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Hong Kong must adopt plain tobacco packaging, say health advocates

Three-quarters of Hongkongers support restrictions on logos, colours and brand images on cigarette and other tobacco product packs in a bid to further reduce smoking

http://www.scmp.com/lifestyle/health-beauty/article/1959203/hong-kong-must-adopt-plain-tobacco-packaging-say-health

We’ve all chosen products purely based on packaging – a bag of chips at the supermarket, a novel at the bookstore, a photo of a dish on a menu. Even when dealing with people, we tend to let first impressions guide our future interactions with them.

The power of packaging to directly influence one’s perception of something or someone is so strong that it’s no surprise the World Health Organisation advocates plain packaging for tobacco products, which kill almost six million people every year.

Momentum for plain packaging has steadily gained in the past few years, starting with Australia’s implemention in December 2012, and now the measure looks to be gaining traction worldwide.

“We’re beginning to see the globalisation of plain packaging,” says Benn McGrady, a legal adviser to the WHO’s Framework Convention on Tobacco Control.

Plain packaging of tobacco products restricts or prohibits the use of logos, colours, brand images and promotional information on packaging other than brand and product names displayed in a standard colour and font style.

Earlier this month on May 20, France and Britain each began implementation of plain packaging. Ireland is also preparing to introduce the measure this year; Hungary and Norway are in the process of developing laws to implement plain packaging; Singapore is undertaking a public consultation with a view to introducing plain packaging; and several other countries, including New Zealand, South Africa and Turkey, have either expressed an intent to implement the measure or are in the policy development process.

Will Hong Kong be next? Antonio Kwong, chairman of the Council on Smoking and Health (Cosh), says Cosh has been advocating the government implement plain packaging since 2012.

About three-quarters of Hongkongers have expressed support for plain packaging, Kwong says, citing results from the 2015 Tobacco Control Policy-related Survey commissioned by Cosh and conducted by Hong Kong University’s School of Public Health to collect public opinion towards current and future tobacco control policies.

“In view of the global successful examples and WHO’s appeal, Cosh recommends the government to actively consider adopting plain packaging in two to three years,” says Kwong.

The WHO is stepping up its drive for plain packaging by making it the theme of this year’s World No Tobacco Day, held annually on May 31 since 1988. WHO has launched a new 86-page guide to plain packaging of tobacco products, which gives governments the latest evidence and guidance on implementing the measure.

“Plain packaging reduces the attractiveness of tobacco products. It kills the glamour, which is appropriate for a product that kills people,” says WHO director-general Dr Margaret Chan, a former Hong Kong director of health. “It restricts tobacco advertising and promotion. It limits misleading packaging and labelling. And it increases the effectiveness of health warnings.”

McGrady says there’s a “strong evidence base” supporting the implementation of plain packaging, including more than 80 peer-reviewed empirical studies, three systematic reviews of the evidence, and an official post-implementation review from Australia.

“As a whole, this body of evidence points in one direction, which says plain packaging is an effective public health intervention,” says McGrady.

Smoking prevalence has been steadily declining in Australia for years and, even if plain packaging hadn’t been introduced the rate, was projected to be 17.77 per cent among those aged 14 and older in 2015. However, research shows that between December 2012 and September 2015, there was an additional 0.55 percentage point fall in smoking prevalence attributable to the packaging changes – meaning a 17.21 per cent prevalence – McGrady says.

This equates to more than 108,000 fewer smokers in Australia as a consequence of plain packaging – a “very big” number, says McGrady. “Plain packaging has decreased tobacco use in Australia beyond trend; it has increased the speed of the downward trajectory.”

Tobacco packs act as a prominent form of tobacco advertising and promotion, not only at the point of sale, but also after, says the WHO report. Tobacco products are “badge products”, meaning they have a high degree of social visibility and that consumers identify with the brand image cultivated on product packaging.

“As internal tobacco industry documents recognise, packaging plays an increasingly important role in promoting tobacco products as other restrictions on tobacco advertising and promotion are tightened,” the report says.

In the evidence gathered in the report, studies show that packaging – in particular colour – affects consumers’ perceptions of risk. Early evidence of this can be found in internal tobacco industry documents released to the public through litigation, the report says.

For example, a 1990 tobacco industry document recognised that so-called “lower delivery products” were featured in lighter packs because they have a clean healthy connotation. Other studies tested consumer reactions to ultra-light products packaged in different colour packs. Consumers ranked the perceived tar level of products in different colour packs and commented on factors such as the harshness and strength of the flavour of different colour packs with otherwise identical products inside them.

