The Power of Produce: Fighting Non-Communicable Diseases Through Diet

September 12, 2025

Dietary habits have undergone a profound transformation as global economies have grown and shifted. Rising incomes, urbanization, and increased access to global food markets are modifying traditional diets toward less nutrient-dense foods. This change is fueling a global surge in non-communicable diseases (NCDs) like obesity, type 2 diabetes, heart disease, and even some cancers. While NCDs used to be more prominent in high-income countries, they are now rising in low- and middle-income countries, highlighting how poor nutrition is a global challenge. Twenty-eight people die prematurely from a noncommunicable disease each minute. ⁱ

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This white paper examines the lifestyle and dietary transitions driving the rise in NCDs and underscores the critical role that fruits and vegetables can play in reversing this trend. It highlights the health risks associated with modern eating patterns and outlines evidence-based strategies to promote healthier food choices—particularly among vulnerable populations like families and children. Without timely intervention, the growing burden of NCDs threatens to strain healthcare systems and undermine public health initiatives to improve health and nutrition.

By exploring the intersection of economic development, nutrition, and disease prevention, this paper offers actionable solutions to help global economies, with a specific focus on middle class economies, adjust to a more modern lifestyle and conveniences while preserving the benefits of a diet rich in fruits and vegetables.

Shift in Country-Level Economics

Child at a wooden table holding red fruit with blue lockers in the background. Since 2000, there has been significant global economic growth, fueling an expansion of the middle class. Half of the countries in the early 2000s that were considered low-income by the World Bank are now classified as middle-income, with significant changes in classifications in Asia, Africa, and Latin America. Today, middle-income countries now house roughly 75% of the global population, representing a significant shift in a short amount of time.ⁱⁱ While this economic mobility has provided many benefits to the populations of these countries, this trajectory tends to shift dietary habits toward a more ‘western’ diet. This includes an increase in convenience-based processed foods that are higher in sodium, saturated fat, and added sugar, and a decline in more traditional, staple foods such as locally grown grains, legumes, or even fruits and vegetables. These populations may also be less active, further contributing to worsening health outcomes. Over time, rates of NCDs, like obesity or overweight, diabetes, and cardiovascular disease, have begun to rise.

Global Burden of Disease

While significant progress has been made in reducing or preventing infectious diseases, the increase in NCDs is alarming and experts caution that the burden of these diseases will continue to rise. In 2021, hypertension, high blood glucose levels, and high body mass index which indicates overweight or obesity, were among the leading risk factors for disease burden globally.ⁱⁱⁱ Diabetes experienced the most rapid growth among causes of health loss after adjusting for age and population size. Noncommunicable diseases were responsible for at least 43 million deaths in 2021, equivalent to 75% of non-pandemic related deaths worldwide. ^iv The prevalence of NCDs was typically restricted to high-income countries, but now, low- and middle-income countries are seeing the number of people with chronic disease rise faster than in developed countries. At present, almost 80% of the deaths from NCDs are in low- and middle-income countries and nearly 75% of the 537 million adults globally who have diabetes live in a low- or middle-income country. ^v In sub-Saharan Africa alone, the percentage of people with diabetes increased fivefold from 2000 to 2021 as the populations moved toward more urban city centers with less nutrient dense foods, and less opportunities to be physically active.^vi

Double Burden of Malnutrition

Many low- and middle-income countries are experiencing the double burden of malnutrition where individuals have deficiencies of certain micronutrients, referred to as “undernutrition,” due to being unable to access nutritious foods or due to a shift in dietary habits, while also experiencing “overnutrition” meaning overweight or obese. Micronutrient deficiencies are no longer only seen in low-income countries but are becoming more and more prevalent in middle-income and high-income countries. Globally, iron deficiency affects over 1.2 billion people, potentially leading to iron-deficiency anemia as well as impaired cognitive functioning and weakened immune systems. ^vii Additionally, vitamin D deficiency affects about 1 billion people around the world, while 50% of the population has vitamin D insufficiency. ^viii

