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Summary
- Alcohol marketing is causally linked to young people drinking from an earlier age and more than they otherwise would.
- Individuals living in deprived areas experience greater health inequalities in comparison to those living in the least deprived areas.
- There is limited research on outdoor advertising of alcohol in the UK, but researchers have noted that there is a high prevalence of outdoor advertising of unhealthy commodities in deprived areas.
- Alcohol outlet availability and associated advertising in areas of deprivation can contribute to higher crime rates in those areas.
- Despite financial challenges that local councils are facing, restricting outdoor unhealthy commodity advertising (including alcohol) could help to reduce health and social problems (including alcohol harms) that drive inequalities.
Introduction
Alcohol advertising consists of various mediums (outdoor, print, television, radio, online/social media, etc.) intended to promote and sell alcohol products.[1] This marketing directly impacts the drinking behaviour of individuals consistently exposed to them.[2] Alcohol marketing has been associated with increased drinking interest, overall alcohol consumption, early-age drinking, and heavy episodic drinking.[3] Alcohol marketing can also negatively affect former drinkers who are in recovery from alcohol-related issues, as it may trigger cravings for alcohol, leading to alcohol consumption.3
The advertising of alcoholic products is therefore one example of how commercial entities impact health and well-being, referred to as the commercial determinants of health. Marketing strategies deployed by the alcohol industry encourage the sale and consumption of alcohol, which in turn contributes to the increase in non-infectious diseases.[4] These diseases include liver cirrhosis, type-2 diabetes, cancer, cardiovascular disease, and obesity.[5]
Local councils have the authority to regulate outdoor alcohol advertising within their communities to protect the rights of their community members, and some have been proactive in leveraging this power. However, limited research in the UK about the relationship outdoor alcohol advertising has with alcohol-related harms presents a challenge to decisionmakers seeking to introduce novel public health policies.
This briefing explores the prevalence of outdoor advertisements for unhealthy commodities, the impact of alcohol advertising, the distribution of alcohol advertisements by area of deprivation, and the limitations and possibilities of local councils regulating unhealthy commodity advertising.
Alcohol advertising and consumption
Alcohol outlet availability and marketing can cause children to start drinking alcohol at a younger age and drinking more than they usually would.[6], [7], [8]
In an analysis of the impact alcohol marketing has on alcohol consumption, researchers suggest that alcohol marketing gives the brain cues that stimulate one’s interest to drink, and that the developing brains of adolescents are particularly responsive to this.[9] There are a few stages that children go through as a response to alcohol marketing. These stages include:10
Outdoor advertisements of unhealthy commodities
What is outdoor advertising?
Outdoor advertising is a fundamental pillar of marketing. Defined as any type of advertisement that is shown outside, typically in public areas,[10] outdoor advertising has been found to reach 98% of the UK population weekly.[11] Outdoor advertising is utilised by many industries, including entertainment and leisure, food, drink, finance, travel and transport, government, retail, accessories, and many others. These types of advertisements provide a substantial amount of revenue to the UK. In 2023, outdoor advertising generated about £1.3 billion in revenue.[12] Figure 1 shows the outdoor advertising revenue from 2010-2023.13
Figure 1. 2010-2023 UK outdoor advertising revenue (£) (Source: Outsmart, 2024)
How is outdoor advertising regulated?
Outdoor advertising is regulated by Local Authorities, the Advertising Standards Authority (ASA), and the Committee of Advertising Practice (CAP). This includes the advertising of unhealthy commodities.
CAP is responsible for writing and maintaining the UK Advertising Codes. One of the specified intentions of the Codes is to ensure that adverts do not “cause serious or widespread harm or use approaches that are likely to encourage socially irresponsible behaviour”.[13]
Regarding alcohol, Section 18 of the ASA UK advertising codes specifically addresses alcohol advertisements, primarily focusing on social responsibility, protection of individuals under 18, and health claims.[14] For instance, an ASA advertising code specifically for the protection of individuals under 18 is as follows:
18.14: Marketing communications must not be likely to appeal particularly to people under 18, especially by reflecting or being associated with youth culture. They should not feature or portray real or fictitious characters who are likely to appeal particularly to people under 18 in a way that might encourage the young to drink. People shown drinking or playing a significant role should not be shown behaving in an adolescent or juvenile manner.
