The biggest McDonald's outlet in the world, in the centre of the Olympic enclosure (above), has hired 2,000 people to serve 1.75 million Mc'Meals'

London. Yes, you probably have seen this picture already, of the commercial 'cathedral' erected just up the road from King's Cross where I live. It's the biggest McDonald's 'restaurant' in the world. As I write, the issue of the sponsorship of the Olympics has finally blown up here in London. Curiously, this is not mainly because of health. The issue is obsessive imposition of ridiculous restraints on many normal activities. The rule apparently is that any marketing by any company other than the official sponsors (such as McDonald's and Coca-Cola), or small business, pub or charity group that in any way links their products with the Olympics, is banned: in the Olympic arena, anywhere in the London area close to the stadium, and it seems anywhere in Britain! Furthermore any linking of any non-sponsor company's logo or other publicity to the Olympic symbol, the stadium, the idea of the Olympic sports and even – or so I heard – to 'London 2012' as this became a catch phrase for the Olympics, is threatened with a ban, with a maximum fine of £20,000.

Last night on the radio I heard Jacques Rogge, the president of the International Olympic Committee (IOC), based in Switzerland. This is an organisation which, like the International Federation of Football Associations (FIFA), also based in Switzerland, is itself a type of transnational corporation that can politely trample over national governments' susceptibilities. Both are widely described as a law unto themselves, whose senior executives live like emperors as a result of special treatment from future bidders for the Olympic Games or the World Cup.

Jacques Rogge was sounding so reasonable, when he said that if somebody came in to the Olympic stadium wearing a t-shirt with a Pepsi-Cola logo they would not be banned despite the sponsor in the non-alcoholic drinks business being Coca-Cola. This was in response to Lord Sebastian Coe, the UK Olympics Delivery boss, previously saying that yes, any ticket-holder wearing a Pepsi t-shirt would be denied entrance and told to get lost, or at least to go home and change.

It seems that Lord Coe got it wrong. However, Jacques Rogge continued, if a group of people tried to attract attention to a product competitive with an official sponsor, then this group would not be allowed to enter the stadium. He sounded so reasonable implying that the UK Olympics Delivery Committee had been over- interpreting the criteria. There had been an earlier problem. At first, all eating places in the Olympics enclosure had been told that they were forbidden to serve chips (French fries) because of the need to protect the brand of sponsor McDonald's. This rule was then relaxed. Chips by themselves are still banned, but chippies that also serve fish are permitted. It seems that there is a small army of sponsorship enforcers, who I suppose will check to see that people inside the enclosure who choose not to buy McChips, eat the fish.

Three London Olympic sponsors: McDonald's, Coca-Cola and Cadbury (owned by Kraft Foods). Results? Left: Big Mac. Right: obese person.

The privatisation of public goods

Why do I bother with this nonsense? Because the so-called 'neo-liberal' takeover of national political and economic policy and programmes all over the world is now so pervasive and obviously damaging, that this is now being discussed even in the general media. It certainly affects us profoundly in our work. 'Neo-liberal' may sound like a friendly phrase. The reality is that governments have ceded what should be their prime responsibility to transnational corporations. It has become generally accepted that private business can perform more and more public duties better than any public body, and that deregulation of business in favour of a commercial free-for-all, will enable the optimum development of any economy. This is despite the notorious chaos of the banking system. Now just before the Olympics the government has had to intervene, because a private company had been assigned multiple security jobs including checking for terrorist bombs during screening, and it became apparent that the executives could not guarantee the attendance of even 7000 of the 10,000 temporary guards. So at the last moment police and troops have been called in, and even more held on stand-by (1).

Here in Britain we are in the grip of the most radical societal changes seen since the first democratic socialist government after the Second World War. Then, the UK education system was properly established, so that all boys and girls had free school education, and talented pupils were able to go to university without paying anything. For example, having gained a state scholarship, I paid no tuition fees, and had my student expenses including accommodation and living, paid with a grant that was enough to allow me to go camping in Europe in my vacations!. Similarly, the UK National Health System was also established with principles and an ethic which I followed as a young physician, of treating a tramp arriving in the casualty department from the street, in just as meticulous a way as the millionaire arriving with his complaints.

This is now all changed. Now the UK school education system is being broken up, with the formation of numerous 'Academies' receiving money from government with almost no controls in place. Universities are charging up to £9,000 a year for fees alone. The hospital system and the National Health Service is being dismantled, on the basis that private companies are more efficient at providing services cheaply.

All this malign ethic applies also to public health nutrition. There is no concern for the health consequences of promoting Coca Cola and McDonalds by the International Olympic Committee or the Olympics Delivery Committee. It is very likely that the advertising and publicity of these giant firms is changing society's perceptions of what is appropriate and even healthy. McDonald's employs anything up to 1.5 million people worldwide and 85,000 in the UK. Its aim is to become part of the fabric of British society. A marketing journal explains: 'Domestically, the restaurant chain aimed to raise its credentials as a trustworthy, UK-focused company with a campaign highlighting its use of British farm produce from well cared-for, healthy animals. McDonald's used the activity to emphasise its sponsorship of the London 2012 Olympics, another avenue for reinforcing its commitment to British' (2).

