What are the most effective public health interventions?

Evidence-based public health interventions have saved millions of lives since 1854, when Dr. John Snow first identified a public water well as the source of a major cholera outbreak in London. In the decades since, public health interventions have been instrumental in improving the health and well-being of people in large and small communities.1

A public health intervention is an organized effort to promote those specific behaviors and habits that can improve physical, mental and emotional health. These interventions can also reframe the perspective of unhealthy habits to change the way people think about those behaviors.

Public health interventions play an important role in the overall health, longevity and productivity of a community, as they can improve quality of life, reduce human suffering, help children thrive, and save money. The people and programs involved in public health work to create the healthiest nation possible.

Public health interventions have been saving lives and reducing disability for decades, but these great achievements tend to go unnoticed. The Centers for Disease Control and Prevention (CDC) lists the ten greatest public health achievements from 1900 to 1999 as:2

• Vaccination
• Motor vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard

But how have these public health interventions helped save lives? Well, it was a public health intervention that pushed for the passage of seat belt laws, and the 90 percent adherence to those laws saves nearly 15,000 lives each year, according to the National Highway Traffic Safety Administration (NHTSA).3 Vaccinations wiped out smallpox, diphtheria and paralytic polio and have nearly wiped out measles, rubella, mumps and other infectious diseases. Achievements in public health have also greatly improved safety in the workplace.

One of the most important public health achievements has been a dramatic reduction in deaths from cardiovascular disease (CVD). According to CDC statistics, the age-adjusted death rates from CVD have declined 60 percent since 1950.4

Public health intervention programs can be cost-effective solutions to some of the most pressing community health issues in the nation today. In a study by Trust for America's Health, researchers found that investing just $10 per person per year in community-based programs that improve nutrition, increase physical activity and prevent tobacco use could save the nation more than $16 billion annually within the first five years of the investment. Of the $16 billion in savings, private payers could save more than $9 billion, Medicare would save more than $5 billion and Medicaid would enjoy more than $1.9 billion in savings.5

Today's public health requires a multidisciplinary team of public health workers that might include epidemiologists, biostatisticians, public health nurses, medical assistants, midwives or medical microbiologists. Together, they can implement a variety of preventive and/or responsive interventions, including the six outlined below.

1. Epidemiology and Surveillance

Epidemiology focuses on the causes and distribution of infectious diseases and other health issues and works to stop them from spreading.

Epidemiologists, public health physicians and nurses, and public policymakers participate in epidemiology and surveillance work. Research by epidemiologists and other epidemiology professionals can impact maternal and child health, environmental health, responses to bioterrorism, substance abuse and other public health issues.

2. Outreach

Outreach programs identify populations-of-interest or populations-at-risk and provide information about the nature of a particular health concern, possible solutions and ways residents can obtain medical services. Outreach specialists help promote affordable health care options and provide health education, advocacy and community awareness around public health issues such as obesity, stress, maternal and childhood health, and sexually transmitted infections.

A number of organizations, such as community health centers, federally qualified health centers, public hospitals and other nonprofit organizations, hire outreach professionals.

3. Screening

Population-based screening is an essential component of public health because it helps identify individuals with asymptomatic diseases or unrecognized health risk factors. Screening has two main goals: Identifying diseases in their early states and identifying risk states, such as high blood pressure, so that patients may begin treatment early. Public health screening may include newborn screening for genetic disorders and mammography to detect breast cancer before it is palpable.

4. Health Teaching

Professionals responsible for public health teaching interventions communicate ideas, facts and skills that can change the level of knowledge, attitudes, behaviors, beliefs, values and practices of communities, systems, families and individuals. They work in a variety of settings, including schools, hospitals and community health centers. Public health educators work to ensure that community members understand health risks and concerns relevant to their age group and location.

5. Social Marketing

Social marketing seeks to bring about behavioral changes that improve health. Social marketing may be effective for the promotion of breastfeeding practices in community and workplace settings, for example, and can help educate policymakers about the benefits of breastfeeding.

