From Dysfonction érectile - Tobacco Info No. 4 - February 2011
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Health warning renewals
on cigarette packs set for 2011

Canadian Health Minister revamps anti-tobacco campaign

(See our TV recordings on YouTube)

By Joe Strizzi

After flip-flopping on the issue of renewing health warnings on cigarette packages, Health Canada announced that it intends to launch a set of new warnings as well as a social marketing campaign aimed at preventing youth from starting to smoke and encouraging them to quit. The plan consists of larger, more graphic images that will cover 75% of cigarette packs, up from 50%, and will include a pan-Canadian quitline toll-free telephone number and web address. The new warnings will also include improved health information messages and toxic emission statements. The new designs may appear on packages late in 2011, although no deadline has yet been chosen.

“The combination of larger health warning messages and social marketing will help the new messages reach as many smokers as possible,” said Federal Health Minister Leona Aglukkaq at the press conference held on December 30, 2010. “This comprehensive strategy will ensure Canada remains a world leader in tobacco control initiatives. The government is committed to helping Canadians quit.”

Health groups and tobacco control experts have applauded the new measures proposed by the government.

“The minister has committed the government to precisely the warning reforms that solid research shows will be effective,” said Geoffrey Fong, professor at the University of Waterloo and an expert who completed research on warnings in 20 countries. “Larger, more graphic, more emotive warnings work. And if these messages are strengthened by moving testimonials and support for smokers via a toll-free telephone cessation service, they will have a very substantial positive health impact.”

“The effectiveness of health warnings increases with size. The larger the warnings, the greater the impact,” said Rob Cunningham, Senior Policy Analyst with the Canadian Cancer Society. “Implementation of the new, larger package warnings will be an important achievement and will reduce cancer and other tobacco-related diseases in Canada.”

Campaign breakdown

The enhanced package warning system for cigarettes and little cigars includes the following: a set of 16 new package health warnings, with an increase in warning size from 50% to 75% of the package front and back; the use of testimonials; and the addition of a toll-free quitline number and a web address. International experience shows that calls to quitlines increase substantially when a toll-free number is added prominently to the package. The new warnings will address, for the first time, a new series of health effects, e.g., bladder cancer and the impact on vision. In addition, the exterior warnings will be supplemented by enhanced health messages inside the package, which will have new content as well as colour pictures. Also, an improved set of toxic emission messages will appear in rotation on the side of the package. Furthermore, Health Canada has committed to linking the new package warnings to a social marketing campaign targeting youth and young adults.

“Warnings that occupy 75% of the major faces of the package constitute a huge step toward plain and standardized packaging, a major tobacco control goal of the national health community,” said Melodie Tilson, Director of Policy for the Non-Smokers’ Rights Association. “The health minister deserves praise for deciding to move forward with these reforms.”

As the health sector celebrates this announcement, we must remember that just a few short months ago, the Health Minister’s pronouncement on the fate of health warning renewal had experts puzzled and disheartened.

Prelude

Health groups were disappointed to learn in late September 2010 that the Health Minister had suspended plans to place larger, more graphic warnings on cigarette packs. The Minister made the announcement behind closed doors at a meeting with provincial and territorial health officials, saying that it will refocus efforts on contraband — this despite having conducted extensive studies and research on updating package warnings since 2004. Following an outcry by health groups and substantial negative coverage in the media, the Minister later claimed that she had not shelved the warnings, but was merely slowing down the process to ensure that the government developed the best possible package of reforms.

In Canada, graphic warning labels have not changed since their first inception in January 2001. The country, once the international leader in health warnings, fell behind the likes of Panama and Singapore, which are already on their second round of pictorial warnings, Brazil and Thailand are on their third round and Uruguay its fourth.

The announcement that the warnings were at best delayed caused health groups, provincial ministers and newspaper editors to ask why the government couldn’t pursue both strategies at the same time; i.e. increase anti-contraband efforts and improve health warnings, especially considering that the costs of implementing new warnings would be incurred by the tobacco companies themselves.

“The Harper government’s sudden policy shift is ill-conceived. At a minimum, the shift is wasting years of work and taxpayer dollars,” wrote Matthew Stanbrook and Paul Hebert in an editorial in the Canadian Medical Association Journal published in early November, following the announcement. “Without warning labels, smoking rates will rise and eventually result in increased smoking-related illness and death. Certainly, the problem of contraband must be addressed. However, there is no obvious reason why fighting contraband should stop the government from proceeding with new warning labels that have already been developed and extensively researched.”

