Municipal tobacco control in the Northern Netherlands: a quantitative content analysis of local health policies

A smoke-free society by 2040 is a key target for Dutch municipalities, mandated by law. Smoking remains a public health issue in Northern Netherlands, where approximately one in four adults still smoke. This study evaluates the content of municipal health policies related to tobacco control and their correlation to regional smoking rates.

We used open-access datasets to assess municipal health policies using a quantitative scoring model inspired by the Dutch Public Health Act. We developed the model using elements from the logic of events theory, which assesses policy impact across four dimensions: Obligations, Goals, Opportunities and Resources. We examined differences across municipalities and regions, exploring correlations between health policy scores, smoking prevalence and municipal-level factors, including socioeconomic status. We created an interactive policy map to visualise the results.

Municipalities in the Groningen region achieved the highest health policy score (28 of 33), yet the region also had the highest smoking prevalence (24.68%), compared with Drenthe (20.51%) and Friesland (22.49%). Among the four policy impact determinants, Opportunities differed across regions. At the municipal level, socioeconomic status was negatively correlated with the total health policy score (r=-0.38), with specific correlations for Opportunities (r=-0.36) and Resources (r=-0.33).

We developed a reproducible approach to assess regional disparities in tobacco control efforts. Despite high policy scores in some municipalities, smoking prevalence remained high, suggesting barriers to effective implementation, including socioeconomic factors, governance and financial planning.