Evidence of the effectiveness of approaches to increase vegetable and fruit consumption
The evidence presented in Policy and Action for Cancer Prevention was evaluated in four dimensions: physical environmental, economic, social and personal. Each dimension is discussed briefly in relation to vegetables and fruits below.
The physical environment includes both the living and built environment. Encouragement of smallholdings and home farms and gardens can increase availability of vegetables and fruits. Schemes in high-income countries to encourage people to grow their own vegetables and fruits are likely to become more attractive as the price of food in shops increases. The location of supermarkets affects availability and accessibility of healthy foods and drinks. Within supermarkets, and other retail and catering outlets, priority to positioning of healthy foods and drinks is important. Finally, climate change could have a substantial effect on global production of vegetables and fruits, but currently it is not clear what the damaging or beneficial effects are likely to be.
Economic factors influence the amount, quality, and types of foods and drinks that people consume. In both the UK and USA, prices of vegetables and fruits have decreased relative to consumer price indices. However, most people in these countries fail to consume 5 servings of vegetables and fruits each day; thus price reduction alone is not sufficient. There is evidence that people with lower incomes consume less vegetables and fruits and that certain interventions can be beneficial. Providing vouchers for vegetables and fruits to mothers on low income, for example, has been shown to increase consumption of vegetables and fruits. Clear, simple, uniform, and explicit nutrition labelling is important. New schemes are more accepted if accompanied by information and education campaigns (for example the ‘traffic light’ labels in the UK). There is relatively little advertising and promotion aimed at healthy foods, although there is evidence that promotion of vegetables and fruits in supermarkets can increase consumption. For example, the US national ‘5 a Day for Better Health’ campaign increased consumption by providing information through the media and supermarkets.
The social dimension includes ethnic background, culture, religion, schools, workplaces and family. Schools have been shown to be a good setting for interventions to promote healthy eating. These include school lunches as well as healthy choices in vending machines and tuck shops. Introduction or strengthening of academic and practical nutrition in school curricula is also effective. Workplace based health initiatives can also be effective and lead to increased consumption of vegetables and fruits. Social inequalities are important, and higher socioeconomic status in highincome countries is associated with a higher vegetable and fruit consumption. Reduction in social inequalities requires political will and committed partnership of all actors.
The personal dimension includes family habits and values, personal knowledge, attitudes and belief, and health status. There is evidence that involving families, friends or close-knit communities in interventions to encourage healthy ways of life increases the efficacy of the intervention, since people are more likely to eat and drink healthily if they have the support of family and friends. Moreover, the preparation, cooking and sharing of meals, as in families, teach healthy habits early in life. The evidence shows that interventions to change dietary habits are more effective when these include nutrition education components. Increased knowledge of a healthy lifestyle on its own may not necessarily lead to dietary change, however. Attempts to reinforce or change behaviour are most likely to be effective and sustained when supported by health professionals, and other actors including governments. Policy makers and actors will be more likely to succeed in changing dietary habits when they take into account the impact of characteristics such as age and sex, for example Programmes should be tailored to fit people at different stages of life.
In summary, the evidence shows that policies and actions directed at increasing vegetable and fruit consumption can be effective, particularly if they are multifactorial and involve several actor groups. Programmes that are sustained and have the support of all interested actors, including government, civil society associations, professional organisations, industry, employers and the media are most effective.