Responsibility deals

Richard Cienciala, Judy Hargadon, David Haslam: UK government, civil society and health professional views on UK obesity and how to control it

I guess you are feeling all this is self-evident. So let me take you to a debate in which I took part a few days before I write this, towards the end of July. It was part of the UK's Faculty of Public Health's Annual General Meeting in Cardiff, Wales. This 'Great Public Health Debate' also involved Richard Cienciala, deputy director of the obesity programme of the government's Department of Health, Judy Hargadon, chief executive of the School Food Trust, and David Haslam, chair of the National Obesity Forum.

In my talk I explained the fundamental importance of economic and social factors in driving the obesity epidemic, citing the UK Chief Scientist's Foresight Report analyses (3). I set out an agenda, derived from work I had already done for the UK Parliament's Select Committee on Public Health. During the process of developing our advice to the Parliamentary Committee, I had been gently told by two other expert advisors to the Committee that their work on tobacco and alcohol was directly relevant to my own analyses, as we prepared to advise the Committee of future needs for public health.

So last week in Wales I explained what I had learned from the other Parliamentary advisors and set out the parallels between food, tobacco and alcohol control. To increase profits, companies involved in these three fields had learned three basic lessons. First, that the price of a product was crucial. Second, its ready availability day or night wherever you were was important in increasing sales. The third factor which affects company profits is marketing – not just to children but to everybody.

Statutory regulation is essential

The advice I received from the experts on tobacco and alcohol was very clear. Statutory fiscal and regulatory restrictions are crucial in determining population behavioural trends. Health education messages on their own have very modest if any benefits unless accompanied by other economic and social measures such as increases in tax, restrictions on outlets in terms of place and timing and – certainly as far as tobacco and alcohol are concerned – a complete ban on any form of advertising. Certainly with obesity it is well known that health education alone is almost useless with media campaigns being considered hopelessly cost-ineffective (4).

I was followed by Richard Cienciala (left, above), who I remembered as a very knowledgeable, committed senior administrator. He had to put forward the government's arguments. He highlighted the new work of the UK government's 'Responsibility Deal' whereby many of the UK arms of transnational corporations are now partners in choosing the policies for tackling the obesity and chronic non-communicable disease epidemics.

When challenged by the audience, he said that if companies change their approach for example to product composition or marketing, this voluntary approach was far more rapid and potentially effective than the slow, rigid process involved in legislation. This is theoretically true. The problem though, is to get companies to agree to anything substantial. They are well aware of the potential for competitive advantage by other companies that do not take part in conjoint action.

What's the deal?

It was announced on 24 March that some of the world's biggest food and drink manufacturers, owning some of the best known brands, were making Responsibility Deal commitments to cap and cut calories, and that more than three-quarters of the retail market was also signed up to the Deal (5). Companies signed up say that they are all together going to remove a billion kilocalories from the UK food system, in order to reduce obesity rates, with the eventual target being 5 billion.

This sounds good. But my long experience has taught me that in all previous negotiations in Europe, attempts to move companies have been pathetically slow. Even a European parliamentary initiative to have traffic light labelling on all foods was sabotaged by the big food manufacturers – and this despite their claims that information and education were the way to go forward with tackling public health problems relating to food!

The food manufacturing and allied industries are far bigger than the tobacco or alcohol industries. They are now a central part of the political and economic system that has become dominant since the 1980s. In arguing the need for changes in our food system, we have to recognise that we are fighting against this system, which still, despite continual evidence of its failure, gives big business a free hand and insists that any problems are ones of individual responsibility and choice.

Lack of regulation has led to much of the world now continuing to be on the brink of bankruptcy. Yet political, financial industrial and even professional leaders continue to accept that the way things are now, is right, or at least inevitable, and that – for example – gross inequities between and within countries are just part of a process of 'shakeout'. This view is infectious. I am increasingly hearing about medical consultants beginning to behave like the bankers and others in the financial, industrial and marketing world.

This is not a political point, curiously enough; but it becomes political by virtue of understanding the needs of public health nutrition. Yes, we need to amass evidence on the economic and social determinants of food systems, and how these influence disease, health and well-being. And yes also, we need to work out – given the current reality of political power and the morally infected establishment – how to develop a set of rational economic and social policies, and also schemes which encourage consumers to act as citizens and to insist on change. We need to learn from experience of control of tobacco and alcohol, how to shift professional, medical, media and societal thinking, so that new political and economic initiatives become feasible and are seen by politicians as election-winners.

Perhaps we should start with the Olympic sponsorship. But I am reminded that the International Olympic Committee has signed deals with McDonald's, Coca-Cola and other corporations up to and including the 2020 Games. Can we overturn this on the grounds of the over-riding importance of public health? Our challenges are global. We cannot ignore them.

References

1. McGuire K. Olympics security farce explodes the myth that the private sector is cheaper, better, and more reliable. Daily Mirror, 17 July 2012.
2. 2http://www.bradtop100.co.uk/03-Food-Confectionery/04-mcdonalds-restaurants-ltd/
3. The Foresight report.Tackling Obesities: Future Choices – Follow Up Actions. Government Office for Science. October 2007. http://www.foresight. gov.uk/Obesity/Obesity.html
4. Sassi F. Obesity and the economics of prevention. Fit not fat. . Organisation for Economic Co-operation and Development. 2010
5. http://responsibilitydeal.dh.gov.uk/2012/03/24/new-calorie-reduction-pledge.