Abstract
Fruit and vegetable (FV) intake is declining in New Zealand, and over half of New Zealand’s children do not meet the recommendation of two serves of fruit and three serves of vegetables daily (with even lower adherence among children in high-deprivation neighbourhoods). The aim of this study was to map the potential causal pathways explaining this decline and possible actions to reverse it. Semi-structured interviews were held in April–May 2018 with 22 national actors from the produce industry, food distribution and retail sector, government, and NGO health organisations. The qualitative systems dynamics method of cognitive mapping was used to explore causal relationships within the food system that result in low FV intake among children. Barriers and solutions identified by participants were analysed using thematic analysis and according to a public health intervention framework. Participants were in agreement with the goal of improving FV intake for health and economic outcomes, and that health promotion strategies had been ineffectual to date due to multiple systemic barriers. Common barriers discussed were poverty, high food prices, low skills/knowledge, unhealthy food environments, climate change, and urbanization. Solutions with the strongest evidence of efficacy identified by the participants were subsidizing FVs and early childhood interventions to improve FV exposure.
Highlights
Eating fruits and vegetables (FVs) in childhood provides valuable nutrients for growth and development, strengthens immunity, aids digestion, decreases the risk of obesity and obesity-related illnesses, and establishes a healthy dietary pattern for life [1]
This research explored the systemic barriers to children eating FVs and gathered ideas for potential interventions to reverse the decline in FV intake in New Zealand (NZ)
The actors from across all parts of the food system held similar views about the importance of children eating FVs, believing that declining FV intake would result in poor health outcomes, increased costs to the health system, and have a negative effect on the
Summary
Eating fruits and vegetables (FVs) in childhood provides valuable nutrients for growth and development, strengthens immunity, aids digestion, decreases the risk of obesity and obesity-related illnesses, and establishes a healthy dietary pattern for life [1]. Many children worldwide do not eat a minimum of 400 grams of FVs daily as recommended by the World Health Organization. The annual New Zealand (NZ) Health Survey collects parent/caregiver-reported usual number of serves per day of FVs for children aged 2–14 years. The 2016/17 NZ Health Survey reported that 51%. Of children had the age-appropriate recommended serves of vegetables a day (two serves for children aged under five years, and three serves for children 5–14 years old), and 72% had the recommended two or more serves of fruit a day [2]. In the last five years, fruit intake has remained unchanged. Public Health 2019, 16, 1387; doi:10.3390/ijerph16081387 www.mdpi.com/journal/ijerph
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