Fruit and vegetable consumption reduces the risks of heart disease. Europeans therefore need to be encouraged to eat more fresh fruit and green vegetables. Yet, in most European countries, supplies of this vital source of nutrients and fibre are insufficient to meet the WHO-recommended dietary intake. Should European policy encourage the production of more local produce?
Cardiovascular diseases - including coronary heart disease and stroke - are the main cause of death in Europe. They are also a major cause of premature death. One in eight men and one in seventeen women die from CVD before the age of 65 years, according to a recent report from the European Heart Network. (1)
About one third of all cardiovascular disease is caused by poor diet and lack of exercise. Small increases in fruit and vegetable consumption could help prevent heart disease. For example, one extra serving a day has recently been found to be associated with significant benefits in CVD and all cause mortality. (2)
The European Commission’s Eurodiet Project proposes that people should eat on average at least 400g of fruit and vegetables per day, while consuming less fat, particularly saturated fat, less salt and limiting sugary intakes. The recommendation is based on World Health Organization’s calculation that roughly five portions of fruit and vegetables per day could reduce overall deaths from chronic diseases (such as heart disease, stroke and cancer) by up to 20%. (3)
Support information campaigns
To take advantage of these health benefits, Europeans need to modify their diet choices. To help them, more information and education should be made available relating to food, nutrition and physical activity, says the European Heart Network. It proposes that one way to keep information campaigns buoyant would be to produce a regular report on the state of nutritional health across Europe and within Member States.
Another exciting idea is a proposal that the European Commission finances public information programmes to encourage the consumption of fruit and vegetables. Currently, the CAP has a budget for the generic promotion of diary produce and for subsidised sales of milk to schools and hospitals. The European Heart Network believes that such provision should be extended to the promotion of the foods that can be consumed plentifully in recommended diets, namely fruit, vegetables, cereal products, potatoes, fish, low-fat milk and other low-fat products. (4)
A longer term proposal is for a major investigation of the barriers that prevent improvements in diet. What socio-cultural factors are important? One may be that children often pick up the wrong messages from television advertisements. The marketing practices of food and drink companies are increasingly seen to be one factor in the poor diet of some children. Another area of research may be in the schools. Stronger policies and better practices might break through another obstacle to achieving good child nutrition in Europe.
The low consumption of fruit among low-income groups may be a result of cultural and financial constraints. The storage of fruit and its short shelf life in the home may also discourage purchase. People living in high-rise buildings or who do not have cars often find it difficult to buy high quality, low cost healthy foods. As hypermarketisation has grown, the number of so-called "Food deserts" - areas abandoned by retailing - has also increased. (5)
The link between consumption and production
The consumption of fruit and vegetables - and the associated health benefits - is clearly related to availability. While this problem is obvious at the local level, shortages of food and vegetables are not usually as obvious at the national level. They nevertheless exist.
A total availability of 600g per person per day is needed to take into account the average of 30% of fruit and vegetables lost due to spoilage, waste or destruction. Among the 15 current Member States, only six countries - Greece, Portugal, Italy, Spain, Belgium and the Netherlands - make this adequate amount available. In the wider Europe of 48 countries, only 12 meet the necessary supplies. The problem is worst in Tajikistan, which has only 210g of fruit and vegetables available per head. (1)
The health benefits missed as a result of the under-supply fruit and vegetables are worrying. In the UK, where supplies are below the 600g per head target, twice as many people die prematurely from coronary heart disease compared with Spain, for example. The Spanish grow and eat more fruits and vegetables, and rates of coronary heart disease and cancer are correspondingly low.
Re-orientate subsidies
Changes in European agricultural policy are necessary on health and nutritional grounds to stimulate the availability of certain foods - and especially supplies of fruits and vegetables. The European Heart Network say there is a need to re-orientate production incentives and subsidies in favour of heart-healthy nutrition in Europe. Others agree. Expert groups researching at the national level have made similar recommendations. For example, a group of UK health experts advising on the farming and food sector has told the Government: "The promotion of greater production and consumption of fruit and vegetables ought to be a priority feature of any new Farming and Food Policy." (5)
The need for debate
Should European policy be used to encourage the availability of fruit and vegetables? Would such changes in policy adversely affect the export prospects of developing countries - or harm availability in other European countries? These questions and many others are likely to be among those addressed during the European Health Forum Gastein in Austria, 25-28 September 2002, where the European Heart Network is organising a programme on nutrition and food policy.(6)
During the programme, Dr Derek Yach from WHO in Geneva is expected to address the issue of whether international policy making bodies should play a role in reducing the burden of food-related ill health. Will European health experts decide the time has come to ensure that European farming and food policy changes to benefit health?
Food safety, nutrition and health
Although food safety makes the headlines, poor diet is the real menace to health. This can be clearly demonstrated with the help of the World Health Organization’s system of measuring the overall burden of ill-health and disease in terms of DALYs (disability-adjusted life years). DALYs measure time lost due to premature death plus time lived with a disability quantified in a single indicator. In established market economy countries, only 0.2% of total disability-adjusted life years is related to diarrhoeal diseases, such as salmonella. The percentage lost to BSE is incalculably low. On the other hand, cardiovascular disease accounts for 18.6% of DALYs and cancer for 15%. Source: Why Health is the key to the future of food and farming, A joint submission to the Policy Commission on the Future of Farming and Food.
References:
(1) Food, nutrition and cardiovascular disease prevention in the European Region: Challenges for the new Millenium, European Heart Network, May 2002
(2) Khaw et al. 2001, Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. The Lancet; 357: 657-663
(3) Eurodiet Project 2001, Public Health Nutrition, V4, 1A. Special issue, February 2002. Eurodiet website at http://eurodiet.med.uoc.gr/
(4) Food, Nutrition and Cardiovascular Disease Prevention in the European Union, European Heart Network, June 1998
(5) Why Health is the Key to the Future of Food and Farming, A joint submission to the Policy Commission on the Future of Farming and Food, edited by Tim Lang and Geof Rayner. It is available from the UK Public Health Association
(6) Website address for the Gastein meeting: http://www.ehfg.org
Info:
Susanne Logstrup, Director
European Heart Network (EHN)
Rue Montoyer 31 B-1000 Brussels, BELGIUM
Tel: + 32 2 512 91 74
Fax: + 32 2 503 35 25
E-mail: slogstrup@skynet.be
Website: http://www.ehnheart.org