6. Policy Development

Public health professionals play an important role in the policy-making process by conducting analyses of similar policies and communicating their findings, developing partnerships between decision-makers and health care providers, and by promoting and implementing evidence-based public health interventions.

Public health leaders often have a college degree in public health, such as a Bachelor of Science in Public Health (BSPH), a Master of Public Health (MPH) or a Doctor of Philosophy in Public Health (Ph.D.). Professionals holding a BSPH often work in health promotion and education, environmental and occupational health, and health services administration. MPHs may work in biostatistics, environmental health services, epidemiology, health policy and management, and social behavioral sciences. Those carrying a Ph.D. in public health might specialize in epidemiology, prevention science, and health policy and management.

Public health intervention professionals occupy various roles and manage diverse responsibilities, which can include:

• Disease and vaccination research in diagnostic laboratories
• Teaching members of the community how to eat nutritious foods
• Developing guidelines for safeguarding against toxic substances and potential safety hazards
• Monitoring air and water quality as part of a government agency
• Managing healthcare clinics and nursing homes
• Working with emergency specialists to develop disaster response strategies
• Drafting policies for community access to basic healthcare services

Think your place in public health may be in the intervention space? Explore the possibilities with the online Master of Public Health from Kent State University, with available specialties in Health Policy and Management and Social and Behavioral Sciences.

1. Retrieved on June 8, 2018, from blogs.cdc.gov/publichealthmatters/2017/03/a-legacy-of-disease-detectives/
2. Retrieved on June 8, 2018, from cdc.gov/mmwr/preview/mmwrhtml/mm4850bx.htm
3. Retrieved on June 8, 2018, from nhtsa.gov/seat-belts/seat-belts-save-lives
4. Retrieved on June 8, 2018, from cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm
5. Retrieved on June 8, 2018, from healthyamericans.org/reports/prevention08/Prevention08.pdf

1. GBD 2017 Risk Factor Collaborators Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1923–1994. [PMC free article] [PubMed] [Google Scholar]

2. Watkins D.A., Nugent R., Saxenian H., Yamey G., Danforth K., Gonzalez-Pier E., Mock C.N., Jha P., Alwan A., Jamison D.T. Intersectoral Policy Priorities for Health. In: Jamison D.T., Gelband H., Horton S., Jha P., Laxminarayan R., Mock C.N., Nugent R., editors. Disease Control Priorities: Improving Health and Reducing Poverty. 3rd ed. The International Bank for Reconstruction and Development/The World Bank; Washington, DC, USA: 2017. [Google Scholar]

3. Patnode C.D., Evans C.V., Senger C.A., Redmond N., Lin J.S. Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2017;318:175–193. [PubMed] [Google Scholar]

4. Prüss-Utün A., Wolf J., Corvalán C., Bos R., Neira M. Preventing Disease through Healthy Environments: A Global Assessment of the Burden of Disease from Environmental Risks. WHO; Geneva, Switzerland: 2016. [Google Scholar]

5. Prüss-Ustün A., Wolf J., Corvalán C., Neville T., Bos R., Neira M. Diseases due to unhealthy environments: An updated estimate of the global burden of disease attributable to environmental determinants of health. J. Public Health. 2017;39:464–475. doi: 10.1093/pubmed/fdw085. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

6. RIVM Volksgezondheid en Zorg. [(accessed on 15 September 2018)]; Available online: https://www.volksgezondheidenzorg.info/

7. Lacombe J., Armstrong M.E.G., Wright F.L., Foster C. The impact of physical activity and an additional behavioural risk factor on cardiovascular disease, cancer and all-cause mortality: A systematic review. BMC Public Health. 2019;19:900. doi: 10.1186/s12889-019-7030-8. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Blaga O.M., Vasilescu L., Chereches R.M. Use and effectiveness of behavioural economics in interventions for lifestyle risk factors of non-communicable diseases: A systematic review with policy implications. Perspect. Public Health. 2018;138:100–110. doi: 10.1177/1757913917720233. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