What once was considered a higher-income country issue, we are seeing rising rates of overweight and obesity in low- and middle-income countries. In 2022, 1 in 8 people in the world were living with obesity. ^ix Today, about 70% of those living with obesity or overweight, live in low- and middle-income countries, a stark contrast from only a couple of decades ago. ^x Globally, since 1990, adolescent obesity has quadrupled, and adult obesity has more than doubled. ^xi Obesity rates are forecasted to continue to rise with the most rapid accelerations being expected in north Africa, the Middle East and Latin America and the Caribbean, where one-third of all the world’s children and adolescents with obesity (130 million) are expected to live in 2050. ^xii

Moving Toward Solutions

Person chopping carrots on a white cutting board in a kitchen. Tackling under- and overnutrition requires a dedicated, concerted effort of implementing proven public health and nutrition programs and policies. Non-governmental organizations, foundations, and the private sector can all play a significant role in investing in systems-level change, implementing effective solutions, and advocating for evidence-based strategies to prevent and reduce non-communicable diseases around the globe. By combatting preventable, chronic diseases, not only will global life expectancy increase but greater quality of life will be achieved through these health improvements. It can also have major positive economic impacts by supporting a better business environment through increased productivity from fewer sick days and longer lifespans to work, lowering healthcare costs, and reducing poverty and inequalities. We have an incredible opportunity to reverse the trend of non-communicable diseases for low-, middle-, and high-income countries and through increasing consumption of fruits and vegetables.

The Power of Fruits & Vegetables

In 2017, the World Health Organization estimated that 3.9 million deaths worldwide were attributed to inadequate fruit and vegetable consumption. ^xiiiFruits and vegetables are a powerful tool in improving health and nutrition and preventing and managing non-communicable diseases. Higher fruit and vegetable intake is associated with reducing the risk of cardiovascular disease and stroke due to containing fiber, potassium, antioxidants, and certain phytochemicals. ^xiv In addition, fruits and vegetables can also lower the risk of certain cancers including colorectal cancer and breast cancer. ^xv ^xvi Research has shown that replacing high energy density foods with lower energy density foods, like fruits and vegetables, can be an effective weight management tool, helping to reduce overweight or obesity and type 2 diabetes. ^xvii While much of the focus on fruit and vegetable consumption is aimed at preventing or reducing the risk of NCDs, they also play a role in the management of NCDs as well. Increasing fruit and vegetable intake after being diagnosed with a nutrition-related chronic condition can help to manage blood pressure, improve cholesterol levels, and support glycemic control. ^xviii

A kitchen counter with sliced pineapple, papaya, mango, lime, onion, cucumber, tomato, and bowls of cheese and green beans.

Improving the consumption of fruits and vegetables can improve health by reducing the risk of, and aiding in the management of, non-communicable diseases. These improvements can result in lower healthcare costs and improved economic benefits in countries of all incomes. One study that analyzed subsidizing healthy foods like fruits and vegetables, on a national scale, found that not only would this prevent nearly 2 million cardiovascular disease events, but it would save nearly $40 billion health care costs. ^xixAlthough NCDs are attributable for three quarters of all deaths globally, the prevention and treatment of them receives only 1-2% of global investments specific to health. ^xxWe must collectively work together to harness the power of fruits and vegetables to tackle the nutrition-related chronic disease epidemic impacting countries around the world.

Although economic changes have led to substantial and meaningful economic growth, this shift should not come at the expense of nutrition and public health. While the expansion of the middle class has brought numerous benefits to individuals and communities, like improved access to education, healthcare, and other goods or services, it can also inadvertently foster the adoption of increased consumption of energy-dense foods and sedentary lifestyles which can increase the risk of non-communicable diseases such as diabetes, hypertension, and cardiovascular disease. Country governments, non-governmental organizations, foundations and other stakeholders can align economic growth with prevention strategies that allow families and communities to maintain a nutritious diet. By proactively addressing these issues, we can help families and children sustain a nutritious lifestyle amid changing economic and social conditions.

