Policy analysis indicates health-sensitive trade and subsidy reforms are needed in the UK to avoid adverse dietary health impacts post-Brexit

The role of diet in cancer: the potential of shaping public policy and clinical outcomes in the UK

Cancer universally represents one of the largest public health concerns, substantially contributing to global disease burden and mortality. The multifaceted interplay of environmental and genetic factors in the disease aetiology and progression has required comprehensive research to elucidate modifiable elements which can reduce the risk of incidence and improve prognosis. Among these factors, diet and nutrition have emerged as the most fundamental with a significant potential for influence and effect. Nutrition is not only an essential part of human survival, but also a vital determinant of overall health. Certain dietary requirements are necessary to support normal physiology. This includes individualised levels of macronutrients (proteins, carbohydrates and fats) and specific micronutrients (vitamins and minerals). Extensive research has demonstrated that diet plays a role in cancer pathogenesis at the genetic, epigenetic and cellular level. Therefore, its potential as a modifiable determinant of cancer pathogenesis for the purpose of prevention and improving management of disease must be further explored and implemented. The ability to influence cancer incidence and outcomes through dietary changes is underutilised in clinical practice and insufficiently recognised among the general public, healthcare professionals and policy-makers. Dietary changes offer the opportunity for autonomy and control over individuals health outcomes. Research has revealed that particular dietary components, as well as cultural behaviours and epidemiological patterns may act as causative or protective factors in cancer development. This review aims to comprehensively synthesise this research to further explore how to best utilise this knowledge within the community and clinical environment for more effective cancer prevention and therapeutic strategies. The identified key areas for improvement include the development of more specific, widely accepted guidelines, promoting increased involvement of dieticians within cancer multidisciplinary teams, enhancing nutritional education for healthcare professionals and exploring the potential implementation of personalised nutrition tools. A greater understanding of the complex interactions between diet and cancer will facilitate informed clinical interventions and public health policies to reduce global cancer burden and improve care for cancer patients and survivors.

International food trade contributes to dietary risks and mortality at global, regional and national levels

Food trade is generally perceived to increase the availability and diversity of foods available to consumers, but there is little empirical evidence on its implications for human health. Here we show that a substantial proportion of dietary risks and diet-related mortality worldwide is attributable to international food trade and that whether the contributions of food trade are positive or negative depends on the types of food traded. Using bilateral trade data for 2019 and food-specific risk-disease relationships, we estimate that imports of fruits, vegetables, legumes and nuts improved dietary risks in the importing countries and were associated with a reduction in mortality from non-communicable diseases of ~1.4 million deaths globally. By contrast, imports of red meat aggravated dietary risks in the importing countries and were associated with an increase of ~150,000 deaths. The magnitude of our findings suggests that considering impacts on dietary risks will become an important aspect of health-sensitive trade and agriculture policies, and of policy responses to disruptions in food chains.

Brexit, trade and the governance of non-communicable diseases: a research agenda

BACKGROUND

The UK's post-Brexit trade strategy has potentially important implications for population health and equity. In particular, it will impact on the structural risk factors for non-communicable diseases (NCDs), including the consumption of health-harming commodities such as tobacco, alcohol and ultra-processed food and beverages. This article catalogues recent developments in UK trade policy. It then presents a narrative review of the existing research literature on trade and health and previous, prospective studies on the health impacts of Brexit. In so doing it identifies key questions and foci for a future research agenda on the implications of UK's emerging trade regime for NCD prevention.

MAIN TEXT

We identify five key areas for future research. (1) Additional scholarship to document the health effects of key trade agreements negotiated by the UK government; (2) The implications of these agreements for policy-making to address health impacts, including the potential for legal challenges under dispute settlement mechanisms; (3) The strategic objectives being pursued by the UK government and the extent to which they support or undermine public health; (4) The process of trade policy-making, its openness to public health interests and actors and the impact of the political and ideological legacy of Brexit on outcomes; (5) The impact of the UK's post-Brexit trade policy on partner countries and blocs and their cumulative impact on the global trade regime.

CONCLUSIONS

Further research is urgently need to understand the ways in which the UK's post-Brexit trade strategy will impact on NCDs and policy responses to address these, including the openness of the trade policy architecture to health issues. The outcomes of this process will have wider systemic effects on the global trade regime with implications for health. Researchers must be cognizant of the ideological components of the policy debate which have been absent from previous analysis of Brexit, trade and health.

Climate-friendly and nutrition-sensitive interventions can close the global dietary nutrient gap while reducing GHG emissions

Sustainable food systems require malnutrition and climate change to be addressed in parallel. Here, we estimate the non-CO2 greenhouse gas emissions resulting from closing the world's dietary nutrient gap-that between country-level nutrient supply and population requirements-for energy, protein, iron, zinc, vitamin A, vitamin B12 and folate under five climate-friendly intervention scenarios in 2030. We show that improving crop and livestock productivity and halving food loss and waste can close the nutrient gap with up to 42% lower emissions (3.03 Gt CO2eq yr-1) compared with business-as-usual supply patterns with a persistent nutrient gap (5.48 Gt CO2eq yr-1). Increased production and trade of vegetables, eggs, and roots and tubers can close the nutrient gap with the lowest emissions in most countries-with ≤23% increase in total caloric production required for 2030 relative to 2015. We conclude that the world's nutrient gap could be closed without exceeding global climate targets and without drastic changes to national food baskets.