9. Woolf S.H. Necessary but not sufficient: Why health care alone cannot improve population health and reduce health inequities. Ann. Fam. Med. 2019;17:196–199. doi: 10.1370/afm.2395. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

10. Kaplan R.M., Spittel M.L., David D.H. Population Health: Behavioral and Social Science Insights. Government Printing Office; Washington, DC, USA: 2015. [Google Scholar]

11. National Research Council (US) U.S. Health in International Perspective: Shorter Lives, Poorer Health. National Academies Press; Cambridge, MA, USA: 2013. [Google Scholar]

12. Lantz P.M., Golberstein E., House J.S., Morenoff J. Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of US adults. Soc. Sci. Med. 2010;70:1558–1566. doi: 10.1016/j.socscimed.2010.02.003. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

13. Ministerie van Volksgezondheid Welzijn en Sport Nationaal Preventieakkoord. [(accessed on 15 December 2019)]; Available online: www.nationaalpreventieakkoord.nl

14. World Economic Forum . Maximizing Healthy Life Years: Investments that Pay Off. World Economic Forum; Geneva, Switzerland: 2015. [Google Scholar]

15. Zwaap J., Knies S., van der Meijden C., Staal P., van der Heiden L. Kosteneffectiviteit in de Praktijk. Zorginstituut Nederland; Diemen, The Netherlands: 2015. [Google Scholar]

16. Sassi F. Calculating QALYs, comparing QALY and DALY calculations. Health Policy Plan. 2006;21:402–408. doi: 10.1093/heapol/czl018. [PubMed] [CrossRef] [Google Scholar]

17. Greenberg D., Earle C., Fang C.-H., Eldar-Lissai A., Neumann P.J. When is cancer care cost-effective? A systematic overview of cost–utility analyses in oncology. J. Natl. Cancer Inst. 2010;102:82–88. doi: 10.1093/jnci/djp472. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

18. Salomon J.A., Carvalho N., Gutiérrez-Delgado C., Orozco R., Mancuso A., Hogan D.R., Lee D., Murakami Y., Sridharan L., Medina-Mora M.E. Intervention strategies to reduce the burden of non-communicable diseases in Mexico: Cost effectiveness analysis. BMJ. 2012;344:e355. doi: 10.1136/bmj.e355. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

19. Vos T., Carter R., Barendregt J., Mihalopoulos C., Veerman L., Magnus A., Cobiac L., Bertram M., Wallace A. Assessing Cost-Effectiveness in Prevention: ACE–Prevention September 2010 Final Report. University of Queensland; St Lucia, Australia: 2010. [Google Scholar]

20. Tengs T.O., Adams M.E., Pliskin J.S., Safran D.G., Siegel J.E., Weinstein M.C., Graham J.D. Five-hundred life-saving interventions and their cost-effectiveness. Risk Anal. 1995;15:369–390. doi: 10.1111/j.1539-6924.1995.tb00330.x. [PubMed] [CrossRef] [Google Scholar]

21. Wilson N., Davies A., Brewer N., Nghiem N., Cobiac L., Blakely T. Can cost-effectiveness results be combined into a coherent league table? Case study from one high-income country. Popul. Health Metr. 2019;17:10. doi: 10.1186/s12963-019-0192-x. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

22. Hutton G., Water S., World Health Organization . Considerations in Evaluating the Cost-Effectiveness of Environmental Health Interventions. World Health Organization; Geneva, Switzerland: 2000. [Google Scholar]

23. INHERIT Database of Promising Practices. [(accessed on 15 December 2018)]; Available online: www.inherit.eu/resources/about-database

24. Augustovski F., Colantonio L.D., Galante J., Bardach A., Caporale J.E., Zarate V., Chuang L.H., Pichon-Riviere A., Kind P. Measuring the Benefits of Healthcare: DALYs and QALYs—Does the Choice of Measure Matter? A Case Study of Two Preventive Interventions. Int. J. Health Policy Manag. 2017;7:120–136. doi: 10.15171/ijhpm.2017.47. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

