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May 28th, 2016:

GET READY FOR PLAIN PACKAGING

May 28th, 2016
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May 31st 2016 World No Tobacco Day Tobacco packaging is a mobile billboard promoting consumption of tobacco products. Tobacco packaging makes products more attractive, advertises and promotes tobacco consumption, distracts from health warnings and deceives people into thinking that some products are less harmful than others.

If you strip back the decoration, gloss and misleading elements of tobacco packaging, you are left with little more than a box of deadly and addictive products that kills approximately 6 million people a year and harms the health of many more. Plain packaging helps reveal the grim reality of tobacco products.

What is plain packaging?

Plain packaging (also called standardized packaging) refers to “measures to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style (plain packaging)”.1

Plain packaging has also been described as packaging that is “black and white or two other contrasting colours, as prescribed by national authorities; nothing other than a brand name, a product name and/or manufacturer’s name, contact details and the quantity of product in the packaging, without any logos or other features apart from health warnings, tax stamps and other government-mandated information or markings; prescribed font style and size; and standardized shape, size and materials. There should be no advertising or promotion inside or attached to the package or on individual cigarettes or other tobacco products.”2

Guidelines for Implementation of Article 11 (Packaging and labelling of tobacco products) and Article 13 (Tobacco advertising, promotion and sponsorship) of the WHO Framework Convention on Tobacco Control (WHO FCTC) recommend that Parties consider adoption of plain packaging.

Goals of plain packaging

The goals of plain packaging include:
1. reducing the attractiveness of tobacco products;
2. eliminating the effects of tobacco packaging as a form of advertising and promotion;
3. addressing package design techniques that may suggest that some products are less harmful than others; and
4. increasing the noticeability and effectiveness of health warnings.

As the WHO FCTC recognizes, tobacco control relies upon implementation of comprehensive multisectoral measures that work together in a complementary way. In this respect, plain packaging is a demand reduction measure that builds on other measures designed to reduce demand for tobacco products, such as mandatory health warnings and comprehensive prohibitions on tobacco advertising, promotion and sponsorship.

Status of implementation

In December 2012, Australia became the first country to implement fully tobacco plain packaging. It is now possible to observe the globalization of plain packaging. France, Ireland and the United Kingdom of Great Britain and Northern Ireland have all passed laws requiring implementation of plain packaging from May 2016. Other countries are at an advanced stage of the policy process.

Evidence justifying plain packaging

A large body of evidence justifies the introduction of plain packaging.

Experimental studies, surveys and focus group studies conclude that plain packaging achieves its objectives. These conclusions are supported by three separate systematic reviews of the evidence conducted since adoption of the guidelines to Articles 11 and 13 of the WHO FCTC.

Early evidence of Australia’s experience implementing plain packaging suggests that the measure has begun to achieve its public health objectives. The evidence shows that plain packaging in Australia is reducing the appeal of tobacco products, increasing the effectiveness of health warnings and reducing the ability of the pack to mislead. An expert analysis conducted as part of Australia’s review found that introduction of plain packaging together with introduction of larger health warnings and new warnings had reduced smoking prevalence in Australia beyond the pre-existing downward trend.

Specifically, the report estimated that between December 2012 and September

2015 “the 2012 packaging changes reduced average smoking prevalence among Australians aged 14 years and over by 0.55 percentage points”.3 According to the model, average smoking prevalence in the post-implementation period would have been 17.77% rather than 17.21% with the changes to packaging. This effect on smoking prevalence is expected to grow over time.

What should be done?

• Policy makers should consider adopting legislation or regulations to implement plain packaging of tobacco products as part of comprehensive, multisectoral approaches to tobacco control.
• This process should include establishing a formal plan and timeline for implementation of plain packaging, in line with each Member State’s tobacco control programme and priorities.
• In some cases, to prepare for plain packaging, policy makers may:
– strengthen health warnings;
– strengthen bans on misleading packaging and labelling;
– ensure that bans on advertising, promotion and sponsorship are comprehensive; and
– ensure that each of these measures is well enforced.
• Policy makers should resist interference in the policy process by the tobacco industry in line with Article 5.3 of the WHO FCTC and its guidelines for implementation.