How prevalent is the outdoor advertisement of unhealthy commodities?
The unhealthy commodity industries typically include the manufacture, marketing, and selling of tobacco, alcohol, foods and drinks that are high in fat, salt, or sugar (HFSS), and gambling.[15]
Four in five outdoor billboard advertisements are located in the most deprived half of England and Wales.[16] It has also been found that, across England, there are more than six times as many outdoor advertisements for harmful products in the country’s most deprived areas than in the least deprived areas.[17] Table 1 shows the distribution of outdoor advertising by levels of deprivation.18
Table 1. Distribution of outdoor advertising by decile of the English Index of Multiple Deprivation (Source: Adfree Cities, 2024)
In a study based in Bristol and South Gloucestershire, they found that people living in more deprived areas and young people observed more HFSS advertisements, but there was less evidence of such a correlation for alcohol or gambling.16
The impact of outdoor alcohol advertising
Studies have identified that alcohol advertising may contribute to alcohol-related inequalities as advertisements are concentrated in deprived areas.[18], [19] Palmer et al. (2021) conducted a study to identify unhealthy commodity advertisements in street view images in Liverpool, UK, to see if they reinforce social inequalities in health. In this study, they extracted 10,106 advertisements in the town, and found a higher prevalence of unhealthy advertisements, including for alcohol, in deprived areas and student populations, highlighting that advertisements in these areas could exacerbate inequalities in health-related conditions.[20]
The influence that alcohol marketing has on alcohol consumption among children can be even more influenced by alcohol outlets within their neighbourhood. Alcohol outlet availability in areas of deprivation can be a determinant of the amount of alcohol advertising that is present within a community.[21] In Scotland, there are more alcohol outlets – both on-trade and off-trade outlets – in the most deprived neighbourhoods than in the least deprived neighbourhoods.[22] As a result of the high density of alcohol outlets in deprived neighbourhoods, violent crime was also higher in these areas in Scotland. Violent crimes include sexual offences, domestic housebreaking, vandalism, drug offences, and common assault.23 Across Scotland, neighbourhoods with the most alcohol outlets had crime rates four times higher than neighbourhoods with the least.23 In general, studies have noted that there is an association between alcohol outlets’ use of alcohol advertising and violent crimes, as high alcohol outlet availability further increases opportunities for at-risk communities to engage in violent acts.[23], [24], [25]
Although evidence is lacking on the correlation between alcohol advertising as a contributor to the increase in violent acts in the UK, there are studies based in other countries that have recognised the correlation. A study based in South Africa assessed the impact of exposure to alcohol advertisements on women’s alcohol consumption, reproductive history, and health and social outcomes for those living in urban and rural areas. Amanuel et al. (2018) found that women who said that they had high exposure to alcohol advertisements in their communities were 4.2 times more likely to experience inter-partner violence and 3.4 times more likely to report heavy community drinking.[26]
A study in the US in Baltimore City, Maryland, also analysed the association between outdoor alcohol advertisements visible at off-premise alcohol outlets and violent crime, before state officials placed restrictions on retail alcohol establishment advertising practices in 2017. Trangenstein et al. (2020) highlights three reasons why alcohol ads may increase violence:
- Advertisement exposure increases alcohol consumption, which could then increase violent crime.
- Advertisements often display price discounts, and low-price alcohol is independently associated with higher levels of consumption and violence.
- Advertisement content shapes social norms in ways that promote aggression and violence.
Specifically, in Baltimore City, they concluded that outdoor alcohol advertisements were associated with about 15% higher levels of aggravated assault, forcible rape, and robbery, and nearly 30% higher levels of homicide.25
For future research, the extent to which alcohol outlets and its alcohol advertising – and alcohol advertising independently – contribute to violence in deprived areas in the UK should be studied as it can provide more insight into how beneficial alcohol advertising restrictions could be to reducing inequalities.
