Food Marketing Regulation and Childhood Obesity Prevention

Lead Research Organisation: University of Liverpool
Department Name: Law

Abstract

Obesity, or excessive fatness, is not a new phenomenon. What is startling is the recent increase in overweight and obesity prevalence in almost every country in the world, including low and middle income countries. As obesity carries with it a wide range of health problems, it has also an adverse economic impact, imposing a cost not only on affected individuals and their families, but also on society as a whole. The challenge facing governments and health authorities is to deliver a sustainable response to overweight and the obesity 'pandemic' by putting in place effective multisectoral strategies dealing with the many determinants of obesity.

As the regulation of food marketing is seen as a cornerstone of effective obesity prevention strategies, the 193 Member States gathered at the Sixty-third World Health Assembly in 2010 unanimously endorsed a set of Recommendations intended to guide efforts by Member States in designing new and/or strengthening existing policies on food marketing to children (the Recommendations) through adoption of Resolution WHA 63.14. Since then, the World Health Organization has commissioned a Framework Implementation Report which I co-drafted with a view to putting some flesh on the bones of the Recommendations and provide guidance to Member States on how best to implement them.

The project is a follow up to the adoption of the Recommendations as interpreted by the Framework Implementation Report. It seeks to provide further guidance to Member States on how these Recommendations could help to improve the regulatory framework at a national level. It is therefore intended to assist policy makers and other stakeholders in developing the legal skills required to design food marketing policies. This will, in turn, contribute to the adoption of more effective childhood obesity prevention strategies.

The project is divided into three distinct, closely related phases. The first phase consists of a six-month placement at the headquarters of the World Health Organization in Geneva, in the Unit dealing with population-based prevention for diet and physical activity as two major risk factors for non communicable diseases. Using the Framework Implementation Report I co-drafted, I will provide direct support to a selected number of Member States from across the WHO Regions, including the UK as well as a range of low and middle income countries, to identify potential barriers to implementation and develop potential solutions. I will work on developing a specific evaluation tool which the selected Member States will use to identify the barriers for implementation and develop strategies to overcome them.

The second part of the project consists of the organisation of a one-day workshop in London which will focus on what the UK should do to fully comply with the Recommendations. This workshop will be designed specifically for all stakeholders directly or indirectly involved in the decision-making process and will ensure their participation at all stages of the workshop, from its preparation to its delivery and dissemination.

The third and final part of the project consists of the publication of a book in English on the regulation of food marketing to children which will capture existing knowledge on this issue and allow for its broad dissemination. It is therefore intended to support the development of effective childhood obesity prevention strategies at both national and international level.

Planned Impact

Firstly, the project will assist WHO and policy makers in developing the legal skills required to design food marketing policies. It will therefore contribute to the adoption of more effective childhood obesity prevention strategies at national, regional and international level. The project will be of particular benefit to the selected Member States working with the Investigator for the duration of the project, particularly during her six-month placement at WHO. It has been agreed that these States would include the UK in light of the her expertise and her knowledge of English law, as well as a selection of low and middle income countries which may not have the capacity to invest in policies restricting food marketing to children as much as growing obesity trends would require and are therefore in particular need for the development of creative solutions. The project nonetheless has the potential to reach all 193 Member States parties to the Recommendations through the sharing of the investigator's expertise with, and the training of, WHO staff members.

Secondly, the project will benefit consumer and public health organisations as key stakeholders involved in the design, implementation, monitoring and evaluation of obesity prevention strategies. The project will inform their advocacy campaigns for stronger restrictions on the marketing of food to children and therefore assist them in developing the tools required to promote public health objectives at national, regional and international level. In particular, it will help them counteract more effectively the misconceived argument regularly advanced by food and advertising industry operators - and often relayed by policy makers - that the constitutionally protected right to free commercial speech prevents the imposition of any restrictions on food marketing to children.

Similarly, the project should benefit child-focused NGOs and children's rights advocacy groups, with a stronger basis to propose alternative strategies in the future. Adopting a children's rights approach to the issue of unhealthy food marketing offers much potential for law and policy reform, even though the development of obesity prevention strategies has tended to be rather low (if at all) on the agenda of children's rights NGOs/campaigners. This project aims to promote the best interest of the child in all policy areas, as mandated by the UN Convention on the Rights of the Child. Indirectly, therefore, it should benefit children and their families, and therefore improve their welfare, particularly but not exclusively in the UK.

