Prevention in numbers: physical activity receives far more visible funding than alcohol and smoking
At the “Onderzoek dat Voedt!” knowledge session, the question arose of how much prevention funding actually goes to food. The available RIVM and VWS data point to relatively limited, direct prevention funding for préventing the consequences of poor diet, compared with physical activity. To see whether that pattern holds more broadly, the prevention budgets for alcohol and smoking are set out here as well.
Prevention funding is the part of the national budget aimed at preventing health damage caused by lifestyle. This analysis sets the healthcare spending that RIVM/VZinfo attributes to each theme against the funding that VWS/Rijksfinanciën links to it — for both 2015 and 2022, and, where the source provides it, in two different readings side by side.
Food: relatively little direct prevention funding, under every reading
Food-related healthcare spending is defined differently depending on the source: from €1.58 billion (the official, narrow RIVM/VZinfo reading) to €10.4 billion (a broad reading, including blood sugar, blood pressure, overweight and LDL cholesterol) in 2022, compared with €6.0 billion under the older 2015 framing. The corresponding VWS budget for healthy lifestyles and healthy weight is roughly €30.8 million in 2022 and roughly €10.5–11.1 million in 2015 — under almost every combination of these figures, the share of prevention funding comes out between 0.18% and 1.94% of attributed healthcare spending.
Against physical activity (5.10% in 2022), that share is consistently lower, even under the narrowest food reading. That is the core of the question this article started with: it appears that relatively little direct funding is available to prévent the consequences of poor diet, while the associated healthcare spending — depending on the definition used — ranks among the highest of the four themes compared here.
Healthcare spending and disease burden per theme, 2015 and 2022
RIVM and VZinfo attribute part of direct healthcare spending to risk factors per theme. The methodology differs between the older 2015 framing (RIVM/VTV) and the 2022 framing (RIVM/VZinfo); both are shown side by side here, rather than as a directly comparable time series.
| Theme | Disease burden 2015 | Healthcare spending 2015 | Disease burden 2022 | Healthcare spending 2022 |
|---|---|---|---|---|
| Food, broad reading | 8.1% | €6.0 bn | 16.2% | €10.379 bn |
| Physical activity (insufficient activity) | 2.3% | €2.7 bn | 1.8% | €3.572 bn |
| Smoking | 9.4% | €2.4 bn | 7.6% | €2.473 bn |
| Alcohol use | 1.5% | €0.9 bn | 3.0% | €1.276 bn |
| Smoking + alcohol combined (gross) | 10.9% | €3.3 bn | 10.6% | €3.749 bn |
Smoking + alcohol is a simple gross combination for the purpose of the ratios; RIVM notes that risk factors can overlap. The narrow food reading (official RIVM/VZinfo reading for 2022) comes to €1.583 bn in healthcare spending and 2.8% disease burden — used as a reference point in the budget table below.
Prevention funding as a share of healthcare spending — 2015 and 2022, both common readings
The VWS budget is organised by policy article, not by risk factor. Where the source offers two readings — a narrow, realised annual-report reading and a broader policy proxy — both are shown side by side below. The figures are budget proxies: an order of magnitude, not a precise cost-effectiveness analysis.