There’s also evidence that plain packaging influences the intention and increases the urgency of smokers to quit. It also reduces active smoking and the display of tobacco packs in outdoor settings.

Plain packaging also prevents misleading packaging, the report says, such as labels like “light”and “mild”, which suggest products are less harmful to health than regular brand variants when this is not the case. Rather, consumers compensate for the lower tar and nicotine yields in these products, including by smoking more of a cigarette and taking deeper puffs.

With all this compelling evidence, why aren’t more governments rushing to implement plain packaging?

“I think the resistance to tobacco control and plain packaging are driven by the tobacco industry using its deep pockets to oppose implementation of good public health policies. It’s political; it’s nothing to do with evidence or public policy,” says McGrady. “That’s what’s slowing down tobacco control globally.”

Tobacco industry opposition to plain packaging dates back more than 20 years, McGrady says. Most recently the world’s top four tobacco companies challenged Britain’s new plain packaging law, arguing that it unlawfully took away their intellectual property. The High Court struck down the challenge and the law came into effect on May 20.

“It is wrong to view this issue purely in monetised terms,” the ruling said. “There is a significant moral angle embedded in the regulations, which is about saving children from a lifetime of addiction, and children and adults from premature death and related suffering and disease.”

One person dies from a tobacco-caused disease approximately every six seconds according to the WHO. Annual deaths are forecast to rise from 6 million to more than 8 million by 2030.

In Hong Kong, the prevalence of daily cigarette smokers among persons aged 15 and over has decreased steadily from 23.3 per cent in 1982 to 10.5 per cent in 2015 (except for years from 2000 to 2002). Still, a Chinese University study last year found that smoking costs the city HK$11.3 billion each year, in health care expenses and productivity losses related to tobacco.

The WHO recommends implementing plain packaging as part of a comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.

Says Kwong: “Through the implementation of a comprehensive and multipronged strategy, including a policy of long-term tobacco tax increases to reduce affordability, expansion of statutory no-smoking areas, restriction of tobacco promotion and packaging, the banning of tobacco product displays at points of sale, raising the minimum age to buy cigarettes to 21, increasing resources for smoking cessation services, strengthening smoke-free education and promotion, placing responsibility on venue managers for smoking offences in their premises etc, we hope the smoking prevalence will drop to below 5 per cent in the near future.”

Anti-smoking fight heats up

Bringing Hong Kong’s smoking rate down to single digits from one of the world’s lowest will be a slow and difficult drive, with the government considering a two-pronged strategy.

http://www.thestandard.com.hk/section-news.php?id=181900

Undersecretary for Food and Health Sophia Chan Siu-chee said this in an interview with The Standard, as the government is set to gazette an amended law enlarging the size of scare-tactics health warnings to at least 85 percent of the cigarette packets before the current term ends on June 30.

Chan said the government will study new strategies to encourage about 600,000 hard-core smokers to quit and prevent young people from taking up the habit.

Hong Kong’s smoking rate is 10.5 percent – down from 28 percent in the 1980s – but Chan said the long-term goal is to bring down the prevalence rate to single digits, although no deadline has been set for achieving that for several reasons.

“We know that as smoking prevalence decreases to such a low extent – 10.5 is actually one of the lowest rates in the world – the rate of further lowering would be slower than before because many people who are motivated or are prepared to quit have probably already quit,” she said.

But it would be very difficult to get the hardcore smokers to quit.

“But it doesn’t mean we are not doing anything. We just need a different strategy to deal with this group of more hard-core people,” said Chan.

“We need to study the remaining population of smokers more carefully to ascertain how hardcore they are and what strategy we need to deal with the different stages of readiness to quit.”

Chan also said it was very important to prevent young people from picking up the habit.

“That’s why it is also important for us to regulate for example, e-cigarettes which are like a gateway to smoking.”

The Food and Health Bureau is studying the legislative framework to carry that out, she said, but it would not be ready anytime soon.

The Department of Health will study whether the expanded health warnings would have any effect on bringing down the smoking rate once the enhanced warnings were put in place.

“We have international evidence that it would reduce smoking prevalence,” she said.

It would be the first time for pictorial health warnings to be expanded since the warning covering 50 percent of packets was introduced in 2007.

The government will allow the tobacco industry 12 months from the enactment of the law to sell off existing stock and prepare for the expanded warnings that will also include 12 pictures, up from the current six, to be used on a rotation basis.

