Common Agricultural Policy influence on Health

Presentation on European Union Common Agricultural Policy by Christopher Birt at our seminar in Sheffield, 11th October 2013

The origins of the Common Agricultural Policy were in  the famine and starvation in Europe in 1940s and  post-war rationing which was retained in UK to feed Germany. The first aim of European agricultural policy was to ensure that this never recurred.

The Common Agricultural Policy  is designed to protect the rural economy, and  to ensure food self-sufficiency. It is based on support to the production of certain commodities.  In the first 20 years this led to “beef mountains”, “milk lakes”, “butter mountains”, etc., CAP responses included milk quotas, free butter for hospitals (!), etc. There was agreement in 2003 to “uncouple” production and subsidy (implemented from early 2005). Farm support is now linked to environmental protection, food safety, and animal welfare standards, etc., but there is no real incentive to alter production to meet changing needs.

There are now three main components of CAP:

  • direct “whole farm payments”,
  • price guarantees to producers, and
  • use of subsidy to manipulate market, e.g.
    • free butter for hospitals,
    • subsidised school milk,
    • school fruit scheme,
    • purchase of wine for distillation, etc.

    Health impacts of  the Common Agricultural Policy

The INTERHEART Study described how ”nine potentially modifiable risk factors account for over 90% of the risk of an initial acute myocardial infarction”. Diet explains more than half the deaths from heart disease.

potentially modifiable risk factors associated with myocardial infarction
Salim Yusuf et al . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet  364  9437   11 Sept 2004

Common Agricultural Policy and Sugar

At world price no European production  of sugar would be economic. The creation of an artificial high price is in the interests of producers. There is a large export subsidy and import tax;  all this lowers world price and hits producers in the developing world.  There is a recent World Trade Organisation agreement to reduce export taxes (and therefore internal EU price) by a third – not it is not yet implemented.

Common Agricultural Policy and Beef

There is a massive subsidy (“over 90% of income” for some farmers), so  a massive market has developed for “cheap” beef. This diverts grain production to animal food, and results in massive grain and soya imports  from developing countries, large quantities of mass-produced home- produced and imported beef, cheap burgers full of saturated fat, and a high incidence and death rate from Coronary Heart Disease  throughout the EU.

Common Agricultural Policy and milk

Dairy fat is the principal cause of high levels of population mean serum cholesterol. There is massive subsidy to milk producers, •massive overproduction, of which Commission is required to dispose. The public are encouraged to buy low fat dairy products, but the residual (saturated) dairy fat is used in cakes, pies, pastries, etc.

Common Agricultural Policy and Cereals

Cereals should be a cheap plentiful supply of fibre and micronutrients, while also being low in fat content. There is a

high subsidy and maintenance of high price. Cereal production is diverted to support meat factory farming, but it should provide a cheap basis for a healthy human diet.

Common Agricultural Policy and fruit and vegetables

There was no subsidy until recently, but there has been regular destruction of cheap production to maintain high price. Fruit and vegetables can now be included within the  “whole farm payment” scheme. There is considerable under-production in relation to need. Thus there is insufficient EU production to support “5 a day” if there were 100% take-up in the  UK alone!
Ffruit and vegetables protect against cardiovascular disease and some cancers, and the World Health Organisation recommends at least 400g fruit and vegetables (excluding potato) daily.

 Common Agricultural Policy and Tobacco

Direct subsidies to farmers for tobacco production ended in 2010 but tobacco can still be grown within the “whole farm payments” scheme!

Common Agricultural Policy influence on Health

Within the European Union the Common Agricultural Policy has caused:
•over-consumption of saturated fat-rich beef,
•over-consumption of saturated fat-rich dairy products,
•consumption of saturated fat-rich cakes, pies, pastries, etc.,
•under-consumption of fruit, vegetables and cereals,
•under-consumption of vegetable protein products containing “healthy” fats,
•overproduction of high tar tobacco (exported to developing countries), and
•high incidence and death rate from CVDs and cancers, both in EU and beyond.

