Ten years after U.S. Congress passed the Family Smoking Prevention and Tobacco Control Act, on August 15 this year, the Food and Drug Administration finally issued a proposed rule that pictorial warnings be carried on cigarette packages and advertisements. Once this is finalised, the FDA will be able to specify the images to be used along with the written warning. The images and text will occupy the top 50% of the front and the back panels of the packages. At present, cigarette packages in the U.S. carry only text warnings and only on one side.
Canada was the first to introduce pictorial warnings on cigarette packets 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 written health warnings in 1966 and updated it in 1984 to include the Surgeon General’s warning still does not carry pictorial warnings on its cigarette packets.
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Stiff opposition from the tobacco industry on the ground that graphic images violate its First Amendment rights protecting 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 warnings even after the FDA published the final rule.
By virtue of their 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 the varied risks of smoking. They also convey the central message immediately and easily.
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The power of pictures
Tobacco companies are well aware of the power of pictorial warnings in reducing tobacco consumption, urging users to quit smoking and preventing young adults from taking up 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, one of the biggest markets in the world (1.4 million children between the ages of 12 and 17, and 34 million adults currently smoke).
A 2017 study based on modelling found that pictorial warnings could reduce the prevalence of smoking in the U.S by 5% by 2020 and up to 10% by 2065. 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. For instance, in Canada, there was 12% relative reduction in smoking prevalence in just six years after graphic images were made mandatory on cigarette packages. Similarly, Australia, which introduced graphic images in 2006, witnessed more than a 10% drop in prevalence between 2004 and 2008. The U.K. saw a 10% relative decline in 2009, just a year after image warnings were introduced. The biggest threat that pictorial warnings pose to tobacco companies is in 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 brand building, packages with graphic images will become a mobile medium to spread public health messages at no cost to the government.
prasad.ravindranath@thehindu.co.in