Centenary of the Health Council of the Netherlands. I. Introduction

The Health Council of the Netherlands [Dutch name: Gezondheidsraad] is an independent, statutory advisory body whose task is to inform the Dutch government on the current level of knowledge with respect to public health issues. Its work covers the entire terrain of curative and preventive healthcare, environmental protection, nutrition, occupational hygiene and environmental hygiene. The Health Council has existed in one form or another since 1 August 1902. Its present form was established by the 1956 Health Act, which was amended in 1997. To perform its task, the Health Council brings together multidisciplinary committees of leading experts--nominated in a personal capacity--on specific topics both at the government's request and on its own initiative. About thirty committees are operative at any one time. The Health Council has published more than 2000 advisory reports during its 100 years of existence.     

Centenary of the Health Council of the Netherlands. III. Hospital care and research

In 1983 a ministerial decree based on Section 18 of the Hospital Provisions Act came into force, under which a number of top clinical centres could only give certain specialised care if they obtained a permit from the minister of Health, Welfare and Sport. Following the Health Council's report 'The Limits of Care' published in 1986, the government instructed the Health Council in 1989 to develop a policy for regularly reporting the status of certain section-18-activities and to put forward proposals for investigative medical research. This led to the Health Council's so-called annual reports, which have played a pivotal role in the balanced introduction and dissemination of special provisions. In 1995 the Health Council stopped issuing its annual report due to the ambiguity which arose concerning the implementation of a number of proposals it had made. In 1997 all top clinical activities were made subject to section 2 of the Specific Medical Procedures Act. This meant that there was no longer a statutory obligation to advise the government. However, under the Specific Medical Procedures Act, the Health Council has been able to continue its important advisory role. For example, the Health Council's advice was taken into consideration when the practice of in-vitro fertilisation was evaluated and during the drafting of the Embryo Act.     

Centenary of the Health Council of the Netherlands. IV. Infectious diseases

Many advisory reports of the Health Council of the Netherlands in the past century have dealt, directly or indirectly, with infectious diseases. One example is vaccination against smallpox. At the start of the last century, advice on this subject was important: initially, vaccination was compulsory by law, but people became increasingly aware of the associated side effects. A second example is immunisation against acute anterior poliomyelitis, which became a reality during the fifties. The advice also contained a discussion of which vaccine should be chosen: the inactivated 'dead' (Salk) form or the attenuated 'live' form (Sabin). Due to sound national organisation and associated logistics, a high level of vaccination was (and still is) achieved and the clinical disease known as polio disappeared from the Netherlands. Food-borne infections form the third example. The effect of the advice published by the Council on this subject (from 1960 onwards) has been limited, for a large part due to the significant economic consequences of the proposals for beef farming. The developments in the field of infectious diseases, immunology and vaccinology, together with social developments make it likely that in the coming years the Council will also frequently be asked for advice in the field of infectious diseases and the fight against them.     

Repetitive strain injury (RSI); a report from the Health Council of the Netherlands

The Health Council of the Netherlands has published its advisory report on Repetitive Strain Injury (RSI). The report provides clear information on the state of this syndrome, including the definition of the problem, the epidemiology, various hypothetical pathophysiological mechanisms, occupational and personal risk factors, and possible methods of treatment. The council states that with regard to the last aspect, too few data are available to draw any conclusion as to the most promising therapy. Nevertheless, patients should get consistent advice from their GP or company doctor. The council emphasises that encouraging physical exercise and eliminating any possible causative strain should be part of an integrated approach, embracing work-related psychosocial and personal issues. Of particular interest is the council's advice to prevent RSI by improving the physical condition and by selective training of muscle function. The report recommends that more research be carried out in order to provide insight into the effectiveness of the treatment of RSI.     

Centenary of the Health Council of the Netherlands. II 'Public health'

In its 100-year existence (1902/2002), the Health Council has played an important role in the introduction of effective measures in the area of public health and in doing so has made a significant contribution to improving health in the Netherlands. Successes have been achieved in vaccinations (from before 1900 to about 1985), infectious-diseases control (since about 1900), safety at work (since about 1900), healthier mothers and babies (since about 1900) and safer and healthier food (since 1920). Success factors in implementing an advisory report are the extent to which political support is forthcoming, the evidence on which the advisory report is based, the economic consequences of implementing the advisory report, the ethical implications and the extent to which social and/or scientific developments provide a basis for the advisory report.     

