Sadiq Khan’s eye-catching ban on junk food advertising across the Transport for London public transport network is a hugely significant public health intervention, perhaps the largest of its type in any city anywhere.
TfL’s advertising space is the most valuable in the world, with 30 million journeys made on the network every day. The ban covers advertising worth some £13 million, approaching 10 per cent of TfL’s total annual advertising take – a bold move given current pressure on TfL budgets.
Revenue loss will be “minimised”, TfL believes, by working with advertisers to up their spend on healthy alternatives. The policy is backed by more than eight in 10 Londoners, including Jamie Oliver. Objectors such as the Adam Smith Institute seem to be a distinct minority.
London’s child obesity “timebomb” is at the heart of Khan’s announcement. It’s a stark public health truth, set out dramatically by Mayoral health adviser Dr Tom Coffey last month: “London has the heaviest children in Britain.”
Almost four in 10 London children are overweight or obese when they leave primary school, with obesity rates in the poorest areas of the capital twice those in the least deprived areas. And there are more than 8,000 takeaway food outlets in London, again clustered in poorer areas.
Will the ban make a difference? With a range of expert endorsements, the signs look promising. According to Chief Medical Officer for England Professor Dame Sally Davies, for example, while it’s not a silver bullet, “the evidence is clear that…restricting the amount of junk food adverts children are exposed to will help reduce obesity.”
And it is just part of a range of initiatives set out in the Mayor’s Health Inequalities strategy, launched in September, including support for early years providers and a high level child obesity taskforce chaired by healthy food entrepreneur Paul Lindley.
A further ban, on all new fast food takeaways within 400 metres of primary or secondary schools, is promised in the Mayor’s draft new London Plan, though this still needs to get over its public inquiry hurdle.
The strategy is a blueprint for creating “a healthier, fairer city, where nobody’s health suffers because of who they are or where they live,” Khan says. Nevertheless, it comes with its own health warnings, particularly the need for buy-in across London, and the cash to pay for it all.
As the strategy itself states, it “cannot succeed without the support and commitment of London’s local authorities”. The Mayor has a statutory duty to produce the strategy, but limited powers.
City Hall funding for it is just over £2 million in 2018/19. The boroughs, on the front line since taking over public health responsibilities in 2013, received some £600 million in government public health funding this year. But public health budgets nationally will be down by £700 million by 2019. An extra £3.2 billion a year is needed to reverse the impact of the cuts, according to health improvement charity the Health Foundation.
A Green Paper on prevention is promised next year, following this month’s “prevention is better than cure” vision paper. The influential King’s Fund is not holding its breath: “It seems, to date at least, that prevention is better than cure, except when it comes to paying for it.”
Dr Jeanelle de Gruchy, president of the Association of Directors of Public Health and formerly Haringey’s public health chief, warns that public health and wider local government cuts “are a real threat to giving everyone a fair chance in life”.
She told MPs last week: “If you cut councils by 40 per cent, the room to innovate, the public health expertise available and the ability to create healthier places is limited. If we got that resource – wow, what could we be doing?”
Meanwhile Greater Manchester is planning public health policy across its city region following health and care devolution. Time for a new push on health devolution to London?