PETER A. J. BOUHUIJS
The Netherlands is a small country in Western Europe of approximately forty thousand square kilometers. Many areas of the country have been reclaimed from the sea. Twenty-seven percent of the country lies below sea level, and about 60 percent of the population lives in this area. The country is densely populated, increasing from about four million in 1880 to about 15. 1 million in 1991 (442 people per square kilometer). About two-thirds of the population lives in urban or suburban areas. For many years the birthrate was higher in the Netherlands than in neighboring countries. This factor, combined with a low infant mortality and a favorable life expectancy, produced a considerable annual population growth until 1970. Since 1970, however, the situation has changed. In a few years the birthrate declined sharply, from 16 per thousand inhabitants in 1970 to 12.9 per thousand inhabitants in 1976, as a reflection of the changes in attitude toward birth control and of other changes in life-style. Population forecasts proved to be dramatically wrong; the current population is about 15 percent less than expected twenty years ago. Due to increased immigration and a slight increase in the birthrate over the past few years (13.2 per thousand in 1990), the population will increase with a growth rate of about 0.5 percent during this decade.
Industrial and trade activities are the most important income sources for the national economy. According to generally accepted indices of national health conditions, the Netherlands is in a rather good position in comparison with many other countries. Perinatal death is 9.6 per thousand live births ( 1990), among the lowest rates in the world. According to the Statistisch Jaarboek, average life expectancy at birth was 73.8 years for men and 80.1 for women in 1991 ( 1992). The sex difference in life expectancy is mainly due to the higher risks of lung cancer, heart failure and traffic accidents among men. A generous social system has resulted in a society in which almost everybody lives in housing which has a safe water supply, sanitary facilities, and electricity. Irrespective of their income situation, the population has access to a sophisticated network of health services.