Is diet gettingtoo little prevention funding?
Prevention policy pays a lot of attention to physical activity, smoking and alcohol. That is justified. But when healthcare expenditure and prevention budgets are placed side by side, a striking pattern emerges: diet causes or influences a large share of health damage, while receiving relatively little directly visible prevention funding.
This data-led opinion piece compares diet, physical activity, smoking and alcohol. It is not a definitive cost-effectiveness analysis, but a policy reality check: are prevention resources proportionate to the societal and healthcare burden?
Diet: relatively little direct prevention funding
Diet-related healthcare expenditure can be framed in different ways: from €1.583 billion in the official, narrow RIVM/VZinfo category for unhealthy diet to €10.379 billion in a broader, non-official reading that also includes high blood glucose, high blood pressure, overweight and obesity, and high LDL cholesterol. In 2022, the corresponding visible VWS budget for healthy lifestyle and healthy weight was around €30.776 million.
Against the official narrow diet category, that equals 1.94% of attributed healthcare expenditure. Against the broader diet-related reading, it falls to 0.30%. By comparison, the Sport Agreement proxy for physical activity comes to 5.10% in 2022.
Healthcare expenditure and disease burden by theme
RIVM and VZinfo attribute direct healthcare expenditure to risk factors. The method differs between the older 2015 framing and the 2022 framing; the figures are therefore shown side by side, not as a strict time series.
| Theme | Disease burden 2015 | Healthcare expenditure 2015 | Disease burden 2022 | Healthcare expenditure 2022 |
|---|---|---|---|---|
| Diet, older broad reading | 8.1% | €6.0bn | – | – |
| Diet, official narrow reading | – | – | 2.8% | €1.583bn |
| Diet-related, broad non-official sum | – | – | 16.2% | €10.379bn |
| Insufficient physical activity | 2.3% | €2.7bn | 1.8% | €3.572bn |
| Smoking | 9.4% | €2.4bn | 7.6% | €2.473bn |
| Alcohol use | 1.5% | €0.9bn | 3.0% | €1.276bn |
| Smoking + alcohol, gross sum | 10.9% | €3.3bn | 10.6% | €3.749bn |
Smoking + alcohol is a simple gross sum used for ratio purposes. RIVM notes that risk factors can overlap. The broad diet-related reading is therefore policy-relevant, but not an official total estimate.
Why diet looks smaller in 2022
In the older RIVM framing, unhealthy diet was linked to cardiovascular disease, cancer and diabetes, partly indirectly through high blood pressure, high blood glucose, overweight and cholesterol. In the current method, these pathways are recorded much more as separate person-related risk factors.
| 2022 component | Type | Disease burden | Healthcare expenditure 2022 |
|---|---|---|---|
| Unhealthy diet | Behaviour | 2.8% | €1.583bn |
| High blood glucose | Person-related | 4.5% | €3.527bn |
| High systolic blood pressure | Person-related | 5.0% | €2.794bn |
| Overweight and obesity | Person-related | 2.3% | €1.512bn |
| High LDL cholesterol | Person-related | 1.6% | €0.963bn |
| Simple broad diet-related sum | Non-official, with overlap | 16.2% | €10.379bn |
This creates a paradox: diet appears smaller in the official 2022 category, but much of the diet-related health damage has not disappeared. It is booked elsewhere.
Prevention funding as a share of healthcare expenditure
The VWS budget is structured around policy articles, not around risk factors. The figures below are therefore budget proxies: useful orders of magnitude, not an exact cost-effectiveness analysis.
