At the dawn of the new year, newspaper headlines reported that the UK and Ireland were ranked “the world’s best at eating fruit and vegetables”. And this seemed surprising to me, as a public health expert. Just on economic grounds, the UK imports 50% of its vegetables, and 84% of its fruit – largely from Europe, Africa, and the Americas. These foods are relatively expensive in the UK, costing on average £11.79 per 1,000 kcal, versus £5.82 for 1,000kcal of processed foods. And this is at a time of constrained household incomes. Cucumbers, for example, increased in price by more than 50% between 2022 and 2023.
And of course, the UK and Ireland simply aren’t known for having the healthiest diets. Scotland did invent the deep-fried Mars bar. Could Britons really be eating more fruit and veg than our European neighbours such as Italy, Spain, France, Denmark and Greece? I had to investigate.
I traced the stories back to a linked report that was produced by the OECD, entitled Health at a Glance 2023, which compares performance in health across OECD countries and certain emerging economies. And, yes, figure 4.10 shows that Britain and Ireland have the highest percentage of what the OECD calls, “daily consumption of five or more portions of fruit and vegetables in 2019, or nearest year”. It’s worth flagging, though, that this data is from before Brexit was finalised. Brexit increased overall food prices by 6% and the past few years have seen fruit and vegetable shortages described as the “new normal”. So this dietary data should first be seen as a snapshot of the past: pre-Brexit, pre-Covid-19, and pre-cost of living crisis.
Pushing further, the quality of any study is in the methodology. Ask a senior researcher what two parts of a study they read first, and it’s methodology followed by financial support – in short, how did the authors find the answers and how was it paid for? The OECD study relies on a previous European health interview survey (EHIS), which involved people in various countries self-reporting on their health. People were asked to answer variations on the question “How many portions of fruit and vegetables do you eat a day?”, and their answers provided the data.
The self-reported method is the standard approach to diet surveys. But we know from other studies that if you compare what people say they eat, versus objectively measuring the nutrients they consume, that there is systemic misreporting. People may misunderstand the question, misunderstand the sometimes arcane rules for what counts as fruit and veg, misjudge how much they actually eat, or even outright fib. In simple language, what people say they eat isn’t necessarily what they eat.
Health surveys care so much about diet because an unhealthy diet is a key risk factor for obesity and chronic disease: 25.9% of adults in England were estimated to be obese, with a further 37.9% overweight in the Health Survey for England 2021. These numbers have increased over the past decade. The UK also has much higher levels of obesity than Greece, Spain, Germany, France or Italy. Alongside the increase in obesity, there have been increases in linked conditions such as diabetes, heart disease, hypertension and cancer.
In addition, more than 800,000 patients were admitted to hospital with malnutrition and nutritional deficiencies in England and Wales in 2022. These were for the most part people with a caloric-dense diet that was nonetheless lacking essential nutrients (such as protein, vitamins and minerals). Dietary deficiencies in childhood are reflected in height: there is clear evidence that “the greater the deprivation, the shorter the child”. Data shows that children in the UK are becoming shorter compared to other countries, and it’s been asserted that the average height of a five-year-old in the UK is likely to have decreased because of rising child poverty and Conservative austerity policies.
So the UK has major issues in public health related to (though not limited to) diet. I don’t think anyone would dispute that.
If you want a more reliable and valid measure of how healthy a country is, child height and overall wellbeing are probably the best ones. Before becoming excited that Britain is “world-leading” in yet another area, the headlines should have instead specifically said: “The population of the UK and Ireland say they’re the world’s best at eating fruit and vegetables, pre-Brexit.” As we know in public health research, just because someone says they ate something, it doesn’t mean they actually did.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