By developing a more thorough understanding of the arguments underpinning the debate about the regulation of food marketing to children, the project also has the potential to help food and advertising industry operators re-assess their position and more willingly embrace the need for significant changes in the discourse and the approaches they have adopted to date.

Finally, the Investigator's ability to frame the debate in more conceptual terms may also indirectly influence the thinking of policy makers and other stakeholders involved in the development of restrictions on the marketing of other products, including alcoholic beverages, tobacco products and pharmaceuticals, as part of effective public health strategies.

The project therefore has a very broad range of potential research user beneficiaries, both direct and indirect. This is due to at least three factors. Firstly, growing childhood obesity rates are a cause for concern in all countries in the world, thus making obesity a public health priority at national, regional and global levels. Secondly, obesity is a multifactorial condition which requires the concerted action of a broad range of stakeholders in a range of policy areas, including food marketing regulation. Finally, food marketing is a global issue affecting all countries in the world, thus making it an inherently international issue (see below).

Publications

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Related Projects

Project Reference Relationship Related To Start End Award Value
ES/J020761/1 31/12/2012 31/03/2013 £98,745
ES/J020761/2 Transfer ES/J020761/1 01/04/2013 31/12/2013 £73,556
 
Description This ESRC Follow-On grant has allowed me to contribute to a better understanding of the role that legal instruments can play in promoting healthier lifestyles, and more specifically childhood obesity prevention. I have not discovered new knowledge as such (this was not the purpose of the grant obtained), but I have sharpened my ability to explain difficult legal concepts to a non-legal audience and therefore allowed non-specialists to understand the need to engage with such concepts if they are to regulate effectively the marketing of foods and non-alcoholic beverages to children (and other risk factors for non-communicable diseases).
Exploitation Route I am in the process of setting up a Research Centre in Liverpool Law School to continue the work I have carried out over the last ten years, and particularly as part of my ESRC research grant, on the role of law in preventing and controlling non-communicable diseases. This may in the medium term become a WHO Collaborating Centre.

I have also started to recruit a couple of PhD students to work specifically on law and non-communicable diseases (NCDs).

Furthermore, I am working with other experts on law and NCD prevention on a range of policy-making initiatives in the UK, Europe and beyond, thus contributing fully to the development of this new discipline at both national and global levels.
Sectors Agriculture, Food and Drink,Digital/Communication/Information Technologies (including Software),Healthcare,Government, Democracy and Justice