25. Rodriguez Barrios J.M., Perez Alcantara F., Crespo Palomo C., Gonzalez Garcia P., Anton De Las Heras E., Brosa Riestra M. The use of cost per life year gained as a measurement of cost-effectiveness in Spain: A systematic review of recent publications. Eur. J. Health Econ. 2012;13:723–740. doi: 10.1007/s10198-011-0326-y. [PubMed] [CrossRef] [Google Scholar]

26. Husereau D., Drummond M., Petrou S., Carswell C., Moher D., Greenberg D., Augustovski F., Briggs A.H., Mauskopf J., Loder E. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Pharmacoeconomics. 2013;31:361–367. doi: 10.1007/s40273-013-0032-y. [PubMed] [CrossRef] [Google Scholar]

27. Spronk S., Van Kempen B., Boll A., Jørgensen J., Hunink M., Kristiansen I.S. Cost-effectiveness of screening for abdominal aortic aneurysm in the Netherlands and Norway. Br. J. Surg. 2011;98:1546–1555. doi: 10.1002/bjs.7620. [PubMed] [CrossRef] [Google Scholar]

28. Smeets W., Hammingh P., Aben J.M.M. De Kosten en Baten Voor Nederland van Het Commissievoorstel ter Vermindering van de Nationale Emissies van Luchtverontreinigende Stoffen: Analyse van Het Voorstel van 18 December 2013. PBL; Den Haag, Nederland: 2015. [Google Scholar]

29. Ballinger A., Chowdhury T., Sherrington C., Cole G. Air Pollution: Economic Analysis. Eunomia Research & Consulting Ltd; Bristol, UK: 2016. Main Report. [Google Scholar]

30. Crombie H., O’Rourke D., Robinson S. Air Pollution: Outdoor Air Quality and Health DRAFT Evidence Review 1 on: Environmental Change and Development Planning. National Institute for Health and Care Excellence; London, UK: 2016. [Google Scholar]

31. De Wit G., Van Gils P., Over E., Suijkerbuijk A., Lokkerbol J., Smit F., Spit W., Evers S., de Kinderen R. Maatschappelijke Kosten-Batenanalyse van Beleidsmaatregelen om Alcoholgebruik te Verminderen. [(accessed on 15 December 2019)];2019 Available online: https://www.rivm.nl/bibliotheek/rapporten/2018-0146.pdf

32. Holm A.L., Veerman L., Cobiac L., Ekholm O., Diderichsen F.J. Cost-effectiveness of preventive interventions to reduce alcohol consumption in Denmark. PLoS ONE. 2014;9:e88041. doi: 10.1371/journal.pone.0088041. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

33. Cobiac L.J., Vos T., Veerman J.L. Cost-effectiveness of interventions to reduce dietary salt intake. Heart. 2010;96:1920–1925. doi: 10.1136/hrt.2010.199240. [PubMed] [CrossRef] [Google Scholar]

34. Van Gils P.F., Over E.A., Hamberg-van Reenen H.H., de Wit G.A., van den Berg M., Schuit A.J., Engelfriet P.M. The polypill in the primary prevention of cardiovascular disease: Cost-effectiveness in the Dutch population. BMJ Open. 2011;1:e000363. doi: 10.1136/bmjopen-2011-000363. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

35. Nagy B., Zsólyom A., Nagyjánosi L., Merész G., Steiner T., Papp E., Dessewffy Z., Jermendy G., Winkler G., Kaló Z.J. Cost-effectiveness of a risk-based secondary screening programme of type 2 diabetes. Diabet. Metab. Res. Rev. 2016;32:710–729. doi: 10.1002/dmrr.2791. [PubMed] [CrossRef] [Google Scholar]

36. Albert S.M., Raviotta J., Lin C.J., Edelstein O., Smith K.J. Cost-effectiveness of a statewide falls prevention program in Pennsylvania: Healthy Steps for Older Adults. Am. J. Manag. Care. 2016;22:638–644. [PubMed] [Google Scholar]