Resisting interference from the tobacco industry

Countries can expect substantial tobacco industry opposition to plain packaging, including tobacco companies bringing claims against plain packaging before the courts.

Australia, for example, successfully defended a claim before its domestic courts and a claim under a bilateral investment treaty, but is still defending claims under the law of the World Trade Organization.

Such industry opposition demands a careful policy design process, but countries should rest assured that the evidence base justifies introduction of plain packaging as part of a comprehensive approach to tobacco control.

Further information

For more detailed information about designing and implementing plain packaging laws see www.who.int/tobacco.

World No Tobacco Day communications actions

May 28th, 2016
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Smoking makes low-income people even poorer: Minister

May 28th, 2016
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http://www.thejakartapost.com/news/2016/05/28/smoking-makes-low-income-people-even-poorer-minister.html

Indonesia has some of the lowest cigarette prices in the world, with a pack costing just US$1.

In a country where 28.6 million people are still living below the poverty line, cigarette addiction makes low-income people even poorer, to the extent where some people sacrifice basic necessities — such as their children’s education — in order to buy cigarettes.

Health Minister Nila F. Moeloek said recently that she had noticed an alarming trend where children dropped out of school because their parents preferred to spend their income on cigarettes, rather than education.

“There are many children who have to drop out of school because of a lack of money. And we have lost count of how many children are malnourished because the household spending goes mostly to cigarettes,” she said.

The poorest families in Indonesia spend almost 12 percent of their incomes on cigarettes, according to a report on Indonesia by the Global Adult Tobacco Survey ( GATS ) in 2011.

Furthermore, cigarettes have become the second biggest household expense in both urban and rural families after rice, according to a 2015 survey from the Central Statistics Agency ( BPS ).

While there has yet to be a study on how many children’s educations are sacrificed because of their parents’ smoking habit, there are many real-life anecdotes.

One instance is the case of a fisherman in Muara Angke, North Jakarta, whose two children dropped out of school because their father’s daily income of Rp 50,000 went to four packs of cigarettes per day, according to National Commission on Tobacco Control commissioner Fuad Baradja.

Nila said that Indonesian children stayed an average of 8.3 years in school, further indicating that high cigarette consumption ate up money that could have been spent on other necessities.

“While there could be many reasons that children drop out of school, one of them might be because the parents are not focusing enough on funding their children’s education. Even though the government has provided financial assistance for education, why is it only eight years?” she said.

There are countless other intangible costs of smoking, which are often easily forgotten.

“If a father is smoking inside his house and his daughter is having respiratory problems because of that, just count the cost incurred from the days when she has to skip school. What about medicine for her? And the father might also have to leave work to take his daughter to the doctor,” said Nila. ( bbn )

Plain cigarette packaging to put smokers off, ministry hopes

May 28th, 2016
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http://www.thejakartapost.com/news/2016/05/28/plain-cigarette-packaging-put-smokers-ministry-hopes.html

The Health Ministry is pushing for plain packaging on all cigarettes sold in Indonesia to reduce the alarmingly high smoking rate, especially among adolescents, which claims 200,000 lives per year.

The idea behind plain packaging is that a uniform, ugly color and the lack of brand logos on products may deter consumers from picking up a pack.

Indonesia began moving into that direction in 2014 when it required companies to put graphic warnings on their cigarette packages.

“But only three of these five images are scary. The other two are not scary at all, as they just depict men smoking,” former Indonesian Broadcasting Commission deputy chairwoman Nina Mutmainnah Armando said.

With pictorial warnings deemed insufficient, plain packaging is seen as the logical next step to contain consumption.