 
Description When I embarked on this ESRC project, the role that legal instruments could play in promoting healthier lifestyles, and healthier diets more specifically, had attracted very little attention both within and beyond academic circles. Consequently, public health policy-makers entrusted with the development and implementation of obesity prevention strategies had not come to appreciate the importance of involving legal experts at an early stage of the policy process. This was not without consequences: laws, which are not merely a set of rules but fit within a broader legal system, were often ill-conceived and not always sufficiently respectful of higher norms derived from international trade law, fundamental rights law or constitutional law. As a result, the food industry, which has tended to have more legal capacity than the public health sector, has been able to rely on these higher norms in order to minimise the interference of policy-makers with their businesses, often to the detriment of public health. To some extent, the lack of legal capacity and the low level of engagement of the public health community with lawyers still exist. However, the impact of this project has been to significantly raise awareness on the important role legal instruments can (and should) play in promoting healthier diets, and healthier lifestyles more generally. It has done so at all levels and has targeted the broad range of stakeholders I had identified as potential beneficiaries in my ESRC application back in October 2011. The five-month secondment I undertook at the headquarters of the World Health Organization in Geneva from February to June 2013 has contributed to a better understanding of the opportunities the law offers for the obesity and NCD prevention agendas and has arguably had a strong 'multiplier effect', in the sense that one activity has led to another: - I have contributed to a better understanding within WHO (at headquarters and in its regional offices) of the importance of engaging with legal arguments to promote healthier lifestyles. - I have worked directly with several Member States to help them develop their legal frameworks on the marketing of foods and non-alcoholic beverages to children. - I have been asked to produce a report for WHO on the extent to which the WHO Recommendations on the marketing of foods and non-alcoholic beverages to children have been implemented in the Member States and how their implementation could be improved. - I have organised an expert consultation on marketing of foods and non-alcoholic beverages to children in the Eastern Mediterranean Region, Amman, Jordan, 18-19 September 2013 for the East-Mediterranean Regional Office of WHO - for whom the University of Liverpool has become one of the key partners in relation to the development of their obesity and NCD prevention agenda. - I have trained several non-governmental organisations working in the field of public health, consumer and children's rights protection, showing them how lawyers have a significant contribution to make in the debates surrounding healthier lifestyles. - I have participated in several multi-disciplinary, high-profile conferences and workshop intended to promote healthier lifestyles. - I have been asked to participate in a range of Ad Hoc expert group meetings to reflect on obesity and NCD prevention, not least the Ad Hoc Expert Group on Science and Evidence that advises the Commission on Ending Childhood Obesity which the Director-General of WHO set up in June 2014. The one-day interdisciplinary workshop I organised in London in September 2013 has contributed to the ongoing reflection at national level on the extent to which existing rules restricting the marketing of unhealthy food to children should be reviewed in light of the WHO Recommendations my research project focused on. Several initiatives have resulted from this event: I was asked to replicate the seminar in Paris to inform the debates surrounding the marketing of unhealthy foods in France; I was invited to organise and chair a parallel session devoted to food marketing at the Annual Conference of the UK Association for the Study of Obesity in September 2014; and I became a member of a working group the British Heart Foundation has set up on food marketing to children. The proceedings of the London workshop will be published as a Special Issue of the European Journal of Risk Regulation in the first half of 2015. Not only has one activity led to another, but the work I have done on one NCD risk-factor - unhealthy diets - has attracted the attention of stakeholders working on other NCD risk-factors - not least tobacco and excessive alcohol consumption: - I have produced a policy report for Action on Smoking and Health (ASH) and Cancer Research UK (CRUK) on the compatibility of the proposals to introduce plain packaging in the UK with the recently revised EU directive on tobacco products. - I participated in the CINDI Policy Academy which the Regional Office for Europe of WHO organised in Porto in October 2014 on the marketing of food and alcoholic beverages, where I delivered one of two keynote lectures and provided direct advice to Member States in helping them develop their laws on food and alcohol marketing. - I delivered a plenary talk at the Eurocare conference held in Brussels in November 2014 and whose main purpose was to reflect on the future of the EU Strategy on Alcohol-Related Harm. - At a more local level, I am working with local charities involved in obesity and NCD prevention. In light of the growing importance of tackling NCD prevention, the many questions that call for a stronger engagement of the academic community, the requests I have received for legal advice from the broad range of stakeholders I have worked with, I have decided to set up a research unit at Liverpool Law School whose focus will be on Law and NCD Prevention. It is intended to build on the expertise I have gained over the years, and have significantly developed during this ESRC project. It has been approved and will be launched later this year. One of its first activities will be the organisation in Liverpool in 2015 of a one-week bi-regional training course for WHO Member States from the East-Mediterranean and the European Regions to help States build their legal capacity and improve their advocacy strategies when addressing the growing burden of NCDs. Liverpool University is an ideal setting for this type of research, in light of its reputation in public health research. The book I have undertaken to write as part of this ESRC project will bring together all the knowledge and experience I have gathered over the years. It was delayed, not least as a result of the many impact opportunities which have resulted from the growing understanding that legal experts should be an integral part of the NCD prevention and control agenda. It will complement the book I wrote in 2010 on EU Law and Obesity Prevention (Kluwer Law International, October 2010), and the book I co-edited (with Alberto Alemanno from HEC Paris) on Regulating Lifestyles in Europe - Tobacco, Alcohol and Unhealthy Diets (Cambridge University Press, January 2015). It is notable that the WHO Global Action Plan for the prevention and control of NCDs for 2013-2020 which the Sixty-sixth World Health Assembly adopted unanimously in May 2013 refers specifically to the role that legal instruments can play in promoting healthier lifestyles. In many ways, this ESRC research project has contributed to the growing understanding that the unprecedented rates of NCDs worldwide require a more effective use of legal instruments; it certainly has allowed me to contribute to the provision of evidence-based solutions to defeating the unprecedented global NCD epidemic. It is however difficult to further demonstrate the extent of the impact this project has had - bearing in mind the nature of committee work and the fact that the momentum does not rest on the work of one individual alone. If one relies on the multiplier effect of my involvement both in terms of engagement and policy initiatives, as well as in terms of NCD risk factors (to cover unhealthy food, but also alcohol and tobacco consumption) and growing stakeholder engagement, there is clear evidence that the project has delivered in impact terms beyond what it had embarked upon.
First Year Of Impact 2013
Sector Agriculture, Food and Drink,Digital/Communication/Information Technologies (including Software),Healthcare,Government, Democracy and Justice
Impact Types Policy & public services

