Protect youth, save the economy with pictorial health warnings on Cigarette Packs

Protecting the youth, and saving the economy of Pakistan through pictorial health warnings on Cigarette Packs.

“There is unrelenting international momentum for countries to use graphic pictures on cigarette packages to show the lethal health effects of smoking. For decades, the tobacco industry has hidden the harms of smoking behind deceptive marketing and attractive packaging. Picture health warnings and increased warning sizes will help reduce global tobacco industry sales and will save lives lost to cancer and other tobacco-related diseases.”(Cunningham)

Health warnings on tobacco product packaging (cigarette packs)are critical to any effective tobacco control strategy. These are the labels on tobacco products that constitute the most cost-effective tool for educating smokers and non-smokers alike about the health risks of tobacco use. They increase public awareness of tobacco use’s serious health risks and help ensure that the packaging tells the truth about the deadly product within.

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Pictorial warnings may be significant in communicating health information to populations with lower literacy rates. Evidence from low- and middle-income countries also supports the effectiveness of large pictorial warnings over text-only warnings and even suggests that pictorial warnings maybe even more effective in these countries because warning labels represent one of the few sources of information about the health risks of smoking (in some countries, warnings are the only systematic source of such information).In many countries, more smokers report getting information about the health risks of smoking from warning labels than any other source except television.

Pakistan signed and ratified Framework Convention on Tobacco Control (FCTC) in 2004. Article 11 of the FCTC requires that tobacco products “carry health warnings describing the harmful effect of tobacco use.” Besides, guidelines to Article 11 adopted in 2008 by the Conference of Parties (COP) to the international treaty stipulate that warnings should appear on both the front and back of the package, be larger and clear and describe specific illnesses caused by tobacco.

Tobacco is unique among legal consumer products – and not in a positive sense. It is the only such product that kills when used exactly as intended by the manufacturer. Up to one-half of all smokers will die from tobacco-related diseases, and half of these will die prematurely.

Tobacco packages’ health warning that includes images is a particularly powerful and cost-effective vehicle for communicating health risks.  This is because:

  • Warnings that use pictures or graphics in addition to text has been shown to be particularly effective in communicating risk and motivating behavioral change;
  • Pictorial Warning are critical in communicating health risks to the large number of people worldwide who cannot read;
  • Pictorial health warnings detract from the overall attractiveness of tobacco packaging and this act as a deterrent to new users, who are often young and image- and brand-conscious.

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Health warnings on packaging should be thought of as a mass media campaign virtually guaranteed to be seen by almost all smokers and by many potential smokers:

A pack-a-day cigarette smokers sees the package – including an effective health warning – at least 7300 times a year;

Strong, conspicuous warnings could be placed on smoking devices.

Large Warning to be as large as possible

Larger Warnings are more effective than smaller warnings.

Larger Warnings are more noticeable.

Smokers are more likely to recall Large Warning than smaller ones, and even tend to equate the size of the Warning with the magnitude of risk of tobacco use.

Recent studies in Canada show that increasing the size of the health warning from the current size of 50% of the main pack o faces to up to 100 % would have a greater add-on impact.

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The WHO FCTC recommends that warnings occupy 50% or more of the principal display area of a tobacco product package and requires that they occupy no less than 30%. Because of the evidence that the effectiveness of warnings increases with their size the Article 11 of FCTC guidelines to the treaty recommends that warnings cover more than 50% and as much as possible of the principal area.

As of January 22, 2021, a total of 134 countries and jurisdictions have finalized pictorial health warnings of the principal display areas of the pack. Timor-Leste (East Timor) now has the largest warning requirements in the world at 92.5% on average of the package front and back. Nepal and Vanuatu are tied for second at 90%, New Zealand is fourth at 87.5%, and Hong Kong, India, and Thailand are tied for fifth at 85%. Pictorial health warnings are especially valuable for low- and middle-income countries where there are higher rates of illiteracy and where governments may have few resources.

In the world where countries are now progressing forward for saving their youth, future, economy, and public health to keep them and save from the merchants of death i.e., the Tobacco industry by appropriate legislation, strategies, and implementation of laws. This also includes the legislation on the Plain packaging of tobacco products.

Plain packaging means the removal of the promotional, marketing, and advertising features on packs of tobacco but leaves the health warnings, tax stamps, and other features required by the government.

There is enormous impetus across the world for tobacco plain packaging. There are now 38 countries and territories moving forward with plain packaging, with 21 having adopted the measure, 3 having it in practice, and 14 working on it. Canada implemented plain packaging in 2019 and was among the first 10 countries to do so and is tied for 19th in the world in terms of package warning size.

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Regrettably, there is outrageous abandonment in Pakistan regarding the Government of Pakistan’s ownership of tobacco control,  tobacco control legislation, and implementation of existing laws. The existing rules on pictorial health warnings of cigarette packs mandated 60% of size implemented from 2019. This size has to be revised and increased through notification of a new enhanced-sized pictorial health warning in 2020. Unfortunately, it seems due to the tobacco industry’s influence and neglect of the responsible ministry, this notification is yet to be notified. This will be in the best interest of the youth of Pakistan, and citizens of Pakistan that the Government of Pakistan immediately issue notification for enhancement in the size of new pictorial health warning and announce their future plan to notify plain packaging in the country, to be in par with the rest of world in protecting t health, future, and economy of the citizens of Pakistan.

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This write-up has been contributed by Dr. Ziauddin Islam. He is a Public Health Consultant & Tobacco Control Expert, and the Country Lead Pakistan Tobacco Control, Vital Strategies.

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