Several studies have highlighted the importance of alcohol advertising regulation to reduce the likelihood of alcohol-related harms increasing across the UK in the future. As inequalities persist, alcohol-related deaths and hospital admissions are costing the NHS and society significant amounts of money. The cost of alcohol harm in England alone stands at £27.4 billion.28 Figures for Scotland, Wales, and Northern Ireland are more dated, with estimates ranging between £6.9 – £11.9 billion total.[27]
Figure 3. Cost of alcohol harm in England 2021/2022 with an overall cost of £27.44 billion (£485 per head) (Source: IAS, 2024)
Local council reliance on outdoor advertising
According to McKevitt et al. (2023), local authorities have the power and leverage to reduce the marketing of harmful commodities in public spaces through local policies.[28] The number of local councils that are utilising their power to combat inequalities associated with unhealthy commodity advertising (including alcohol) is increasing.
However, financial hardship faced by many councils means they may rely on revenue from advertising. There are currently 1 in 5 councils at risk of issuing a section 114 notice due to financial hardship, making it harder to uphold key services (e.g., education, waste and recycling, social care, general domestic safety issues, etc.).[29] A Section 114 notice is given if the expenditure of a council is likely to exceed the financial resources that are available, resulting in debt, and therefore a budget is not balanced.
Councils can raise revenue in various ways to deal with the challenges that come from high-level debt. Revenue is received through council tax, government grants, business rates and sales, fees, and charges.[30] Across local councils, there have been cuts to essential services and increases to local taxes, with greater need of funds from the government. Some local councils struggle to maintain social care services financially because these significant cuts require long-term plans to support vulnerable communities. To respond to financial pressures, councils can and have taken advantage of advertisements to help with income needs. For example, councils in Wales – Blaenau Gwent, Torfaen, Wrexham, and Vale of Glamorgan councils – have been displaying website advertisements since 2014 and have benefited financially, with the councils having generated £34,585 (as of 2017).[31] However, unhealthy commodities such as gambling, alcohol, and drugs were prohibited from being placed on these websites.
It is unclear how much revenue local councils, especially those with high debt levels, make from the outdoor advertising of alcoholic products in the UK. However, in studies that have evaluated the distribution of unhealthy commodities, advertisements include alcohol products. So, there is a high chance that some local councils receive some form of revenue from the alcohol industry to promote their products, but freedom of information (FOI) requests are needed to confirm revenue from the alcohol industry. There was an FOI completed in Scotland about the money made by the Scottish Government from alcohol sales. No direct revenue was received or money made by the Scottish Government from alcohol companies for advertising between 2018 – 2022.[32]
A longer-term strategy to try to reduce the cost of harm would involve restricting unhealthy commodity marketing. Some local councils have already acted to reduce outdoor unhealthy commodity advertising:
- In 2019, Transport for London (TfL) put a ban in place on HFSS food, and in 2008, it banned drinking alcohol or carrying open containers of alcohol on all tube, bus, DLR, London Overground, and tram services and stations.[33], [34] The HFSS advertising ban has contributed to a 1,000 calorie decrease in unhealthy commodity purchases in people’s weekly shopping.[35]
- In March 2021, Bristol City Council became the first local authority outside of London to ban advertisements of unhealthy commodities, gambling, alcohol, and payday loans on council-owned outdoor sites (e.g. bus shelters and billboards).[36]
- In June 2021, Norwich Council voted to limit harmful advertising and developed an advertising strategy that recognises the harmful effects of HFSS foods, environmentally polluting products, payday lenders, gambling, and alcohol, along with their impact on community members.[37]
- For 2024-2026, the Sheffield City Council Advertising and Sponsorship Policy restricts the promotion of harmful commodities (e.g., alcohol, vaping, gambling, HFSS foods and drinks, and environmentally harmful products).[38]
As alcohol-related harms continue to rise, there are opportunities for more local authorities across the UK to utilise and leverage the power that they have to reduce the inequalities deepened by alcohol advertising.
