Excluding bottled water, only 1.3% of food and beverage advertising across the Sydney train network is consistent with a healthy diet

New research from the Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders at the University of Sydney, and Sydney Law School, has investigated the quality of nutrition of food and beverage advertising on every station of Sydney’s metropolitan train network.

Judged by revenues, outdoor advertising of food, on billboards and other advertising spaces, is on the rise.

Sydney Trains generated over $12 million in advertising revenue in the 2013-14 financial year, and this was expected to increase to at least $100 million over the subsequent 5 years.

A research team, led by Emma Sainsbury, collected data in February (summer) and July (winter) of 2016, photographing a total of 6931 advertisements across the 178 stations in the network.

Each advertisement was coded as core (a healthy food or beverage recommended for daily consumption), or discretionary (high fat, sugar and/or salty food not recommended for daily consumption), based on the Australian Guide to Healthy Eating.

The results tell you what you probably already know: Sydney train stations are a great place to advertise junk food and beverages.

Just over a quarter of total advertisements (1915/6931, or 27.6%) promoted food and beverages.

Of the food and beverage advertisements, 84.3% were for discretionary foods/beverages, 8% were for core foods/beverages, and the remainder (7.6%) were miscellaneous advertisements, mostly brand-only advertisements that did not mention specific products.

Significantly, the core foods/beverages category consisted mostly of bottled water vending machines (74.4%), and billboard advertisements for bottled water (11%).  When advertisements for bottled water were excluded, only 1.3% of food and beverage advertising on the Sydney train network was for core foods.

The most commonly advertised discretionary products were potato chips (25%), sugar-sweetened beverages (23%, mostly flavoured milks and soft drinks), and intense or artificially-sweetened beverages (18.7%).

Despite food advertisements comprising just over a quarter of all advertisements, Coca-Cola and PepsiCo (which includes PepsiCo beverages and The Smith’s Snackfood Company) were the largest advertisers overall, contributing 10.9% and 6.5% of total advertising across the network.

Advertisements for alcohol made up over 6% of food and beverage advertising, and about 2% of total advertising.

There is obviously a total disconnect between foods and beverages advertised on Sydney trains and the kinds of foods and drinks that make up a healthy diet.

What do advertisers have against healthy food and beverages, I wonder?

A large number of self-regulatory initiatives ostensibly regulate food and beverage advertising in Australia.

However, these have failed to achieve a healthy food advertising environment, probably by design.

The results of this study support the case for government to pressure industry to shift the mix of food and beverage advertising towards products that are more consistent with a healthy diet.

The paper reviews some of the regulatory approaches that might be used, from outright bans, to interim and longer-term targets for reductions in the overall volume of unhealthy food advertising, based on a credible nutrient profiling system that evaluates the quality of nutrition of the product.

Restrictions on the volume of particular kinds of advertising, as a percentage of total advertising, do exist in other jurisdictions.

In Ireland, for example, the General Commercial Communications Code limits the volume of television advertising of foods high in fat, salt or sugar, to a maximum of 25% of sold advertising time across the broadcast day (para 16.10).

However, much of the impetus for constraints on unhealthy food advertising arises from the belief that children are particularly vulnerable and deserve to be protected.  Unlike, say, television programs that are made specifically for children, the train network is used by substantial numbers of both adults and children.

Another approach could be to significantly increase the proportion of train station advertising allocated to the promotion of healthy, core foods and beverages, perhaps through higher pricing strategies for advertising of junk foods and sugary drinks.

The food, beverage and advertising industries ought to be taking the lead here, but how likely is that?!

The prevailing ideology, shared by the food and beverage industries, their allies and lobbies, is that you get the health you deserve.

If you can beat temptation and eat a healthy diet, you deserve to be healthy.

But if you eat a poor diet, if you routinely consume the diet that is overwhelmingly advertised, then you get what’s coming to you.

That’s personal responsibility.

It’s great for business (there’s great margins on nutritionally poor foods), but not great for the health budget, nor for individuals and families.

Maybe that’s why the food and beverage industry needs round-the-clock lobbyists in Canberra to explain to politicians and the rest of us how the world works.

Because otherwise someone might start asking crazy questions…like…Why shouldn’t the mix of advertising across the Sydney train netework be better aligned with a healthy diet?

The paper can be downloaded free of charge here.

Does Coca Cola have a role in delivering Pacific aid?

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Posted by Roger Magnusson and Alexandra Jones

The Foreign Minister, The Hon. Julie Bishop MP has announced that Australia will partner with companies like Coca-Cola to distribute essential medicines to Pacific Island recipients of Australian aid.

The Minister is right about one thing: tobacco and fizzy drink companies have strong distribution networks that reach into the remotest parts of low income countries around the world.  And they would welcome the legitimacy that comes from “being part of the solution” – from “helping to save lives”.

But conflict of interest looms large.  In some islands of the Pacific, more than a third of the population have diabetes (See the table at the bottom of this post, drawn from a recent paper on non-communicable diseases (NCDs) in the Pacific.  The table is worth reproducing in full, since it illustrates just how bad everything is). Combined rates of overweight and obesity among men and women in some Pacific island recipients of Australian aid reach or exceed 80%.  In some countries obesity rates alone exceed 45% (in Tonga, the rate of obesity in men and women > 20 years is 59.5%).  Do these countries really need Coca Cola?