More questions were raised when documents tabled with the Parliamentary Health Committee by Health Canada showed that the department spent six years and nearly $4 million on the development of new warnings, including extensive public-opinion research.Dr. Robert Strang, Chief Public Health Officer with the province of Nova Scotia testified at the hearing of the House of Commons Health Committee examining why the Conservative government had shelved the renewal plan. He said that provincial representatives had been told to get ready for an increased volume of calls to quitlines, suggesting the new warnings including the phone numbers were intended to roll out last year.

 “Provincial and territorial governments remain puzzled as to why the initiative to renew health warnings was stopped at the last minute with no consultation,” said Dr. Strang at the hearing. “The background work...had been completed, and there was no hint of concern or reluctance on the part of Health Canada officials as that work progressed. One has to wonder what role the tobacco industry played in the decision to not move ahead with the renewal of health warning labels on tobacco packages.”

Dr. Strang’s suspicion was echoed by many ministers and authorities in tobacco control after a CBC News investigation found that the three leading tobacco companies, Imperial Tobacco Canada, JTI-Macdonald and Rothmans, Benson & Hedges, had met with various government officials a combined 53 times in just over two years. The number jumped to 82 when other industry associations and smaller tobacco companies were factored in, with many details shrouded in secrecy.

The CBC also found that the ‘Big Three’ hired lobbyists with strong conservative ties, leading members of the opposition to accuse the government of being ‘in bed’ with the tobacco industry.

Following a rough day of questioning of Health Canada officials by the Health Committee on December 14, Minister Aglukkaq continued her refusal to commit to launching larger, more graphic warnings on cigarette packages. Aglukkaq added that she was still looking into health warnings as part of an anti-smoking communications strategy that would be unveiled within weeks, which might include other avenues like social media.

Imperial Tobacco responds

Ironically, one of the tobacco industry giants is accusing the federal government of caving in to political pressure.

Imperial Tobacco Canada (ITC) released a statement on December 30 immediately following the Health Minister’s announcement “lamenting” her decision to “abandon her commitment to tackle the nation’s contraband tobacco problem and impose new regulations on the legal tobacco industry.”

“This announcement is simply poor policy for political gain and has little to do with the Ministry’s stated health objectives,” said John Clayton, Vice President of Corporate Affairs with ITC. “Three months ago, the Minister of Health stated that illegal tobacco was her priority. Instead, she caved in to the pressure of a handful of anti-tobacco groups. Increasing the size of health warnings will not provide consumers greater awareness or decrease the number of smokers.”

Ironically, it seems that illegal sales have declined in the past few years, and this according to the tobacco companies themselves.

In its 2010 semi-annual report, British American Tobacco, the multinational that owns ITC, noted that, “volume growth was achieved on the backs of a significant reduction in illicit product as a result of the authorities’ enforcement activities.”

Philip Morris International, owner of Rothmans, Benson & Hedges, reported an increase in sales volume during its first two quarters, which it also attributed to “stronger government enforcement measures to reduce contraband sales.”

Research shows bigger is better

Health Canada commissioned Decima Research to study health warning messages and health information messages for tobacco products. The study, released in June 2009, found that the size of the warning does make a difference in terms of the impact on the viewer, as does the newness of the message.

“The new warnings promised [December 30] will once again position Canada as a global leader in tobacco control,” said David Hammond, professor at the University of Waterloo and a former advisor on tobacco warnings to the World Health Organization. “Despite claims by the tobacco industry, warnings that are larger and that trigger a stronger emotional response are extremely effective.” He added that with larger warnings, the tobacco manufacturers have less opportunity to use creative design to detract from the warnings and to increase the appeal of their products to young people.

A Chinese study published in the October 2010 supplement issue of the journal Tobacco Control found similar results.

“Strong health warnings are the foundation of a comprehensive approach to tobacco control because the objective of health warnings is to inform the public about the harms of tobacco products, using methods that will increase the likelihood that smokers will be motivated to quit and youth will be less likely to take up smoking,” the study’s researchers wrote.

Launch date

Despite the Minister’s announcement, it could still be some time before Canadians actually start seeing the labels on cigarette packs. Aglukkaq said she hopes to publish draft regulations in the Canada Gazette Part I “as soon as possible,” which will be followed by a consultation period with the public and tobacco industry. Once the regulations are finalized, tobacco companies will be given a transition period before the new warning labels must be printed on all packs.