Indonesians spent at least Rp 330 trillion (US$ 24.3 billion) last year to finance their smoking habit. Data from the 2014 Global Youth Tobacco Survey reveal that 20.3 percent of Indonesian teenagers between 13 and 15 years of age are smokers. The same survey shows that 62.7 percent of the surveyed teenagers are exposed to cigarette advertisement on TV or in movies.

Tobacco companies are increasingly targeting children — their source of income for decades to come. While the government discourages smoking through its packaging policy, the Industry Ministry’s tobacco industry road map 2015 states the goal of doubling the production of cigarettes — to 524.2 billion a year — by 2020.

“The road map is focused on raising the production of mild tobacco, so it is clearly targeting children, because mild cigarettes are smaller in size, with more feminine and slimmer packaging,” University of Indonesia public health expert Hasbullah Thabrany said.

Since only 2.7 percent of Indonesian women smoke, the more feminine packaging appears to be aimed at the largely untapped female market.

“The industry is really smart in targeting children and the youth. That is why we need plain packaging,” said Tara Singh Bam, regional advisor for the Asia Pacific tobacco control program at the International Union Against Tuberculosis and Lung Disease.

The use of plain packaging is catching on around the world as countries try to protect their young generation. Fourteen countries have laws mandating plain packaging, including Australia, the UK, France, Hungary, Slovenia, Singapore, Canada, New Zealand, Sweden, Finland and South Africa.

But not all have enforced those laws, with Singapore expecting to start enforcing plain packaging by the end of this year.

“It will always be opposed by the tobacco industry. Take for instance Australia, which won two lawsuits filed by the industry, one at the WTO and the other at the constitutional court,” National Commission on Tobacco member Kartono Muhammad said.

Indonesia’s largest tobacco producer, PT HM Sampoerna, said plain packaging would not be effective in deterring smokers.

“More than three years after taking effect in Australia, plain packaging has failed to meet its stated goal of reducing smoking,” Sampoerna regulatory affairs, international trade and communications head Elvira Lianita said.

According to her, Australian government data suggested that smoking may have actually increased in the first full year of plain packaging in states representing 95 percent of the population.

However, an Australian government review on the implementation of plain packaging concluded that the plain packaging rule had begun to achieve its public health objectives of reducing smoking and exposure to tobacco smoke and that it was expected to continue to do so.

The Health Ministry is lobbying for the government to follow Australia. “But it might be a bit difficult, because to implement plain packaging would require a government regulation, which is an inter-ministerial process,” the ministry’s law department head, Barlian, said.

A growing gulf in the terrain of tobacco control

May 28th, 2016
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http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930658-4/fulltext

The theme for World No Tobacco Day on May 31, an annual initiative of WHO and the Secretariat of the Framework Convention on Tobacco Control (FCTC), is plain packaging of tobacco products. Plain packaging prohibits the use of logos, colours, and promotional labelling on cigarettes and hand-rolled tobacco and gives graphic health warnings more prominence. In the FCTC, the legally binding international treaty to curb tobacco use signed by 180 nations, a ban on branded cigarette packaging is considered a key demand reduction strategy.

On May 31, WHO calls on countries to “get ready” for plain packaging, following the example of Australia, which introduced plain packs in 2012 and has since seen declines in smoking. France, Ireland, and the UK will imminently require plain packaging, and Canada, India, New Zealand, South Africa, and other European countries are considering tougher packaging laws for tobacco.

Plain packaging is a big step forward on the journey to reducing tobacco use and its associated health risks. But it has not been an easy road. The Government of Australia spent AUS$50 million fighting a court battle against tobacco giant Philip Morris, which argued that plain packs threatened the company’s intellectual property. The French subsidiary of Imperial Tobacco is planning a similar lawsuit. Last month, however, the European Court of Justice said the new EU law on plain packaging and a forthcoming ban on menthol cigarettes were legal. And on May 19, a high court in London ruled against four major tobacco companies who argued the plain packaging move violated UK and European law.

