Impacts of Brexit on fruit and vegetable intake and cardiovascular disease in England: a modelling study

Seferidi, Paraskevi; Pearson‐Stuttard, Jonathan; Bandosz, Piotr; Collins, Brendan; Guzman-Castillo, Maria; Capewell, Simon; O’Flaherty, Martı́n; Millett, Christopher

doi:10.1136/bmjopen-2018-026966

Cited by 26 publications

(27 citation statements)

References 20 publications

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“…One strength of our analysis is that the expert judgement median estimates we obtain by elicitation are consistent with central estimates produced by UK Trade Policy Observatory and by the British Retail Consortium1 and other modelling studies 28. However, we add further information for decision support by presenting quantified uncertainties around our estimates.…”

Section: Discussionsupporting

confidence: 63%

Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach

Barons

Aspinall

2020

BMJ Open

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Introduction Food insecurity is associated with increased risk for several health conditions and with poor chronic disease management. Key determinants for household food insecurity are income and food costs. Whereas short-term household incomes are likely to remain static, increased food prices would be a significant driver of food insecurity. Objectives To investigate food price drivers for household food security and its health consequences in the United Kingdom under scenarios of Deal and No deal for Britain's exit from the European Union. To estimate the 5% and 95% quantiles of the projected price distributions. Design Structured expert judgement elicitation, a well-established method for quantifying uncertainty, using experts. In July 2018, each expert estimated the median, 5% and 95% quantiles of changes in price for ten food categories under Brexit Deal and No-deal to June 2020 assuming Brexit had taken place on 29th March 2019. These were aggregated based on the accuracy and informativeness of the experts on calibration questions. Participants Ten specialists with expertise in food procurement, retail, agriculture, economics, statistics and household food security. Results when combined in proportions used to calculate Consumer Prices Index food basket costs, median food price change for Brexit with a Deal is expected to be +6.1% [90% credible interval:-3%, +17%] and with No deal +22.5% [+1%, +52%] Conclusions The number of households experiencing food insecurity and its severity are likely to increase because of expected sizeable increases in median food prices after Brexit. Higher increases are more likely than lower rises and towards the upper limits, these would entail severe impacts. Research showing a low food budget leads to increasingly poor diet suggests that demand for health services in both the short and longer term is likely to increase due to the effects of food insecurity on the incidence and management of diet-sensitive conditions. Overall % change ONS CPI sub-Foods, with category weights Mean +6.4% ± 6.0 Median +6.1% [-2.7, +16.9] Mean +24.0% ± 15.4 Median +22.5% [+1.49, +51.7] Food basket cost changes by June 2020 (in £'s) Change in CPI weekly cost relative to 2018 year end Basket total £58.00* Mean +£3.78 ± £3.76 Median +£3.53 [-£1.90, +£10.41] Mean +£13.97 ± £9.52 Median +£13.00 [+£0.08, +£31.02] Change in family of 4 Healthy Food Basket basis weekly cost £93.56** Mean +£6.30 ± £6.71 Median +£5.80 [-£3.68, +£18.17] Mean +£22.58 ± £16.14 Median+£20.98 [-£1.07, +£50.98] Change in single pensioner Healthy Food Basket basis weekly cost £35.44** Mean +£2.28 ± £2.56 Median +£2.09 [-£1.51, +£6.80] Mean +£8.11 ± £6.23 Median +£7.55 [-£1.05, +£18.99]

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Section: Discussionsupporting

confidence: 63%

Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach

Barons

Aspinall

2020

BMJ Open

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“…26 The UK is especially dependent on imports of fresh fruit and vegetables and a recent modelling study estimated that a No Deal Brexit could lead to between 6,000 and 23,000 excess deaths from cardiovascular disease between 2021 and 2030. 27 Further, many elements of UK laws on public health derive from EU legislation, for example on air pollution, health and safety, and trade within the single market in substances posing a risk to health, such as tobacco. There are concerns that the UK may use Brexit to roll back some of these measures, especially as it has failed to meet some of the existing EU standards, for example on air quality.…”

