Determinants Health In All Policies

The Coca Cola bus and other commercial sponsorship

Sorry to be a killjoy and at the same time restate the blindingly obvious, too much sugar  is not a good thing.

There’s a great deal of concern about the impact of marketing of some types of foods  on the attitudes, awareness and behaviour of our kids. Spend a bit of time watching the adverts on certain forms of media and it seems to have an impact, you don’t see many adverts for bran or apples. This was picked up in the PHE evidence review on sugar, and specifically the report on marketing and

You’ll all have clocked that it’s the time of year the Coca Cola bus is coming to many of our towns. Your kids will drag you to town to stand in a queue for an hour to get a can of pop. Mine did last year. It was a thoroughly miserable hour and they tell me they definitely don’t want to go back (job done).

It’s often put forward as emblematic, but it is a small part of a much bigger issue.

Robin Ireland and John Ashton’s editorial is excellent

Bigger picture

The Coke bus is part of a broader picture. Visible, emblematic yes. But only one part.

It will be present in your town no doubt.

Advertising is common …………

This study looked at differences in outdoor food advertising, and the type and nutritional content of advertised foods in a city – split by deprivation.

“In all, 1371 advertisements were identified; 211 (15 %) of these were for food. The advertisements covered 6765 m2, of which 1326 m2 (20 %) was for food. Total advertising and food advertising space was largest in the least affluent tertile. There was little evidence of socio-economic trends in the type or nutritional content of advertised foods”.

Others will, I’m sure, have considered gambling advertising.

………..& Televised food advertising has strong effects on individual food choice

See here

“Those exposed to food advertising chose 28% more unhealthy snacks than those exposed to non-food-advertising & a total caloric value that was 65 kcal higher”

Quell surprise

Three practical questions

Three potential practical asks (thanks Scott Lloyd) @scottylloyd1979

  • ask internally about bus stop advertising. Normally tendered out with the provision of bus stops with some restrictions on advertising (religion, tobacco etc.). Next time could it include junk food… The only direct influence that a LA has on advertising.
  • sponsored roundabouts? Few near us lovingly supported by your fave fast food giant. And couldn’t planning be used to limit external ads on establishments?
  • billboard advertising? And the deals LAs may do with their events and sports and leisure can involve sponsorship and marketing

Events sponsorship

is there an organisational policy on sponsorship.  Many big events are sponsored by organisations that may not fit with a “healthful” image – not wishing to be all a bit health zealot about it. Events are good for the economy, they are also good for vibrant town centres and are obviously a part of any municipal year.

For sure the issue will have been discussed several times over the years but never resolved as events are good for the economy.  Many nationally organised events come with a sponsor already in place and so we are often in a position of either accept the sponsor or we don’t get the event, other local events are reliant on sponsorship to cover costs.

Street advertising

What does the contact with those that run street hoarding boards say re what can or can’t be advertised. It’s likely to be unrestricted.

Commercial partnerships

There ARE plenty of examples of commercial partnerships between specific companies and some infrastructure (most often parks). This is a tricky area. I’m told Blackpool and Sefton have good approaches in this space, including an ethical framework


I won’t repeat the points re needless calories, teeth or obesity. They speak for themselves.

Here are a few thoughts and things to consider as you raise this. How you do it will obviously be context specific.

Advertising and availability drives consumption

no doubts there. Good evidence.

Companies don’t spend mega dollars for nothing – there was a viral tweet a few weeks ago suggesting that one company alone (McDonalds in this case) spends 30 times as much on traditional marketing (i.e. Never mind the online) as the whole of the PHE marketing budget (for everything).

The key points from Ireland and Ashton re the marketing and other issues are here:

• Excellent PHE evidence report noted that any comprehensive campaign must include  substantially reducing the opportunities to market and advertise high sugar food and drink products.

• Coca-Cola’s tactics in attempting to frame the debate around healthy weight, and physical activity.

• shaping research / sponsorship of mega events / funding community sports activities /  raising funds to distribute food for people in need

• mission is clearly both to promote its business and shape public opinion.

