India to use scarier yet banal pictorial warnings on tobacco products


The new pictorial warning that will be used on tobacco products from September 2018.

Starting September 2018, all tobacco products will have scarier pictorial warnings and new grimmer written messages. And for the first time, toll-free telephone numbers will be displayed on packets to help people who want to quit. The graphic warnings will have less effects as they will highlight the same theme of oral cancer.

Contrary to tobacco companies’ claims, there is now empirical evidence that large, graphic pictorial warnings on tobacco products have a telling effect on consumer behaviour. From 38% in 2009-10, the proportion of cigarette smokers in India who thought of quitting due to pictorial warnings increased sharply to nearly 62% in 2016-17. Though not dramatic, the proportion of bidi smokers who wanted to quit also increased from about 30% to 54%, according to the Global Adult Tobacco Survey (GATS), undertaken in 2009-10 and 2016-17, respectively. The increase among adults wanting to quit smokeless tobacco was also significant — 34% to 46% during the two periods.

In all probability, the proportion of tobacco users wanting to quit will see an even sharper increase when the next GATS survey is carried out. The reason: the size and graphic nature of the images used as warnings in India.

India has come a long way from the small, meaningless and ineffectual pictorial warnings that were first used on tobacco products in May 2009. The size of the warnings was increased from 40% of the principal display area on only one side of the packet to 85% on the front and back sides of the packet from April 2016 onwards. India now has the third largest warnings in the world after Nepal and Vanuatu. India has moved to the third rank among 205 countries with 85% implementation of pictorial warnings on tobacco products packs, a huge leap from the 136th position it held in 2014.

In September, India will follow the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) guidelines by using scarier images to shock tobacco users. Several studies carried out in other countries have shown that shocking, graphic images on tobacco products are likely to make people quit. Tobacco products will also carry new grimmer written messages. And for the first time, toll-free telephone numbers will be displayed on packets to help people who want to quit.

The drawback

But there is one reason why the new set of images may fail to achieve the desired effect. Though scary, they will highlight the same theme of oral cancer. The fatigue that sets in on seeing the same theme may reduce the informational and shock value of the pictorial warnings, a fact that the WHO also pointed out.  “The novelty effect of new health warnings and messages is important, as evidence suggests that the impact of health warnings and messages that are repeated tends to decrease over time,” the WHO says.

Images field-tested in India prior to finalising the new images revealed that people were unable to understand the connection between tobacco and lung cancer and other diseases. While the devastating effects of oral cancer are plainly visible and shocking, every effort should be taken to depict the other negative fallout of tobacco. After all, one purpose of pictorial warnings is to educate people on the multitude of conditions and ailments caused by tobacco. The Health Ministry has been steadfast in its goal to turn tobacco packaging to its benefit and so cannot be found wanting in 2020 when the next set of images is released.

Published in The Hindu on April 30, 2018