Article Text

other Versions

Potential impacts of post-Brexit agricultural policy on fruit and vegetable intake and cardiovascular disease in England: a modelling study
  1. Paraskevi Seferidi1,
  2. Anthony A Laverty1,
  3. Brendan Collins2,
  4. Piotr Bandosz2,
  5. Simon Capewell2,
  6. Martin O’Flaherty2,
  7. Christopher Millett1 and
  8. Jonathan Pearson-Stuttard1,2
  1. 1Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
  2. 2Department of Public Health and Policy, University of Liverpool, Liverpool, UK
  1. Correspondence to Paraskevi Seferidi, Public Health Policy Evaluation Unit, Imperial College London School of Public Health, London W6 8RP, UK; paraskevi.seferidi14{at}


Background Current proposals for post-Brexit agricultural policy do not explicitly incorporate public health goals. The revised agricultural policy may be an opportunity to improve population health by supporting domestic production and consumption of fruits and vegetables (F&V). This study aims to quantify the potential impacts of a post-Brexit agricultural policy that increases land allocated to F&V on cardiovascular disease (CVD) mortality and inequalities in England, between 2021 to 2030.

Methods We used the previously validated IMPACT Food Policy model and probabilistic sensitivity analysis to translate changes in land allocated to F&V into changes in F&V intake and associated CVD deaths, stratified by age, sex and Index of Multiple Deprivation. The model combined data on F&V agriculture, waste, purchases and intake, CVD mortality projections and appropriate relative risks. We modelled two scenarios, assuming that land allocated to F&V would gradually increase to 10% and 20% of land suitable for F&V production.

Results We found that increasing land use for F&V production to 10% and 20% of suitable land would increase fruit intake by approximately 3.7% (95% uncertainty interval: 1.6% to 8.6%) and 17.4% (9.1% to 36.9%), and vegetable intake by approximately 7.8% (4.2% to 13.7%) and 37% (24.3% to 55.7%), respectively, in 2030. This would prevent or postpone approximately 3890 (1950 to 7080) and 18 010 (9840 to 28 870) CVD deaths between 2021 and 2030, under the first and second scenario, respectively. Both scenarios would reduce inequalities, with 16% of prevented or postponed deaths occurring among the least deprived compared with 22% among the most deprived.

Conclusion Post-Brexit agricultural policy presents an important opportunity to improve dietary intake and associated cardiovascular mortality by supporting domestic production of F&V as part of a comprehensive strategy that intervenes across the supply chain.

  • dietary patterns

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.


  • Contributors PS, AL, JPS, MOF, CM conceived the study. PS analysed the data with inputs from all authors. PS drafted the paper with inputs from all authors. All authors made a substantial contribution to the data interpretation and critical review of the submitted manuscript.

  • Funding PS, AL and CM are funded by the National Institute for Health Research (NIHR) via a Research Professorship Award to CM (grant number: RP 2014-04-032).

  • Disclaimer NIHR had no role in the design, analysis or writing of this article. The Public Health Policy Evaluation Unit is grateful for the support of the NIHR School of Public Health Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Model input data are available on request from the corresponding author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.