during a lockdown. In this article we highlight three of these barriers, just the tip of the iceberg. And discuss what needs to happen to change for the better.
The first barrier concerns exercise
During lockdown we are only allowed to go outside for a walk or a workout or do an online class. But that is often not enough, not feasible and not safe.
According to the Dutch Health Council (2017), who also advices the Dutch government on vaccination, adults must exercise at least 2,5 hours per week at moderate intensity and do strength exercises at least twice a week. Elderly should also do balance exercises. Kids should exercise at least one hour per day and do strength exercises at least three times per week. Exercising more often, longer and at higher intensity is even better for all age groups. Sitting a lot needs to be avoided. The Council emphasizes that these guidelines are only the minimum. The benefits of exercising are a lower risk of coronary heart diseases, diabetes, obesity, mental health issues, cancer, and preliminary death. The negative effects of sitting a lot are a higher risk of coronary heart diseases and of preliminary death.
According to the National Institute for Public Health and the Environment and Statistics Netherlands (2019) only half of the Dutch adultsmeet the exercise standards, based on pre- Corona data. If we cannot meet the minimum standard for exercise under normal circumstances, what effect will a long-lasting lockdown have on public health?
Furthermore, exercising outside is not feasible for everyone. Because the neighborhood is not safe or pedestrian friendly enough; because we are stuck in meetings from early morning to late at night; because we have a disability that makes it impossible to do outdoor exercises; or because it is too slippery outside due to snow. Online workouts also are not feasible for everyone. For example, because there is not enough space to workout at home, or we have roommates or neighbors to take into account. Not to mention the fact that we already spend our entire day online.
An important aspect what seems to be overlooked is the role of the professional coach. Exercising under the direct supervision of a professional coach is crucial for exercising in a safe and effective manner andto prevent injuries during (online or solitary) exercise. More injuries means more hospital visits.
The second barrier concerns nutrition
Although supermarkets are open, the governmental advice isto minimize shopping. This stimulates buying long lasting often unhealthy processed food, and less fresh perishable products like fruit and vegetables.
Furthermore, a sedentary ‘indoor’ lifestyle is often accompanied by an unhealthy eating pattern. Spending more time indoors means spending more time near the kitchen and the fridge. This increases the risk of cravings and snacking. And some people discover ‘the art of baking’.
What also needs to be mentioned is that socio- economic status affects lifestyle. Having less income or becoming unemployed due to Corona can have a negative effect on nutritional and exercise habits. Unhealthy food is cheap.
According to the Dutch Health Council, adults should eat a moderate amount of food per day, with lots of vegetables, fruits, legumes, fish, whole wheat products, lean dairy, and lean meat. Healthy nutrition lowers the risk of preliminary death, obesity, coronary heart diseases and diabetes.
According to the National Institute for Public Health and the Environment (2018) nutrition plays an important part, together with smoking and overweight, in public health issues. Yet only 16% of Dutch adults between the age of 18 and 64 meet the vegetable standard of at least 200 grams per day. Only 13% eat 200 grams of fruit per day. Less than half of the Dutch adult population eat enough whole wheat products. According to Wageningen University(2021), especially people with obesity and highly educated people are eating even less healthy during lockdown.
If we do not meet the nutritional standards under ‘normal’ circumstances, if more than half of the Dutch population is already overweight pre- Covid-19, and if we know that being overweight puts us at higher risk of severe Covid-19 complications, what can we expect during and after this long-lasting lockdown? Especially since professional lifestyle coaches are not allowed to work during the current lockdown. Yes, online consults are allowed, but we cannot overlook the crucial role of personal contact on adherence and the effect of treatment.
The third barrier concerns mental health
Stress, anxiety, loneliness, mental health issues, feelings of despair and frustration and a lack of social interaction are serious public health issues that have become more common since the lockdown. According to Maastricht University (2021) the costs of treating people for feelings of loneliness are 2 billion euros, based on pre- Corona data. According to Trimbos Institute for Mental Health (2020), the number of people who suffer from mental health issues such as depression and sleeping disorders is growing rapidly during lockdown.
The three lifestyle aspects mentioned in this article, exercise, nutrition and mental health, interact. For example, exercising less is often accompanied by eating less healthy; an unhealthy lifestyle is often accompanied by mental health issues; which can make it harder to start exercising andeating healthy: the downward spiral. That is why Trimbos Institute for mental health together with several other organisations represented by Lifestyle4Health (2020) advised the Dutch government to integrate lifestyle as part of the publicpolicy on fighting Covid-19.
Paradox of fighting a disease but getting sicker
If we are becoming less healthy, we are at higher risk for severe complications in case of a Covid- 19 infection. Lifestyle plays an importantrole in maintaining and improving health. In 2015, already 6 years ago, an unhealthy lifestyle caused over 35.000 death and 9 billion euro of medical costs. Over half of all chronic diseases is caused by an unhealthy lifestyle. The number of people with an unhealthy lifestyle has grown ever since, even without this long-lasting lockdown.
It is a paradox of fighting a disease but getting even sicker: An unhealthy lifestyle increases the risk of severe complications in case of a Covid-19 infection; which increases the risk of being hospitalized; which increases the risk of more governmental Covid-19 restrictions; which increases the risk of an even unhealthier lifestyle; which increases the number of people suffering from chronic lifestyle diseases that all need treatment in the near future. We are getting sicker.
It is time to break the downward spiral and start investing in a healthy lifestyle. By protecting the vulnerable in our society against Covid-19; by accelerate the vaccination program with the help of logistics experts; by fully integrating lifesyle as part of public policy; by giving people the opportunity to exercise indoor under the supervision of aprofessional; by allowing professional coaches in preventive health to coach in person; by giving people the opportunity to buy healthy fresh food at localshops and markets; and to interact again.
It is a delicate balance between public health and….. public health!
CBS. (2019) National Health Survey/Lifestyle Monitor. www.cbs.nl
Meisters, R. et al(febr. 2021). Does Loneliness Have a Cost? A Population-Wide Study ofthe Association Between Loneliness and Healthcare Expenditure. In: Int J Public Health, 02 February 2021.
Obesitas platform (2020). E-learning Obesitas enCovid-10. www.obpl.nl
RIVM. VTV-2018.Synthese. Leefstijl en Omgeving.www.rivm.nl
Poelman M.P.et al. (febr 2021). Eating behavior and food purchasesduring the COVID-19 lockdown: A cross-sectional study among adults in theNetherlands. research.wur.nl
RIVM. VTV-2018.Synthese. Leefstijl en Omgeving.www.rivm.nl
Trimbos Instituut. (2020) Mentaal gezond de coronacrisis door: zevenadviezen. www.trimbos.nl
Trimbos Instituut. (2020). Nieuwe cijfers:neerslachtiger, meer slaapproblemen en gedachten aan de dood door corona. www.trimbos.nl