It is an irony that a country that introduced text health warnings in 1966 and updated it in 1984 to include the Surgeon General’s warning, cigarettes packages in the U.S still do not carry pictorial warnings.
Ten years after the Congress passed the Family Smoking Prevention and Tobacco Control Act, on August 15 this year, the U.S. Food and Drug Administration (FDA) finally issued a proposed rule that requires pictorial warnings to be carried on cigarette packages and advertisements. Once the proposed rule is finalised, the FDA will be able to specify the images to be used along with text warnings. The pictorial warning with text will occupy the top 50% of the front and the back sides of the packages. Currently, cigarette packages carry only text warnings on just one side.
Canada was the first to introduce pictorial warning on cigarette packets way back in 2001. By October 2018, 118 countries had implemented such warnings in line with the World Health Organisation’s Framework Convention on Tobacco Control that came into force in 2005. It is an irony that a country that introduced text health warnings in 1966 and updated it in 1984 to include the Surgeon General’s warning, cigarettes packages in the U.S still do not carry pictorial warnings.
Stiff opposition from the tobacco industry on the ground that graphic images violates its First Amendment rights of free speech has been the main reason why the U.S has not been able to introduce them. Even the new proposed rule came into being only after the U.S. court for the District of Massachusetts issued an order in March 2019 directing the FDA to publish a rule by August 2019 and a final rule in March next year.
It is almost certain that tobacco companies will challenge the FDA rule before March 2020. In June 2011, the tobacco companies had successfully challenged the introduction of pictorial warning even after the FDA published the final rule.
By virtue of its small size and placement, text warnings largely remain invisible and fail to convey the harmful effects of smoking. On the other hand, gory pictures are very likely to be noticed, leave a lasting impression of varied risks of smoking and easily convey the central message even to people with low literacy.
Tobacco companies are well aware of the power of image warnings in reducing tobacco consumption, creating greater urge in users to quit smoking and preventing young adults from start smoking. It is for these reasons that the industry will pull out all the stops to prevent the introduction of graphic images in the U.S, which is one of the biggest markets — over 34 million adults and 1.4 million children (12-17 years) currently smoke.
A 2017 study based on modelling found that pictorial warning can reduce the prevalence of smoking in the U.S by 5% by 2020 and up to 10% by 2065. Actual data from countries that introduced pictorial warnings show how powerful they can be in shaping public opinion and causing a sharp drop in tobacco consumption in a few years after they have been introduced.
For instance, in the case of Canada, there was 12% relative reduction in smoking prevalence in just six years after graphic images were made mandatory on cigarette packages. Similarly, in Australia, which introduced graphic images in 2006, witnessed over 10% drop in prevalence between 2004 and 2008. Ditto in the case of the UK, which saw a 10% relative decline in 2009, just a year after image warnings were introduced. The effect of plain packing with huge pictorial warnings has been even better in Australia.
The biggest threat that pictorial warnings pose to tobacco companies is by reducing the appeal and consumption of tobacco. About 30% of young adults in 28 European countries and Canada reported that graphic images made them less likely to start smoking.
Pictorial warnings can turn the power of packaging on its head — far from reinforcing and brand building, packages with graphic images will become a mobile medium to spread public health messages at no cost to the government.