Soon after the major polio epidemic in 1957, the government started vaccinating children against this disease. This was the go ahead for the National Immunisation Programme, which was offered to everyone free of charge and to which other vaccinations weresubsequently added. Today, the programme protects children against a number of dangerous diseases and prevents epidemics. RIVM directs the National Immunisation Programme and coordinates its implementation by the Community Health Services, Child Health Clinics and the Centres for Children and Families.
The number of vaccines in the National Immunisation Programme has increased, vaccines are continually being improved, and the target group has extended from children to include 13-year old girls. Based on ongoing innovation and improvement, theeffectiveness and safety of the immunisationprogramme and vaccines are continuously monitored. Currently, immunisation is offered against 12 diseases. Population participation in all immunisations is high, between 92 and 99%, with the exception of the human papillomavirus vaccination, for which participation is 58%.
Public Health Status and Forecast
Instead of reading thousands of reports, one report is sufficient”, says Henk Smid, Director of the Netherlands Organisation for Health Research and Development, ZonMw.
At four-year intervals since 1993, RIVM has published the Public Health Status and Forecast Report in the Netherlands. This report provides an overview of disease and health status, disease prevention, health care and policy in the Netherlands. The report has considerable impact, and the results are used as the basis for formulating public health policy prepared by the Ministry of Public Health, Welfare and Sport.
The sixth edition published in June 2014 has taken a new direction. In addition to an overview of current and future public health trends, the report presents future scenarios based on public health perspectives. These scenarios present a vision of the future and what needs to be done to achieve this, for instance, through policy.
The scenarios are based on discussions with stakeholders to assess whether the Dutch population can recognise itself in the scenarios. Thus, the report has become more of a co-creation than previous editions, which were based on close cooperation with health care professionals and other partners. As the report is available online, the results are widely accessible.
To the website www.eengezondernederland.nl (Dutch only)
RIVM’s work on air quality is wide ranging. As well as monitoring quantities of air pollution, RIVM investigates the impact of air pollution on people and the environment.
Long-term exposure to fine air particles can aggravate health conditions, such as cardiovascular and respiratory diseases, causing thousands of deaths in the Netherlands annually. Air pollution is also a threat to the natural environment, to plant and animal biodiversity. Thus, emissions of air pollutants have to be reduced.
RIVM’s work on air quality is wide ranging. As well as monitoring quantities of air pollutants, the institute investigates the impact of air pollution on people and the environment. The results of these investigations are used as the basis for decisions by government on measures to mitigate air pollution have to be reduced.
Expertise is combined in the National Cooperation Programme on Air Quality, in which the Dutch Government and other government bodies work to ensure that the Netherlands promptly meets EU limit values set for fine particles and nitrogen dioxide emissions.
Every hour of the day, RIVM updates the air quality map of the Netherlands for nitrogen dioxide, ozone and fine particles on the website of the National Air Quality Monitoring Network. RIVM also publishes forecasts for several days of these substances. Being warned of concentrations exceeding certain levels is vital for COPD and asthma patients in planning their
outdoor activities. This type of information is also available on the new app on air quality.
Set up 40 years ago, the National Air Quality Monitoring Network is now the official reference point for air quality measurement in the Netherlands. RIVM also plays a key role internationally in monitoring air quality. RIVM leads the European Topic Centre for Air Pollution and Climate Change Mitigation, a consortium of 14 organisations in Europe that collect and monitor data on air pollution, climate and noise in Europe. Studies are also carried out to evaluate the effectiveness of human health and environmental policy. In addition, RIVM transfers knowledge on air quality monitoring to other countries such as Turkey.
An innovation in monitoring fine air particles is the iSPEX-app that enables citizens to monitor levels themselves on smartphones. RIVM expects that this new technology will provide additional information about the type of fine particles in the air. iSPEX was developed by a large team of scientists from different organisations in the Netherlands.
iSPEX is a great innovation, involving citizens in air quality and health. By measuring air pollution, you are contributing to scientific insights and solutions.
Drs. Mariette van Empel Director Climate, Air and Sound, Acting Director General Environment and International Affairs, Ministry of Infrastructure and the Environment
Attention to health in schools has advantages for students, teachers, schools and parents. RIVM is active in promoting the Healthy School.
The Healthy School concept was developed in the USA and builds on what schools are already doing. The school selects relevant health themes from a range of themes that include health education, school environment, and ways to identify student health problems. The approach is embedded in school policy and the school evaluates its
health activities every year.