One of the best ways to accomplish this is through country-wide nutrition programs that provide nutritious foods on an ongoing basis to under-resourced or vulnerable populations. In 2022, more than 407 million children participated in school meal programs, with one in four primary and secondary school-aged children receiving meals globally. Access to school meal programs is highest in Latin America and the Caribbean, with over half of children having access, followed by Europe, Central Asia, and North America with 42% of children having access. In South and East Asia and the Pacific, only 22% have access, 21% have access in the Middle East and North Africa, and the lowest access of only 19% is in sub-Saharan Africa. In addition to disparities in access, there is a wide disparity in the food and food groups served in these programs as well. In upper-middle and high-income countries, 94% of programs serve fruits, while low-income countries only serve fruits in 19% of programs. Furthermore, cruciferous vegetables like broccoli appeared in only 11% of school meal programs in low-income countries, compared to 23% in lower-middle-income countries, 55% in upper-middle-income countries, and 63% in high-income countries. xxi

Assisting low- and middle-income countries to overcome challenges related to incorporating fruits and vegetables, like cost, storage, and procurement, can help in closing the disparity gap between low-income countries and high-income countries. In school meal programs in low- and middle-income countries, school gardens are a key strategy in increasing access to fresh produce and cultivating culturally relevant, healthy food preferences. Eighty-four percent of school meal programs were paired with school gardens in low- and lower-middle income countries. ^xxiiNot only can this increase the access and consumption of healthy foods, but it can offer a platform for food and nutrition education which can be effective in increasing fruit and vegetable intake. ^xxiii

In addition to school meals, other country-wide programs exist that provide nutritious foods, including fruits and vegetables, to women and adolescent girls of reproductive age before, during, and after pregnancy in countries across the economic spectrum. One of the best examples of this is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in the United States that provides women, infants, and children under five with a supplementary food package that helps meet their nutritional needs. Included as part of this package is a cash value voucher (CVV) or cash value benefit (CVB) that allows the participant to purchase fruits and vegetables each month. The WIC program improves health outcomes, reduces food insecurity, increases breastfeeding rates, and has long-term health benefits and cost savings. ^xxivThis type of cash voucher program is not specific only to high-income countries. In India, the Pradhan Mantri Matru Vandana Yojna (PMMVY), which was implemented as part of the National Food Security Act of 2013, can be used by mothers to purchase nutritious foods, like fruits and vegetables. ^xxvIn Bangladesh, the World Bank helped support the country’s government to implement a pilot of a conditional cash transfer program called Shombhob. Mothers received the cash benefits if they attended education or counseling sessions to improve their child’s nutrition and if they utilized the community clinics’ growth monitoring services. ^xxviThe program improved dietary diversity and increased participant’s nutrition knowledge. ^xxviiIn Brazil, the Auxílio Brasil program provides financial assistance through a conditional cash transfer program to pregnant women, like the ones in Bangladesh and India. Results of the program found that it had a protective effect on maternal nutrition through increasing access to, and consumption of, a healthy diet. ^xxviiiThese programs that provide financial assistance to low-income individuals and families, paired with nutrition education, can improve maternal and infant health and nutrition outcomes by making nutritious foods more affordable and accessible.

I Hands holding a plate of red rambutan fruits by a window. n addition to programs that can increase fruit and vegetable consumption, enacting policies that increase fruit and vegetable consumption is a vital public health strategy with far-reaching social and economic benefits. These initiatives not only reduce the burden of non-communicable diseases like diabetes and hypertension but also promote dietary equity by improving access to fresh produce across income levels. By incorporating health and nutrition objectives into policies, governments can create environments where healthy, nutritious options become accessible, affordable, and sustainable. Well-crafted, evidence-based policies have the power to transform food systems by elevating individual health and well-being, strengthening local economies, and nurturing lifelong nutrition habits that span from early childhood and development through older adulthood.

