Policy PrécisMaking the link: agriculture and health equity

The World Health Organization’s Commission on the Social Determinants of Health (CSDH) has identified

principles and recommendations to tackle health inequities: the factors responsible for avoidable health

inequalities, which persist globally and in the European Union. This series of summaries, updated and

expanded online at www.equitychannel.net, introduces how those and other recommendations, as part of

evidence based health promoting approaches, could be applied to a range of European Union legislations,

policies and programmes. The aim is to improve international, national and local policies and practices within

and beyond health systems, in order to promote better health and well-being for all.

Why making the link matters

• Needs have changedThe European Union’s Common Agricultural Policy (CAP) consumes approximately 40% of the EU

budget - almost 55 billion Euro of production subsidies each year - and, through a variety of measures

affecting food availability, quality and cost, has a profound effect on the health of the population.

While the CAP’s original purpose was to ensure the availability of safe, adequate food at reasonable

prices and also sustainable production, measures such as intervention buying of surplus produce gave

rise to overproduction of foodstuffs. This overproduction has resulted in some adverse consequences

for the environment, international trade and economic burdens. It has also had a detrimental effect on

public health as dietary habits have been influenced, impacting most upon people from lower socio-

economic profiles in the EU and beyond.I

• TowardsnewgoalsSuccessive attempts to reform the CAP have mitigated some adverse impacts, but have largely

overlooked public health concerns. An evaluation of the impact of agricultural policies on health equity

and well-being would make sense in terms of practical measures arising from the EC Communication

on Solidarity in Health, plus the CSDH priority recommendation on measuring and understanding

problems, in addition to the EC strategy on counteracting obesity. A sustainable food system that can

supply safe and healthy food, with a low environmental impact while contributing to overall well-being,

should be the renewed goal for agriculture policies.

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“In the corn field”, Lars Plougmann, available under a Creative Commons Attribution-Share Alike license

Policy Précis

Thesituation

• Thecausesofthecausesofillhealth

Subsidies have underpinned produce with high saturated fat and protein content, incentivising increased production

of these foodstuffs in nutritionally unbalanced proportions. In addition, the EU has used the instrument of intervention

buying for fruit and vegetables to keep prices high. Unbalanced overproduction increased availability of meat

products and relatively cheap dairy produce, and has contributed largely to the high consumption of saturated

fats, particularly in low income households. Although diet is influenced by many different factors of social, medical

and cultural origin, food choices are also largely determined by price, access and availability, most notably among

people from lower socio economic groups.II

• Burdensofdiseases

Chronic Non-Communicable diseases (NCDs) pose one of the greatest threats to public health and economic growth. WHO

Europe report that obesity, CVD, cancer and diabetes collectively pose the greatest burden of disease (77%) in the European

region and furthermore, identify diet as one of the major modifiable risk factors for NCDs.II Societal and cultural trends have

indicated that EU Member States are moving towards converging diets characterised by energy dense, highly processed,

nutrient poor foods. This combined with lower levels of physical inactivity plays an important role in increasing rates of

Chronic Non-communicable diseases and thus, leads to diminishing health status and decreasing overall well-being.III

• Economiccosts

As populations grow and age the burden of diseases associated with obesity will result in escalating numbers of

early deaths and long-term incapacity with associated reductions in quality of life. Not only will this nutrition-related

disease significantly reduce a person’s well-being but it also constitutes a significant economic burden for health-

care systems. For example, in England, the Sustainable Development Commission estimates that the cost of obesity

to the economy could be up to £3.7 billion per year.IV

“Fresh! Fruits and vegetables in León HDR”, marcp_dmoz, available under a Creative Commons Attribution-Noncommercial-Share Alike license

The Slovenian Ministry of Health and the WHO European Region conducted an impact study (HIA) of agriculture,

food, and nutrition policies, stimulated by Slovenia’s application to join the EU. Recommendations covered agricultural

issues including the fruit and vegetable, grain, and dairy sectors and rural development funding. An unforeseen

outcome was that the health and agricultural sectors began to support each other in the types of policies that they

wanted to be implemented, with successful outcomes including economic benefits.V

A report entitled ‘Focusing on obesity through a health equity lens’ has been compiled by EuroHealthNet as an

accessible source of ideas and inspiration. The report highlights local and regional projects acting for improving

nutrition and health equity, including:

- The Chai Centre has proved a success with communities in England. By providing several services, it aims to

improve health and quality of life and to reduce health inequalities.

- The HealthyMightbeTastyproject in Hungary aimed to increase fruit and vegetable consumption among primary

school children and to determine the most effective approach.

