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Canadian Journal of Public Health

, Volume 108, Issue 2, pp e152–e161 | Cite as

The economic benefits of fruit and vegetable consumption in Canada

  • Hans KruegerEmail author
  • Jacqueline Koot
  • Ellie Andres
Quantitative Research
  • 1 Downloads

Abstract

OBJECTIVES: The objectives of this study were to determine the proportion of the population that meets or exceeds Canada’s Food Guide (CFG) recommendations regarding the number of daily servings of fruits and vegetables (F/V), to assess trends in this proportion between 2000 and 2013, to estimate the annual economic burden attributable to inadequate F/V consumption within the context of other important risk factors, and to estimate the short- and long-term costs that could be avoided if modest improvements were made to F/V consumption in Canada.

METHODS: We used a previously developed methodology based on population-attributable fractions and a prevalence-based cost-of-illness approach to estimate the economic burden associated with low F/V consumption.

RESULTS: Over three quarters of Canadians are not meeting CFG recommendations regarding the number of daily servings of F/V, leading to an annual economic burden of $4.39 billion. If a 1% relative increase in F/V consumption occurred annually between 2013 and 2036, the cumulative reduction in economic burden over the 23-year period would reach $8.4 billion. Consumption levels of F/V, and the resulting economic burden, varied by sex, age and province.

CONCLUSION: A significant majority of Canadians are not consuming the recommended daily servings of F/V, with important consequences to their health and the Canadian economy. Programs and policies are required to encourage F/V consumption in Canada.

Key Words

Economic burden of disease populations at risk risk factors fruit and vegetable consumption 

Résumé

OBJECTIFS: Déterminer la proportion de la population qui respecte ou dépasse les recommandations du Guide alimentaire canadien (GAC) quant au nombre de portions quotidiennes de fruits et de légumes (F et L) pour évaluer les tendances dans cette proportion entre 2000 et 2013, afin d’estimer le fardeau économique annuel imputable à la consommation insuffisante de F et L dans le contexte d’autres importants facteurs de risque et d’estimer les coûts évitables à court et à long terme si l’on apportait de légères améliorations à la consommation de F et L au Canada.

MÉTHODE: Nous avons utilisé une méthode déjà élaborée, fondée sur les fractions attribuables dans la population, et une démarche de calcul du coût de la maladie fondée sur la prévalence pour estimer le fardeau économique associé à la faible consommation de F et L.

RÉSULTATS: Plus des trois quarts des Canadiens ne respectent pas les recommandations du GAC quant au nombre de portions quotidiennes de F et L, ce qui mène à un fardeau économique annuel de 4,39 milliards de dollars. S’il y avait chaque année une augmentation relative de 1 % de la consommation de F et L entre 2013 et 2036, la baisse cumulée du fardeau économique sur cette période de 23 ans atteindrait 8,4 milliards de dollars. Les niveaux de consommation de F et L, et le fardeau économique qui en résulte, ont varié selon le sexe, l’âge et la province.

CONCLUSION: Une grande majorité de Canadiens ne consomment pas les portions quotidiennes recommandées de F et L, ce qui a d’importantes conséquences pour leur santé et pour l’économie canadienne. Des programmes et des politiques sont nécessaires pour encourager la consommation de F et L au Canada.

Mots Clés

fardeau économique de la maladie populations à risque facteurs de risque consommation de fruits et de légumes 

