India: Scary Photos Of Cancer On Cig Packets

From 1 June 2007, tobacco products in India will have pictorial warnings with photographs of tobacco-related cancer patients. Many countries like Thailand, Canada, Australia, South Africa, Poland and Singapore already have a strong warning label regulation. Bobby Ramakant ponders over the effectiveness of warning labels in preventing needless tobacco-related deaths:

Health warning labels, both on cigarette packages and on all tobacco marketing materials, help create informed consent between tobacco companies and their customers and are an inexpensive and important first step in a national health education programme.

On 27 January 2004, NEW ZEALAND had ratified the World's fist corporate accountability and public health treaty - FCTC (Framework Convention on Tobacco Control). Article 11 of the FCTC states that warning messages should cover at least 50% of the principal display areas of the package (i.e. both the front and back), but at a minimum must cover at least 30% of the principal display areas. It also requires that the messages be rotated and encourages the use of pictures and pictograms as well as the use of non-health messages ( e.g. "Quit smoking — Save money").

"We have tried everything but it has been of no use. So now we have decided to put scary photos of cancer patients on tobacco products to discourage consumers" said India's Union Health Minister Dr Ambumani Ramadoss said on 10 April 2007 at the New Delhi summit of CII (Confederation of Indian Industries) and FAO (Food and Agriculture Organization of the United Nations).

Dr Ramadoss further announced that "all tobacco products would from 1 June 2007, bear photographs of patients suffering from cancer caused by tobacco consumption as further warning".

Tobacco product packaging should be designed to maximize informed consent on the part of the consumer, not to maximize the appeal of the product. Strong and prominent health warning labels, limits on labels such as "slim" and "light," package inserts containing detailed health and ingredient information, and standardized packaging formats are among the ways to accomplish this goal.

Unfortunately, warning labels tend to be weak in all but a few countries. More than 40 developing countries do not require any warning labels at all. Of those that do, 73% require weakly worded warnings on the side of the package and many of those are in English rather than local languages.

Numerous studies have been done to determine which elements are most important in creating effective labels. Findings include:

* To command attention, warning labels should occupy a minimum of 25% of the top of the front and back of the package. They should be in black and white or other sharply contrasting colors. Type style and size also must be specified to avoid industry efforts to undermine the impact of the warning.
* Messages should be unequivocal, simple, and stark. They should convey both the nature and magnitude of the risks, since studies show smokers underestimate most
risks associated with tobacco use.

Pictorial warnings may also be appropriate, particularly in countries with low literacy rates or where research shows that smokers are ignoring standard warning labels.

Several nations have implemented strong health warning label requirements. Examples include:
- Canada, whose health minister recently proposed enlarging the labels from 30% of the package face to 60%;
- Thailand, which has added the message "SMOKING CAUSES IMPOTENCE" to its list of required warnings; and
- Australia, which was the first nation to require that "how to quit" information be printed on every pack.
- South Africa, Singapore and Poland also require strong warning labels.

Tobacco companies use words such as "light," "ultralight," "slim" and "superslim" in their brand names and in their marketing materials. Research suggests that these words are intended to make implicit health claims minimizing the harmfulness of the product, and may encourage smokers motivated to quit to switch to a "light" brand. These words also appeal to smokers, primarily women, who believe they can use cigarettes to lose weight.

These pictorial warnings provide smokers with helpful information on the health effects. Most smokers want this information, and certainly want their children to have this information too. The tobacco industry is continuing its decades-long strategy of trying to minimize the effectiveness of package warnings. The tobacco industry is no friend of smokers — and ironically it's true that 'the tobacco industry kills its best customers'.

Also package warnings are a good public health strategy because the cost of package warnings is paid for by tobacco companies, not government. Also this should not be looked upon as an isolated initiative rather has to be supported by comprehensive healthcare, legislations and education programmes to attain long-run public health gains.

(The author is a senior health and development journalist writing for newspapers in Asia and Africa. He is also the member of NATT (Network for Accountability of Tobacco Transnationals) and can be reached at: bobbyramakant@yahoo.com)

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