Health
Dutch Health Agency Calls for New Measures to Curb Cross-Border Tobacco Purchases
The Dutch public health agency is urging the government to tighten regulations on cross-border tobacco purchases, warning that the country’s high tobacco taxes are increasingly being undermined by smokers sourcing cheaper products from abroad.
Following a significant hike in tobacco taxes in 2024 — 24% on cigarettes and 45% on rolling tobacco — the Netherlands now ranks among the highest-taxed countries for tobacco in the European Union. The measure was welcomed by health advocates as a step toward reducing smoking rates.
However, new research by the Dutch public health agency shows that while the tax hike led to some positive outcomes — with 7% of smokers quitting and another 22% cutting down — a large number of smokers responded by purchasing tobacco outside the Netherlands. According to the study, cross-border tobacco purchases surged to 60% in 2024, up from 40% in 2023 and 30% in 2020.
“Policy must focus on reducing purchases of tobacco products made abroad,” the agency stated, noting that easy access to cheaper tobacco in neighboring countries is threatening the effectiveness of domestic anti-smoking policies.
To address the issue, the agency has recommended introducing stricter limits on the quantity of tobacco products that individuals can bring into the country. It also called for the implementation of excise duties on e-cigarettes to discourage youth from taking up vaping, which it warned could serve as a gateway to traditional smoking.
The situation highlights the broader challenge facing high-income, geographically compact nations, where borders can be crossed with relative ease. While the World Health Organization (WHO) endorses tobacco taxation as one of the most effective public health tools — recommending a minimum tax rate of 75% — its impact is lessened when consumers can easily circumvent high prices.
A study published last year indicated tobacco tax increases led to a 9% drop in cigarette use in low-income countries between 2014 and 2020, compared to just 6% in wealthier nations, where cross-border purchasing is more feasible.
The Dutch agency cautioned that unless regional prices are aligned, the proportion of people attempting to quit smoking could decline. It pointed to ongoing discussions at the European Commission level, where proposals are being considered to dramatically raise tobacco taxes across the EU — potentially by 139% on cigarettes and 258% on rolling tobacco.
In 2024, the Netherlands, along with 15 other EU member states, urged the Commission to adopt bloc-wide tax reforms, arguing that disparities — ranging from €1.92 per pack in Bulgaria to €9.92 in Ireland — were distorting the single market. Currently, the Netherlands has the second-highest tobacco tax in the EU, at €7.66 per 20-pack.
Health
World Cup Emotion Can Strain the Heart, Cardiologists Warn Fans at Risk
As the World Cup begins, medical experts are cautioning football fans with underlying heart conditions that the emotional intensity of matches can place unexpected strain on the cardiovascular system.
Cardiologists say that the excitement, tension, and anxiety generated during high-stakes games can trigger physical reactions similar to intense exercise, raising heart rate, blood pressure, and stress hormones.
“Intense emotions, whether positive or negative, can act as ‘precipitating risk factors’ for cardiovascular events such as heart attack,” said Paola Santalucia, a cardiologist and board member of the European Heart Network.
She explained that moments of extreme excitement, such as a decisive penalty shootout or a last-minute goal, may pose risks for people already living with heart disease. Those with additional risk factors, including hypertension, obesity, or smoking habits, are also advised to be cautious during emotionally charged matches.
Research using wearable devices has shown that during major football events, some fans experience heart rates climbing as high as 150 beats per minute. That level is comparable to sprinting and reflects how strongly the body reacts to emotional stress.
A study examining supporters during the 2025 German Cup final found that even watching from home can significantly affect physiological responses. “They still had an increase in heart rate that compares to walking, even though they didn’t walk,” said Christian Deutscher, professor of sports economics at Bielefeld University and co-author of the study.
He noted that the most intense reactions often occur not during goals themselves, but during moments of uncertainty such as VAR checks, penalty shootouts, or shots striking the post. These unpredictable situations, he said, are what drive the strongest emotional and physical responses among fans.
Deutscher also pointed out that stadium spectators may experience even greater strain due to environmental factors such as heat and alcohol consumption.
However, experts emphasize that football itself is not inherently dangerous. Instead, it is the body’s natural response to excitement that can create temporary stress.
“The adrenergic stimulation is at its max: extreme high blood pressure, high heart rate, and adrenaline, cortisol, skyrocketing,” said Dan Atar, professor of cardiology at Oslo University Hospital. In rare cases, he added, this surge can contribute to the rupture of arterial plaque in vulnerable individuals, potentially leading to a heart attack.
Atar stressed that such events can occur in everyday situations as well, including physical exertion like shoveling snow. “It is in no way dangerous to watch a football game,” he said. “All this is physiologic. It’s not dangerous to be excited.”
Still, he acknowledged that combining emotional stress with alcohol, heat, and pre-existing conditions can increase risk for some viewers.
Doctors advise those at higher risk to continue prescribed medications, limit alcohol intake, avoid smoking, and watch for warning signs such as chest pain or irregular heartbeat.
“The key message is not to avoid enjoying the match, but to do so with moderation and awareness,” Santalucia said.
Health
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