References

  1. 1.
    Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, et al. Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386(10010):2287–323. PMID: 26364544. doi: 10.1016/S0140-6736(15)00128-2.PubMedCrossRefGoogle Scholar
  2. 2.
    Krueger H, Williams D, Ready AE, Trenaman L, Turner D. Improved estimation of the health and economic burden of chronic disease risk factors in Manitoba. Chronic Dis Inj Can 2013;33(4):236–46. PMID: 23987220.PubMedGoogle Scholar
  3. 3.
    Krueger H, Turner D, Krueger J, Ready AE. The economic benefits of risk factor reduction in Canada: Tobacco smoking, excess weight and physical inactivity. Can J Public Health 2014;105(1):e69–78. PMID: 24735700. doi: 10.17269/cjph. 105.4084.PubMedCrossRefGoogle Scholar
  4. 4.
    Krueger H, Krueger J, Koot J. Variation across Canada in the economic burden attributable to excess weight, tobacco smoking and physical inactivity. Can J Public Health 2015;106(4):e171–77. PMID: 26285186. doi: 10.17269/cjph.106. 4994.PubMedCrossRefGoogle Scholar
  5. 5.
    Rehm J, Ballunas D, Brochu S, Fischer B, Gnam W, Patra J, et al. The Costs of Substance Abuse in Canada 2002. Canadian Centre on Substance Abuse, 2006. Available at: http://www.ccsa.ca/Resource%20Library/ccsa-011332-2006.pdf (Accessed May 24, 2016).Google Scholar
  6. 6.
    Public Health Agency of Canada. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2015: Alcohol Consumption in Canada, 2016. Available at: http://healthycanadians.gc.ca/publications/department-ministere/state-public-health-alcohol-2015-etat-sante-publique-alcool/index-eng.php (Accessed May 24, 2016).Google Scholar
  7. 7.
    Wang X, Ouyang Y, Liu J, Zhu M, Zhao G, Bao W, et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: Systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 2014;349:g4490. PMID: 25073782. doi: 10.1136/bmj. g4490.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Hu D, Huang J, Wang Y, Zhang D, Qu Y. Fruits and vegetables consumption and risk of stroke: A meta-analysis of prospective cohort studies. Stroke 2014; 45(6):1613–19. PMID: 24811336. doi: 10.1161/STROKEAHA.114.004836.PubMedCrossRefGoogle Scholar
  9. 9.
    Block G, Patterson B, Subar A. Fruit, vegetables, and cancer prevention: A review of the epidemiological evidence. Nutr Cancer 1992;18(1):1–29. PMID: 1408943. doi: 10.1080/01635589209514201.PubMedCrossRefGoogle Scholar
  10. 10.
    Glade MJ. Food, nutrition, physical activity, and the prevention of cancer: A global perspective. Nutrition 1997;15(6):523–26.Google Scholar
  11. 11.
    Hung H-C, Joshipura KJ, Jiang R, Hu F, Hunter D, Smith-Warner S, et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 2004; 96(21):1577–84. PMID: 15523086. doi: 10.1093/jnci/djh296.PubMedCrossRefGoogle Scholar
  12. 12.
    George SM, Park Y, Leitzmann MF, Freedman N, Dowling E, Reedy J, et al. Fruit and vegetable intake and risk of cancer: A prospective cohort study. Am J Clin Nutr 2009;89:1–7. PMID: 19056579. doi: 10.3945/ajcn.2008.26722.CrossRefGoogle Scholar
  13. 13.
    Boffetta P, Couto E, Wichmann J, Ferrari P, Trichopoulos D, Bueno-de-Mesquita H, et al. Fruit and vegetable intake and overall cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2010;102(8):529–37. PMID: 20371762. doi: 10.1093/ jnci/djq072.PubMedCrossRefGoogle Scholar
  14. 14.
    Key T. Fruit and vegetables and cancer risk. Br J Cancer 2011;104(1):6–11. PMID: 21119663. doi: 10.1038/sj.bjc.6606032.PubMedCrossRefGoogle Scholar
  15. 15.
    Vieira AR, Abar L, Vingeliene S, Chan D, Aune D, Navarro-Rosenblatt D, et al. Fruits, vegetables and lung cancer risk: A systematic review and meta-analysis. Ann Oncology 2015;27(1):81–96. doi: 10.1093/annonc/mdv381.CrossRefGoogle Scholar
  16. 16.
    Liu J, Wang J, Leng Y, Lv C. Intake of fruit and vegetables and risk of esophageal squamous cell carcinoma: A meta-analysis of observational studies. Int J Cancer 2013;133(2):473–85. PMID: 23319052. doi: 10.1002/ijc.28024.PubMedCrossRefGoogle Scholar
