Intended for healthcare professionals


Will Europe's agricultural policy damage progress on cardiovascular disease?

BMJ 2005; 331 doi: (Published 21 July 2005) Cite this as: BMJ 2005;331:188
  1. Karen Lock, research fellow (karen.lock{at},
  2. Martin McKee, professor1
  1. 1 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to: K Lock

    Trends in cardiovascular disease in Europe have shown an east-west divide for over 30 years. Rapid declines in the European Union contrast with stagnant or rising trends in Russia and central and eastern Europe, with some notable exceptions, such as Poland and the Czech Republic, where rates have fallen since the 1990s.1 2 These improvements are attributed primarily to improved nutrition,1 2 which can be traced to the economic transition that followed political change in the late 1980s.

    In Poland many food subsidies, in particular for animal fats, were abolished. Wider availability and lower prices for unsaturated fats and fruits caused rapid dietary changes. Zatonski and Willett explore the impact of these changes, suggesting that the reduction of over a third of coronary heart disease in Poland between 1990 and 2002 can be attributed mainly to increased consumption of polyunsaturated fats, with sustained reduction in saturated fats.1 They estimate that the small reduction in smoking and the increase in the intake of imported fruit have made little impact on cardiovascular disease.

    The paper clearly shows that dietary change had a major impact on cardiovascular mortality, but the authors, by considering changes in the intake of imported fruit only, have underestimated changes in consumption of the full range of fruits and vegetables known to have significant cardioprotective effects.3 The introduction of a market economy had major consequences for domestic production and the retail sector. There has been large investment in agriculture, with central European producers now integrated with wider European agricultural production. Much non-traditional produce is now grown locally, and fruits and vegetables are available to consumers throughout the year. Consequently, to capture the full impact of changing availability of food since the 1990s, the changes in both the total and the seasonal consumption of all fruits and vegetables need to be taken into account.

    Zatonski and Willett also show that it is possible to achieve quite remarkable reductions in deaths from cardiovascular disease over a short period. Yet, in Poland, this has been achieved mainly by economic and agricultural policies, and not health policies. In contrast, policies advocated by health ministries, exemplified by the English white paper Choosing Health (, remain focused on medical models of education and behaviour change, even though these have had little impact on rising rates of unhealthy diets and obesity.

    The health gains achieved in Poland, however, may be threatened. The European Union's Common Agricultural Policy, introduced in the 1950s, is a major determinant of what people in Europe eat4 but fails to produce the range of foods that would allow the EU population to meet basic healthy eating guidelines.5 As Poland and others implement the Common Agricultural Policy—following accession to the EU in 2004—they risk suffering the consequences of policy that places large scale agricultural production and economics above health. Studies in some countries, such as Slovenia and Sweden, have shown numerous adverse health effects of the Common Agricultural Policy, including the externalised costs on non-communicable diseases and obesity through subsidies for production and consumption of animal fats, tobacco and alcohol, and insufficient supply of fruits and vegetables.5 Reform of the policy is again high on the political agenda. However, current debates about the EU budget between the UK prime minister, Tony Blair, and the French president, Jacques Chirac, are characterised more by political horse trading than the possibility of supporting poor and rural populations while also improving the diet and health of all Europeans.


    • Competing interests None declared.


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