37. VeiligheidNL Rekenhulp Valpreventie. [(accessed on 15 January 2020)]; Available online: https://www.veiligheid.nl/valpreventie/over-valpreventie/rekenhulp-valpreventie

38. Olij B.F., Erasmus V., Barmentloo L.M., Burdorf A., Smilde D., Schoon Y., van der Velde N., Polinder S. Evaluation of implementing a home-based fall prevention program among community-dwelling older adults. Int. J. Environ. Res. Public Health. 2019;16:1079. doi: 10.3390/ijerph16061079. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

39. Zarca K., Durand-Zaleski I., Roux C., Souberbielle J., Schott A., Thomas T., Fardellone P., Benhamou C.J.O.I. Cost-effectiveness analysis of hip fracture prevention with vitamin D supplementation: A Markov micro-simulation model applied to the French population over 65 years old without previous hip fracture. Osteoporos. Int. 2014;25:1797–1806. doi: 10.1007/s00198-014-2698-1. [PubMed] [CrossRef] [Google Scholar]

40. Titov N., Dear B.F., Ali S., Zou J.B., Lorian C.N., Johnston L., Terides M.D., Kayrouz R., Klein B., Gandy M.J. Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: A randomized controlled trial. Behav. Ther. 2015;46:193–205. doi: 10.1016/j.beth.2014.09.008. [PubMed] [CrossRef] [Google Scholar]

41. Lynch F.L., Hornbrook M., Clarke G.N., Perrin N., Polen M.R., O’Connor E., Dickerson J.J.A. Cost-effectiveness of an intervention to prevent depression in at-risk teens. Arch. Gener. Psychiatry. 2005;62:1241–1248. doi: 10.1001/archpsyc.62.11.1241. [PubMed] [CrossRef] [Google Scholar]

42. Walker S., Walker J., Richardson G., Palmer S., Wu Q., Gilbody S., Martin P., Hansen C.H., Sawhney A., Murray G.J. Cost-effectiveness of combining systematic identification and treatment of co-morbid major depression for people with chronic diseases: The example of cancer. Psychol. Med. 2014;44:1451–1460. doi: 10.1017/S0033291713002079. [PubMed] [CrossRef] [Google Scholar]

43. Knapp M., King D., Romeo R., Schehl B., Barber J., Griffin M., Rapaport P., Livingston D., Mummery C., Walker Z.J.B. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): A pragmatic randomised controlled trial. BMJ. 2013;347:f6342. doi: 10.1136/bmj.f6342. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

44. Van Beek A., de Gruijter D., van Kamp I., Swart W. Beleidsdoorlichting geluid: Artikel 20, begroting IenM. De sanering van knelpunten. RIVM; Bilthoven, The Netherlands: 2016. 2015-0096. [Google Scholar]

45. Sacks G., Veerman J.L., Moodie M., Swinburn B.J.I. ‘Traffic-light’nutrition labelling and ‘junk-food’tax: A modelled comparison of cost-effectiveness for obesity prevention. Int. J. Obes. 2011;35:1001–1009. doi: 10.1038/ijo.2010.228. [PubMed] [CrossRef] [Google Scholar]

46. Cobiac L.J., Tam K., Veerman L., Blakely T.J.P. Taxes and subsidies for improving diet and population health in Australia: A cost-effectiveness modelling study. PLoS Med. 2017;14:e1002232. doi: 10.1371/journal.pmed.1002232. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

47. Magnus A., Haby M., Carter R., Swinburn B.J.I. The cost-effectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children. Int. J. Obes. 2009;33:1094–1102. doi: 10.1038/ijo.2009.156. [PubMed] [CrossRef] [Google Scholar]

48. Te Velde S.J., Veerman J.L., Tak N.I., Bosmans J.E., Klepp K.-I., Brug J.J.E., Biology H. Modeling the long term health outcomes and cost-effectiveness of two interventions promoting fruit and vegetable intake among schoolchildren. Econ. Hum. Biol. 2011;9:14–22. doi: 10.1016/j.ehb.2010.09.001. [PubMed] [CrossRef] [Google Scholar]

