When London Mayor Sadiq Khan introduced a ban on junk food advertising on the city’s buses and tubes, he faced a backlash from big food companies.

Meanwhile, tobacco companies went all-out trying to stop Montevideo in Uruguay and Kampala in Uganda from banning smoking in public areas, including resorting to litigation.

Tobacco company Phillip Morris took the government of Uruguay to court to try to prevent it from banning smoking in closed public spaces, Mayor Carolina Cosse told the inaugural Partnership for Healthy Cities Summit on Wednesday.

The summit brought together mayors and officials from more than 50 cities to discuss how to prevent noncommunicable diseases (NCDs) and injuries.

Not only did Uruguay win its case, but the court ruling set a precedent by establishing that commercial benefit should not be considered above public policy, said Cosse.

“So in Uruguay, we know very, very well that, when we talk about multinationals, their ambition is limitless,” said Cosse.

In Uganda, British American Tobacco (BAT) fought the government’s efforts to eliminate smoking in public areas, said Kampala’s Mayor Erias Lukwago.

In 2016, Uganda’s Parliament introduced a Bill to ensure public spaces were smoke-free – but BAT “fought our efforts left, right and centre, even mobilising local farmers”, added Lukwayo.

After Parliament passed this Bill, BAT took its opposition to the Constitutional Court.

“We got embroiled in protracted litigation until 2019 when we won the case, but even after winning the case, they started indulging in some other shenanigans,” said Lukwayo.

These involved overt efforts such as mobilising and transporting tobacco farmers to demonstrate against the law, and more covert efforts to undermine the implementation of the law.

“We banned single cigarette sales, apart from banning cigarette adverts and smoking in public places,” said Lukwayo. 

“But implementation is a challenge thanks to BAT and all those struggles they have engineered. What BAT does is to instigate small traders to violate the law and enforcement is a challenge on our side because we are very thin on the ground.”

Addressing the big four

Anna Gilmore, Professor of Public Health at the University of Bath in the UK, said that the “commercial determinants of health” was complex, and that “most commercial actors play an incredibly vital role in society”. 

However, she singled out four products – alcohol, tobacco, ultra-processed food and fossil fuel – as being responsible for between 19 and 33 million deaths a year.

“That’s at least a third of all global deaths. Just by addressing those we can really achieve a huge amount,” said Gilmore.

“The problems aren’t just these products,” said Gilmore, adding that the World Health Organization’s (WHO) Best Buys report, published in 2017, explained how to tackle NCDs and harmful products.

“But many countries and cities and local governments are struggling to put these policies in place because they face opposition from incredibly powerful commercial actors,” added Gilmore.

Big corporations consistently opposed Best Buy policies “using the same arguments and strategies” – and that it was possible to “predict and prepare and counter those industry efforts to derail policy”, said Gilmore.

“But at the end of the day, of course, political will is vital.”

Stick and carrot

A newer tactic being used by some cities was “carbon advertising bans” such as for holidays, for large vehicles, or anything that’s going to increase pollution”, said Gilmore.

Cities could also expand smoke-free, alcohol-free, junk-food-free public places, and reduce the density of outlets selling unhealthy food products. 

“What about introducing ‘polluter pays’ type approach? We’ve seen that recently in Spain, tobacco companies have to pay for the litter that they create?” asked Gilmore.

However, she also said that incentives could be used to reward positive contributions. Cities could use their local procurement and contracting policies to “contract people who pay a fair wage and who limit their ratio between executive pay and average worker pay” to address growing inequality

They could also contract small accountancy firms instead of large ones, and use locally sourced food from small producers for school feeding schemes.

Incentives for healthy canteens

Montevideo’s Cosse, who won an award for her city’s food policy innovations, said her city used incentives to promote healthy canteens in the city’s public institutions and hospitals.

“A healthy canteen can sell soft drinks, but they cannot publicise them. They’re obligated to have a healthy menu with vegetables and fruit and easily accessible clean water,” said Cosse. 

If an institution was awarded a healthy canteen certificate, they were entitled to “freebies” such as a free audit, which could save them $3,000 a year.

At the start of the summit, Michael Bloomberg, WHO Global Ambassador for NCDs and Injuries, warned that, ‘in low- and middle-income countries, 40% of all deaths are people under 70 dying from NCDs and injuries”. 

“Sadly, the death toll will only grow, unless we do something. It won’t take a miracle. It will take smart policies – and the political will to implement them and defend them,” added Bloomberg.

The Summit was hosted by Bloomberg Philanthropies, WHO, Vital Strategies, and Mayor Khan.

Image Credits: Bloomberg Philanthropies.