Conclusion
Research has repeatedly shown the impact the advertising of unhealthy commodities, including alcohol, has on drinking behaviours among both children and adults, that this deepens health inequalities, and contributes to alcohol-related harms.
People have a right to be protected from harmful commodity marketing, including alcohol marketing. This is particularly the case for nonconsensual, outdoor advertising, as there is often no way for children or vulnerable people to avoid such advertising.
Evidence that specifically relates to the outdoor advertising of alcohol is limited. More research is needed that investigates the distribution of alcohol advertisements across the UK, especially in deprived areas. However, more generally across the public health literature, there is agreement that outdoor advertising of unhealthy commodities must be regulated as they deepen inequalities for disadvantaged populations.16,[39],[40],[41] Furthermore, it is believed that restrictions on unhealthy commodity advertising can contribute to a possible 5-8% reduction in alcohol consumption.[42]
Local councils that have established restrictions on unhealthy commodities have shown the benefits of doing so through improvements in public health. Further restrictions on outdoor alcohol advertisements could be a positive start in reducing alcohol-related harms that continue to burden communities across the UK.
[1] Institute of Alcohol Studies. (2020, October). Alcohol and marketing. https://www.ias.org.uk/wp-content/uploads/2020/12/Alcohol-and-marketing.pdf
[2] World Health Organization. (2022). Digital marketing of alcoholic beverages: what has changed? https://iris.who.int/bitstream/handle/10665/352521/9789240045002-eng.pdf?sequence=1
[3] Murray, R. L., Leonardi-Bee, J., Barker, A., Brown, O. B., & Langley, T. (2022). The effect of alcohol marketing on people with, or at risk … Alcohol Focus Scotland. https://www.alcohol-focus-scotland.org.uk/media/440167/the-effect-of-alcohol-marketing-on-people-with-or-at-risk-of-an-alcohol-problem-a-rapid-literature-review.pdf
[4] Burgess, R. C., Nyhan, K., Dharia, N., Freudenberg, N., & Ransome, Y. (2024). Characteristics of commercial determinants of health research on Corporate Activities: A scoping review. PLOS ONE, 19(4).
[5] Petticrew, M., Glover, R. E., Volmink, J., Blanchard, L., Cott, É., Knai, C., Maani, N., Thomas, J., Tompson, A., van Schalkwyk, M. C., & Welch, V. (2023). The commercial determinants of Health and Evidence Synthesis (codes): Methodological guidance for systematic reviews and other evidence syntheses. Systematic Reviews, 12(1).
[6] Alcohol Health Alliance. (2021). No escape: How alcohol advertising preys on children and vulnerable people. https://ahauk.org/wp-content/uploads/2021/11/MarketingReport-FINAL.pdf
[7] Snyder, L. B., Milici, F. F., Slater, M., Sun, H., & Strizhakova, Y. (2006). Effects of alcohol advertising exposure on drinking among youth. Archives of Pediatrics & Adolescent Medicine, 160(1), 18. https://doi.org/10.1001/archpedi.160.1.18
[8] Smith, L. A., & Foxcroft, D. R. (2007). The effect of alcohol advertising and marketing on drinking behaviour in young people: A systematic review. Alcohol Education and Research Council.
[9] Alcohol Focus Scotland. (2022a). Realising Our Rights: How to protect people from alcohol marketing. https://www.alcohol-focus-scotland.org.uk/media/440172/alcoholmarketingreport2806.pdf
[10] Shopify. (2022b, November 10). What is outdoor advertising? definition and guide. https://www.shopify.com/blog/what-is-outdoor-advertising
[11] Outsmart. (n.d.). Why OOH works. Outsmart Out of Home Ltd. https://www.outsmart.org.uk/why-ooh-works
[12] Outsmart. (2024). UK Out of Home Revenue. https://www.outsmart.org.uk/site/userfiles/File/20240604120106_UK_Out_of_Home_Revenue_-_2024_Q1_vF.pdf
[13] The Advertising Standards Authority Ltd. (n.d.). Harmful. ASA | CAP. https://www.asa.org.uk/issue/Harmful.html
[14] The Advertising Standards Authority Ltd. (n.d.). 18 Alcohol | CAP Code. ASA | CAP . https://www.asa.org.uk/type/non_broadcast/code_section/18.html#:~:text=18.4,or%20daring%20people%20or%20behaviour.
