A coherent approach: effective policy actions for fruits and vegetables throughout the NOURISHING framework. Bryony Sinclair Policy and Public Affairs Manager World Cancer Research Fund International

1. Policy coherence to promote
fruit and vegetable intake
EGEA – 3 June 2015
World Cancer Research Fund International
Policy & Public Affairs Manager
Bryony Sinclair

2. Overview
1. What is policy coherence and why is it
important?
2. A coherent approach: effective policy
actions for fruits and vegetables
throughout the NOURISHING
Framework

3. What is “policy coherence”?
 OECD definition: “…the systematic promotion of
mutually reinforcing policy actions across
government departments and agencies creating
synergies towards achieving the agreed
objectives.”
 Put simply, policies that do not undermine
each other to achieve objectives already
agreed by government.

4. Why do we need policy coherence?
Multiple, mutually-reinforcing, coherent
actions needed across govt depts to
support individuals to adopt healthy
behaviours:
• Direct behaviour change
interventions (eg from doctors)
• The food environments which
influence these behaviours
• The food systems which underpin
these environments
1. For people

5. Many sectors & govt depts need to take
action to achieve policy coherence
Policies that meet objectives for other sectors
will engage those sectors in our efforts to
improve fruit and vegetable consumption
e.g. economic objective for agriculture sector
Greater sales/consumption of fruit &
vegetables provides livelihood for fruit &
vegetable growers
2. Policy coherence to leverage support from
other sectors

6. www.wcrf.org/NOURISHING
WCRF recommendations for cancer prevention.

7. A coherent approach:
examples of effective policy actions
for fruits and vegetables throughout
the NOURISHING framework

8. Source: Amaro S, Viggiano A, Di Costanzo A, Madeo I, Viggiano A, BaccariME, et al. Kalèdo, a new educational board-game, gives
nutritional rudiments and encourages healthy eating in children: a pilot cluster randomized trial. European Journal of Pediatrics
2006;165(9):630–5.
• Board game designed to
transfer knowledge about a
healthy diet (randomised
controlled trial)
• Students playing game weekly
for 24 weeks showed:
– significant increase in nutrition
knowledge
– significant increase in weekly
intake of vegetables (0.7 servings
more per week)
Kalèdo educational board game

9. • Aim: increase fruit & vegetable
consumption through individual nutrition
counselling sessions with tailored nutrition
education package
• After 6 weeks, patients with dentures who
received two 121 nutrition counselling,
sessions showed:
– a significant increase in fruit consumed
– a significant increase in readiness to change their
diet ( fruits and vegetables)
Source: Bradbury, J, Thomason JM, Jepson NJ, Walls AW, Allen PF, Moynihan PJ. Nutrition counselling increases fruit and vegetable
intake in the edentulous. Journal of Dental Research 2006;85(5):463-8.
Dietary counselling sessions in a dental setting

10.  Knowledge
• Significant increase of
recommended servings of
fruit and vegetables (77.7%-
89.2% for fruit; 20.4%-43.9%
for vegetables)
Source: Pollard CM et al. 2007
 Consumption
• Significant  in vegetable intake during
campaign (esp for men)
• Self-reported fruit and vegetable
consumption  by 0.8 servings/day after
campaign (0.2 servings of fruit; 0.6
servings of vegetables)
Fruit and vegetable public awareness
campaign in Western Australia
• Mass media (TV, radio, press)
• Publications (e.g. cookbooks)
• Public relations events
• Point-of-sale promotions
• School-based activities
• Community activities
• Website: www.gofor2and5.com

11. Green Carts in New York City
• NYC made 1,000 licenses available through
Local Law 9 to street vendors who sell fresh
fruit & vegetables in neighbourhoods with
limited access to healthy foods and where
consumption is low
• 92% of customers said location & prices are
2 main reasons for shopping at Green Carts
• 71% of customers reported increased
consumption of fresh fruit & vegetables
since shopping at the Green Cart

12. 0
0.5
1
1.5
2
2.5
Low income
countries
Low middle
income
countries
Upper middle
income
countries
High income
countries
Billionkgfruit&veg
Need
Supply
Source: Siegel KR, Ali MK, Srinivasiah A, Nugent RA, Narayan KM. Do we produce enough fruits and vegetables to meet
global health need? PLoS One. 2014 Aug 6;9(8):e104059.
Need for fruit &
vegetables vs
supply, by
country income
level
Investment needed
in low-and middle-
income countries in
producing fruit &
vegetables & getting
into domestic market
- roads, transport,
refrigeration

13. Source: Dalmeny et al, 2003

14. Australian example:
• Nutritional status improved among
aboriginal children whose families
received weekly boxes of subsidised
fruit and vegetables
• Significant increases in the levels of
biomarkers of fruit and vegetable
intake (e.g. vitamin C)
Sources: Black AP, Vally H, Morris P, et al. Nutritional impacts of a fruit and vegetable subsidy programme for disadvantaged Australia
Aboriginal children. British Journal of Nutrition 2013; 110:2309-2317. Black AP, Brimblecombe J, Eyles H, et al. Food subsidy programs and the
health and nutritional status of disadvantaged families in high income countries: a systematic review. BMC Public Health 2012;12:1099
Fruit and vegetable subsidy programmes for disadvantaged families
Subsidy schemes that work:
• 12.5% supermarket price
discount on healthier options
• Subsidised monthly food
vouchers
• Subsidised weekly family food
packages
• Free home-delivered fruit juice
weekly
• Fruit and vegetable vouchers
for local supermarket or
farmers market

15. • Eg offering fruit and vegetable
in schools
• In USA over 1 school year, low
income children
• Fresh fruit and vegetable
intakes were higher among
students at schools participating
in Fresh Fruit and Vegetable
Program (0.32 servings/day)
• 1st step to effect gradual change

17. Action is needed across sectors to promote fruit and vegetable intake
Health
e.g.
Government/ministry,
health NGOs,
healthcare providers,
health insurance
companies
Agriculture
e.g. Government/ministry, fruit & vegetable producers,
traders/importers, wholesalers, retailers, processors, agriculture
NGOs
Education
e.g.
Government/ministry
schools, school
authorities, NGOs,
professional
associations, higher
education institutions
Food service
e.g. restaurants,
catering/cafeteria
/canteen services
…and communications, environment, commerce & trade,
consumer protection, etc

18. In summary
 Policy coherence…
– Ensure coherence/consistency in environments
and systems that underpin choices people
make
– Leverage support from other sectors
 Benefits of increased markets for fruit and
vegetables
– Health and economic eg increased market for
fruit and vegetables for producers, increased
health & reduced health care costs

19. For further information
@wcrfint
facebook.com/wcrfint
www.wcrf.org
Bryony Sinclair
Policy & Public Affairs Manager
b.sinclair@wcrf.org
Thank you!