Centenary of the Health Council of the Netherlands. V. Ethical-social issues

Since its inception, the Health Council of the Netherlands has included normative aspects in its reports. Over the past decades, ethics and rights have received increasing attention, particularly since the establishment of the Standing Committee on Medical Ethics and Health Law in 1977. In particular, the ethical implications of bio-molecular life sciences (genetic counselling, genetic screening, research with human embryos) have been discussed in the Council's publications. The Council has also been involved from an early stage in the euthanasia discussion. It is accepted that policy advice concerning scientific developments implies normative considerations. However, the extent to which the Council's role is simply to highlight these considerations or to present conclusions remains a recurring question. In the latter case, priority is often given to the principle of respect for autonomy, while underestimating the significance of solidarity.     

Centenary of the Health Council of the Netherlands. VII. Influencing the human brain in the future

On the occasion of its centenary, the Health Council of the Netherlands issued an advisory report on future possibilities for influencing the human brain. The Council foresees that, in the future, it will probably become possible to prevent or extensively delay diseases such as dementia and Parkinson's disease. The burden of many mental disorders will be markedly relieved by early detection and treatment. Developments are to be expected in the fields of function enhancement, pharmacotherapy, psychotherapy and electrostimulation. The promising developments aimed at the prevention of brain disorders have important ethical and societal implications which require uninterrupted attention.     

The benefit of population screening for breast cancer; an advisory report from the Health Council of the Netherlands

A recent Cochrane review does not nullify the evidence supporting the practice of mammographic population screening for breast cancer for women aged 50 years and over. Thus concludes the Health Council of the Netherlands in an advisory report to the Dutch Government. A central feature of the Cochrane review is the conclusion that breast-cancer mortality is an unreliable outcome that is biased in favour of screening. The Health Council finds this conclusion too extreme and does not support the view that breast-cancer mortality must be replaced by overall mortality as an outcome. The Health Council does agree with the view that the use of disease-specific mortality as the only endpoint renders cancer-screening trials subject to bias. Therefore, careful attention should be paid to total cancer mortality, other important causes of death, and overall mortality.     

Health Council of the Netherlands advisory report 'Vaccination against pertussis'--time for a new vaccine

An advisory report on vaccination against pertussis by the National Vaccination Programme Review Committee of the Health Council of the Netherlands makes recommendations on improving pertussis vaccination in the Netherlands. Since 1996, between 4000 and 8000 cases of pertussis have been reported each year, mainly in young children who have already been vaccinated. The main cause of this increase, apart from decreasing immunity in older children and adults, seems to be diminished vaccine effectiveness due to the occurrence of non-vaccine related strains of the pertussis bacterium in the Netherlands. The cellular vaccine used in the Netherlands contains low levels of the major antigens pertussis toxin and pertactin. The Health Council recommends the fastest possible transition to the use of an acellular combination vaccine. Such a vaccine will be effective and will have considerably fewer side effects than the one currently in use. The Committee recommends that research is done into the sources of pertussis infections in young infants.     

Report from the Health Council of the Netherlands on disputed memories

The Health Council of the Netherlands recently has published an advisory report to the Minister of Health, Welfare and Sport on 'Disputed Memories'. The committee, which was established to formulate the report, has answered questions about the accessibility of memories of traumatic events, about the circumstances that might make memories accessible again, and about the possibility of recalling memories of events that were never experienced. The role of psychotherapy in retrieving traumatic memories is discussed extensively, leading to specific recommendations. In contacts with patients and law enforcement agency therapists are expected to refrain from judgments about the historical truth of recovered memories.     

Scientific research in trauma care; an advisory report from the Health Research Council of the Netherlands

Within the medical sciences, traumatology is a relatively under-researched field. The Health Research Council of the Netherlands [Dutch: Raad voor Gezondheidsonderzoek; RGO] has issued an advisory report to the Minister of Health, Welfare and Sport aimed at reducing this shortfall in the coming years. The advisory report recommends that a specific budget is set apart for traumatology research. The assessment and selection of research submissions must have a strong subject-specific component. Innovative areas within the subject need to be chosen, for which the RGO has formulated recommendations. With this administrative breakthrough in the area of funding provision, the opportunity for research groups to carry out structured research has been created. If these recommendations are followed, then the subject specialists will face the challenge of taking the next step.     

