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Background Public-Private Partnerships (PPPs) are increasingly promoted as a key mechanism to improve population health, including addressing dietary risk factors for non-communicable disease. In 2011, England introduced the Public Health Responsibility Deal (RD), a PPP which gave greater freedom to the food industry to set and monitor targets for sodium intakes, and replaced an internationally recognised scheme involving more independent scrutiny. We estimated the impact of the RD on trends in population level sodium intake and associated changes in cardiovascular disease (CVD) and gastric cancer (GCa) incidence and mortality and their economic costs in England from 2011–2025. Methods We used interrupted time series models with 24-hour urine sample data to assess trends in sodium intake both before and after the implementation of the RD. We used the IMPACTNCD microsimulation model to estimate impacts of these changes in sodium consumption on CVD and Gastric Cancer incidence, mortality and economic impacts, as well as equity impacts. We modelled a baseline scenario of sodium intake continuing as it had pre-RD and compared observed intakes with this. Results Between 2003 and2010 mean sodium intake was falling annually by 0.20 grams/day among men and 0.12 g/d among women (p value for trend both Discussion These findings suggest that declines in sodium intake slowed after implementation of the RD in England and this likely generated excess CVD and cancer burdens, plus additional healthcare, and societal costs. Public private partnerships such as the RD which lack robust and independent target setting, monitoring and enforcement are unlikely to produce optimal health gains. Funding for this research was from the UK Prevention Research Partnership. UKPRP Consortium Development Grant. UKPRP_CO1_105. QUEST: QUantifying Equitable Solutions To prevent Non-Communicable Diseases. The School of Public Health at Imperial College London is grateful for the support of the NIHR SPHR.

Background Brexit might produce a new agricultural regime in the UK. The current Agriculture Bill, which will shape this regime, aims to provide financial assistance for the delivery of environmental aims. However, the current Bill may represent a missed opportunity to positively influence food systems and improve public health. Potential health-improving measures could include expanding the UK production of fruits and vegetables (F&V), thus increasing F&V availability and affordability. Currently, only 1.4% of total agricultural land in England is allocated to F&V. This study aims to estimate the potential impacts of allocating additional land to F&V production on F&V intake and associated cardiovascular disease (CVD) and inequalities in England between 2021 and 2030. Methods We used the previously validated IMPACT Food Policy model. We translated changes in land allocated to F&V into changes in F&V intake and associated CVD mortality, expressed in number of deaths prevented or postponed by age group, sex, and Index of Multiple Deprivation (IMD) quintile. The model combined publicly available data on agricultural land use and quality, F&V supply, waste, purchases and IMD-stratified intake, IMD-stratified CVD projections, and appropriate relative risks. We modelled two scenarios that assumed a linear increase in agricultural land allocated to F&V between 2021 and 2027 (the implementation period of the new policy) until it covers (a) 10% and (b) 20% of all high quality land suitable for production of horticultural crops in England. We assumed that F&V prices would drop to a new market equilibrium. We used Monte-Carlo simulations to produce uncertainty intervals. Results Our model suggested that by 2030, fruit intake might increase by approximately 4% (95% Uncertainty Interval: 2%-7%) and vegetable intake by approximately 8% (4%-13%) under the first scenario. Under the second scenario, fruit intake could increase by approximately 17% (10%-29%) and vegetable intake by approximately 37% (26%-51%). These increases in F&V intake might prevent or postpone approximately 3,360 (1,760–5,920) CVD deaths under the first scenario and 15,700 (9,000–24,310) CVD deaths under the second scenario, between 2021 and 2030. Our modelled scenarios could also reduce inequalities, with some 16% of these fewer deaths occurring in the most affluent group compared with 22% in the most deprived group. Conclusion Policymakers should urgently consider the public health impacts of the post-Brexit agricultural regime in England. Increasing the land allocated to F&V production could substantially reduce the burden of CVD and associated inequalities.