There might well be novel ways of partnering with the private sector to improve aid performance.  Results matter: the Minister is absolutely correct on this point.  But this applies at home as well.  For example, under-performing public health initiatives such as the stalled Food and Health Dialogue – which was supposed to deliver a healthier food supply with less salt and saturated fat – also need to be overhauled.  (A recent paper by Roger Magnusson and Belinda Reeve illustrates how “regulatory scaffolding” could be used by government to strengthen the performance of this vital initiative while minimising the need for direct, statutory regulation).

In Pacific Island Countries and Territories, partnering with the multinationals that are driving risk factors for obesity and diabetes makes no sense.  Australian Aid wouldn’t partner with a tobacco company like Philip Morris, so why partner with a fizzy drink company selling empty calories to some of the most obese and diabetic countries in the world?

Unlike, say, Unilever, which can diversify into healthier products and create healthier brands, Coca Cola and Pepsico have a real problem: their leading brands are soft drinks.  It would be economic suicide to sacrifice the full-sugar variants, and yet this colours every positive contribution they might otherwise seek to make to development or public health.  People who want to move towards a healthier weight – not to mention better dental health – need less soda, not more, and yet reducing consumption is bad for profits.  Suffice it to say that Coca Cola would surely be delighted at the prospect of becoming integrated into the public health infrastructure in these fragile island states.

It’s worth asking: just how did Coca Cola get inside the Minister’s head?  Why is its name bobbing up now?

At the Joint Forum Economic and Pacific Health Ministers Meeting in Honiara in July 2014, Economic and Health Ministers from Pacific Island Forum countries agreed that non-communicable diseases (NCDs) are ‘financially unsustainable’.  They committed to develop country-specific roadmaps covering the following five priorities (Joint Economic Forum and Pacific Health Ministers Meeting 2014). These priorities are:

    • Strengthening tobacco control;
    • Considering an increase in taxation of alcohol products;
    • Reducing consumption of unhealthy food and drink;
    • Improving efficiency of existing health expenditure; and
    • Strengthening the evidence base to ensure optimal use of resources.

These commitments take place against the background of the World Health Organisation’s Western Pacific Regional Action Plan on NCDs  and the World Bank’s NCD Roadmap Report.  Both documents identify “best buys” and other policy priorities that countries should adopt in order to reduce death and disease from NCDs.

Let’s be honest here: the commitments of Joint Economic Forum and Pacific Health Ministers are not only a business risk to Coca Cola, but to tobacco multinationals and other junk food and beverage companies that operate in the region.  Other risks loom on the horizon.  For example, the World Health Organisation has established a Commission on Ending Childhood Obesity, which has already released an interim report which identifies a number of policy options for reducing intake of unhealthy foods and non-alcoholic beverages by children.  The Commission is holding a hearing in Auckland for the Western Pacific Region within the next few weeks.

Is Coca Cola really part of the solution?  If you have any lingering doubts, just ask a dentist.

Readers may also be interested in a recent paper by Jenny Kaldor and Roger Magnusson (from Sydney Law School) and from Stephen Colagiuri (from the University’s Boden Institute of Obesity, Nutrition Exercise, a WHO Collaborating Centre) on how law and regulation could contribute to efforts to wind back Australia’s epidemic of diabetes.

Selected risk factors for non-communicable diseases in Pacific Island Countries and Territories, compared to Australia 

Obesity rates % (2013)a
Country Men>20 years Women >20 years Men & women >20 years
Kiribati 39 56 47.5
Samoa 46 69 57.5
Tonga 52 67 59.5
Australia 28 30 29
Smoking prevalence % (2011)b,c
Country Men >15 years Women >15 years Men & women> 20 years
Kiribati 67 37 52
Papua New Guinea 55 27 41
Solomon Islands 45 18 32
Tonga 43 12 28
Australiad   18 14 16
Diabetes prevalence % (2013)e,f
Country Total adult population
Cook Islands 26
Federated State of Micronesia 35
French Polynesia 22
Kiribati 29
Marshall Islands 35
Nauru 23
Tokelau 38
Vanuatu 24
Australiag 4

a Statistics sourced from Ng M, Fleming T, Robinson M, et al (2014) Global, Regional and National Prevalence of Overweight and Obesity in Children and Adults During 1980-2013: A Systematic Analysis for the Global Burden of Disease Study 2013. Lancet 384, 766-781.

b Statistics sourced from World Bank (n.d.) World Development Indicators: Health Risk Factors, viewed December 2014 <http://datatopics.worldbank.org/hnp/HNPDash.aspx&gt;.

c Statistics for Australia sourced from Australian Bureau of Statistics (ABS) (2012) Australia’s Health Survey: First Results, 2011-2012, Tobacco Smoking. 4364.0.55.001, 29 October 2012, viewed December 2014  <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/73963BA1EA6D6221CA257AA30014BE3E?opendocument&gt;.

d Australian data are for daily smoking rates among adults aged >18 years, for 2011-2012.

e Statistics sourced from Chan J, Cho N, Tajima N, Shaw J (2014) Diabetes in the Western Pacific Region – Past, Present and Future. Diabetes Research and Clinical Practice 103, 244-255.

f Statistics for Australia sourced from ABS (2012) Australia’s Health Survey: First Results, 2011-2012, Diabetes Mellitus. 4364. 0.55. 001, 29 October 2012, viewed December 2014 <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/D4F2A67B76B06C12CA257AA30014BC65?opendocument&gt;.

g Australian data are for the period 2011-2012.

As part of its Master of Health Law program, Sydney Law School offers several units of study that consider global health, law and development.  These include Critical issues in Public Health Law; Law, Business and Healthy Lifestyles; Global Health Law; and Trade Regulation, Health and the Environment.

[Thanks to Alexandra Jones for references and for information about Australia’ health aid program]