Policy options can vary based on country-income levels, but there are evidence-based policies that have proven to improve nutrition through increased fruit and vegetable consumption. Dozens of countries have implemented front-of-package nutrition labels (FOPNL) to help consumers identify the healthfulness of food or beverage items. France, Chile, United Kingdom, Mexico, and Canada are a few examples that have adopted FOPNL systems which have consistently helped consumers make healthier food choices. When FOPNL were implemented in Chile, households purchased 37% less sugar, 22% less sodium, 16% less saturated fat, and 23% total fewer calories. ^xxixChile also saw a 23.7% reduction in sugar-sweetened beverage purchases. ^xxxAdditionally, Nutri-Score adoption in countries across Europe improved product comparisons and nutrition literacy. ^xxxi A meta-analysis that included FOPNL systems from more than 47 countries found that interpretive labels had a statistically significant positive effect on purchase intentions – highlighting the benefits of using this type of scheme. ^xxxii

Improving access to fruits and vegetables through policies that provide financial incentives can also be beneficial. In the Philippines, their Bureau of Internal Revenue (BIR) announced in 2021 that they would exempt all imported unprocessed fruits and vegetables from the 12% value-added tax, which lowered consumer prices. ^xxxiiiThis exemption aligned with legislation that aimed to simplify importation while simultaneously promoting access to nutrient-rich foods. ^xxxivIn the United States, nutrition incentive programs help participants in the Supplemental Nutrition Assistance Program (SNAP), consume more fruits, vegetables, and other healthy foods. These programs, often referred to as “double up bucks” allow participants to receive matching funds to spend on fruits and vegetables when they buy eligible fruits and vegetables. These programs have yielded positive results including increasing purchases of produce by 12-16% and by increasing the consumption of fruits and vegetables – by as much as ¼ cup more per day. ^xxxv

On the opposite end of the incentive spectrum, numerous countries or localities have enacted taxes on sugar-sweetened beverages or ultra-processed foods. For sugar-sweetened beverages, most tax levels are determined based on the size of the beverage and the sugar content it contains as is the case in countries like Mexico, United Kingdom, Portugal, and Chile. Taxes on ultra-processed foods are a newer mechanism to reduce consumption of energy-dense foods. Colombia was one of the first countries to implement a tax like this, requiring foods that are high in sodium, added sugars, and saturated fat to be taxed at higher rates (10% in 2023, 15% in 2024, and 20% in 2025). ^xxxvi

Efforts around the world to promote fruit and vegetable consumption reflect a growing recognition that nutrition is foundational to public health, economic resilience, and environmental sustainability. From school gardens in Malawi to conditional cash transfers in Brazil and produce prescriptions in the United States, governments are leveraging diverse strategies to reshape food systems and empower healthier choices. These programs and policies demonstrate that progress is possible when industries, governments, and other stakeholders align toward a common goal: making nutritious food not just available, but accessible, affordable, and desirable. As momentum builds, the path forward lies in scaling proven programs and policies, strengthening supply chains, and enhancing nutrition education and awareness that centers cultural preferences and addresses health disparities while fostering lifelong dietary patterns that support disease prevention, improve equity, and contribute to resilient, health-promoting food systems.

