Author: Dr Lucy Baker, Aberystwyth University
New ways of tackling obesity in transport and urban policy
Research suggests exposure to unhealthy food advertising contributes to unhealthy eating, weight gain and obesity [iii]. It is estimated that people are 2.6% less likely to be obese if they live in areas where no food is advertised than those living in areas where 30% of outdoor advertisements are generally for food[iv].
People are exposed to advertisements on bus shelters, bins, telephone or Wi-Fi booths, street signs and billboards, many of which are classified as unhealthy. Across Northern England cities, a third of all outdoor advertisements were found to promote McDonalds, a brand which also dominates the content of food ads in bus shelters[v]. In Scotland, 22% of bus shelter ads were marketing confectionary and fast-food products[vi].
Despite the harmful influence of high fat, sugar, or salt (HFSS) product ads on people’s health, local authorities are generating income through arrangements with marketing companies that broker public advertising space to food and drink manufacturers and outlets. Local authorities commonly use this strategy to acquire and maintain bus shelters.
Unhealthy advertisements and health inequalities
Current evidence does not suggest a causal link between HFSS food ad placement and its impact on health inequalities, however, it suggests that some people are more exposed to unhealthy adverts than others because they live in central urban locations.
This is because market interest steers advertising companies to place advertisements in built up urban areas with higher pedestrian footfalls. In some cases, Black and Minority Ethnic communities and the most deprived communities are more exposed to unhealthy ads than more affluent and White communities[vii].
The UK advertising industry self-regulates
The ASA, established by the advertising industry, is responsible for regulating the content and placement of advertisements in UK broadcast and non-broadcast media. The ASA’s Committee on Advertising Practice (CAP) writes and maintains the non-broadcast advertising code (the CAP code). CAP and the ASA are responsible for assessing advertisement compliancy following individual complaints.
The only regulation in place on HFSS product advertisements in public space and in public transport is under CAP code 15.18. That is, HFSS food and drink ads must not be directed at under-16s through the selection of media or the context in which they appear and no medium with an audience that consists of more than 25% of under-16s should be used to advertise HFSS products[viii].
The code has been used by advertising companies to restrict the placement of static HFSS food and drink ads within 100-meter distance of schools. These ads are not restricted in any other areas where children and young people are present more so than average, or where families tend to go on holiday, nor are they restricted near leisure centres, cinemas, or retail areas.
Part of the reason why this has not led to healthier ad content in these places is the difficulty of demonstrating over 25% of an advert’s audience is under 16. The charity Sustain[ix] highlight how the ASA determined an unhealthy ad on a bus acceptable because it was likely to pass through locations representative of the general population. The proportion of under 16’s in the UK is 17.8% of the population and falling[x].
However, there are many residential areas and circumstances where proportions of under 16 years of age are 25% and over. The latest census data shows in Cardiff, 5 Middle Layer Super Output Areas (MSOAs), have a population comprising of 25%, or more, under 16-year-olds. These are some of the most deprived areas of the city. If you consider under 18s (the legal definition of a child), 11 out of 49 MSOAs in Cardiff have a child population of over 25%.
It is possible to attain data on the age of bus passengers when audiences viewing ads in bus stops are considered and in some cases, advertising companies can produce footfall data. However, assessing the precise fluctuation of children and young people passing a bus stop at any time, by car, bus, foot, or otherwise, on a specific route is more difficult.
The CAP has not developed a standard method to assess the audience of advertisements in public space. Nor does it provide any justification that is available publicly that demonstrates precisely how and why the 25% proportion of an audience is considered the most plausible threshold that once crossed, necessitates the safeguarding of children (under 16). Contrarily, in broadcasting, robust methods assess TV programme audience viewings using precise information available about audience demographics to control advert content[xi].
There is scope for more dynamic advertising that could control the content of advertisements in relevant places at various times of the day, week and year, to safe-guard children and young people from unhealthy advertisements. Similarly, such an approach could minimise uneven exposure to advertisements within cities for adult audiences. Adequate data and more robust analytics would be required for this approach, however.
A shift toward tighter restrictions on harmful public advertisements
Transport for London (TfL) have banned HFSS product advertisements across its estate [xii]. Bristol City Council, Haringey, Southwark and Merton local authorities have followed suit with some variations in their policies regarding council-controlled advertising space. These policies seek to protect adults as well as children, which is relevant given that numbers of overweight adults are far higher.