49. Akanni O., Smith M., Ory M. Cost-effectiveness of a community exercise and nutrition program for older adults: Texercise Select. Int. J. Environ. Res. Public Health. 2017;14:545. doi: 10.3390/ijerph14050545. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

50. Bemelmans W., Wendel-Vos G., Bogers R., Milder I., De Hollander E., Barte J., Tariq L., Jacobs-van der Bruggen M. Kosteneffectiviteit beweeg-en dieetadvisering bij mensen met (hoog risico op) diabetes mellitus type 2. Literatuuronderzoek en modelsimulaties rondom de Beweegkuur. RIVM; Bilthoven, The Netherlands: 2008. [Google Scholar]

51. Dallat M.A.T., Hunter R.F., Tully M.A., Cairns K.J., Kee F.J. A lesson in business: Cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace. BMC Public Health. 2013;13:953. doi: 10.1186/1471-2458-13-953. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

52. Peels D.A., Hoogenveen R.R., Feenstra T.L., Golsteijn R.H., Bolman C., Mudde A.N., Wendel-Vos G.C., de Vries H., Lechner L.J.B. Long-term health outcomes and cost-effectiveness of a computer-tailored physical activity intervention among people aged over fifty: Modelling the results of a randomized controlled trial. BMC Public Health. 2014;14:1099. doi: 10.1186/1471-2458-14-1099. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

53. Over E.A., Wendel-Vos G.W., van den Berg M., Hamberg-van Reenen H.H., Tariq L., Hoogenveen R.T., van Baal P.H.J.C.E., Allocation R. Cost-effectiveness of counseling and pedometer use to increase physical activity in the Netherlands: A modeling study. Cost Eff. Resour. Alloc. 2012;10:13. doi: 10.1186/1478-7547-10-13. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

54. Dalziel K., Segal L., Elley C.R.J.A., health N.Z. Cost utility analysis of physical activity counselling in general practice. Aust. N. Z. J. Public Health. 2006;30:57–63. doi: 10.1111/j.1467-842X.2006.tb00087.x. [PubMed] [CrossRef] [Google Scholar]

55. Pil L., Hoorens I., Vossaert K., Kruse V., Tromme I., Speybroeck N., Brochez L., Annemans L.J. Burden of skin cancer in Belgium and cost-effectiveness of primary prevention by reducing ultraviolet exposure. Prev. Med. 2016;93:177–182. doi: 10.1016/j.ypmed.2016.10.005. [PubMed] [CrossRef] [Google Scholar]

56. Pil L., Hoorens I., Vossaert K., Kruse V., Tromme I., Speybroeck N., Annemans L., Brochez L.J. Cost-effectiveness and budget effect analysis of a population-based skin cancer screening. JAMA Dermatol. 2017;153:147–153. doi: 10.1001/jamadermatol.2016.4518. [PubMed] [CrossRef] [Google Scholar]

57. De Kinderen R., Wijnen B., Evers S., Hiligsmann M., Paulus A., de Wit G., van Gils P., Over E., Suijkerbuijk A., Smit F.J. Social cost-benefit analysis of tobacco control policies in the Netherlands: Paul Van Gils. Eur. J. Public Health. 2019;29:ckz185–793. doi: 10.1093/eurpub/ckz185.793. [CrossRef] [Google Scholar]

58. Guerriero C., Cairns J., Roberts I., Rodgers A., Whittaker R., Free C.J. The cost-effectiveness of smoking cessation support delivered by mobile phone text messaging: Txt2stop. Eur. J. Health Econ. 2013;14:789–797. doi: 10.1007/s10198-012-0424-5. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

59. Vemer P., van Mölken M.P.R., Kaper J., Hoogenveen R.T., Van Schayck C., Feenstra T.L. If you try to stop smoking, should we pay for it? The cost–utility of reimbursing smoking cessation support in the Netherlands. Addiction. 2010;105:1088–1097. doi: 10.1111/j.1360-0443.2010.02901.x. [PubMed] [CrossRef] [Google Scholar]