'Knowledge Infrastructure for Public Health': an advisory report from the Advisory Council on Health Research

Social, scientific and technological developments are forcing health care systems to shift the focus from disease to health and from cure to prevention. The Advisory Council on Health Research (RGO) has published an advisory report about the knowledge infrastructure serving the needs of public health in the Netherlands. The Council's concept of public health also includes aspects such as policy and health management. The Council concludes that more research is needed on the following determinants of health: environmental issues, social factors, unhealthy behaviour and genetic factors. Intervention research must focus on health protection, health promotion and disease prevention. The public health infrastructure can be improved by amalgamating research groups, establishing departments of public health at every academic medical centre, and linking service, education and research.     

The advisory report 'Neonatal screening' from the Health Council of The Netherlands

The Health Council of the Netherlands has published an advisory report on neonatal screening in view of developments in diagnostics, therapy and the prevalence of neonatal diseases. Currently it involves screening for phenylketonuria, congenital hypothyroidism and congenital adrenal hyperplasia. Because screening may lead to considerably better outcomes in affected newborns, the council recommends expanding current screening to include medium-chain acyl-CoA dehydrogenase deficiency, sickle-cell disease and 12 other rare disorders: biotinidase deficiency, galactosaemia, glutaricaciduria type I, HMG-CoA lyase deficiency, holocarboxylase-synthetase deficiency, homocystinuria, isovaleric-acidaemia, long-chain hydroxyacyl-CoA dehydrogenase deficiency, maple syrup urine disease, 3-methylcrotonyl-CoA carboxylase deficiency, tyrosinaemia I and very-long-chain acyl-CoA dehydrogenase deficiency. A better detection method for cystic fibrosis must be developed before it is included in screening to restrict the number of sweat-test referrals of unaffected newborns. The council recommends providing information on neonatal screening during pregnancy and gives special attention to the possibility of detecting carriership in the parents.     

Representation strategies in public participation in health policy: the Aboriginal Community Health Council

Within Canada's Aboriginal population, an ongoing health promotion strategy has been the facilitation of community participation in the development and application of health policy. The Calgary Health Region's Aboriginal Community Health Council has provided a setting for involving the local Aboriginal population in health policy and program development for over a decade. This paper represents the results of a case study to identify the Council's strategies for this work. Data sources included documents, such as meeting minutes and other reports; key informant interviews with past and present Council members and health region representatives; and participant observation of Council functions. Although direct membership in the Council provided a core approach for representing the community, other strategies were actively utilized to involve the public. These included building links and partnerships with community organizations, networking, consultation activities and the identification of special needs groups.     

Report of the Health Council on the use of benzodiazepines. The Netherlands Health Council]

The Netherlands Health Council has issued a report on the appropriate use of benzodiazepines, detailing current knowledge on mode of action, indications for use, adverse effects and the prescribed volume in the Netherlands. About 3% of the adult population are chronic users of benzodiazepines. Chronic use is complicated by the risk of falling; the relative risk of hip fractures in chronic benzodiazepine users in about 1.7. Chronic use should be discouraged. However, most chronic users are fragile elderly people for whom a good night's sleep implies temporary escape from a sorry existence with somatic or psychic symptoms. Such circumstances should be kept in mind when treating individual patients.     

'Treatment of drug-addicted detainees': and advisory report by the Health Council of the Netherlands