  17. 17.
    Chuang S-C, Jenab M, Heck JE, Bosetti C, Talamini R, Matsuo K, et al. Diet and the risk of head and neck cancer: A pooled analysis in the INHANCE consortium. Cancer Causes Control 2012;23(1):69–88. PMID: 22037906. doi: 10.1007/s10552-011-9857-x.PubMedCrossRefGoogle Scholar
  18. 18.
    Azagba S, Mesbah SF. Disparities in the frequency of fruit and vegetable consumption by socio-demographic and lifestyle characteristics in Canada. Nutr J 2011;10:118. PMID: 22027238. doi: 10.1186/1475-2891-10-118.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Krueger H, Andres E, Koot J, Reilly B. The economic burden of cancers attributable to tobacco smoking, excess weight, alcohol use, and physical inactivity in Canada. Curr Oncol 2016;23(4):241–49. PMID: 27536174. doi: 10.3747/co.23.2952.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    This analysis is based on the Statistics Canada’s Canadian Community Health Survey Public Use Microdata Files from 2000/01 to 2012. All computations, use and interpretation of these data are entirely those of H. Krueger & Associates Inc.Google Scholar
  21. 21.
    Garriguet D. Overview of Canadians’ Eating Habits. 2006. Statistics Canada. Available at: http://www.statcan.gc.ca/pub/82-620-m/82-620-m2006002-eng. htm (Accessed May 1, 2016).Google Scholar
  22. 22.
    Health Canada. Canadian Community Health Survey Cycle 2.2, Nutrition (2004)–A Guide to Accessing and Interpreting the Data. 2006. Available at: http://publications.gc.ca/pub?id=9.650206&sl=0 (Accessed October 1, 2015).Google Scholar
  23. 23.
    World Health Organization. Global Strategy on Diet, Physical Activity and Health–Diet, Nutrition and the Prevention of Chronic Diseases. 2003. Available at: http://www.who.int/dietphysicalactivity/publications/trs916/en/ (Accessed May 1, 2016).Google Scholar
  24. 24.
    Joshipura KJ, Ascherio A, Manson JE, Stampfer MJ, Rimm EB, Speizer FE, et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999; 282(13):1233–39. PMID: 10517425. doi: 10.1001/jama.282.13.1233.PubMedCrossRefGoogle Scholar
  25. 25.
    Hu FB. Plant-based foods and prevention of cardiovascular disease: An overview. Am J Clin Nutr 2003;78(3):544S–51S. PMID: 12936948.PubMedCrossRefGoogle Scholar
  26. 26.
    Health Canada. Eating Well With Canada’s Food Guide. 2011. Available at: http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/food-guide-aliment/ view_eatwell_vue_bienmang-eng.pdf (Accessed November 1, 2015).Google Scholar
  27. 27.
    Dauchet L, Amouyel P, Hercberg S, Dallongville J. Fruit and vegetable consumption and risk of coronary heart disease: A meta-analysis of cohort studies. J Nutr 2006;136(10):2588–93. PMID: 16988131.PubMedCrossRefGoogle Scholar
  28. 28.
    He F, Nowson C, Lucas M, MacGregor G. Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: Meta-analysis of cohort studies. J Hum Hypertens 2007;21(9):717–28. PMID: 17443205. doi: 10.1038/sj.jhh.1002212.PubMedCrossRefGoogle Scholar
  29. 29.
    Lock K, Pomerleau J, Causer L, Altman D, McKee M. The global burden of disease attributable to low consumption of fruit and vegetables: Implications for the global strategy on diet. Bull World Health Organ 2005;83(2):100–8. PMID: 15744402.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Hu D, Huang J, Wang Y, Zhang D, Qu Y. Fruits and vegetables consumption and risk of stroke: A meta-analysis of prospective cohort studies. Stroke 2014; 45(6):1613–19. PMID: 24811336. doi: 10.1161/STROKEAHA.114.004836.PubMedCrossRefGoogle Scholar
  31. 31.
    Freedman ND, Park Y, Subar AF, Hollenbeck A, Leitzmann M, Schatzkin A, et al. Fruit and vegetable intake and esophageal cancer in a large prospective cohort study. Int J Cancer 2007;121(12):2753–60. PMID: 17691111. doi: 10. 1002/ijc.22993.PubMedCrossRefGoogle Scholar
  32. 32.