60. Kotz D., Stapleton J.A., Owen L., West R.J.T.C. How cost-effective is ‘No Smoking Day’? Tob. Control. 2011;20:302–304. doi: 10.1136/tc.2009.034397. [PubMed] [CrossRef] [Google Scholar]

61. Beenker N., Verdiesen J. Bouwstenen voor een Veiligheidsambitie: Onderzoek Naar Verkeersveiligheidseffecten van Maatregelscenario’s Gericht op Rijkswegen. Dienst Verkeer en Scheepvaart (DVS) Ministerie van Verkeer en Waterstaat; Delft, The Netherlands: 2010. [Google Scholar]

62. Hoekstra A., Eenink R.G., Goldenbeld C. Opdracht van het Ministerie van Justitie, Wetenschappelijk Onderzoek-en Documentatiecentrum WODC. SWOV; Den Haag, The Netherlands: 2017. Progressief boetestelsel en verkeersveiligheid: Geschatte veiligheidseffecten van hogere boetes bij herhaalde snelheidsovertredingen. [Google Scholar]

63. Wijnen W., Stipdonk C., Wegman H., Stipdonk R.W.N., Bos N. Invoering van contourmarkering voor het bestaande vrachtwagenpark: Effecten en kosteneffectiviteit van retrofit in Nederland en in Europa. SWOV; Den Haag, The Netherlands: 2015. [Google Scholar]

64. Van den Berg M., de Wit G.A., Vijgen S.M., Busch M.C., Schuit A.J. Cost-effectiveness of prevention: Opportunities for public health policy in the Netherlands. Ned. Tijdschr. Voor Geneeskd. 2008;152:1329–1334. doi: 10.1016/S1098-3015(10)66278-X. [PubMed] [CrossRef] [Google Scholar]

65. Schwarzer R., Rochau U., Saverno K., Jahn B., Bornschein B., Muehlberger N., Flatscher-Thoeni M., Schnell-Inderst P., Sroczynski G., Lackner M., et al. Systematic overview of cost-effectiveness thresholds in ten countries across four continents. J. Comp. Eff. Res. 2015;4:485–504. doi: 10.2217/cer.15.38. [PubMed] [CrossRef] [Google Scholar]

66. De Bruyn S., Ahdour S., Bijleveld L., de Graaff M., Schep E., Schroten A., Vergeer R. Handboek Milieuprijzen 2017; Methodische Onderbouwing van Kengetallen Gebruikt voor Waardering van Emissies en Milieu-Impacts. CE Delft; Delft, The Netherlands: 2017. [Google Scholar]

67. Gezondheidsraad . Bevolkingsonderzoek naar Aneurysma van de Abdominale Aorta (AAA) Gezondheidsraad; Den Haag, The Netherlands: 2019. [Google Scholar]

68. Härkänen T., Kotakorpi K., Pietinen P., Pirttilä J., Reinivuo H., Suoniemi I. The welfare effects of health-based food taks policy. Food Policy. 2014;49:196–206. doi: 10.1016/j.foodpol.2014.07.001. [CrossRef] [Google Scholar]

69. Wright A., Smith K.E., Hellowell M. Policy lessons from health taxes: A systematic review of empirical studies. BMC Public Health. 2017;17:583. doi: 10.1186/s12889-017-4497-z. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

70. Huynen M., Vliet A.V., Staatsen B., Hall L., Zwartkruis J., Kruize H., Betgen C., Verboom J., Martens P. Kennisagenda Klimaat en Gezondheid (Knowledge Agenda Climate and Health) ZonMw; Den Haag, The Netherlands: 2019. [Google Scholar]

71. Jiao B., Zafari Z., Will B., Ruggeri K., Shukai L., Muennig P. The cost-effectiveness of lowering permissible noise levels around U.S. airports. Int. J. Environ. Res. Public Health. 2017;14:1497. doi: 10.3390/ijerph14121497. [PMC free article] [PubMed] [CrossRef] [Google Scholar]