RIVM cooperates with national and local partners including Community Health Services and the Education Agenda on Sport, Movement and Healthy Life Style.
Community Health Services advise schools that wish to adopt the Healthy School approach. Organisations, such as the Nutrition Centre, Trimbos Institute, and the Netherlands Institute for Sport and Movement (NISB), develop programmes to be implemented in school classes. For instance, the higher age limit on alcohol consumption was the reason for programmes to make schools alcohol free. Schools can develop their own health activities with financial support from the Healthy School project. For instance, six schools and the Community Health Service are working together in an innovative programme to make children aware of the importance of healthy eating.
To the website www.gezondeschool.nl (Dutch only)
Nanotechnology has unknown potential. Solar cells with higher energy yields, better diagnosis and treatment of cancer, new materials with special properties. But as yet too little is known about the risks because nano particles have other characteristics than larger particles of the same substance.
To gain more insight into the potential risks of nanotechnology, the Knowledge and Information Centre for Risks of Nanotechnology KIR-nano) was set up in 2007 to provide independent and verifiable information. This information is used to improve legal frameworks for the safety of products containing nano particles.
KIR-nano is based at RIVM because of the institute’s task in advancing public health and environmental safety. Knowledge and research from different areas are brought together and the results are translated into policy. KIR-nano is represented in all major national and international forums on nanotechnology. As a result, RIVM has a unique position as an objective party, as an institute that informs and advises, and in national and international research.
In line with government policy to stimulate nanotechnology, KIR-nano has an eye for societal and economic advantages. Thus, in the coming years, efforts will be directed to making knowledge and expertise about risks and regulatory frameworks available in order to support innovative developments. KIR-nano is well positioned to establish what knowledge is required and where the knowledge development focus should be. To guarantee its independence, KIR-nano knowledge and expertise are not used to develop specific products.
The Round Table on hospital infections and antibiotic resistance provides maximum transparency on outbreaks of multiresistant bacteria in hospitals in the Netherlands.
Prof. Dr. Marc Bonten | Microbiologist | University Medical Centre Utrecht
In 2012, there was an outbreak of Salmonella Thompson in the Netherlands. Rapid action by Community Health Services, RIVM and the Netherlands Food and Consumer Products Safety Authority revealed that those infected with the pathogen had eaten smoked salmon from a specific producer. The infected salmon was immediately removed from the shops in order to prevent more people becoming infected. To take rapid action in such situations, RIVM has set up a permanent alert system. Regional, national and international alerts are immediately picked up and appropriate action is discussed with experts.
There is increasing concern about emerging infectious diseases, diseases that are new to an area, and known diseases that are occurring more frequently. New emerging diseases are particularly those transmitted from animals to humans (zoonoses), such as Q fever and Middle East respiratory syndrome (MERS), or are modified pathogens making a disease easier to transmit, more virulent and not treatable with known medication. New infectious diseases can be imported through food, animals and other products. In addition, as more people travel worldwide they are likely to come into contact with new pathogens.
Emerging infectious diseases are identified and discussed in three separate Round Tables. The first is the assessment of the ider scope of infectious diseases, the second focuses on infections in hospitals and nursing homes that are often caused by pathogens resistant to antibiotics, and the third concerns zoonoses. In each component, RIVM works closely with Community Health Services, the Netherlands Food and Consumer Products Safety Authority, and where relevant with other parties.
Everyday products, such as household cleaners, clothes, paint, children’s toys, cosmetics and glues, are made with industrial chemicals. Through the use of such consumer products, people can be exposed to substances that could pose potential health risks.
RIVM expertise on the risks of substances and products is recognised nationally and internationally. RIVM has developed the ConsExpo model that has become the standard method in Europe to support experts in assessing consumer exposure. The model is also used by national authorities, institutes and companies in countries, such as Canada, Australia and South Korea.
The extent to which people are exposed to substances in consumer products depends on a range of factors. For instance, the place where the product is used and also the substance properties, extent of exposure and individual sensitivity. On the basis of information obtained from the ConsExpo model, governments and companies can take measures to prevent and limit damage, such as replacing a certain substance in a product. In this way, RIVM contributes to knowledge about the risks of substances to make consumer products safer.
