This thesis aims to understand how public health evidence can be used better to inform
the development of food and agriculture policy. It sets out to achieve this by developing
and applying two methods that have been advocated for use in evidence-based policy
making: health impact assessment (IDA) of agriculture and food policy and calculation
of the burden of disease attributable to nutritional risk factors. Neither of the methods
had Jreviously been used in this policy context. They were selected as they illustrate
two extreme models of evidence-based public health. The fIrst consists of researchbased,
investigator-led analysis producing generalisable, quantitative estimates. The
second involves a more contextual, participatory, inter-sectoral approach to collecting.
analysing and applying a broader range of data. The methods have been developed and
applied using the fruit and vegetable sector as a case study, with specifIc reference to
policies in the Republic of Slovenia, a country that was, during the course of this work,
acceding to the European Union and presented a unique political opportunity. This
thesis explores how these different evidence-based public health approaches are likely
to inform policy, in the light of what we already know about influences on policy
making.
This thesis fmds the total worldwide mortality currently attributable to inadequate
consumption of fruit and vegetables is. estimated to be up to 2.635 million deaths per
year. Increasing individual fruit and vegetable consumption to up to 600 g per day (the
baseline of choice) could reduce the total worldwide burden of disease by 1.8%, and
the burden of disease in Slovenia by 2%. The greatest impact would be on reduction of
ischaemic heart disease and ischaemic stroke. However, such descriptive epidemiology
is an insuffIcient basis for policy formulation as the results say nothing about how
interventions are likely to reduce a problem The results of the health impact
assessment show that evidence demonstrating priorities for public health action will be
different from the type of evidence required for planning, policy implementation or
evaluation.