The EU per capita consumption of protein from animal food products is more than double the world’s average.

Protein consumption in Europe
•in EU-15 in 2001, there were an estimated 48,050 CHD and 17,800 stroke deaths per decade attributable to inadequate fruit and vegetable intake,
•if everyone in EU-15 ate recommended levels of fruit and vegetables, it is estimated that 7% of CHD and 4% of stroke deaths prevented, and
•without subsidies on saturated fat production, assumed that consumption would be 1% less, that unsaturated fat intake 0.5% higher, so mean serum total cholesterol level would be 0.06 mmol/l lower, with 7,000 CHD and 2,000 stroke deaths saved annually (across EU-15).

Reform of the  Common Agricultural Policy

Common Agricultural Policy Reform

reforms introduced in 2005:
•“uncoupling” of production from subsidy,
•from 2005 – 2007 subsidy (“whole farm payments”) available to farmers who:
  •    use land to produce food (and some  other) products,
  •    protect the local rural environment,
  •    maintain standards of food safety, and
  •    maintain adequate standards of  animal welfare.

Outcomes forecast for the 2005 CAP reforms:

•reduction of the emphasis on subsidies for beef, dairy and sugar production, within “whole farm payments”,
•removal of the incentive to maximise production of beef and milk,
•unlikely to result in increased fruit and vegetable production, until 2007 policy change, after which could be included within “whole farm payments”,
•observers considered it unlikely that these reforms would result in any radical changes to “traditional” patterns of production.

 EU Health Strategy 2007-2013


  • Shared health values
  • Health is wealth
  • Health Impact Assessment  in All Policies
  • Health inequalities
  • EU’s global health voice

BUT No specific actions identified for the Common Agricultural Policy

CAP reforms since 2007:

  • School milk regime:
    •   Introduction of a flat rate subsidy for all milk
    •   Extension of the range of products eligible
    •  Inclusion of secondary schools

•Fruit & vegetable regime:

  • Integration of F&V into single payment scheme
  • Promoting consumption: additional funds, limited  free distribution
  • EU school fruit scheme proposal

Further reforms are needed.  While subsidies remain, they should be used to promote health, both in Europe and in developing countries, by:

  •  removal of subsidy from beef, dairy,  and tobacco production (including in whole farm payment subsidies), etc.,
  • transfer of subsidy from saturated fat to unsaturated fat food products,
  • increased use of subsidy to promote fruit and  vegetable production, and
  • maintenance of subsidy for cereals for  human consumption, etc.,
  •     but what should we do about sugar?   Tax it?

Principles for Healthy CAP reform:

  • must be responsive to health requirements,
  • must guarantee health protection requirement of Article 168,
  • CAP (and CFP) should support production and promotion of healthy foods (e.g. to increase consumption of “healthy” oils of fish and vegetable origin in place of saturated fats)
  • the CAP should support production of protein of vegetable origin.
  • CAP must promote health and welfare in rural areas, especially in the new member states,
  • CAP should encourage food industry to produce and promote healthy food, and
  • must not damage developing countries.

Some of our immediate advocacy objectives:

  • gradual phase-out (over 10 years?) from “whole farm payment” scheme of beef (other than entirely grass-fed), dairy (other than low fat) and tobacco production,
  • gradual inclusion within “whole farm payments” scheme of some types of fish farming, and vegetable protein (e.g. pulses),
  • more support to olive, rapeseed, etc., oil production, and
  • •more social marketing of healthy foods throughout EU.

Common Agricultural Policy reform

Questions on price support:

•phase it out for fruit and vegetables?
•what policy for beef and dairy?
•what about sugar?
Can we add Public Health objectives to “whole farm” payments? e.g. could we invent a score for unsaturated fat, fruit and vegetable production?

