By Chandra Ramakrishnan
As per Article 11 of the WHO’s Framework Convention on Tobacco Control (FCTC), all tobacco product packages must carry health warning labels that include a graphic or picture and descriptive messages to inform people about the harmful effects of tobacco products. Countries which have ratified the FCTC, including India, have made efforts to follow these guidelines in spirit and principle.
The new updated Cigarette Package Health Warnings: International Status Report was released in Geneva, Switzerland, at the 8th session of the conference of the parties to the FCTC in October 2018. It highlights the progressive achievement internationally in implementing package health warnings on cigarette packages, with more countries adopting them, many countries increasing the warning size, implementing them on both sides of packets and also having rotational sets of warnings. The worldwide trend for larger graphic warnings is growing with international momentum building up for implementation of plain packaging in due course.
What does the report show?
The cigarette report highlights that 118 countries have now made picture warnings mandatory, representing global public health advancement and 58% of the worlds population is covered by this regulation now. Timor-Leste has the largest warnings in the world on cigarette packages at 92.5% on both front and back, Nepal and Vanuatu are at second at 90%, New Zealand is fourth at 87.5%, and Hong Kong, India and Thailand are at the fifth position with 85% on both sides of cigarette packets. India, is the only SAARC country to have a quit-line number on packets and the fourth in Asia to do so after Thailand, Malaysia and Singapore.
Are health warnings really effective?
Health warning labels convey the harmful effects of tobacco consumption through pictures of patients affected by oral cancer and supporting messages. In a multi-lingual society with low literacy levels, picture health warnings in English and a local language are a cost-effective way to disseminate information to the public on the health hazards of smoking and benefits of quitting. It is seen that they are very effective with teenagers and new users
A cigarette pack has traditionally been a glamorous accessory for smokers and in the youth. For many years, very small plain text warnings appeared on packs, barely visible and often strategically masked by the brand name, a colourful design and logo. However, gradually regulations increased worldwide requiring large, clear, visible and legible picture warnings on both sides of packets along with a key message being enforced. These specifications became essential as following the ban on tobacco advertising, promotion, and sponsorship, tobacco companies were left with only the product design and packaging option as a marketing tool. In India over the last decade, pack warnings gradually increased from 40% to 85% of the pack area, and from one side to both sides of the pack.
Warning labels on tobacco products serve a larger public interest. This includes reducing use, encouraging quitting, preventing non-users from initiating use and preventing former users from relapse. According to a report entitled, ” The State of Evidence Review: Health Warning Labels on Tobacco Products, Institute for Global Tobacco Control 2013″, there is extensive evidence to show that health warning labels on smoked tobacco products work. They increase health knowledge about the harms of tobacco, prevent relapse in former smokers, deter youth and adults from initiating use and experimentation, deter smokers from having a cigarette when they are about to have one. Additionally, they also increase smokers intentions and attempts to quit, reduce the coolness quotient and appeal of the cigarette pack and promote the use of cessation resources.
There is extensive evidence to show that health warning labels on tobacco product packaging help protect the general well-being and health of a population and more and more countries are now serious about public health are following the guidelines as laid down by WHO. India has also demonstrated that it is serious about the health of its citizens through pro-active steps since the last two years, which include implementation of large health warnings on both sides of tobacco packages since Sep 1, 2018, ban on e-cigarettes, the revamped National Health Policy 2017 and Pradhan Mantri Jan Aarogya Abhiyan-Ayushman Bharat.
Chandra Ramakrishnan is a communications and advocacy expert -health.