Kate Oldridge-Turner, Head of Policy & Public Affairs at World Cancer Research Fund, outlines why we need marketing restrictions on unhealthy food for children.
There is strong evidence that greater body fatness causes at least 12 different types of cancer, including kidney cancer.1 Based on the latest estimates in the European Union (EU) countries, 30-70% of adults are living with overweight and 10-30% of adults are living with obesity, meaning that many people across Europe are at increased risk of developing cancer.2
For nearly 30 years, World Cancer Research Fund (WCRF) has been collating and analysing the evidence that shows the links between diet, nutrition, physical activity and cancer. This evidence informs the creation of our Cancer Prevention Recommendations, which were updated in 2018, and include being physically active, eating a diet rich in wholegrains, vegetables, fruit and beans, limiting fast-food and sugary drink consumption and not relying on supplements. These recommendations create a package by which people can make healthy lifestyle choices to reduce their risk of cancer, as it is estimated that nearly 40% of all cancers are preventable if everyone was healthier. This includes not smoking, eating a healthy diet, maintaining a healthy weight and being physically active.
WCRF policy framework
To help everyone have the opportunity to follow WCRF’s Cancer Prevention Recommendations, our Policy & Public Affairs team works with national and international policymakers by providing evidence-informed policy recommendations to help governments around the world take effective action to reduce preventable cases of cancer and other non-communicable diseases (NCDs). One such initiative is WCRF’s policy framework that identifies areas where governments should focus their action in nutrition policy.
Called the ‘NOURISHING framework’, it outlines 10 areas within three domains – food environment, food system and behaviour change communication – where governments can implement policies such as fiscal measures, labelling and restricting food advertising.3 Evidence shows that each of these domains is influential in determining our diets. However, the key issue is that governments need to adopt a comprehensive approach as there is no single action that will fix the obesity crisis. Consequently, NOURISHING is presented as a package where governments should act in a range of areas. WCRF manages a database of policies organised around the NOURISHING framework, which helps policymakers, civil society and researchers to monitor and benchmark progress and explore the approaches of countries in promoting healthy diets.
A number of these policy areas have been explored in more detail in WCRF’s Building Momentum reports, which are a series of policy publications which aim to help policymakers overcome common barriers to implement evidence informed nutrition policy.4 The first report looked at sugar-sweetened beverage taxation and the second focused on front-of-pack labelling.5,6 The third in the series was launched in January 2020 and explores the lessons learned on implementing restrictions on the marketing of foods high in fat, salt and sugar (HFSS) and non-alcoholic drinks to children.7
Marketing exposure and regulations
There is a wealth of evidence regarding the influence of marketing on the food preferences, requests, knowledge and food intake of children. There is also strong evidence that the marketing of HFSS is linked to weight gain; research has shown that seeing 4.4 minutes of food advertising can lead to children eating 60 more calories a day.8 Furthermore, children are particularly vulnerable to marketing techniques and are unable to distinguish between programme content and the persuasive intent of advertising until early adolescence, due to their cognitive defences still being developed.9
To complicate matters, viewing habits have transformed in recent years from mainly broadcast media to phones, computers and tablets. Yet marketing exposure in this digital sphere has a serious lack of regulations. The impact of marketing on the dietary intake of children is so significant that the United Nations (UN) Committee on the Rights of the Child confirmed the need to regulate the marketing of HFSS products, with controls on their availability.10 The rights within the UN Convention on the Rights of the Child provide justification for governments to regulate the marketing of HFSS products, as states that have ratified this treaty have the legal obligation to fulfil the right of the child to enjoy the highest standard of health, and therefore protect them from harmful marketing.11
The child rights approach is an important argument for the implementation of legally binding measures to restrict the marketing of unhealthy food for children and it’s an important tool that can be used to introduce measures. However, the reality remains that many governments chose to implement voluntary marketing measures or let the industry regulate themselves. There are very few examples of best practice to draw on and every system has flaws; such as the mediums covered, or the age of the children protected is too low and frequently only apply to pre-digital media. For example, even though there are marketing restrictions in the United Kingdom (UK), loopholes allow companies to advertise unhealthy food for children. The restrictions only apply to television programmes or websites made exclusively for children or where children are disproportionately represented in the audience. This means it excludes a large number of family television shows and online content that is popular with both adults and children.
Marketing restrictions and reducing risk of cancer
One of the most popular shows in the UK with children is Britain’s Got Talent which is regularly watched by nearly a million children.12 Analysis undertaken by the Obesity Health Alliance on the adverts shown during this programme, which often airs before 9pm, during one week of episodes, found that one in five adverts were for an HFSS product.13 Shockingly, one single episode included four and a half minutes of adverts for unhealthy food and drink – meaning children were exposed to adverts for pizza, burgers, ice cream, cake and chocolate biscuits. Thus, why are marketing restrictions so weak? Often, it’s due to industry interference, who argue that restrictions amount to ‘nanny state interference’, will have a disproportionate economic impact or would breach their right to trade. However commercial rights are not absolute. In fact, they can be restricted on grounds of public interest, including public health.
Our new report brings together lessons learned from countries around the world who have had differing levels of success in implementing restrictions. For example, Norway prohibits marketing directed at children under 18 and advertising in connection with children’s programmes on television, radio and teletext.14 The ban includes any product, including food and beverages, but one of the main limitations of the policy is that it only applies to broadcast media originating in Norway. Under current EU law, national marketing restrictions can only apply to broadcasts emanating from within the country of origin – this means children can still be exposed to marketing where broadcasts are from outside Norway. Attempts by Norway to strengthen the regulation with introduction of the Code of Marketing of Food and Drink aimed at Children were watered down by industry interference.
The evidence on the influential effect of advertising unhealthy food for children is so strong, which means marketing restrictions are an important way governments can promote healthy diets and tackle obesity. However, as our Building Momentum report shows, designing and implementing effective measures has been challenging and there are few examples of best practice; but this doesn’t mean it can’t be done, and done effectively. If governments are serious about the health of their people and reducing the risk of cancers, such as kidney cancer, implementing a strong marketing restriction could have a significant effect.
- WHO Regional Office for Europe, 29/01/2020 http://www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/data-and-statistics
- Russell, S.G., Croker, H., and Viner, R.M. 2018. The effect of screen advertising on children’s dietary intake: A systematic review and meta‐analysis. Obesity Reviews
- Harris, J.L., Brownell, K.D., and Bargh, J.A. 2009. The food marketing defense model: integrating psychological research to protect youth and inform public policy. Social Issues and Policy Review, 2009. 3(1): p. 211–271
- UN Committee on the Rights of the Child, General Comment No. 15 on the Right of the Child to the Enjoyment of the Highest Attainable Standard of Health, CRC/C/GC/15. 2013, United Nations: Geneva
- United Nations Human Rights. 1989. Convention on the Rights of the Child (adopted and opened for signature, ratification and accession by General Assembly Resolution. 44/25 of 20 November 1989; entry into force 2 September 1990, in accordance with Article 49. 1989. Available at www.ohchr.org/en/professionalinterest/pages/crc.aspx
- Vaale-Hallberg, M. and Roald, H.B. 2017. The Norwegian 85. implementation of the WHO’s Recommendations. European Journal of Risk Regulation, 2017. 8(2): p. 298–310