But she said this did not mean the government had made any concessions to the trade, saying: “Even the last time, we gave 12 months when we first introduced the pictorial warning in 2007.”

She insisted that the plan was “to gazette as soon as practicable before June 30.”

While Chan said plain packaging would not happen in Hong Kong anytime soon, she defended the government’s move to go for 85 percent instead of 100 percent health warnings.

The World Health Organization recommends 50 percent or above, she noted.

But there are legal considerations as seen in countries that have mandated plain packaging being sued by the tobacco giants.

The enhanced warnings also include the Department of Health quit line and a message from the government to quit smoking.

Calls to stub out tobacco deals

http://www.thestandard.com.hk/section-news.php?id=180992

Several legislators yesterday called on the government not to extend further concessions to the tobacco trade that is trying to further delay implementation of bigger graphic health warnings on cigarettes to the detriment of public health.

The government proposed in May 2015 to enlarge the size of health warnings to cover at least 85 percent of the packet or retail containers of cigarettes, saying the existing six graphic health warnings which cover half of packets or containers have been in use since 2007.

The Food and Health Bureau has made four concessions to meet the industry’s concerns, including using any background color to show nicotine and tar content and for the English version of the health warning to remain at 50 percent of the surface area of the lid of a drum-shaped container.

Undersecretary for Food and Health Sophia Chan Siu-chee told a Legislative Council health services panel yesterday that the government will also extend the adaptation period from six months to 12 months upon gazetting of the amendment order of the smoking ordinance.

Tourism-sector lawmaker Yiu Si- wing said: “The government is conceding, giving in to the tobacco sector’s pressure.”

The Labour Party’s Fernando Cheung Chiu-hung: “Public health should come first. Especially as I have had some personal health problems, I understand the value of health.

“I understand from the grassroots that smoking is a relief for them from stress but the government should not concede anymore. It has already conceded enough.”

Peter Shiu Ka-fai, of the wholesale and retail sector, questioned whether the government would have evidence to show that bigger warnings would mean “people will stop smoking?”

Wong Ting-kwong, of the import and export sector, said he is a smoker and that bigger warnings will still affect second- and third-hand smokers as “the smoke isn’t less.”

The panel also discussed the Hong Kong Code, a voluntary code aimed at protecting breastfeeding and to impose restrictions on formula milk marketing practices that give misconceptions about the nutritional value of products for children up to 36 months old.

Chan told the legislators: “We consulted the Department of Justice and the code is not breaching the competition law as this is voluntary.”

WHO Letter to HK Government on Tobacco Control Efforts

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CUHK MPH Student Support for Graphic Health Warnings

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HK customs seizes 900,000 suspected illicit cigarettes

HONG Kong Customs on Friday said they have seized about 900,000 suspected illicit cigarettes with an estimated market value of 2.4 million Hong Kong dollars (about US$0.3 million ) and a duty potential of about 1.7 million Hong Kong dollars.

http://www.shanghaidaily.com/nation/HK-customs-seizes-900000-suspected-illicit-cigarettes/shdaily.shtml

During an anti-illicit cigarette operation on Thursday, customs officers intercepted a truck in Kwai Chung. After inspection, customs officers found about 900,000 sticks of suspected illicit cigarettes in 108 carton boxes on board the truck. A 40-year-old man was arrested and the truck was detained. Investigation is ongoing.

Hong Kong customs said, smuggling is a serious offense. Under Hong Kong’s Import and Export Ordinance, any person found guilty of importing or exporting unmanifested cargo is liable to a maximum fine of two million Hong Kong dollars and imprisonment for seven years.

They added that under the Dutiable Commodities Ordinance, anyone involved in dealing with, possession of, selling or buying illicit cigarettes commits an offense. The maximum penalty upon conviction is a fine of one million Hong Kong dollars and imprisonment for two years.

Designing the Tobacco End Game

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Canadian Cancer Society Support on 85% HK Health Warnings

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Hong Kong Department of Health Tobacco Control Zero Efforts

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COSH urges the Government to take full account of public opinions Enact Enlargement of Pictorial Health Warnings Promptly

http://smokefree.hk/en/content/web.do?page=news20170116

Hong Kong Council on Smoking and Health (“COSH”) urges the Government and Legislative Council to enact the enlargement of pictorial health warnings promptly in order to reduce the attractiveness of tobacco, motivate more smokers to quit and deter youth from trying the first cigarette. Mr Antonio KWONG, COSH Chairman remarked, “Results from survey conducted by COSH and two rounds of public consultations organized by the Legislative Council showed that majority of citizens and organizations supported the enlargement of pictorial health warnings to 85%. The Government and Legislative Council should take full account of public opinions and enact the proposed tobacco control measure as soon as possible.”