Some 1.1 million people in the Netherlands are disturbed at night by traffic noise, which together with noisy neighbours are the main sources of noise hindrance in the Netherlands. If noise is too loud or certain sounds are experienced as noise, this can eventually lead to health problems, such as high blood pressure and heart disease.
But sound is more than a collection of decibels. Natural sounds, such as bird song, can be a positive experience and help to relax people, and thus contribute to human health and well-being.
For many years, RIVM has investigated the impact of noise on human health and well-being, and regularly conducts surveys on noise hindrance. RIVM also has expertise on the impact and experience of noise, and carries out studies on the urban population, on the sound quality of their environment, and on noise and vibration along railway lines. RIVM advises government on the consequences of noise hindrance, and records and monitors that legal noise hindrance levels are not exceeded. In these different ways, RIVM contributes to improving the quality of the environment.
More about noise (Dutch only)
RIVM manages three population screening programmes for cancer – breast cancer, cervical cancer and since 2014, bowel cancer. These screening programmes have been set up for early detection of cancer in people who do not have symptoms.
Participating in population screening in the Netherlands reduces your chance of dying of breast cancer by 50%. This is the result of 25 years of continuous improvement.
Drs. Mark J.P. Steinbusch | Management Board | Population Screening South Eindhoven
Since 1990, women in the Netherlands have been screened for breast cancer. All women between the ages of 50 and 75 are invited every two years to participate in breast cancer screening, which is carried out in mobile screening units. In 2015, population screening for breast cancer will have been carried out for 25 years. Breast cancer is the most common cancer in women in the Netherlands. Every year, breast cancer is identified in some 16,000 women and annually some 3,200 women die of the disease. The population screening prevents some 775 deaths annually.
The screening involves a series of steps carried out by different parties: an invitation to participate in the screening; the breast screening (mammogram); assessment of the mammogram; dispatch of the results; and a referral, where necessary. These steps are closely coordinated to safeguard the quality of the screening. RIVM is the national coordinator, ensuring all elements of the screening process meet the highest standards. RIVM also ensures that the screening is easily accessible and cost effective.
More about population screening
Non-smokers live on average five to ten years longer than smokers. Yet people continue to smoke, partly because of an addiction to nicotine. It is less well known that substances are added to tobacco products to enhance the taste of cigarette smoke, such as sugar, liquorice and cacao. As a result, it is easier for people to start smoking and to continue smoking. Also, substances that are harmful or that even cause cancer may be released from burnt sugar.
What are the harmful substances? And what effects do these have on human health? RIVM works as an independent body to investigate the composition of tobacco products. This is done using a smoking robot to simulate a smoker and then the composition of the smoke is analysed.
Based on the findings, information for consumers such as young people is made available on a special website (watziterintabak.nl). RIVM advises policy makers in the Ministry of Health, Welfare and Sports on the EU guidelines on tobacco. The risks of new products, such as the shisha pen(electronic water pipe) and the e-cigarette, are analysed.
For the Netherlands Food and Consumer Products Safety Authority (NVWA), RIVM monitors whether the quantities of tar, nicotine and carbon monoxide in cigarettes are in line with the quantities stated on the packet. RIVM is the WHO Collaborating Centre for Tobacco Product Regulation and Control, and works on new methods to measure harmful particles in cigarette smoke.
People can be exposed to harmful substances after a major fire, accident, attack or other type of incident. Governments and citizens want to know the risks associated with such events and whether adequate measures have been taken. RIVM Environmental Incident Service supports regional and local authorities and helps organisations, such as the police and fire brigade, to answer such questions.
As an independent unit, the Environmental Incident Service monitors the extent and dispersal of hazardous substances, assesses whether people have been exposed and the potential risk to human health and the environment. This information is used by the uthorities in deciding whether measures that are often taken directly after an incident are still applicable, or need to be changed ordiscontinued.
The Environmental Incident Service has specialised knowledge and skills. The highly trained team is equipped with mobile laboratories containing advanced equipment to rapidly monitor, collect and analyse air, water and soil samples at a disaster site. If necessary, samples can be analysed by one of the specialised laboratories in the Netherlands that are combined with RIVM in a Laboratory Network.
The Environmental Incident Service is on call 24/7 and responds to incidents and disasters in the Netherlands and also in other countries.
The lifestyle intervention ‘Be interactive’ aims at raising the social standing of migrant women through walking and running to improve fitness and health. This intervention is published on the intervention database Active and Healthy Living, available on www.loketgezondleven.nl, the support site for health promotion professionals by RIVM and its partners.
