Ban advertising of HFSS on public transport
Restrict all outdoor advertising of HFSS on public transport (i.e. all bus stops, train stations and tube stations, implemented via national regulation)
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Low impact on obesity
Impact refers to the effect on obesity associated with a particular policy intervention.
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Moderate evidence quality
Evidence refers to the effect on obesity associated with a particular policy intervention.
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Low cost to governments
Cost refers to the effect on obesity associated with a particular policy intervention.
What is the policy?
This policy focuses on a national rollout of the restriction of all outdoor advertising of HFSS on public transport, as was implemented by the Mayor of London and Transport for London in 2019.
Specifically, this would require that advertisers who produce, sell, retail, distribute or promote food or non-alcoholic drink must ensure the product featured is HFSS compliant (according to the Nutrient Profile Model). The restriction would apply to HFSS advertising on buses, bus stops, and railway and tram stations.
Recent context
Evidence suggests that advertisement of HFSS foods and drinks can influence food behaviours by changing dietary norms and shifting population-level food and drink preferences. Advertising can influence adult behaviour as well as children’s food choices resulting in pressure being put on parents to buy unhealthy foods.
The regulation of advertising in the UK is the responsibility of the Advertising Standards Authority (ASA). Advertising laws are established for all of the UK and are not devolved. Accordingly, the context is the same in both Scotland and Wales.
There are currently no regulations that restrict the advertising of “less healthy” foods outdoors. The United Kingdom currently prohibits the advertising of “less healthy” food and drink products on television during children’s airtime. Despite this, providers of public transport have the discretion to apply their own guidelines or restrictions to advertising as a business decision.
Welsh Government’s Healthy Weight, Healthy Wales strategy pledged to restrict unhealthy food and drink advertising, sponsorship and promotions in public spaces by 2030. This includes bus and train stations, sporting events, school zones, hospitals and leisure centres. The Scottish Government’s Diet and Healthy Weight Delivery Plan contains an action to engage with local authorities, transport companies and media agencies to develop a code of practice to restrict the marketing and promotion of HFSS, particularly to children. This has yet to be developed.
Case studies
Advertising restrictions through TfL, London
In 2019, the Mayor of London implemented restrictions on the advertising of HFSS through TfL. This included transport on the London Underground (rapid transit) network, the TfL Rail network, transport vehicles run by TfL (including some buses, trains, and taxis), and outdoor spaces owned by TfL (e.g., bus stops and land outside train stations).
Per the TfL Advertising Policy, both direct marketing of HFSS products and incidental images of HFSS products in advertisements are prohibited. Brands with more diverse product ranges (e.g., drinks companies) may have low or zero-calorie alternatives that allow continued brand advertising.
Some councils such as Southwark Council have expanded on TFL’s policy by restricting advertising of HFSS and alcohol on council owned advertising sites. Bristol city has become the first UK city to ban ads for unhealthy food and alcohol advertising across the city’s council owned spaces. This includes billboards, the city’s 180 bus stops, social media, and digital screens at any of the council’s venues, including libraries and museums. Whilst Cardiff Council has already implemented a ban on unhealthy food advertising on bus shelters within 200m of schools, Cardiff and Vale of Glamorgan Council are now working together to understand public attitudes towards HFSS advertising in order to develop further restrictions which they say could ban advertising of HFSS on council land and property, including bus stops.
Considerations for implementing policy
When contemplating a nationwide ban on outdoor advertising of HFSS products across public transport networks, aligning the policy with existing legal and regulatory frameworks surrounding advertising, public health, and consumer protection should be a priority, assessing the need for new legislation or amendments. Moreover, clear enforcement mechanisms and penalties for non-compliance should be established at a national or local government level to ensure fairness across public transport operators.
Estimating the population impact
We estimated this policy would reduce the prevalence of UK obesity rates by x%.
Estimating the per-person impactWe estimated the impact of this policy on using data published in the evaluation of the TfL advertising ban. Yau et al., (2022) evaluated the impact of HFSS advertising restrictions, implemented across the London (UK) transport network in February 2019, on HFSS purchases. The study found an association between the implementation of restrictions on outdoor HFSS advertising and relative reductions in energy, sugar, and fat purchased from HFSS products.
The study found relative (rather than absolute) reductions in:
- Calories purchased – average weekly household purchases of energy from HFSS products were 1,001kcal (6.7%) lower among intervention households following the introduction of the intervention, compared to a control group. Using the mean household size of 2.6 people in the sample, and assuming an even energy distribution, this equates to a relative reduction in purchased energy of 385.0 kcal per person per week.
- Fat and sugar purchased – reductions in fat (57.9g), saturated fat (26.4g) and sugar (80.7g) from HFSS products purchased were seen.
- Chocolate and confectionery purchased – weekly household purchase of energy from chocolate and confectionery fell by 317.9 kcal (19.4%) compared to expected levels
Estimating the population reach of the policy
When modelling the impact of the policy, we assumed the policy would:
- Impact people living with overweight or obesity (i.e. BMI ≥ 25 kg/m2)
- have been implemented for five years
- Result in a net change in daily energy intake of -45.89kcals (when accounting for compensatory effects)
The calculated net change in DEI is then an input to the weight change model described and validated in Hall et al. (2011). Note: Impact for children is not modelled separately as a separate effect size was not available
Cost and benefits
Total cost savings
Based on analyses conducted by Frontier Economics, this policy would result in a cost saving of xx.
