The coronavirus crisis has shown that Dutch health boards are underfunded and understaffed to breaking point, government health advisory body Raad voor Volksgezondheid & Samenleving (RVS) has said in a blistering report which was published on Tuesday.

The RVS is scathing about past and current public health policy calling it ‘haphazard and fragmented, short term and starved of investment’.

Half the population is suffering from one or more chronic illnesses while health inequality is high, the report said. At the same time, life expectancy has plummeted from the top to the European average.

‘We were at the forefront but we’re steadily moving downward,’ RVS chairwoman Jet Bussemaker told the NRC.

The Dutch public health boards (GGDs) are tasked with vaccination, youth care, infectious disease control and assessing health risks posed by, for instance, polluted water.  But due to ‘disastrous’ underfunding and understaffing they are unable to do this, even without the added burden of a pandemic, the RVS said.

The Netherlands is spending ‘shockingly little on public healthcare’, with just €2.8 billion for public health and €97 billion for regular healthcare in 2019. Some health boards, which are council funded, are facing an annual struggle to get the appropriate funding, the RVS said, and are ‘at the point of collapse’.

The reason for the lack of investment in public health may be that it is ‘not sexy’, Bussemakers said, citing the difference in status between a health board doctor and a medical specialist. The work health boards do is also less visible to people, she said.

Recommendations by the RVS to strengthen the ‘narrow and vulnerable foundations’ of public healthcare include upping the budget and anchoring public health goals, such as increasing average life expectancy, in law. This would be overseen by a designated government official who would be in charge of a ‘public healthcare Delta plan.

Staffing is a challenge, the RVS said, but more local visibility of heath boards, for instance by housing them in a local surgery, and more concerted efforts by the national government may help.