Graphic image in which a large billboard looms over a street as people flee before it. The billboard reads "Bad publicity: an Adfree Cities blog series on how omnipresent advertising shapes our lives"

Advertising, public health and the pollution of discourse 

In this blog, part of the Bad Publicity series, Dr Nason Maani, Lecturer in Inequalities and Global Health Policy at the University of Edinburgh, examines how outdoor advertising pollutes our environment and health. Moreover, advertising effects even the way we talk about health and our expectations of what it means to be healthy at all, as the example of smoking ads makes clear.

The water we swim in

In a 2005 speech, the American novelist David Foster Wallace opened with a now famous parable: Two young fish are swimming along and they happen to meet an older fish swimming the other way, who nods at them and says “Morning, boys. How’s the water?” And the two young fish swim on for a bit, then eventually one of them looks over at the other and goes “What the hell is water?”. The point of this story was not, as he went on to say, that he was the wise old fish, explaining the world to the students, but rather, that the most obvious, important things can be the hardest to see or question. 

This is very much true of our health. When you think of health, the first image is often that of medicine, doctors, nurses. But that is healthcare, rather than health. That’s what you need when you are sick, but at the population level our health is overwhelmingly influenced by forces far beyond healthcare. The wealth of our parents, the pollutants in the air, the quality of the food on our supermarket shelves, the education and work opportunities around us, the time we have for leisure, our social connections, what our wider society considers good, or bad, these are examples of what to a large degree determines health at the population level. It is the physical and social world around us. The water in which we swim. 

“We might aspire for our social norms, how we value and make choices over what we do, to be a little less polluted by the weight of commercial influence”

The scale of the problem

So that being said, what affects the water we swim in? What affects these wider environments? Particularly in our modern world, our environments are powerfully shaped by commercial actors, such as through marketing, of which advertising is a part. The scale of advertising can be truly enormous, and is most concerning when it comes to unhealthy products. Diageo (the company behind brands like Johnnie Walker, Guinness, and Smirnoff), spent over £2.7 billion on marketing in 2022, a 51% increase from 2017. When it comes to outdoor advertising in particular, amongst the biggest spenders in the UK in 2022 were McDonald’s, Coca Cola and KFC, who together spent £150 million on outdoor marketing

By way of contrast, the entire World Health Organisation has an annual global budget of around 2.6 billion pounds. If health promotion campaigns (which comprise a small proportion of the WHO budget) sprinkle information about healthy living into the public consciousness, then the global marketing spend by manufacturers of harmful products are like a firehose, dwarfing them in scale. 

A graphic shows a wave of alcoholic drinks falling on two doctors running away.

Unequal harms

Advertising also has unequal effects on different audiences. For people who already have an unhealthy dependency on a certain product (and are therefore among the heaviest consumers), advertising can be an especially strong prompt for additional consumption. For children who are still developing an understanding of the nature and persuasive intent of advertising, advertising is especially potent. Unhealthy food and drink adverts make up a large proportion of overall food advertising, and food promotions have been found to have a direct effect on children’s preferences, intentions to consume, and consumption patterns. These ads are not just prevalent in sporting arenas and events, on TV, or on social media. They are physically all around us too. 

A 2022 survey of residents of Bristol found that 40% of respondents reported seeing outdoor ads for foods high in fat, salt and sugar (HFSS) and of those 16% observed product advertisements aimed at children. The findings, claimed the authors of the report “corroborate previous evidence from other areas indicating that young people and people living in lower socio-economic areas are exposed to, or observe, more advertising of HFSS products”. 

Beyond the scale and the effects on vulnerable groups, advertising has cumulative effects on what we consider normal. It associates certain products with sentiments, values, aspirations or occasions, and then it reinforces those messages. It might seem unthinkable now, but it was advertising campaigns that first popularised cigarette smoking as being healthy and endorsed by the medical profession, then as being linked to masculinity (such as through the Marlboro Man), then, in seeking new markets, as being a symbol of the emancipation of women. These social expectations and values shifted from one to the next, egged on by advertising campaigns from a range of manufacturers. The cumulative effects of lots of different overlapping campaigns added up, in the same way that individual pollutants from many different sources all add up in our physical environment. How we think and talk about things, our discourse, can be polluted, just like our environment is

Image shows two billboards. One has an ad for Mcdonald's, the other an ad for Sprite.

Cleaning up the pollution

There is nothing to stop us seeking to clean it up, and prevent its pollution in the first place. In 2021, Bristol City Council introduced an updated advertising and sponsorship policy, restricting advertising for HFSS products on council-owned advertising sites such as bus stops. A similar move by Transport for London in 2019 was linked to healthier household purchasing across London. Other cities have since introduced similar measures against HFSS ads, including Barnsley, Haringey; Merton and Southwark

Just as we might wish for our physical environment to be cleaner and healthier because we know it constantly influences our well-being and happiness, we might also aspire for our social norms, how we value and make choices over what we do, to be a little less polluted by the weight of commercial influence. We could think of it as making the water we swim in a little clearer, for us, and for our children, who don’t yet know what water is.

This guest blog is part of the Bad Publicity series, in which academics in fields from public health to surveillance, degrowth and behaviour change explore the ways in which advertising intersects with pressing contemporary social and political issues.

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