- The Delta Project in Spain aimed at the promotion of healthy eating habits and physical activity, in a broader

context of education for health.VI

The Report has been submitted for use by the EU Platform on Diet, Health & Physical Activity and the EU High level

Group on Nutrition and Physical Activity.

Setting an example

Pathways to progress

Change is needed in the environments in which people live, but also a policy structure that supports making the healthy choice the easy choice,VII such as progress towards increasing the availability and accessibility of nutrient dense foods like fruit, vegetables, pulses and whole grains. This is not just for producers to do: cooperation is needed from all relevant sectors including health, environments, transport, markets, trade and competition policy, and education.

• EUinitiativesEfforts have been made by the EC to find synergies between agriculture policy and stimulating healthier food choice. This resulted in the introduction of programmes designed to increase the access for vulnerable groups and children to food. For example:

- School Milk Scheme; VIII

- School Fruit Scheme; IX

- Most Deprived Person Scheme. X

A stronger health dimension in impact assessments in agriculture policy is needed to assess the real impact of the CAP on health and well-being. However, 2010-2011 will prove the most important years in terms of framing the post 2013 CAP reform debate. This will provide the opportunity for advocates to push for more health and health equity initiatives to be part of reforming the CAP. In addition, the European Parliament’s role in the CAP has increased due to the changes implemented under the Lisbon Treaty and this may serve as a useful avenue to pursue in order to achieve a CAP that is conducive to supporting healthy lifestyles and well-being.

• TheCSDHrecommendsactionsto:- Encourage healthy eating through retail planning to manage food availability and access;- Including health equity in rural development programmes, including action on sustainable employment;- Health equity impact analysis on agricultural transport, fuel, buildings, industry and waste as part

of climate change strategies;- Include health and well-being in trade and development policies, not only in global health planning. XI

Making the link: agriculture and health equity

Additional Information

• ACAPonHealth?TheimpactoftheEUCAPonPublicHealth, Lang., Tim., Faculty of Public Health, 2007.

• PromotingSocialInclusionandTacklingHealthInequalitiesinEurope,anoverviewofgoodpracticesfromthehealth field.

• Focusing on obesity through a health equity lens - a collection of innovative approaches and promising practices byhealthpromotionbodiesinEuropetocounteractobesityandimprovehealthequity.

• Closing the gap in a generation. Report of the World Health Organization Commission on the Social Determinants

of Health.

• DETERMINE - www.health-inequalities.eu

• DirectorateGeneralforAgricultureandRuralDevelopment

Contacts

Please visit our website – www.equitychannel.net/publications – for an electronic version of this Policy Précis and also

for the additional Policy Précis in this series. Join the Equity Channel community to add your comments or publicise

your work in this field.

EuroHealthNet is a member of the European Public Health and Agriculture Consortium (EPHAC) pressing for health

promoting food policies in the EU. For information see www.healthyagriculture.eu

Sources

I A CAP on Health? The impact of the EU CAP on Public Health. Lang., Tim. Faculty of Public Health, UK. 2007.

II Fact Sheets: Tackling Europe’s major disease: the challenges and the solutions. WHO, Regional Office for Europe. 2006.

III Nutrition in transition: the changing global nutrition challenge. Popkin, B. M., Asia Pac. J. Clin. Nutr., 10 Suppl, S13-S18, 2001.IV Health, place and nature: How outdoor environments influence health and well-being: a knowledge base. Sustainable Development

Commission. London, 2008. http://www.sd-commission.org.uk/publications/downloads/Outdoor_environments_and_health.pdf V EuroHealth. “Integrating Public health with European food and agricultural policy”,

(pgs. 17-20). (Vol 10, No 1, 2004) VI “Focusing on obesity through a health equity lens - a collection of innovative approaches and promising practices by health promotion bodies

in Europe to counteract obesity and improve health equity”. Kuipers Y. M. EuroHealthNet, July 2009.VII Foresight: Tackling Obesities: Future Choices - Project Report. Government office for science, London, 2nd edition, 2007.VIII European School Milk Scheme http://ec.europa.eu/agriculture/markets/milk/schoolmilk/index_en.htm IX The EU School Fruit Scheme - http://ec.europa.eu/agriculture/markets/fruitveg/sfs/index_en.htm X Most Deprived Persons Scheme - http://ec.europa.eu/agriculture/markets/freefood/index_en.htm XI Closing the gap in a generation. Report of the World Health Organization Commission on the Social Determinants of Health, Geneva, 2008.

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Policy PrécisMaking the link: agriculture and health equity