Costs over 5 years
The table below shows a breakdown of costs. The direct costs to the Government are estimated at a £1 million one-off cost for the set up of the required enforcement infrastructure, and a £x million annual cost for the continued enforcement of the policy [1]. The costs to the food industry are estimated at a £5 million one-off cost for transitioning operations to comply with the policy. Advertising businesses are estimated to face a £659 million cost over 25 years, or ~£26 million per year, resulting from lost advertising revenue to advertisers.
5-year cost benefit analysis
We commissioned Health Lumen to assess the shorter term benefits of implementing this policy. After five years this policy would see a cost saving to the NHS of xx. New cases of [insert disease] and [insert disease] would reduce by xx% and xx% respectively.
| Group affected | Cost | Horizon | Detail |
| Costs | |||
| Government | 1 million* | One-off | Enforcement set-up costs; |
| Government | 9 million* | Annual | Enforcement costs |
| HFSS Advertisers | 5 million | One-off | Transition costs |
| HFSS Advertisers | 26 million | Annual | HFSS profit lost |
| Benefits (5-years) | |||
| Government | xx | xx | xx |
| Consumer | xx | xx | xx |
Effect on inequalities
Socioeconomic status
Some groups have been found to be more exposed to HFSS advertising, including socioeconomically disadvantaged groups. This may contribute to the higher prevalence of obesity and diet related diseases we see in disadvantaged groups. Secondary analysis of the TfL evaluation described above found that greater benefits (e.g. a 37% higher gain in quality-adjusted life-years) were expected to accrue to individuals from the most socioeconomically deprived groups.
What works well in combination with this policy?
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Sources
| number of studies | Sample Size | Country (Number of studies) | Age range | Intervention and comparison | Magnitude of effect in SD (95% CI) | Magnitude of effect (calorie intake) | Quality of Evidence* |
|---|---|---|---|---|---|---|---|
| High income countries (lab and field settings); Most studies from USA | High income countries (lab and field settings); Most studies from USA | Intervention: larger-sized portions, package, individual unit or item of tableware Comparison: smaller-sized portions, package, individual unit or item of tableware | Outcome of interest: Consumption; Effect size: SMD -0.60 (95% CI -0.84 to – 0.36, P < 0.001 ) | Mean energy intake on an average snack occasion would be -38 kcal (18.9%) with lower proximity (CI: -53 kcal to -23 kcal) | |||
| High income countries (lab and field settings); Most studies from USA | High income countries (lab and field settings); Most studies from USA | Intervention: larger-sized portions, package, individual unit or item of tableware Comparison: smaller-sized portions, package, individual unit or item of tableware | Outcome of interest: Consumption; Effect size: SMD -0.60 (95% CI -0.84 to – 0.36, P < 0.001 ) | Mean energy intake on an average snack occasion would be -38 kcal (18.9%) with lower proximity (CI: -53 kcal to -23 kcal) |
References
[1] Ejlerskov, Katrine T., Stephen J. Sharp, Martine Stead, Ashley J. Adamson, Martin White, and Jean Adams. “Supermarket Policies on Less-Healthy Food at Checkouts: Natural Experimental Evaluation Using Interrupted Time Series Analyses of Purchases.” Edited by Barry M. Popkin. PLOS Medicine 15, no. 12 (December 18, 2018): e1002712. <https://doi.org/10.1371/journal.pmed.1002712.>
[2] Hollands, Gareth J, Patrice Carter, Sumayya Anwer, Sarah E King, Susan A Jebb, David Ogilvie, Ian Shemilt, Julian P T Higgins, and Theresa M Marteau. “Altering the Availability or Proximity of Food, Alcohol, and Tobacco Products to Change Their Selection and Consumption.” Edited by Cochrane Public Health Group. Cochrane Database of Systematic Reviews, August 27, 2019. <https://doi.org/10.1002/14651858.CD012573.pub2.>
[3] Liu, Peggy J., Steven K. Dallas, Matthew Harding, and Gavan J. Fitzsimons. “The Sales Impact of Featuring Healthy Foods, Indulgent Foods, or Both: Findings from a Large-Scale Retail Field Study.” Journal of the Association for Consumer Research 3, no. 3 (July 2018): 346–63. <https://doi.org/10.1086/698329.>
[4] Restricting Checkout, End-of-Aisle, and Store Entrance Sales of Food and Drinks High in Fat, Salt, and Sugar (HFSS) Impact Assessment (IA) Summary: Intervention and Options RPC Opinion: Fit for Purpose <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1008423/impact-assessment-restricting-checkout-end-of-aisle-and-store-entrance-sales-of-HFSS.pdf>
[5] Shaw, Sarah C, Georgia Ntani, Janis Baird, and Christina A Vogel. “A Systematic Review of the Influences of Food Store Product Placement on Dietary-Related Outcomes.” Nutrition Reviews, June 1, 2020, nuaa024. <https://doi.org/10.1093/nutrit/nuaa024.>
[6] Whitehead, R., S. Greci, H Thomson, G. Armour, K. Angus, and L. Martin. “The Impact of Non-Price In-Premise Marketing on Food and Beverage Purchasing and Consumer Behaviour: A Systematic Review.” Preprint. Public and Global Health, September 16, 2021. <https://doi.org/10.1101/2021.09.13.21258115.>
Mandate retailer and manufacturer calorie reduction targets
Mandate large retail and manufacturing businesses to implement calorie reduction targets with a minimum reduction of 10% applied to product categories specified in Public Health England’s recommendations