Marketing and branding is effective in encouraging the purchase and consumption of unhealthy food and drink, but the impact of outdoor advertising specifically needs further research. Advertising not only influences adult behaviour but also children’s food choices resulting in pressure being put on parents to buy unhealthy foods. The Mayor of London is therefore implementing restrictions on the advertising of high fat, sugar and salt (HFSS) food and drink (as defined by the PHE Nutrient Profile Model) advertising across the Transport for London (TfL) estate. TfL advertising estate makes up approximately 40% of London’s out of home advertising by revenue. This new policy will come into force on 25th February 2019.
SPHR researchers undertook an evaluation of this policy and an evaluation of the process and implementation of the removal of HFSS advertising on: exposure to HFSS advertising, perceptions of HFSS foods and food purchasing in London.
Our research and why it is useful
Our researchers found that the policy was associated with an estimated 1,001 kcal (6.7%) decrease in average weekly household purchases of energy from HFSS grocery products compared with what would have happened without the policy 10 months post-intervention. Average weekly purchases of energy from chocolate and confectionary fell by 317.9 kcal (19.4%). Average weekly household purchases of fat, saturated fat and sugar from HFSS products were similarly lower in intervention households in London compared to expected levels in households not exposed to the intervention: fat (57.9 g; 6.5%), saturated fat (26.4 g; 7.3%) and sugar (80.7g; 10.5%). There was also some limited indication that effects were larger in households with individuals living with obesity.
Subsequent health modelling has suggested that observed reductions in household purchases of energy and nutrients are estimated to have resulted in 94,867 (4.8%) fewer individuals with obesity, and to reduce incidence of diabetes and cardiovascular disease by 2,857 and 1,915 cases respectively within three years post intervention. Over the lifetime of the current London population, the policy would produce an estimated 16,394 additional quality-adjusted life-years and save £218m in NHS and social care costs. Greater benefits were expected to accrue to individuals from more socioeconomically deprived groups.
Their process study suggests that restricting the outdoor advertisement of HFSS foods and beverages at the scale done here is highly feasible within a complex policy and business landscape. The development, design and implementation of the policy was influenced by practical and political factors. Practical challenges include defining ‘junk food’ and navigating the legal landscape. Political challenges included balancing the health and financial impacts of the intervention. Their findings also suggest that consultation during the policy development stage, close communication with industry stakeholders, building on existing legal frameworks and the development of an exceptions process (for products on the boundary of compliance) facilitated the process of developing and implementing the policy.
Real world impact
The project has produced five peer-reviewed papers, including the main impact paper published in PLoS Medicine, and has garnered significant policy and media interest and the team has presented the findings to a range of government departments, charities and local authorities, and at scientific conferences. The team also briefly summarised the findings directly to the Secretary of State of Health at the time, Sajid Javid, as part of an Obesity Roundtable. So far, the results produced by this evaluation have directly led to the continuation of the policy in London. Furthermore, 80 local authorities across the UK are considering the adoption and implementation the policy within their own area using our work as the basis for roll-out.
The impact of this research has included:
• Widespread media coverage, including in The Guardian, The Independent, Sky News, Evening Standard, Mail Online, The Grocer, Jamie Oliver in The House online, Scottish Herald, Central Fife Times, LiveLondon
• UK Official Dissemination Event: Sustain/ADPH/GLA Dissemination event, March 2022
• UK Policy Stakeholder Presentations: PHE/OHID; Greater London Authority; Greater London Authority CIU; GLA Social Exclusion Group & London Boroughs; DHSC Healthier Weights team; DCMS
• UK Policy Meetings: Secretary of State for Health – Obesity Roundtable (including meeting with CMO and DHSC CSA), Nov 2021
• UK Sector Improvement Meetings: OHID/ADPH/LGA National Webinar on Whole Systems Approaches to Obesity, May 2022, ADPH/OHID Healthier Food Advertising Webinar, Sept 2022
• International Policy Events: OHID Global Obesity Programme – Andrew Hamilton & NYC Department of Health & Mental Hygiene, March 2022, Food for Health Food Policy Programme, 75th World Health Assembly (organised by Bloomberg Philanthropies/Judge Business School), May 2022
• Extension of Policy: We have also had discussions with policymakers wishing to extend the policy to the gambling and alcohol including: OHID Gambling – Casey Sharper; Alcohol Concern Scotland
• Policy Uptake: It is reported (The Grocer) that 80 local authorities are currently discussing implementing similar policies, including extensions to other unhealthy commodities including gambling, alcohol
• Local Authorities that have already implemented bans include Bristol, Brighton and Barnsley