Section: Financingmentioning

confidence: 99%

How will Brexit affect health services in the UK? An updated evaluation

et al. 2019

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All forms of Brexit are bad for health, but some are worse than others. This paper builds on our analysis using the WHO health system building blocks framework to assess the likely effects of Brexit on the NHS in the UK. We consider four possible futures: (1) a "No Deal" Brexit under which the UK leaves the EU on 29 March 2019 without any formal agreement on the terms of withdrawal; (2) the Withdrawal Agreement, as negotiated between the UK and EU and awaiting (possible) formal agreement, which provides a transition period until the end of December 2020; (3) if the Northern Ireland Protocol's 'Backstop' comes into effect after the end of that period; and (4) the Political Declaration on the Future Relationship between the UK and the EU. Our analysis shows that a No Deal Brexit is significantly worse for the NHS than a future involving the Withdrawal Agreement, which provides certainty and continuity in legal relations while the Future Relationship is negotiated and put into legal form. The Northern Ireland 'Backstop' has variable impact, with continuity in some areas, such as health products, but no continuity in others. The Political Declaration envisages a future relationship which is centred around a free trade agreement, in which wider healthrelated issues are largely absent. All forms of Brexit, however, involve negative repercussions for the UK's leadership and governance of health, both in Europe and globally, and significant harmful consequences for the ability of parliament and other stakeholders to scrutinize and oversee governmental actions.

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“…30 As price remains a key determinant of consumer behaviour, particularly among deprived groups, the burden of ill health and inequalities attributable to low consumption of F&V may increase. 31 Our study provides valuable data to understand how agentic and structural policy can compensate for price rises and minimise detrimental impacts on population health and the NHS.…”

Section: Discussionmentioning

confidence: 99%

Addressing the low consumption of fruit and vegetables in England: a cost-effectiveness analysis of public policies

Pinho-Gomes

Knight

Critchley

et al. 2020

J Epidemiol Community Health

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BackgroundMost adults do not meet the recommended intake of five portions per day of fruit and vegetables (F&V) in England, but economic analyses of structural policies to change diet are sparse.MethodsUsing published data from official statistics and meta-epidemiological studies, we estimated the deaths, years-of-life lost (YLL) and the healthcare costs attributable to consumption of F&V below the recommended five portions per day by English adults. Then, we estimated the cost-effectiveness from governmental and societal perspectives of three policies: a universal 10% subsidy on F&V, a targeted 30% subsidy for low-income households and a social marketing campaign (SMC).FindingsConsumption of F&V below the recommended five portions a day accounted for 16 321 [10 091–23 516] deaths and 238 767 [170 350–311 651] YLL in England in 2017, alongside £705 951 [398 761–1 061 559] million in healthcare costs. All policies would increase consumption and reduce the disease burden attributable to low intake of F&V. From a societal perspective, the incremental cost-effectiveness ratios were £22 891 [22 300–25 079], £16 860 [15 589–19 763] and £25 683 [25 237–28 671] per life-year saved for the universal subsidy, targeted subsidy and SMC, respectively. At a threshold of £20 000 per life-year saved, the likelihood that the universal subsidy, the targeted subsidy and the SMC were cost-effective was 84%, 19% and 5%, respectively. The targeted subsidy would additionally reduce inequalities.ConclusionsLow intake of F&V represents a heavy health and care burden in England. All dietary policies can improve consumption of F&V, but only a targeted subsidy to low-income households would most likely be cost-effective.

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Impacts of Brexit on fruit and vegetable intake and cardiovascular disease in England: a modelling study

Cited by 26 publications

References 20 publications

Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach

Anticipated impacts of Brexit scenarios on UK food prices and implications for policies on poverty and health: a structured expert judgement approach

How will Brexit affect health services in the UK? An updated evaluation

Addressing the low consumption of fruit and vegetables in England: a cost-effectiveness analysis of public policies

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