‘Be Interactive’ is one example of a recognised lifestyle intervention. Research has shown that these interventions are effective and professionals have established that they can be implemented. By sharing life style interventions online, organisations no longer have to develop interventions themselves.
The quality system for recognised lifestyle interventions and the results published on a website give health care professionals access to the best available interventions. Professionals can also have their own interventions assessed. In addition to the RIVM Centre for Healthy Living, many organisations cooperate in assessing and implementing lifestyle interventions
in the Netherlands.
Promoting an enabling environment to facilitate healthy lifestyles and choices nationally and internationally.
Dr João Breda PhD, MPH, MBA | Programme Manager Nutrition, Physical Activity and Obesity | Division of Non Communicable Diseases and Life-course WHO Regional Office for Europe Copenhagen
Information about lifestyle and diseases is essential for everyone as knowledge about health risks and information about what you can do yourself often helps to prevent problems. However, information on the internet or via other channels is not always understandable, clear and complete. So, RIVM together with other partners in public health have developed a number of toolkits.
A communication toolkit can include films, photos, posters, sample letters, presentations and questionnaires on a specific theme, for instance a toolkit on hand hygiene. The toolkits are on the RIVM website and are easy to download. They are designed for anyone who needs to provide information about disease and care, such as Community Health Services, youth health organisations, schools and pharmacists.
There are toolkits for all types of themes, such as health problems caused by the oak processionary caterpillar, prevention of hearing damage, cold and flu prevention and also health problems caused by extreme weather conditions and air pollution.
What does the Dutch population eat? And how has the diet changed over the years? How healthy is our diet? Every few years since 1987, a detailed survey has been conducted of what people eat in the Netherlands. This survey covers the whole population and also specific groups, such as young children and the elderly.
As an independent government organisation, RIVM coordinates data collection, and is responsible for design, methodology and quality control of the national food consumption survey, and data publication and management. The data are used to calculate the quantities of nutrients consumed, such as vitamins, and potential harmful substances, such as pesticides. The food consumption data are used in formulating policy on healthy diet and food safety to improve the range of food products on offer in the Netherlands, and also in public information and research. Recommended food intake A healthy diet is essential in reducing overweight and in managing chronic diseases. The food consumption survey shows what people are eating on average in the Netherlands in relation to recommended food intake. For instance, we consume too much salt and trans-fatty acids such as butter, but too little fish, fruit and vegetables. This can be improved by adjusting the range of food products on offer and encouraging people to eat a healthier diet. For instance, the food consumption survey shows which products are the main sources of high salt intake. Based on this knowledge, the overnment has stimulated food manufacturers to reduce the salt content of products such as bread, cheese, processed meats, and ready-to-eat products.
Is electromagnetic radiation from my mobile phone harmful? Are my concerns about electromagnetic fields from wind turbines in my neighbourhood justified? The Knowledge Platform Electro-Magnetic Fields and Health provides answers to such questions and concerns about potential health effects of electro-magnetic fields. RIVM is continually looking for professional partners in knowledge platforms and networks. Here are two examples of knowledge networks and platforms in which RIVM is active or has a contributing role.
The Knowledge Centre on Healthy Urban Living provides integrated knowledge to enable people to live healthy, long and independent lives in clean, sustainable and prosperous towns and cities. Five well-known Dutch organisations (TNO, RIVM, KNMI, Utrecht University and Deltares) have combined expertise to find solutions to complex everyday issues in urban areas. This information benefits governments, companies and citizens, nationally and internationally.
RIVM participates in the Biocide Knowledge Network, an independent network of producers, suppliers, professional users, representatives of government and consumer organisations. For instance, biocides are used in disinfectants, in preservatives and in pesticides. By working together, the Knowledge Network ensures the right substance is used at the right time and in the right way.
Healthy Urban Living turns a societal challenge into an economic opportunity by sharing knowledge on healthy living in urban areas with the private sector.
Remco van Lunteren | Vice Governor, Infrastructure, Economics and Finance | Province of Utrecht
This film goes behind the scenes to show RIVM at work. RIVM protects and promotes public health and the quality of the environment. From health and well being in the city to the quality of our food, sooner or later we are all affected by the work of RIVM. Because RIVM works at the centre of Dutch society.