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

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.

Figure 1

Estimated relative change in price of fruit and vegetable subgroups under each modelled Brexit scenario. Error bars indicate 95% uncertainty intervals. Scenario S1: free trading agreement with the EU and third countries; scenario S2: free trading agreement with the EU; scenario S3: no-deal Brexit; scenario S4: liberalised trade regime.

Figure 2

Estimated number of cumulative CVD deaths for 2021–2030 associated with each modelled Brexit scenario by sex. Scenario S1: free trading agreement with the EU and third countries; scenario S2: free trading agreement with the EU; scenario S3: no-deal Brexit; scenario S4: liberalised trade regime. CVD, cardiovascular disease.