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BMJ Open. 2019 Jan 28;9(1):e026966. doi: 10.1136/bmjopen-2018-026966.

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

Author information

1
Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
2
Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
3
Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland.

Abstract

OBJECTIVES:

To estimate the potential impacts of different Brexit trade policy scenarios on the price and intake of fruits and vegetables (F&V) and consequent cardiovascular disease (CVD) deaths in England between 2021 and 2030.

DESIGN:

Economic and epidemiological modelling study with probabilistic sensitivity analysis.

SETTING:

The model combined publicly available data on F&V trade, published estimates of UK-specific price elasticities, national survey data on F&V intake, estimates on the relationship between F&V intake and CVD from published meta-analyses and CVD mortality projections for 2021-2030.

PARTICIPANTS:

English adults aged 25 years and older.

INTERVENTIONS:

We modelled four potential post-Brexit trade scenarios: (1) free trading agreement with the EU and maintaining half of non-EU free trade partners; (2) free trading agreement with the EU but no trade deal with any non-EU countries; (3) no-deal Brexit; and (4) liberalised trade regime that eliminates all import tariffs.

OUTCOME MEASURES:

Cumulative coronary heart disease and stroke deaths attributed to the different Brexit scenarios modelled between 2021 and 2030.

RESULTS:

Under all Brexit scenarios modelled, prices of F&V would increase, especially for those highly dependent on imports. This would decrease intake of F&V between 2.5% (95% uncertainty interval: 1.9% to 3.1%) and 11.4% (9.5% to 14.2%) under the different scenarios. Our model suggests that a no-deal Brexit scenario would be the most harmful, generating approximately 12 400 (6690 to 23 390) extra CVD deaths between 2021 and 2030, whereas establishing a free trading agreement with the EU would have a lower impact on mortality, contributing approximately 5740 (2860 to 11 910) extra CVD deaths.

CONCLUSIONS:

Trade policy under all modelled Brexit scenarios could increase price and decrease intake of F&V, generating substantial additional CVD mortality in England. The UK government should consider the population health implications of Brexit trade policy options, including changes to food systems.

KEYWORDS:

brexit; cardiovascular disease; diet; fruits and vegetables; trade policy

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