[15] Scott, L. J., Nobles, J., Sillero-Rejon, C., Brockman, R., Toumpakari, Z., Jago, R., Cummins, S., Blake, S., Horwood, J., & de Vocht, F. (2023). Advertisement of unhealthy commodities in Bristol and South Gloucestershire and rationale for a new advertisement policy. BMC Public Health, 23(1).
[16] Skopeliti, C. (2024, March 4). Four in five billboard ads in England and Wales in poorer areas. The Guardian. https://www.theguardian.com/media/2024/mar/04/four-in-five-billboard-ads-in-england-and-wales-in-poorer-areas
[17] Adfree Cities. (2024a). “UNAVOIDABLE IMPACT”: How outdoor advertising placement relates to health and wealth inequalities. https://adfreecities.org.uk/wp-content/uploads/2024/03/Unavoidable-Impact-Advertising-Inequality-Full-Report-Adfree-Cities-4th-March-2024-WEB.pdf
[18] Mair, C., Sumetsky, N., Dougherty, M., & Thakar, M. (2022). Do changes to the alcohol retail environment reduce interpersonal violence? Current Epidemiology Reports, 9(4), 282–289.
[19] Kwate, N. O., & Meyer, I. H. (2009). Association between residential exposure to outdoor alcohol advertising and problem drinking among African American women in New York City. American Journal of Public Health, 99(2), 228–230.
[20] Palmer, G., Green, M., Boyland, E., Vasconcelos, Y. S., Savani, R., & Singleton, A. (2021). A deep learning approach to identify unhealthy advertisements in street view images. Scientific Reports, 11(1).
[21] Alaniz, M. L. (1998). Alcohol Availability and Targeted Advertising in Racial/Ethnic Minority Communities . Alcohol Health and Research World, 22(4), 286–289.
[22] Alcohol Focus Scotland. (2018, April). Alcohol Outlet Availability and harm in Scotland. https://www.alcohol-focus-scotland.org.uk/resources/alcohol-outlet-availability-and-harm-in-scotland.pdf
[23] Stewart, K. (2008). How alcohol outlets affect neighbourhood violence. Pacific Institute for Research and Evaluation.
[24] Trangenstein, P. J., Greene, N., Eck, R. H., Milam, A. J., Furr-Holden, C. D., & Jernigan, D. H. (2020). Alcohol Advertising and violence. American Journal of Preventive Medicine, 58(3), 343–351.
[25] Lightowlers, C., Pina-Sánchez, J., & McLaughlin, F. (2023). The role of deprivation and alcohol availability in shaping trends in violent crime. European Journal of Criminology, 20(2), 738–757.
[26] Amanuel, H., Morojele, N., & London, L. (2018). The health and social impacts of easy access to alcohol and exposure to alcohol advertisements among women of childbearing age in urban and rural South Africa. Journal of Studies on Alcohol and Drugs, 79(2), 302–308.
[27] IAS. (2024, May 24). Economy. Institute of Alcohol Studies. https://www.ias.org.uk/factsheet/economy/
[28] McKevitt, S., White, M., Petticrew, M., Summerbell, C., Vasiljevic, M., Boyland, E., Cummins, S., Laverty, A. A., Millett, C., de Vocht, F., Junghans, C., & Vamos, E. P. (2023). Characterizing restrictions on commercial advertising and sponsorship of harmful commodities in local government policies: A nationwide study in England. Journal of Public Health, 45(4), 878–887.