The Minister of Health, Welfare and Sport and the Minister of Justice requested advice from the Health Council of the Netherlands, on options for the treatment of detainees addicted to drugs. It is estimated that 15,000 to 23,000 people per year with addiction problems are detained. On the basis of the Custodial Institutions Act detainees have the right to adequate medical, psychological and psychiatric care, including treatment for drug addiction. The legal possibilities for using compulsion in the treatment of addicted persons in detention are very limited. A consensus needs to be reached on methadone medication; professional groups must reach this consensus. As well as abstinence, Addiction Support Sections should aim to achieve harm reduction, for example, by means of stabilisation with a maintenance dose of methadone. The success of interventions among addicted detainees is largely dependent on both the introduction of pressure in the area of follow-up care and the continuity of care. Bearing in mind the frequent psychiatric comorbidity, more psychiatric care should be available within the penitentiary setting. The Penal Care Facility for Addicts [Dutch acronym: SOV] is a new sanction option in the Penal Code with which drug-addicted repeat offenders can be involuntarily admitted to a drug addiction treatment centre for a maximum of 2 years. There is not enough scientific evidence to support the effectiveness of the SOV approach. The compulsory placement of an addict in the SOV could reduce the addict's motivation to do something about his addiction problem. SOV is a harsh sanction that should only be used once lighter sanctions (based on pressure by means of special conditions) have been shown to be ineffective for the persons concerned.     

'Ageing with ambition'; a recommendation from the Health Council of The Netherlands

The Health Council of the Netherlands, at the request of the policy committee for the elderly of the Dutch parliament, has deliberated over the intermediate- and long-term developments in the field of 'care and ageing'. In a comprehensive report, the overall conclusion is that there is sufficient room for the ambition to stimulate the health, independence and welfare of the elderly. The effects of biological ageing and the connections that exist between ageing, life span, illness and wellbeing are addressed. The number of people with illnesses and functional disorders will inevitably increase with ageing of the population. Nevertheless, numerous opportunities will arise to achieve health benefits and increase the quality of life. A range of measures is proposed in the field of prevention and treatment. An innovative policy on the elderly, political courage and social solidarity will be necessary in order to achieve 'ageing with ambition'. However, as pointed out in the report, health care is not merely an expense but also an important service industry that provides employment to a large number of people.     

The New Brunswick Health Council at a glance

This article presents an overview of the work of the New Brunswick Health Council (NBHC) since its creation by exploring its mandate and by presenting its different initiatives and publications as they relate to the NBHC's areas of work: population health, care experience, sustainability, and citizen engagement.     

Health Council of the Netherlands underestimates interactions in undernutrition in the elderly

The Health Council of the Netherlands has recently published a report on undernutrition in the elderly. Undernutrition is a huge problem associated with negative health outcomes, especially in the frail elderly. Although its review of the recent literature is useful, the report does not contribute anything to clinical practice. The point is that evidence for firm conclusions is still lacking, and that most of all more research is needed to really define undernutrition and that RCTs in homogeneous groups of elderly should yield evidence on the most effective treatment strategies in the different populations in old age. This reductionist viewpoint neglects the fact that undernutrition in the elderly is a geriatric syndrome, which is mainly explained by multifactorial aetiology. Therefore, the only way forward is to study and treat undernutrition in older adults by using a broad geriatric perspective, without aiming for the holy grail of the single best evidenced definition or treatment.     

Promoting audit in primary care: roles and relationships of medical audit advisory groups and their managers.

OBJECTIVES--To investigate perceptions of family health service authorities and medical audit advisory groups of advisory groups' involvement in clinical audit and wider quality issues; communication with the authorities; and manager satisfaction. DESIGN--National postal questionnaire survey in 1994. SETTING--All family health services authority districts in England and Wales. SUBJECTS--Chief executives or other responsible authority officers and advisory group chairpersons in each district. MAIN MEASURES--Priorities of advisory group and authority for audit; involvement of advisory group in wider quality issues; communication of information to, and contacts with, the authority and its involvement in planning the future work of the advisory group; and authorities' satisfaction. RESULTS--Both groups' views about audit were similar and broadly consistent with current policy. Advisory group involvement in wider quality issues was extensive, and the majority of both groups thought this appropriate. Much of the information about their activities collected by advisory groups was not passed on to the authority. The most frequent contact between the two groups was the advisory group's annual report, but formal personal contact was the most valued. Most authority respondents thought their views had been recognised in the advisory group's planning of future work; only a small minority were not satisfied with their advisory groups. Dissatisfied respondents received less information from their advisory groups, had less contact with them, and thought they had less input into their plans. There was some evidence that advisory groups in the "dissatisfied districts" were less involved in clinical audit and with their authorities in wider quality issues. CONCLUSIONS--Most advisory groups are developing their activities in clinical audit and have expanded their scope of work. The quality and availability of information about progress with audit is a cause for concern to both groups.