Could the health and environmental lobbies combine in a strategic alliance?   Environmental lobby objectives include to:

  • •promote environmental protection and sustainability for positive impacts on health,
    •devise tools to support Europe`s high value natural farming systems,
    •link of trade with sustainability,
    •achieve a Soil Directive to prevent degradation,
    •prevent environmental contamination by Genetically Modified Organisms

Beyond this,  the Global Warming Agenda. Farming contributes up to 25% of greenhouse gases. Cows (i.e. beef and dairy) contribute up to 19% (= to all transport!). Accordingly, reduction in both beef and dairy farming could have both health and environmental benefits.

 Health and Environment Impact Assessments:

•as a part of post-2013, these should be inbuilt to agriculture policy development;
•this proposal provides a further platform for joint working between health and environment lobbies;
•improved nutrition should be written into CAP as an objective.
European Commission statement, 18th November 2010: “The Reform of the CAP towards 2020”:

“Creating the conditions for easy access to healthy, sustainable and nutritious diet has clear public health benefits as diet is one of the major modifiable risk factor for chronic non-communicable diseases (obesity, diabetes, cardiovascular disease, cancer).   The number of overweight children increases by 1.2 million per year and (with increase in child obesity 400,000 per year) in the EU.   From a public health perspective, access to nutritious-effective food remains insufficient for some groups of EU citizens (e.g. the most deprived), availability of local and directly marketed food stuffs is limited, and acceptability is largely influenced by mass media which is biased towards unhealthy food stuffs (soft drinks, highly processed foods).   Finally, there are concerns as regards other qualities of the food, which include the ethical factors related to production and the way animals are treated.”

Three options for policy are outlined:

1.“…further gradual changes to the current policy framework.”  (i.e. “steady as she goes”!);
2.“…capture the opportunity for reform… targeted measures…more understandable to the EU citizen…to address…economic, environmental and social challenges…”;
3.“…far reaching reform of the CAP with a strong focus on environmental and climate change objectives,…moving away…from income support and most market measures.”

Commissioner Cioloş said:  “The Common Agriculture Policy has a clear contribution to health policies, providing safe and diverse food, at affordable prices for consumers and in sufficient quantity, promoting a balanced nutrition, based on quality products. But we can do more to create synergies between agriculture, education and health, to ensure that European policies address the challenges of diet related chronic diseases“

EPHAC Policy Debate Public Health’s role in the CAP, European Parliament , June 16th 2011

2011 Proposals

Direct payments – fairer distribution

•Capping is based on percentage cuts within certain income ranges i.e. no direct payments over 300.000 EUR
•Exemption from social, environment and climate change requirements for organic farms, etc.
•Phasing out of historic references – new criteria for distribution of direct aid between member states
Direct payments – greening
•Diversification of crop production, 3 crops (single crop> 5 %   main crop < 70%)
•Maintenance of permanent pasture
•Ecological priority areas must cover 7% of total cultivated area
•Natura 2000 zones and organic farms automatically qualify for the last 30% of whole farm payments
Rural Development
•Simplification of payments to small farmers
•Increased emphasis on developing local and regional food systems – i.e. better market access for small and medium size farms to local markets
Some positive features:
•Increased budget (from 90 – 150M EUR) for School Fruit Scheme and increased EC contribution from 50/75% to 75/90% to improve MS uptake
•Inclusion of nutritional criteria for both School Fruit and School Milk schemes (i.e. low fat products, sugar content)
Some possibly negative features:
•Phasing out of sugar quotas – will lead to lower sugar prices
•Strong lobby by sugar consuming food industries – phasing out already postponed from 2014 to 2015
•More equitable distribution of direct payments between MS (phasing out historical references) and between farmers in MS (capping) linked to social criteria
•Greening, 30 % of direct payments to target crop diversification, ecological focus areas and maintenance of permanent pasture
•Increased focus in Rural Development on small and medium size farms market access local and regional systems
•Increased funding to School Fruit Scheme + increased EC contribution
•School Fruit and School Milk Schemes increased focus on nutrition
One can conclude therefore that while public health nutrition is identified as a very important and desirable objective,

•its provision is still not yet awarded high priority within CAP reform discussions!