The Government briefed the legislative proposals to strengthen tobacco control on 18 May 2015, including enlarging the size of pictorial health warnings to at least 85% of the two largest surfaces of the packet, increasing the number of forms of health warning from six to twelve and adding the quitline 1833 183. The date of enactment is yet to be scheduled after more than one and a half years.

The Legislative Council collected views of the public and held special meetings on the enlargement of pictorial health warnings twice. Among the hundred submissions received in July 2015 regarding the increase in the size of pictorial health warnings, more than 80% supported. Besides, over 100 submissions were received for the special meeting of Legislative Council Panel on Health Services to be held tomorrow (17 January 2017), in which around 70% agreed the proposed measure.

The School of Public Health of The University of Hong Kong was commissioned by COSH to carry out the Tobacco Control Policy-related Survey 2016. It was found that public support on enhancing the pictorial health warnings was overwhelming, 79.5% of all respondents agreed to display more threatening messages about the health risks of smoking. About 72.5% of all respondents supported to increase the coverage of the health warnings to 85% while about half of the current smokers also supported. Majority of respondents opted for plain packaging* of cigarettes as well. In addition, COSH has collected over 26,500 signatures from citizens and organizations through street counters and online platform supporting the enlargement of pictorial health warnings since May 2015.

In recent years, many countries have successfully introduced more stringent measures to regulate tobacco packaging. Prof Judith MACKAY, Director of Asian Consultancy on Tobacco Control and Senior Policy Advisor of World Health Organization claimed, “Hong Kong ranked the 72nd in the world regarding the implementation of pictorial health warning and behind many developing countries like Laos, Myanmar and Sri Lanka. Hong Kong should enlarge and strengthen the pictorial warnings promptly in order to reduce the use of tobacco.” World Health Organization called for more countries to enlarge pictorial warnings covering more than 85% and implement plain packaging. “Get ready for plain packaging” was designated as the theme of World No Tobacco Day 2016.

Recently, some organizations opposed the proposed enlargement of warnings in the pretext that it would lead to a surge in cigarette smuggling activities. A recent study also claimed that illicit cigarettes composed for around 30% of cigarette consumption in Hong Kong. Prof LAM Tai-hing, Chair Professor of Community Medicine cum Sir Robert Kotewall Professor in Public Health, School of Public Health, The University of Hong Kong said, “the public should express reservation on the results of this tobacco industry-funded study. The data collection methods and calculations of the study were unclear using dubious methods.” The tobacco industry and its allies always express strong opposition against tobacco control measures proposed by the Government under the pretext that it will lead to a surge in cigarette smuggling activities. As recommended by the World Health Organization, the most effective measure against smuggling is tight control and aggressive enforcement.

With the Government’s multi-pronged tobacco control policies over the years, the smoking prevalence in Hong Kong has gradually reduced from 23% in early 80s to 10.5% in 2015. In view of the tobacco epidemic in Hong Kong and the international tobacco control trend, we urge the Government and Legislative Councilors to take account of public opinions and implement the enlargement of pictorial health warnings as soon as possible to safeguard public health. The Government should also actively consider adopting plain packaging within 2 to 3 years and develop long-term and comprehensive tobacco control policies including regulating the emerging tobacco products and e-cigarettes, raising tobacco tax substantially, expanding no-smoking areas, increasing resources on education, publicity, smoking cessation services and enforcement to further reduce the smoking prevalence in Hong Kong and protect people from the harms of smoking and secondhand smoke.

*Remarks: Plain packaging standardizes and simplifies the packaging of tobacco products. The pictorial health warnings on the main sides of cigarette pack are expanded. All forms of tobacco branding should be labeled according to the government prescriptions and with simple and plain format. This means that trademarks, graphics and logos are not allowed on cigarette packs, except for the brand name that is displayed in a standard font size, colour and location on the package. The packaging should not contain other colours and should include only the content and consumer information, such as toxic constituents and health warnings required by law. The quitline number should also be displayed at a prominent position. Australia was the first country to introduce plain packaging in 2012. The measure was also implemented in the United Kingdom, France and Hungary in 2016 and will be implemented in Ireland in 2017.