2015
| Theme | Reading | Budget proxy | % of healthcare spending | Per €1,000 healthcare spending |
|---|---|---|---|---|
| Food | realised annual report | €10.526 mln | roughly 0.18% | roughly €1.75 |
| Food | slide-deck basis (earlier analysis) | €11.096 mln | 0.18% | €1.80 |
| Physical activity | slide-deck basis / policy proxy | €59.074 mln | 2.19% | €21.88 |
| Physical activity | full article 6 (Rijksfinanciën) | €73.079 mln | 2.71% | €27.07 |
| Smoking + alcohol | realised annual report | €2.432 mln | 0.074% | €0.74 |
| Smoking + alcohol | broader slide-deck proxy | €3.922 mln | 0.119% | €1.19 |
2022
| Theme | Reading | Budget proxy | % of healthcare spending | Per €1,000 healthcare spending |
|---|---|---|---|---|
| Food | against the broad healthcare-spending reading (€10.379 bn) | €30.776 mln | 0.30% | €2.97 |
| Food | against the narrow healthcare-spending reading (€1.583 bn) | €30.776 mln | 1.94% | €19.44 |
| Physical activity | National Sports Agreement proxy | €182.312 mln | 5.10% | €51.04 |
| Physical activity | full article 6 (Rijksfinanciën) | €469.573 mln | 13.15% | €131.46 |
| Smoking + alcohol | including drugs (only available line item) | €24.557 mln | 0.65% | €6.55 |
For physical activity in both 2015 and 2022, the “full article 6” reading shows a higher percentage, but it is methodologically broader than physical-activity prevention alone: that line item also includes elite sport, facilities and knowledge programmes. The National Sports Agreement proxy and the slide-deck basis sit closer to direct prevention spending.
Targets for 2040, and where things stand
Food
No separate 2040 target within this budget comparison; the food environment and food behaviour are covered in the Onderzoek dat Voedt! analyses of Mensa Mensa and the Amsterdam-Noord MKBA.
Physical activity
Target: 75% of the Dutch population meets the physical activity guidelines by 2040. In 2025 that figure is 46.1%, a gap of roughly 29 percentage points.
Alcohol
Target: excessive drinking among adults down to 5% by 2040. In 2025, 5.5% drink excessively. RIVM describes the impact of the National Prevention Agreement on problematic alcohol use as minimal.
Smoking
Target: fewer than 5% of adults smoking by 2040 (Smoke-free Generation). In 2025, 17.8% of adults smoke. With the Prevention Agreement, RIVM projects around 10% by 2040.
Promising additional measures per theme
| Theme | What RIVM identifies as the most promising additional route |
|---|---|
| Physical activity | A systemic approach through the built environment, workplaces, education, healthcare, municipalities and the Beweegalliantie. |
| Alcohol | Making alcohol more expensive, reducing availability, restricting marketing, improving early detection, and better enforcement of the age limit. |
| Smoking | Further excise-duty increases, and higher take-up of stop-smoking care. |
The pattern holds, even with cautious proxies. Under every reading used here, physical activity is funded more visibly and more directly in policy budgets than smoking, alcohol and food, measured against attributed healthcare spending. For smoking and alcohol, part of the policy effort runs through regulation, excise duties and enforcement rather than a direct prevention-budget line; for food, that distinction is harder to draw, because the budget line is defined broadly (“healthy lifestyles and healthy weight”).
Physical activity: visible funding, target still far off
The Netherlands aims for 75% of residents to be sufficiently active by 2040. In 2025, 46.1% of adults meet the physical activity guidelines. RIVM/VZinfo attributes an estimated €3.572 billion in healthcare spending to insufficient physical activity in 2022. Physical activity is relatively visible in the budget through the National Sports Agreement, Sportakkoord II, GALA, the Brede SPUK, neighbourhood sports coaches, the Beweegalliantie and sports infrastructure; the 2022 proxy used here amounts to roughly €182 million in National Sports Agreement funding, or around 5.10% of attributed healthcare spending.
Alcohol: a clear guideline, budget not separately visible
The Dutch Health Council advises not drinking alcohol at all, or at most one glass a day. In 2025, 46.4% of adults follow that guideline and 5.5% drink excessively. RIVM/VZinfo attributes an estimated €1.276 billion in direct healthcare spending to alcohol use in 2022. Alcohol policy runs through the National Prevention Agreement, NIX18, alcohol legislation, advertising restrictions, age verification, local prevention and enforcement plans, and early detection. In the VWS budget, alcohol is not shown separately: it sits together with smoking and drugs under “prevention of harmful substance use”, which amounts to an estimated €24.557 million in 2022.
