Article Text
Abstract
Background Fruit and vegetable (F&V) intake is an important modifiable risk factor for cardiovascular disease (CVD). Fiscal policies have been recommended to increase F&V consumption, but their potential impact on health and inequalities are not well described.
We therefore explored the potential benefits of five different fiscal policies on F&V consumption, CVD mortality and associated socio-economic inequalities in Madrid, Spain (total population ~6,700,000 residents).
Methods A modelling study using a comparative risk assessment approach.
We compared five policy options:
Option 1) reducing F&V Value Added Tax (VAT) from 4% to 0%;
Option 2) a F&V price discount of 10%;
Option 3) a targeted F&V subsidy of 50% for low-income families;
Option 4) a mass media campaign promoting F&V consumption, and
Option 5) The combination of Options 3 and 4.
We computed F&V intake, CVD deaths prevented or postponed (DPPs), and CVD mortality inequalities between quintiles of area-level socio-economic status (SES) in 2021–2035, compared to a no-intervention scenario based on observed trends in F&V intake and CVD mortality. We used estimates for price elasticities, pass-through of policies, and F&V effect measures from relevant sources. We conducted sensitivity analyses through 5,000 Monte Carlo iterations with wide margins using the statistical software R.
Results A combined mass media campaign and 50% targeted discount could prevent or postpone approximately 700 CVD deaths (95% UI: 50 – 1000) in 2021–2035, representing a 1% reduction in total CVD mortality. A 50% targeted discount alone might generate some 450 DPPs, (95%UI: 300 – 700), a 10% universal subsidy approximately 300 DPPs, (95%UI: 100 – 450), a mass media campaign some 200 DPPs, (95%UI: 150 – 400), and 0% VAT 100 DPPs, (95%UI: 50 – 200). Every option would modestly reduce socio-economic inequalities in CVD mortality, with the combined policy achieving the greatest reduction, approximately 10 DPPs/100,000 population between highest- and lowest-SES areas.
Conclusion Fiscal policies and mass media campaigns targeting F&V consumption applied singly, or ideally in combination, could reduce CVD mortality and decrease social inequalities in a large southern European urban population.
Statistics from Altmetric.com
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.