Mainstreaming prevention: prescribing fruit and vegetables as a brief intervention in primary care.
This paper examines a brief preventive intervention as a model for embedding public health action in primary care.


BACKGROUND
Low fruit and vegetable intake is a major risk factor for cancer, coronary heart disease and stroke. The recommended intake of five portions per day would reduce death rates from these causes by 20%. However, average daily consumption in the UK is under three portions, and it is significantly lower in men, young people and lower socio-economic groups. In order to tackle risk factors such as poor diet, the white paper Choosing Health promises action and funding to mainstream prevention and transform the NHS from a sickness service to a genuine health service.
To promote increased fruit and vegetable consumption, primary care professionals working in a deprived area issue prescriptions which offer the patient discounts on fruit and vegetable purchases. Hand over of each prescription to the patient is linked explicitly to key five a day messages. This brief intervention takes 1-2 min to deploy.
Evaluation is ongoing. However, early feedback suggests that the intervention of prescription plus key messages has a significant impact on patients in highlighting the connection between food and health. Clinicians express satisfaction at having a preventive intervention that can be deployed with confidence and consistency in routine primary care consultations.


CONCLUSIONS
This brief intervention is presented as a potential model for embedding prevention in the day-to-day work of health professionals. Primary care is a natural setting for the promotion of health, but despite success in implementing some public health programmes, it has a patchy record in primary prevention. The reasons for this are examined, the impact of new contractual and commissioning levers is explored, and a general framework for mainstreaming public health action in primary care is proposed.
Kearney
M
M
Castlefields Health Centre, Chester Close, Runcorn, and Community Studies Unit, School of Medical Education, University of Liverpool, Liverpool L69 3GH, UK. matt.kearney@btinternet.com
Bradbury
C
C
Ellahi
B
B
Hodgson
M
M
Thurston
M
M
D002318:Cardiovascular Diseases / Q000517:prevention & control; D005638:Fruit; D006293:Health Promotion / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009369:Neoplasms / Q000517:prevention & control; D011320:Primary Health Care / Q000191:economics / Q000379:methods*; D011635:Public Health Administration; D014675:Vegetables