[29] Vaccari, E., & Marique, Y. (2024, February 14). One in five councils at risk of “bankruptcy” – what happens after local authorities run out of money. The Conversation. https://theconversation.com/one-in-five-councils-at-risk-of-bankruptcy-what-happens-after-local-authorities-run-out-of-money-222541#:~:text=There%20is%20no%20prescribed%20approach,try%20to%20increase%20their%20revenue
[30] Atkins , G., & Hoddinott, S. (2020, March 10). Local government funding in England. Institute for Government. https://www.instituteforgovernment.org.uk/explainer/local-government-funding-england
[31] BBC. (2018, February 3). Adverts on council websites raise £34,500 to boost income. BBC News. https://www.bbc.com/news/uk-wales-42863552
[32] The Scottish Government. (2023, November 7). Money made from alcohol sales: FOI Release. Scottish Government. https://www.gov.scot/publications/money-made-from-alcohol-sales-foi-release/
[33] National Institute for Health and Care Research. (2022). Advertising ban was linked to lower purchases of unhealthy food and drink. https://evidence.nihr.ac.uk/alert/advertising-ban-was-linked-to-lower-purchases-of-unhealthy-food-and-drink/
[34] Mayor of London. (2009). Alcohol ban (1) . https://www.london.gov.uk/who-we-are/what-london-assembly-does/questions-mayor/find-an-answer/alcohol-ban-1
[35] Badshah, N. (2022, February 17). TFl junk food ad ban has helped Londoners Shop more healthily – study. The Guardian. https://www.theguardian.com/society/2022/feb/17/tfl-junk-food-ad-ban-has-helped-londoners-shop-more-healthily-study
[36] Postans, A. (2021, March 12). Bristol City Council bans ads for junk food, booze, and gambling. Bristol Live. https://www.bristolpost.co.uk/news/bristol-news/bristol-city-council-bans-adverts-5138679
[37] Gillett, R. (2021, July 1). Norwich Council votes to limit harmful advertising. Adfree Cities. https://adfreecities.org.uk/2021/07/norwich-council-votes-to-limit-harmful-advertising/
[38] Sheffield City Council. (n.d.). Advertising and Sponsorship Policy 2024-2026: Sheffield City Council Advertising and Sponsorship Policy. https://democracy.sheffield.gov.uk/documents/s66761/Appendix%201%20-%20Sheffield%20City%20Council%20Advertising%20and%20Sponsorship%20Policy%202024-2026.pdf
[39] Olsen, J. R., Patterson, C., Caryl, F. M., Robertson, T., Mooney, S. J., Rundle, A. G., Mitchell, R., & Hilton, S. (2021). Exposure to unhealthy product advertising: Spatial proximity analysis to schools and socio-economic inequalities in daily exposure measured using Scottish children’s individual-level GPS data. Health & Place, 68, 102535.
[40] Thomas, C., Breeze, P., Cummins, S., Cornelsen, L., Yau, A., & Brennan, A. (2022). The health, cost and equity impacts of restrictions on the advertisement of high fat, salt and sugar products across the Transport for London Network: A health economic modelling study. International Journal of Behavioral Nutrition and Physical Activity, 19(1).
[41] Fagerberg, P., Langlet, B., Oravsky, A., Sandborg, J., Löf, M., & Ioakimidis, I. (2019). Ultra-processed food advertisements dominate the food advertising landscape in two Stockholm areas with low vs high socioeconomic status. is it time for regulatory action? BMC Public Health, 19(1). https://doi.org/10.1186/s12889-019-8090-5 Fagerberg, P., Langlet, B., Oravsky, A., Sandborg, J., Löf, M., & Ioakimidis, I. (2019). Ultra-processed food advertisements dominate the food advertising landscape in two Stockholm areas with low vs high socioeconomic status. is it time for regulatory action? BMC Public Health, 19(1).
[42] Saffer H, Dave D. Alcohol consumption and alcohol advertising bans. Appl Econ. 2002;34(11):1325–34.
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