ⁱ Global NCD Compact 2020-2030
ⁱⁱhttps://blogs.worldbank.org/en/opendata/world-bank-country-classifications-by-income-level-for-2024-2025
ⁱⁱⁱ Global Burden of Disease (GBD)
^iv https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
^v Noncommunicable diseases
^vi How chronic diseases like cancer and diabetes are growing, explained in four charts. | Vox
^vii Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med (Lond). 2021 Mar;21(2):107-113. doi: 10.7861/clinmed.2020-0582. PMID: 33762368; PMCID: PMC8002799.
^viiiVitamin D Deficiency: Causes, Symptoms & Treatment
^ix Obesity and overweight
^x Expert Answers: Obesity is Only a Rich Country Problem, Right? Wrong.
^xi New estimates indicate that obesity is the most common form of malnutrition in many countries | World Obesity Federation
^xii Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021 Kerr, Jessica A et al. The Lancet, Volume 405, Issue 10481, 785 – 812.
^xiii Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases
^xiv https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/fruit-and-vegetable-consumption-as-a-preventative-strategy-for-noncommunicable-diseases/2F5990FCB49918964CA24F7AC499A67A
^xv Fruit and Vegetable Consumption | Cancer Trends Progress Report
^xvi Farvid MS, Barnett JB, Spence ND. Fruit and vegetable consumption and incident breast cancer: a systematic review and meta-analysis of prospective studies. Br J Cancer. 2021 Jul;125(2):284-298. doi: 10.1038/s41416-021-01373-2. Epub 2021 May 18. PMID: 34006925; PMCID: PMC8292326.
^xviiCenters for Disease Control and Prevention. “Can Eating Fruits and Vegetables Help People Manage Their Weight?” Research to Practice Series 1. https://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/rtp_practitioner_10_07.pdf.
^xviii Smith, L., López Sánchez, G.F., Veronese, N. et al. Fruit and Vegetable Intake and Non-Communicable Diseases among Adults Aged ≥50 Years in Low- and Middle-Income Countries. J Nutr Health Aging 26, 1003–1009 (2022). https://doi.org/10.1007/s12603-022-1855-z
^xixLee Y, Mozaffarian D, Sy S, Huang Y, Liu J, et al. (2019) Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLOS Medicine 16(3): e1002761. https://doi.org/10.1371/journal.pmed.1002761
^xx Global NCD Compact 2020-2030
^xxiGlobal Child Nutrition Foundation (GCNF). 2024. School Meal Programs Around the World: Results from the 2024 Global Survey of School Meal Programs. Accessed at http://gcnf.org/global-reports/.
^xxiiIbid.
^xxiiiWijesinha-Bettoni R, Orito A, Löwik M, Mclean C, Muehlhoff E. Increasing fruit and vegetable consumption among schoolchildren: efforts in middle-income countries. Food Nutr Bull. 2013 Mar;34(1):75-94. doi: 10.1177/156482651303400109. PMID: 23767283.
^xxivHow WIC Helps | Food and Nutrition Service
^xxvJagannath R, Chakravarthy V. The impact of Pradhan Mantri Matru Vandana Yojna scheme on access to services among mothers and children and their improved health and nutritional outcomes. Front Nutr. 2025 Jan 8;11:1513815. doi: 10.3389/fnut.2024.1513815. PMID: 39845916; PMCID: PMC11752989.
^xxviCan cash transfers solve Bangladesh’s malnutrition?
^xxvii100502-BRI-TF099244-Bangladesh-Oct2015-Box393232B-PUBLIC.pdf
^xxviiiSantana JDM, Pereira M, Lisboa CS, Santos DB, Oliveira AM. Influence of conditional cash transfer program on prenatal care and nutrition during pregnancy: NISAMI cohort study. Sao Paulo Med J. 2022 Jul-Aug;140(4):595-603. doi: 10.1590/1516-3180.2021.0449.R1.23112021. PMID: 35946676; PMCID: PMC9491472.
^xxixDeCan CL, Thure KA. A Need for Front-of-Package Labeling in an Unhealthy Food Environment—Let’s Label It. JAMA Intern Med. 2025;185(7):753–754. doi:10.1001/jamainternmed.2025.1404
^xxxTaillie LS, Reyes M, Colchero MA, Popkin B, Corvalán C. An evaluation of Chile's Law of Food Labeling and Advertising on sugar-sweetened beverage purchases from 2015 to 2017: A before-and-after study. PLoS Med. 2020 Feb 11;17(2):e1003015. doi: 10.1371/journal.pmed.1003015. PMID: 32045424; PMCID: PMC7012389.
^xxxi Nutrition Labeling in Europe: Nutri-Score and Alternative Systems
^xxxiiBatista MF, de Carvalho-Ferreira JP, Thimoteo da Cunha D, De Rosso VV. Front-of-package nutrition labeling as a driver for healthier food choices: Lessons learned and future perspectives. Compr Rev Food Sci Food Saf. 2023 Jan;22(1):535-586. doi: 10.1111/1541-4337.13085. Epub 2022 Dec 13. PMID: 36514235.
^xxxiiiPhilippines: All Imported Fresh Fruits and Vegetables Now
^xxxivVAT Free | USDA Foreign Agricultural Service VAT exemption now covers imported fruits, vegetables | Jasper Y. Arcalas
^xxxvSNAP Healthy Incentives | Food and Nutrition Service
^xxxviColombia's ultra-processed product taxes - Global Food Research Program

Fighting Non-Communicable Diseases Through Diet

The Power of Fruits and Vegetables

Shift in Country-Level Economics

Global Burden of Disease

Double Burden of Malnutrition

Moving Toward Solutions

The Power of Fruits & Vegetables

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