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An apple a day?

Can lives be saved by eating fruit and vegetables?
An apple a day?

At the recent American Heart Association's (AHA) Epidemiology/Lifestyle 2016 Scientific Sessions, two abstracts caught my eye. Both have largely the same underlying message: reducing the price of fruit and vegetables in a meaningful way can have a significant impact on population-level health as measured by cardiovascular disease.

We've known for decades that increasing our consumption of fruit and vegetables is good for our health. We've also known that certain food groups are more 'elastic' than others to price changes. Andreyeva et al published a systematic review in 2009 which showed, to very little surprise, that certain food groups are more responsive to price changes than others. On the basis of the mean price elasticities elucidated in this systematic review of 0.70 for fruit and 0.58 for vegetables, a 10% reduction in the price of these food categories would increase purchases on average by 7.0% and 5.8%, respectively.

The results of this systematic review are not that different from the AHA abstracts that caught my eye (although they use different endpoints). Both abstracts attempt to quantify the number of lives saved with price reductions on fruit and vegetables over a 15-year period. In short, dietary patterns that reduce fruit and vegetable prices by 10% through 2030 could lower the death rate from heart disease and stroke by about 1%, saving approximately 64,000 to 69,000 lives over a 15-year period. A 30% price drop was modelled to be the most effective in saving lives - diminishing the death rate by almost 3%, saving between 191,000 and 205,000 lives over 15 years. The second abstract reached similar conclusions in effect by finding that within five years of a 10% price reduction on fruit and vegetables, deaths from cardiovascular diseases overall could decrease by 1.2% and within 20 years by almost 2%. Specifically, heart attacks could decrease by 2.6% and strokes by 4% over the 20-year period. However, both of these abstracts used some rather sophisticated computer modelling to arrive at their conclusions and this, as always, is part of the problem. Computer models cannot predict or account for all the variables that might affect a population-level behaviour change.

Where is the money that produces these 10% and 30% price reductions going to come from? Not from the farmers that grow the crops. Not from the operating margin of the retail supermarkets that sell these goods. So where? Higher taxes? Re-allocating monies that were ear-marked for education or defence? 

Let's assume we can find the money. Now how are we going to make people aware of the price reductions? And if we're somehow able to make people aware of these price reductions, how much more consumption is required to prevent these cardiovascular events. Do we need to eat 10% more fruit or 20% more vegetables? Or less? And do we need to eat 10% more fruit or 20% more vegetables while decreasing our consumption of 'bad foods'? Or can we continue to consume the same amount of 'bad foods' as long as we increase our consumption of fruit and vegetables by the requisite 10% or 20%?

And what of the elephant in the room whenever we discuss healthcare issues: access. Are we to assume that the low income, inner-city residents of today's cities will have access to these lower-priced fruit and vegetables or will they have to travel great distances to obtain them? What about consumer tastes and preferences? What if a significant proportion of those who don't consume the adequate amount of fruit and vegetables do so because they simply don't like fruit and vegetables. A 10% price reduction isn't going to change that. And then we must address equity. Does a 10% price reduction make the same difference to a low-income family versus an affluent family? Probably not. In that case, are we crafting policy for those who need it most? Probably not.

Without these sophisticated modelling techniques to address these 'big' questions, we might never have an idea of what could work. The goal is not to tear down the incredibly valuable work of the AHA and its funded research but to remind ourselves that initiatives like those involving massive price reductions cannot be a panacea and will rarely work in isolation of other levers that need to be pulled at a population level. And to remind ourselves that we ought to be careful about putting all our eggs in one basket.

Article by
Rohit Khanna

is managing director of Catalytic Health, a healthcare communications, advertising and strategy agency. He can be reached at: rohit@catalytichealth.com

13th April 2016

From: Healthcare

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