Smoking: firm policy, target not yet in sight
Smoking remains one of the largest avoidable causes of illness and death. In 2025, 17.8% of adults smoke and 12.1% smoke daily. The ambition of the Smoke-free Generation is that by 2040 fewer than 5% of adults smoke and no child starts smoking. RIVM/VZinfo attributes an estimated €2.473 billion in direct healthcare spending to smoking in 2022. Policy runs through excise duties, smoke-free spaces, sales restrictions, plain packaging, a flavour ban for vapes, and stop-smoking care. RIVM expects current agreements to fall short of the target: with the Prevention Agreement, the share of adult smokers is projected to be around 10% by 2040, above the ambition of under 5%.
Method and limitations
RIVM’s healthcare-spending figures are calculated via risk factors; the VWS budget is organised by policy article, instrument, subsidy, assignment and contribution. These do not map onto each other one-to-one. Smoking and alcohol often sit together with drugs in a single budget line. Physical activity partly falls under broader sports policy, and also carries substantial municipal sports spending that is not fully captured in VWS prevention lines. Food falls under the broad “healthy lifestyles and healthy weight” line, which does not exclusively cover prevention of food-related healthcare spending. Stop-smoking care runs partly through the Health Insurance Act; alcohol prevention runs partly through municipalities, public health services (GGD) and addiction care.
The prevention budgets shown here are budget proxies, intended as an order of magnitude and an indicative ratio — not as a precise cost-effectiveness analysis or an official total estimate of prevention per risk factor. Healthcare spending figures are direct healthcare spending; broader social costs such as lost productivity, informal care, enforcement, safety and wellbeing are not fully included.
Sources
- RIVM, Factsheet on public health and the environment (2023)
- VZinfo/RIVM, Healthcare spending 2022 in relation to determinants of health (2025)
- VZinfo, disease burden by risk factor
- VWS Annual Report 2015 and 2022, article 1 Public Health (Rijksfinanciën)
- VWS Annual Report 2015 and 2022, article 6 Sport and Physical Activity (Rijksfinanciën)
- CBS, Targets under the National Prevention Agreement (2025)
- RIVM, Impact assessment of the National Prevention Agreement: smoking, overweight and problematic alcohol use (2024)
- Dutch Health Council, Physical Activity Guidelines 2017
- VZinfo, physical activity, alcohol use and smoking among adults
- Trimbos Institute, figures on alcohol and smoking
- Dutch government, alcohol legislation; discouraging smoking
- Loket Gezond Leven, National Sports Agreement II and national smoking policy
- DUS-I, Brede SPUK
- NIX18
- NVWA, flavour ban for vapes (2024)
This analysis is a synthesis of public sources (RIVM, VZinfo, VWS/Rijksfinanciën, CBS, Trimbos, Dutch government) by New Economy, combined with New Economy’s own food analysis from the Onderzoek dat Voedt! knowledge session — not original New Economy fieldwork on physical activity, alcohol or smoking.
Frequently asked questions
In 2022, an estimated €30.8 million goes to food (0.30% to 1.94% of attributed healthcare spending, depending on the reading used), compared with 5.10% for physical activity. Under every reading, the share for food is lower than for physical activity.
Physical activity receives an estimated 5.10% of attributed healthcare spending in prevention and stimulation funding in 2022 (National Sports Agreement proxy), compared with 0.65% for smoking and alcohol combined.
The VWS budget groups smoking, alcohol and drugs under the line item “prevention of harmful substance use”. This line item amounts to an estimated €24.557 million in 2022 and cannot be broken down into the separate themes.
For physical activity: 75% of the Dutch population meets the physical activity guidelines. For alcohol: 5% of adults drink excessively. For smoking: fewer than 5% of adults smoke (Smoke-free Generation).
Not fully. RIVM used a different methodology in 2015 (VTV) than in 2022 (VZinfo), and for some themes both a narrow, realised annual-report reading and a broader policy proxy exist. Both readings are shown side by side in this article.
Related
Prevention policy or impact assessment for a lifestyle theme
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