Scary photos of cancer patients seek to discourage tobacco users [Archives:2007/1044/Health]
Bobby Ramakant
For Yemen Times
From June 1, 2007, tobacco products in India will contain pictorial warnings with photographs of tobacco-related cancer patients. Many countries like Canada, Australia, South Africa, Poland, Thailand and Singapore already have strong warning label regulations. Bobby Ramakant ponders the effectiveness of warning labels in preventing needless tobacco-related deaths.
Health warning labels, both on cigarette packaging and on all tobacco products' 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 program.
On February 22, Yemen ratified the world's first corporate accountability and public health treaty, the Framework Convention on Tobacco Control (FCTC). Article 11 of the convention stipulates that warnings should cover at least 50 percent of the packaging's principal display areas (i.e., both the front and back), but at a minimum, it must cover at least 30 percent of principal display areas.
It further requires the messages be rotated and encourages the use of pictures and pictograms, as well as the use of non-health messages like, “Quit smoking – Save money.”
Speaking April 10 at the New Delhi summit of the Confederation of Indian Industries and the United Nations' Food and Agriculture Organization, India's Union Health Minister, Dr. Ambumani Ramadoss, lamented, “We've tried everything, but it's been of no use, so we've now decided to put scary photos of cancer patients on tobacco products in order to discourage consumers.”
He further announced, “As a further warning, from June 1, all tobacco products will bear photographs of patients suffering from cancer caused by tobacco consumption.”
Tobacco product packaging should be designed to maximize consumers' informed consent rather than maximizing the product's appeal. 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, such warning labels tend to be weak in all but a few countries. More than 40 developing countries don't require any warning labels at all. Of those that do, 73 percent 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 the most important elements in creating effective labels. The findings include:
– To command attention, warning labels should occupy a minimum of 25 percent of the top front and back of the packaging. They should be in black and white or other sharply contrasting colors. Type style and size also must be specified in order to avoid industry efforts to undermine the warning's impact.
– Messages should be unequivocal, simple and stark. They should convey both the nature and magnitude of the risks, since studies show that smokers underestimate most risks associated with using tobacco.
Pictorial warnings also may be appropriate, particularly in countries with low literacy rates or where research shows that smokers ignore standard warning labels.
Several nations have implemented strong health warning label requirements. Examples include:
– Canada's health minister recently proposed enlarging warning labels from 30 percent to 60 percent of the packaging face
– Thailand has added the message, “SMOKING CAUSES IMPOTENCE,” to its list of required warnings
– Australia was the first nation to require “how to quit” information be printed on every package
– South Africa, Poland and Singapore also require strong warning labels
Tobacco companies use words like “light,” “ultra light,” “slim” and “super slim” in their brand names and in their marketing materials. Research suggests that these words are intended to make implicit health claims minimizing the product's harmfulness and may encourage those smokers who are 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.
Pictorial warnings provide smokers helpful information about 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 to smokers – and ironically, it's true that “the tobacco industry kills its best customers.”
Package warnings also are a good public health strategy because tobacco companies, not the government, pay the costs of such warnings. In order to attain public health gains in the long run, this shouldn't be viewed as an isolated initiative; rather, it must be supported by comprehensive health care, legislation and education programs.
Among its many measures, the FCTC treaty requires countries to impose restrictions on tobacco advertising, sponsorship and promotion; establish new packaging and labelling of tobacco products; establish clean indoor air controls; and strengthen legislation to clamp down on tobacco smuggling.
Advertising, sponsorship and promotion
Tobacco products are advertised through sports events, music events, films, fashion – in fact, any place where the tobacco industry can target potential new smokers (young people). The treaty obliges Party States to undertake a comprehensive ban on tobacco advertising, promotion and sponsorship, as far as their constitutions permit.
Packaging and labelling of tobacco products
As advertising restrictions are implemented, tobacco packaging plays an increasingly important role in encouraging tobacco consumption. The treaty obliges Party States to adopt and implement large, clear, visible, legible, and rotating health warnings and messages on tobacco products and its outside packaging, occupying at least 30% of the principal display areas. This is required within three years of entry into force of the Convention.
Protection from exposure to tobacco smoke
Second-hand smoke is a real and significant threat to public health. Children are at particular risk – exposure to tobacco smoke in children can cause respiratory disease, middle ear disease, asthma attacks, and sudden infant death syndrome (SIDS). The treaty obliges Party States to adopt and implement (in areas of existing national jurisdiction as determined by national law), or promote (at other jurisdictional levels), effective measures providing for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places.
Illicit trade in tobacco products
Cigarettes are smuggled widely throughout the world. In addition to making international brands more affordable and accessible, illegal cigarettes evade restrictions and health regulations. The treaty obliges State Parties to adopt and implement effective measures to eliminate illicit trade, illicit m anufacturing, and counterfeiting of tobacco products.
Effective implementation of FCTC is indeed a huge challenge countries are confronted with. There is a long way to go for effective comprehensive tobacco control to become a reality.
Bobby Ramakant is a health and development journalist, senior tobacco control advocate and member of Network for Accountability of Tobacco Transnationals (NATT) and Asia representative for Global Youth Advocacy Training Network (GYAT). He can be contacted at: [email protected]
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