 
Description Involved in the development of childhood obesity policies, specifically on food marketing to children
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact The ESRC grant I was awarded funded a period of research leave which I partly spent working with the World Health Organisation. In particular, I have assisted a range of WHO Regions and Member States in the development of laws and policies intended to promote healthier lifestyles and curb childhood obesity. Since 2013, I have continued to work closely with the WHO and have helped them develop some training material to help WHO, Member States and non-governmental or international organisations use legal instruments more effectively to promote healthier lifestyles and oppose challenges from industry operators (food, but also alcohol and tobacco).
URL http://applications.emro.who.int/docs/IC_Meet_Rep_2014_EN_15285.pdf?ua=1
 
Description Member of a Group of International Experts on alcohol marketing to children
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a advisory committee
Impact Alcohol Focus Scotland convened an international working group to work on how best Scotland, within the scope of its devolved powers, could regulate alcohol marketing to protect children from its harmful impact. The working group produced a report, published in February 2017, which has been welcomed by a number of Scottish MPs.
URL http://www.alcohol-focus-scotland.org.uk/news/scottish-government-urged-to-curb-alcohol-marketing/
 
Description Member of the Ad Hoc Expert Group on Science and Evidence advising the WHO Commission on Ending Childhood Obesity
Geographic Reach Multiple continents/international 
Policy Influence Type Membership of a guideline committee
Impact The Ad Hoc Expert Group on Science and Evidence provided the evidence required to the WHO Commission on Ending Childhood Obesity to produce its recommendations to the World Health Assembly of May 2016. The WHA welcomed the report and has urged the WHO Director General to propose an implementation plan which is due to be discussed at the WHA in May 2018.
URL http://www.who.int/end-childhood-obesity/commissioners/en/
 
Description Policy report for Action on Smoking and Health and Cancer Research UK on tobacco plain packaging
Geographic Reach Europe 
Policy Influence Type Influenced training of practitioners or researchers
Impact My colleague Professor Alberto Alemanno and I were approached by ASH and CRUK in 2014 to write a legal opinion for them on the compatibility with the EU Tobacco Products Directive of 2014 of the UK proposal to standardise the packaging of tobacco products (which have since been adopted).
URL http://www.ash.org.uk/current-policy-issues/advertising-and-promotion/standardised-plain-packaging
 
Description Building legal capacity for the implementation of the WHO Recommendations on the marketing of food and non-alcoholic beverages to children 
Organisation World Health Organization (WHO)
Country Global 
Sector Public 
PI Contribution I was asked to develop, organise and run two bi-regional workshops for the WHO with a view to helping Member States develop the legal capacity required to implement the WHO Recommendations on the marketing of foods and non-alcoholic beverages. Over 30 Member States from the European, the East-Mediterranean, the Western Pacific and the East-Asian Regions attended.
Collaborator Contribution The WHO identified the relevant members of the audience requiring training, reviewed the programme we had developed and played a key role in the running of the seminars both in Amman (June 2015) and in Kuala Lumpur (December 2015).
Impact - We have produced a package of course documents for WHO. - We have produced a report on the marketing of food and non-alcoholic beverages to children in the East-Mediterranean Region, looking specifically at how the WHO Recommendations on the marketing of foods and non-alcoholic beverages to children have been implemented in the Region. This report is in its third phase. We started to work on it in 2013 (as part of my secondment at WHO during my funded research leave); a draft was produced in 2015; it is now being updated for publication later in 2017. The updates are based on questionnaires that have been circulated to all 22 countries in the Region as well as our developing knowledge of the field. - We have been a member of a WHO EMRO working group on Law and NCD Prevention. - We have reinforced our existing links with WHO (which started in 2010) and have contributed to a range of events they have organised and have advised them and Member States on an ad hoc basis. For example, I am expected to travel to Oman in May 2017 with two of my colleagues from the Law & Non-Communicable Diseases Unit (based in the Law School of the University of Liverpool). Our visit will be intended to help the Omani Government develop its regulatory framework to better protect children from unhealthy food marketing. - As a result of this successful collaboration, we have joined a network advising the UN Interagency Task Force on the role that legal instruments can play in preventing non-communicable diseases. A meeting took place in New York in February 2016 to advise the Task Force on how it should reflect on the use of law in the prevention and control of NCDs.
Start Year 2015
 
