People of all ages across the world must have the opportunity to live in good health. SDG 3 aims to ensure global health and promote global well-being. Healthcare authorities can prevent premature mortality by treating disease and mental health problems, providing better care for mothers and infants, preventing and treating drug and alcohol abuse, and reducing the number of traffic deaths
Summary of results
- Medium-term trends (2015-2022) for three indicators point to decreasing well-being: a lower vaccination rate for measles, relatively fewer people with no mental health problems, and the increasing share of the population who are overweight.
- Trends for the number of hours worked in the care sector, the percentage of smokers and the number of people with long-term limitations due to health problems signal increasing well-being.
- Where it is possible to compare the Netherlands with other EU countries, it is often in the top or the middle group.
- One exception is neonatal mortality, where the Netherlands is in the lowest quartile of the EU.
Dashboard and indicators
Under SDG 3, people of all ages must have the opportunity to live as healthy a life as possible: they must have access to medical treatment when they are physically ill or have mental problems, so that they do not die unnecessarily. Research and vaccination programmes should be implemented to end epidemics of known infectious diseases by 2030. SDG 3 also addresses addiction prevention and care, road traffic deaths and birth control.
Four of the indicators that show a clear trend are moving towards the targets, while three are moving in the opposite direction. If we look at its position in the EU, we see that the Netherlands has a high and therefore favourable position for half the indicators. Only one indicator, neonatal mortality, has a low position in the rankings.
Resources and opportunities
The Dutch public health and healthcare sector faced a difficult period from 2020 to 2022, with the outbreak of Covid-19, an infectious disease caused by a new coronavirus. In the period March 2020 to October 2022, 47,076 people in the Netherlands died of diagnosed or suspected Covid-19. Initially, the pandemic led to a huge number of hospital admissions and very many patients in long-term intensive care. After that, the sector had to catch up and carry out regular care deferred during this period. Nursing and care homes also had to cope with the constant pressure of infected elderly people. Coronavirus affected the whole population in one way or another. At the end of 2020 and 2021, more people than in previous years reported mental health problems, especially those in the youngest age groups. Obviously, these developments have contributed to recent well-being, but the monitor – and the SDG 3 dashboard – focuses on medium-term trends (2015-2022).
Resources and opportunities relate to the resources used to maintain and improve the healthcare system. Although the medium-term trend in spending on healthcare as a percentage of GDP is stable, percentages in 2020 and 2021 were clearly higher due to the coronavirus crisis. These larger shares of GDP are the result of higher care costs combined with lower economic growth. No figures are available for 2022. Care staff worked significantly more hours per capita in both cure and care in 2022: 107 hours. The trend is upward and green. In the context of SDG 3, this rising trend is seen as improving well-being for the individuals receiving care. In terms of hours worked in care as an indicator for the level of care provided, the Netherlands has a high position in the EU27 rankings. The trend in job vacancies in the cure and care sectors is rising, which is a point of concern from the perspective of resilience of important systems. The job vacancy rate in the Dutch care sector is one of the highest in the EU.
Use concerns behaviour that affects health and how people use health care services. People who eat and drink too much and take too little exercise will become overweight. Alongside smoking, this is an important lifestyle factor. In 2014, for the first time more than half the population aged 20 years and older (50.3 percent) had a BMI of 25 kg/m2 or more and were therefore considered to be officially overweight. This had risen to 51.1 percent in 2022. The trend has changed from neutral to rising. The situation is relatively less unfavourable in the Netherlands than in other countries (fifth out of 26 countries in 2019). Dutch people also drink a relatively small amount of alcohol compared with the rest of the EU (on the basis of alcohol content, beer, wine and spirits are converted to litres of alcohol consumed per capita). The percentage of Dutch smokers continues to fall, amounting to 17.9 percent of the population aged 12 years and older in 2022, compared with 24.6 percent at the start of the trend period (2015). The figure includes people who smoke tobacco products, but not people who use electronic cigarettes.
The measles vaccination rate is also an indicator for the use of healthcare. The rate in the Netherlands is below the WHO standard of 95 percent, the level deemed necessary to eradicate measles. The trend is downward. Although the national vaccination programme did continue during the pandemic, vaccination of babies born in this period was slightly lower. In 2022, 92.7 percent of babies born in 2019 had received an MMR vaccination.