| Theme | 2015 | 2022 official narrow reading | 2022 broad diet reading |
|---|---|---|---|
| Diet | €11.096m / €6.0bn = 0.18% | €30.776m / €1.583bn = 1.94% | €30.776m / €10.379bn = 0.30% |
| Smoking + alcohol | €3.922m / €3.3bn = 0.12% | €24.557m / €3.749bn = 0.65% | – |
| Physical activity | €59.074m / €2.7bn = 2.19% | €182.312m / €3.572bn = 5.10% | – |
| Physical activity relative to diet | 11.8× | 2.6× | 17.2× |
| Smoking + alcohol relative to diet | 0.64× | 0.34× | – |
2040 targets and current position
Promising additional measures by theme
| Theme | Promising additional route |
|---|---|
| Physical activity | A systems approach through the living environment, work, education, care, municipalities and the Beweegalliantie. |
| Alcohol | Increasing alcohol prices, reducing availability, restricting marketing, improving early identification and improving compliance with age limits. |
| Smoking | Further excise increases and higher participation in smoking cessation care. |
| Diet | A comparable systems approach around healthy food environments, pricing, supply, public meals, school meals, food skills, marketing and income security. |
Physical activity: visible budget, target still distant
The Netherlands aims for 75% of residents to meet the physical activity guidelines by 2040. In 2025, 46.1% of adults meet those guidelines. RIVM/VZinfo attributes around €3.572 billion in direct healthcare expenditure in 2022 to insufficient physical activity.
In the 2022 proxy used here, approximately €182 million is attributed to Sport Agreement funding, or around 5.10% of the attributed healthcare expenditure.
Alcohol: clear guideline, no separate visible budget
The Dutch Health Council advises not drinking alcohol, or at least no more than one glass per day. In 2025, 46.4% of adults follow that guideline and 5.5% drink excessively. RIVM/VZinfo attributes around €1.276 billion in direct healthcare expenditure in 2022 to alcohol use.
Alcohol is not separately visible in the VWS budget. It is grouped with smoking and drugs under the prevention of harmful substance use, a budget line of around €24.557 million in 2022.
Smoking: strong policy, target not yet in sight
In 2025, 17.8% of adults smoke and 12.1% smoke daily. The Smoke-free Generation ambition is that fewer than 5% of adults smoke by 2040 and that no child starts smoking.
RIVM/VZinfo attributes around €2.473 billion in direct healthcare expenditure in 2022 to smoking. RIVM expects the current Prevention Agreement to reduce adult smoking to around 10% by 2040, still above the target.
What does this mean for prevention policy?
The policy question is not whether physical activity, smoking and alcohol receive too much attention. They deserve attention. The question is whether diet has structurally received too little public prevention infrastructure.
Stronger diet-related prevention policy is not only about individual information campaigns. It also concerns healthy food environments, affordable healthy meals, food skills, school meals and public food provision, healthy canteens and workplaces, pricing and supply-side policy, restrictions on marketing for unhealthy products, local food infrastructure in vulnerable neighbourhoods and links with poverty policy and income security.
If diet is one of the major levers for health, prevention funding should be visible as a serious public investment.
Method and sources
The prevention budgets are proxies. The VWS budget does not map one-to-one onto RIVM risk factors. Smoking, alcohol and drugs are often grouped in one budget line. Physical activity partly runs through wider sport policy. Diet falls under a broad line for healthy lifestyle and healthy weight.
- RIVM, Factsheet Ongezonde voeding, 2021.
- RIVM, Factsheet volksziekten en leefomgeving, 2023.
- VZinfo/RIVM, Zorguitgaven 2022 in relatie tot determinanten van gezondheid, 2025.
- VWS annual reports 2015 and 2022, Article 1 Public Health and Article 6 Sport and physical activity.
- CBS, targets from the National Prevention Agreement, 2025.
- VZinfo, adults and physical activity; adults and alcohol use; adults and smoking.
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How much prevention funding goes to diet compared with physical activity?
In 2022, around €30.8 million goes to diet-related healthy lifestyle and healthy weight. That equals 0.30% to 1.94% of attributed healthcare expenditure, depending on the diet reading. The physical activity proxy used here is 5.10%.
Why is the broad diet reading not official?
Because high blood glucose, high blood pressure, overweight and LDL cholesterol are also influenced by other factors and can overlap. The broad reading shows that diet-related damage is partly booked outside the narrow diet category.
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