The Welsh Government have proposed a ban on the advertising of HFSS products in public by 2030. This includes in bus and train stations, sporting events, family attractions, in and near to schools, hospitals, and leisure centres.
In their 2022-2024 plan to tackle obesity, the Welsh Government state HFSS products will not be advertised to children and young people (although it does not detail how it will enforce this)[xiii]. Healthier food options will be promoted within local communities and on public transport. Public Health Wales are beginning to consult with stakeholders to do this.
To view the full-length article ‘Advertising in Wales and the UK: a need for transport and health integration to create healthier places’, including challenges to restricting advertisements and suggestions for future research, please follow this link: THINK Academy Publications – The Transport and Health Integrated research NetworK (THINK) (aber.ac.uk)
You can make a complaint about an advertisement you have seen here: https://www.asa.org.uk/make-a-complaint.html
Please note: the content of the advert in the above image has not been assessed using the Department of Health’s Nutrient Profiling Model and may not be classified as a HFSS food product.
Food Action Cities. London, United Kingdom: a ban on unhealthy food advertising across the transport system. Available at: https://foodactioncities.org/app/uploads/2021/04/LCS2_London_Ban_On_Unhealthy_Food_Advertising.pdf
Sustain. Taking down junk food ads. Available at: https://www.sustainweb.org/publications/taking_down_junk_food_ads/
In the spirit of academic peer review, THINK welcome referenced response blogs to encourage open discussion. If you would like to write a response blog please email email@example.com with the subject line 'Blog Response'
[i] Public Health Wales. N.d. Child Measurement Programme for Wales. Available at: https://publichealthwales.nhs.wales/services-and-teams/child-measurement-programme/ [Accessed 21/04/2022]
[ii] NHS Wales (n.d.). Overweight and Obesity. Available at: https://phw.nhs.wales/topics/overweight-and-obesity/
[iii] Boyland, E. et al., (2016) ‘Advertising as a cue to consume: a systematic review and meta-analysis of the effects of acute exposure to unhealthy food and non-alcoholic beverage advertising on intake in children and adults’, American Journal of Clinical Nutrition, 103(2), p519-533.
[iv] Lesser, L. I., et al. 2013. Outdoor advertising, obesity, and soda consumption: a cross-sectional study. BMC Public Health, 13(1), p.20.
[v] Finlay, A., et al. 2022. An analysis of food and beverage advertising on bus shelters in a deprived area of Northern England. Public health nutrition, pp.1-31.
[vi] Olsen, JR, et al. 2021. Exposure to unhealthy product advertising: spatial proximity analysis to schools and socio-economic inequalities in daily exposure measured using Scottish Children’s individual-level GPS data. Health Place 68
[vii] Adams, J, et al. 2011. Socio-economic differences in outdoor food advertising in a city in Northern England. Public Health Nutr. 14, 945–950.Adjoian, T. et al. 2019. Density of outdoor advertising of consumable products in NYC by neighborhood poverty level. BMC Public Health, 19(1), pp.1-9.
Cassady, D.L. et al. 2015. Disparities in obesity-related outdoor advertising by neighborhood income and race. J. of Urban Health, 92(5), pp.835-842.
Palmer, G., et al. 2021. A deep learning approach to identify unhealthy advertisements in street view images. Scientific reports, 11(1), pp.1-12.
Settle, P, et al. 2014. Socioeconomic differences in outdoor food advertising at public transit stops across Melbourne suburbs. Austr N Z J Public Health 38, 414–418.
[viii] Advertising Standards Agency. N.d. CAP Code 15: Food, food supplements and associated health or nutrition claims. https://www.asa.org.uk/type/non_broadcast/code_section/15.html
[ix] Sustain. 2020. Taking down junk food ads. Available at: https://www.sustainweb.org/publications/taking_down_junk_food_ads/
[x] Office for National Statistics. 2020. ONS.gov.uk
[xi] Advertising Standards Agency (ASA). N.D. Identifying TV programmes likely to appeal to children: Advertising Guidance (broadcast) *c1eaecc7-f805-468a-ac01683985dbe9e9.pdf (asa.org.uk)
[xii] Transport for London. 2019.TfL ad policy: approval guidance food and non-alcoholic drink advertising. London: Transport for London. Available at: http://content.tfl.gov.uk/policy-guidance-food-and-drink-advertising.pdf
[xiii] Welsh Government, 2022. Healthy Weight: Health Wales: moving ahead in 2022 – 2024. Welsh Government. https://gov.wales/healthy-weight-healthy-wales-2022-2024-delivery-plan