Outcomes refer to the physical and mental health of the population in relation to the quality of healthcare. Diabetes is one of the most common chronic illnesses in the Netherlands and is also responsible for a substantial disease burden. Nearly five percent of the Dutch population were taking diabetes medication in 2021. The average hospital stay for inpatients is shorter in the Netherlands than in all other EU countries. At 5.2 days in 2021, it was very slightly down on the average length of stay in the first year of the coronavirus pandemic (5.3 days). Healthcare suppliers and health insurance companies in the Netherlands have agreed acceptable waiting-list times for outpatient care, the ‘Treek’ norms. In 2021, waiting-list times between a first appointment and start of treatment exceeded this norm of four weeks at the most in 32.4 percent of cases. Fewer data on waiting times became available in 2020 because of the coronavirus crisis, and the data that were provided may also have been distorted by the effects of the crisis. As a result of a new survey method, waiting times in 2021 are based on data for January to August 2021. Therefore, no trend can be calculated for this indicator.
Nearly six hundred live-born babies (597) died before their first birthday in 2021: 3.3 per thousand live births. Over three-quarters of these babies died within 28 days of being born (neonatal mortality): 2.6 babies per thousand live births. In 2022, preliminary CBS estimates put this figure at 2.4 babies per thousand live births. The medium-term trend (2015-2022) in neonatal mortality is neutral. A lot has improved in this area since the 1980s: more and better prenatal screening, fewer multiple pregnancies and fewer very young mothers. There has also been increased attention for sudden infant death syndrome (SIDS).
Life expectancy at birth has risen slightly in 2022: to 80.1 years for men and 83.1 years for women. This is five months more for men and one month more for women than in 2021. In spite of the increases, life expectancy is still four months shorter for men and five months shorter for women than in 2019. On average, life expectancy increases year-on-year, but the coronavirus pandemic had a downward effect on it.
Life expectancy gives an indication of how long people can expect to live, given present mortality risks. Not only just how long people live is important, however, but also how long they remain in good health. To measure this, healthy life expectancy combines mortality rates and health statistics, adding a qualitative element to ‘normal’ life expectancy. It can be applied in several ways; here we use life expectancy (at birth) in health that people themselves describe as good or very good. Healthy life expectancy at birth in 2022 was 63.2 years for Dutch men and one year shorter for Dutch women. These are the lowest values since the beginning of this century. This monitor analyses the medium-terms trends, for 2015-2022. The medium-term trends were neutral.
Within this period, people were surprisingly positive about their own health in the two coronavirus years, 2020 and 2021. This was reflected in relatively high healthy life expectancy rates for these years. In 2022, a substantially smaller share of the population rated their health as ‘good’ or ‘very good’. This, in combination with a reasonably stable ‘normal ‘life expectancy, resulted in considerably lower healthy life expectancy in 2022 than in 2021. Dutch men and women are both in the EU middle groups. The data used for the international comparison are compiled according to a slightly different definition of healthy life expectancy than those used to calculate the Dutch trend: for the international comparison data refer to ‘disability-free life expectancy’.
In 2022, 5.0 percent of the population aged 16 years and older faced serious limitations in their daily activities because of long-term health problems. The medium-term trend is decreasing, but the figure was 0.7 of a percentage point up on 2021. Long-term health complications leading to these limitations are defined as problems that have lasted six months or longer. A considerable share of people who have had Covid-19 still suffer effects for long periods after their infection. It is difficult to establish just how many people are affected, but an expert information session in the House of Representatives on the impact of coronavirus held in December 2022 put the number at between 120 and 600 thousand people. Whether these long-Covid or post-Covid symptoms will lead to an increase in the group of people with serious limitations in the future remains unclear.
In its most extreme form, the mental health of the population is measured in terms of the trend in the number of suicide deaths. In 2021, the suicide rate was 10.6 per 100 thousand inhabitants, an average five deaths every day. Men are more likely than women to commit suicide: 14.9 per 100 thousand inhabitants, compared with 6.4 for women. A second indicator of mental health is the share of the population with no mental health problems (in previous editions of the monitor this was called the ‘mentally healthy population’). This is based on five questions from the Mental Health Inventory-5 (MHI-5). The questions concern how people have been feeling recently: calm, peaceful, happy, nervous, downhearted/blue or completely ‘down in the dumps’ with no visible way out. People scoring at least 60 points are considered not to have mental health problems.
The trend for people without mental health problems is downward. The figure for 2021 in particular, the second year of the coronavirus pandemic, shows a notable deterioration (-3.2 percentage points): 84.9 percent of the population aged 12 years and older recorded an MHI-5 score of 60 or more. In 2022 the share had risen again: 86.2 percent.
Subjective assessment concerns people’s satisfaction both with their own health and with the Dutch healthcare system. Only for the former aspect is an indicator available. The share of the Dutch population describing their health as ‘good’ or ‘very good’ was 77.2 percent in 2022. This is clearly lower than in 2020 and 2021, and also low compared with the years before that. In 2020 and 2021, possibly as a result of the coronavirus pandemic, a large share of the Dutch population were positive about their own health. The Netherlands is in the top group within Europe for this indicator.