• marketing goes into overdrive as newspapers across the country regurgitate press releases for its Christmas truck tour, with advertorials promoting the truck as a Christmas tradition

• Paid advertisement for the Coca Cola bus will by far outgun any counter messaging, which won’t be well received and will be seen as a little killjoy.

Clive Bates, in a rapid response, made a number of helpful points. I’ll say that I don’t always agree with Clive, but he writes well, is challenging and puts strong views in a way that makes me stop and think very hard. It is well worth reading and reflecting on it. The response may inflame a strong response – as it should. I find some his points highly arguable, and I know he’s a well known critic of the “public health establishment”.

We need the income, or the event doesn’t happen

We need the revenue from food traders to pay for the events, if we pose restrictions they will go elsewhere – we need them more than they need us.

That might be countered by a blanket approach across a large geography that pushes traders to improve standards. We want street trade, it’s good for business, it’s good for the city centre, but we want street trade that doesn’t contribute further to a well known problem.

Industry will self regulate

I’m all for industry self regulation. It’s always heartening when the “source” of a “problem” stumps up and acts to address that problem. History, however, tells us a story akin to Turkeys voting for Christmas. Self regulation will almost always be a weaker option than mandated regulation.

Walk around the next big town centre street event one lunchtime. I’d guess you will find the full works on  offer – snow cones, fizzy drinks, donuts, hotdogs and pick and mix.  Imagine looking after your kids after they’ve eaten that. I doubt you will find a banana store.

Policy and structural interventions that affect whole pops more equitable and efficient at influencing behaviours than seeking to change behaviour with services, one person at a time. Weight management services vs sugar tax territory. See here on obesity (summary of the excellent McKinsey report) and this comparison of different approaches to diabetes prevention

Make sure you’re framing the issue in the evidence properly. Use arguments framed in “the economy” to counter arguments framed in “the economy”

There is a clear link between advertising – soft and hard & multiple media use, availability, price and consumption.

Consumption has consequences – that are monetisable. So frame the monetisable consequences of obesity as one of the externalities in a definition of “the economy”, or more pertinently the “economy” also includes downstream impacts on public services and lost productivity. See especially Klim McPherson’s 2017 paper & also the McKinsey report on that front.

Cigs v sugar etc

Draw closer parallel between tobacco and sugar, but be careful of obvious traps – ahh but sugar isn’t tobacco. Both do harm. But “seen” differently.

Maybe a tricky game as tobacco is definitively more dangerous, but added sugar certainly doesn’t do us good etc

Cumulative impact

Of course a single advert on a single billboard, or a trip to town from the Coca Cola bus isn’t going to drive a diabetes epidemic, but collectively over a long period etc. Frame it in the language of cumulative impact, saturation of public realm space with adverts that encourage us to consume less than ideal nutrition.

The obvious trade off is income from that advertising now with clinical and economic case re obesity and diabetes down the line.

That CANT be pinned on one risk, and even if it could the down the line economic loss will be tricky to quantify well (the here and now income loss isn’t).

There are winners and loosers – the winners are town centre events and a vibrant programme. The losers are ever so slightly and rather tricky to quantify poorer health, (don’t forget the inequality issue), lost life years, cost to NHS treatment wise, lost economic productivity.

Get an organisational policy on this sort of stuff that doesn’t just ignore the above issues.

Choice v commercial determinants, choice architecture

Of source it’s a “free” choice that I make to consume certain products. The “nanny state” essay is for another time, but our choices are influenced by the environment in which we live.

This is  an issue that can be framed in the language of nudge, choice architecture and bombardment of public realm space with messages to encourage us to consume food that is less than healthy

Final views

So…… don’t be deterred from drafting up strong recommendations in this space on economic grounds….just be open about trade offs etc

call it out as you see it. Call out the sides of the argument

Try not to be absolutist about it, people see the world in different ways.

Don’t give too much grief to your colleagues who have seemingly lost this one in their towns, their job is hard enough. This is a very tricky one to get right.

There isn’t anywhere that’s nailed this issue.

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