    Freedman ND, Park Y, Subar AF, Hollenbeck A, Leitzmann M, Schatzkin A, et al. Fruit and vegetable intake and head and neck cancer risk in a large United States prospective cohort study. Int J Cancer 2008;122(10):2330–36. PMID: 18092323. doi: 10.1002/ijc.23319.PubMedCrossRefGoogle Scholar
  33. 33.
    Rice DP. Cost-of-illness studies: Fact or fiction? Lancet 1994;344:1519–20. PMID: 7983947. doi: 10.1016/S0140-6736(94)90342-5.PubMedCrossRefGoogle Scholar
  34. 34.
    Rice DP. Cost-of-illness studies: What is good about them? Inj Prev 2000; 6:177–79. PMID: 11003181. doi: 10.1136/ip.6.3.177.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Canadian Institute for Health Information. National Health Expenditure Trends, 1975 to 2013. Ottawa, ON: CIHI, 2014.Google Scholar
  36. 36.
    Public Health Agency of Canada. Economic Burden of Illness in Canada, 2005–2008. Ottawa, ON: PHAC, 2014.Google Scholar
  37. 37.
    Canadian Institute for Health Information. Discharge Abstract Database, 2011/12 (data purchased for this modelling).Google Scholar
  38. 38.
    Steenland K, Armstrong B. An overview of methods for calculating the burden of disease due to specific risk factors. Epidemiology 2006;17(5):512–19. PMID: 16804473. doi: 10.1097/01.ede.0000229155.05644.43.PubMedCrossRefGoogle Scholar
  39. 39.
    Health Canada. Economic Burden of Illness in Canada, 1998. Ottawa, ON: Health Canada, 2002.Google Scholar
  40. 40.
    Krueger H, Goldenberg SL, Koot J, Andres E. Don’t Change Much: The economic impact of modest health behaviour changes in middle-aged men. Am J Men’s Health 2017;11(2):275–83. PMID: 27702887. doi: 10.1177/ 1557988316671567.CrossRefGoogle Scholar
  41. 41.
    Livingstone M, Robson P. Measurement of dietary intake in children. Proc Nutr Soc 2000;59(2):279–93. PMID: 10946797. doi: 10.1017/S0029665 100000318.PubMedCrossRefGoogle Scholar
  42. 42.
    Eck L, Klesges R, Hanson C. Recall of a child’s intake from one meal: Are parents accurate? J Am Diet Assoc 1989;89(6):784–89. PMID: 2723300.PubMedGoogle Scholar
  43. 43.
    Statistics Canada. Table 326-0021–Consumer Price Index, Annual (2002=100), CANSIM. Available at: http://www5.statcan.gc.ca/cansim/a26?lang=eng&id= 3260021 (Accessed October 1, 2015).Google Scholar
  44. 44.
    Glade MJ. Food, nutrition, and the prevention of cancer: A global perspective. American Institute for Cancer Research/World Cancer Research Fund, American Institute for Cancer Research, 1997. Nutrition 1999;15(6):523–26. PMID: 10378216.PubMedCrossRefGoogle Scholar
  45. 45.
    Hoffmann K, Boeing H, Volatier J-L, Becker W. Evaluating the potential health gain of the World Health Organization’s recommendation concerning vegetable and fruit consumption. Public Health Nutr 2003;6(8):765–72. PMID: 14641947. doi: 10.1079/PHN2003500.PubMedCrossRefGoogle Scholar
  46. 46.
    Boeing H, Bechthold A, Bub A, Ellinger S, Haller D, Kroke A, et al. Critical review: Vegetables and fruit in the prevention of chronic diseases. Eur J Nutr 2012;51(6):637–63. PMID: 22684631. doi: 10.1007/s00394-012-0380-y.PubMedPubMedCentralCrossRefGoogle Scholar
  47. 47.
    Vainio H, Weiderpass E. Fruit and vegetables in cancer prevention. Nutr Cancer 2006;54(1):111–42. PMID: 16800779. doi: 10.1207/s15327914nc5401_13.PubMedCrossRefGoogle Scholar
  48. 48.
    Hung H-C, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA, et al. Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 2004;96(21):1577–84. PMID: 15523086. doi: 10.1093/jnci/djh296.PubMedCrossRefGoogle Scholar
  49. 49.
    WHO Technical Staff. Increasing Fruit and Vegetable Consumption to Reduce the Risk of Noncommunicable Diseases: Biological, Behavioural and Contextual Rationale, September 2014. Available at: http://www.who.int/elena/titles/bbc/fruit_vegetables_ncds/en/ (Accessed November 1, 2016).Google Scholar

Copyright information

© The Canadian Public Health Association 2017

Authors and Affiliations

  1. 1.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  2. 2.H. Krueger & Associates Inc.DeltaCanada

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