Description Building legal capacity for the protection of children from harmful alcohol marketing 
Organisation IOGT International
Country United States 
Sector Learned Society 
PI Contribution We teamed up with IOGT and the European Regional Office of the WHO to design a training on children's rights and alcohol marketing to a range of NGOs based in Europe and whose main purpose is to fight alcohol-related harm. I travelled with three of PhD students and members of the Law & Non-Communicable Diseases Unit. We designed the training and delivered it over the course of a full day.
Collaborator Contribution Our partners contacted their network and were responsible for the logistics and the publicity around the event.
Impact We are reflecting on the way forward and have agreed with IOGT that we would produce a short briefing note for policy makers and civil society on the use of human rights (and children's rights more specifically) to protect children from the adverse impact of alcohol marketing.
Start Year 2016
 
Description Chidren's Rights and Food Marketing 
Organisation UNICEF
Country Global 
Sector Public 
PI Contribution Following recommendations from various experts on childhood obesity with whom we have worked over the years, we were contacted by UNICEF in the summer of 2015 to write a report on the impact of food marketing on children's rights.
Collaborator Contribution UNICEF has identified the issues which it would like us to focus on and has placed childhood obesity high on its agenda.
Impact The work is ongoing. We are about to submit the first policy report written which promotes a children's rights approach to childhood obesity prevention, and the regulation of unhealthy food marketing more specifically.
Start Year 2015
 
Description Course for WHO EMRO in Amman, Jordan 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The Eastern Mediterranean Regional Office of the World Health Organisation (EMRO) asked me to spend a couple of weeks in Cairo in April-May 2013, as part of my placement with the Head Office in Geneva in 2013. Following my visit, I was asked to work on a report on the implementation of the WHO Recommendations on the marketing of foods and non-alcoholic beverages to children in the Region. After the first draft was produced, the Regional Director and his teams working on health promotion and non-communicable diseases asked me to organise a course on EMRO's behalf for health ministries in the Region, with a view to providing the technical capacity required to implement successfully the WHO Recommendations as part of effective obesity prevention strategies. A two-day course therefore took place in Amman, Jordan, in October 2013.

The course helped raise awareness in the Region on the importance of regulating unhealthy food marketing to children. The momentum is growing. In order to prepare for the course, a mapping exercise was carried out which showed that very few countries had regulated food marketing to children in the Region. This showed how much remained to be done. We are now in the process of updating the draft report with a view for publication and preparing for a bi-regional one-week course (with WHO European Regional Office) (see separate entry on this course).

Here is the relevant extract from the Regional Director's activity report for the year 2013 (URL below):

"A regional mapping study of progress in the implementation of the WHO recommendations on the marketing of foods and nonalcoholic beverages to children, conducted in collaboration with Liverpool University, showed limited awareness of the recommendations, poor development of legal frameworks to control such marketing, and lack of attention to cross-border marketing. An expert consultation, attended by representatives from consumer groups, child health protection groups, nutritionists, lawyers and media networks, recommended Member States to adopt a comprehensive approach to regulate marketing, and made key recommendations to accelerate the implementation of the WHO recommendations, including the establishment of a national multisectoral working group in each country led by the Ministry of Health. This work will be carried forward in 2014 with focus on building the capacity of consumer protection groups in this area, and on advocacy development and enforcement of marketing regulation."
Year(s) Of Engagement Activity 2013
URL http://www.emro.who.int/annual-report/2013/noncommunicable-diseases.html
 
Description Policy training workshop for the European Public Health Alliance in Brussels on Law and Non-Communicable Diseases in Europe 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact The purpose of the meeting was to try and build capacity of Brussels based NGOs on the extent they could use legal instruments to promote healthier lifestyles in Europe. We focussed specifically on the ongoing revision of the audio-visual media services directive and its provisions on food and alcohol marketing; on the implementation of the Tobacco Products Directive and in particular the extent to which it allows Member States to adopt standardised packaging of tobacco products; and the future of the EU Alcohol Strategy.
Year(s) Of Engagement Activity 2015