These recent victories against Big Tobacco are another triumph for public health. However, they also put into stark focus the massive gap between countries in delivering tobacco control.

For the bulk of the world’s lower income countries, implementation of agreed commitments in the FCTC has been staggeringly slow and may be at risk of stalling. The least compliant countries are often the ones with the highest rates of tobacco use, which compounds growing disease and cost burdens of tobacco. The Pan American Health Organization (PAHO), for example, released a report last week revealing uneven headway across the Americas. Just 17 of the region’s 35 member countries have smoke-free public spaces and workplaces, and only five have banned tobacco advertising and sponsorship. Only 16 countries mandate full graphic health warnings. Tobacco taxation is the most effective cessation and prevention strategy, but only one American nation has implemented the treaty’s agreed measure. Although 12 countries have some form of tobacco tax, only Chile levies taxes greater than 75% of the retail sale price of cigarettes. The USA has yet to even ratify the FCTC.

Progress in Africa and Asia, both key markets for tobacco companies where epidemics may be worsening, is similarly poor, as a series in The Lancet last year documented.

Smoking remains the number one cause of preventable disease and early death. It is the single common risk factor for the priority non-communicable diseases whose burdens are exploding in the very countries where tobacco use runs largely unabated. Without fuller implementation of the FCTC, no country will reach the global target of a 30% reduction in the prevalence of tobacco use by 2025, nor contribute substantially to the one-third reduction in premature deaths from non-communicable diseases targeted in the Sustainable Development Goals.

The basic ingredients of the framework convention—advertising bans, smoke-free spaces, graphic warnings, and taxation—are effective and cost little. So lack of implementation is not a matter of financial resources, it is political. Overcoming the inability to galvanise political will to fight for tobacco control should be the real focus of World No Tobacco Day.

Although we are encouraged by and celebrate the progress several countries have made to limit tobacco’s appeal through the use of plain packaging, the global community must remain vigilant to ensure a robust and even implementation of strategy across all countries. The FCTC is supposed to equip countries with policies and practices to fight against tobacco. We renew our call for a high-level UN summit on tobacco control, with stronger accountability mechanisms to bridge the gap between countries on-track and off-track for a tobacco-free world.

Editorial: Tobacco tax increases must be matched by more help for smokers

May 28th, 2016
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http://www.stuff.co.nz/dominion-post/80484061/Editorial-Tobacco-tax-increases-must-be-matched-by-more-help-for-smokers

OPINION: The Government stands accused of making a fortune out of tobacco addicts. The 10 per cent annual increase in tobacco taxes for the next four years will bring in a staggering $425m. The tax increases will, of course, hit the poor hardest.

NZ First leader Winston Peters raises the spectre of poor children going hungry while their addicted parents continue to buy cigarettes. Others have questioned whether the increase in taxes reduces tobacco consumption as much as the Government claims.

It has long been the conventional public health wisdom that price rises cut cigarette consumption. The Government says the 10 per cent annual tax rises in recent years have cut per capita consumption by around a quarter.

There is evidence, however, that the effect on consumption is weakening. Partly this is because the cigarette companies have not passed on the total tax increases, especially in the cheaper brands. If a 10 per cent tax increase leads to only a five per cent price increase, the effect on consumption is lower.

For that reason many public health experts called for a much stiffer tax increase, perhaps as high as 40 per cent in the first year and 20 per cent annual rises after that.

There is a risk that smokers simply factor in the 10 per cent rise and live with it. A much bigger increase would shock many more into quitting.

The Government would have been justified in doing this on public health grounds. After all, about 5000 people in New Zealand die prematurely each year as a result of smoking. Cutting smoking means saving lives.

But the same experts also called for much greater help for smokers to quit. The Government has not done this: it is happy to harvest another $425m from its tobacco tax and use it to help build a surplus (probably for future tax cuts).

The Government should have given a massive boost to quitlines and other programmes to help smokers stop. Poor tobacco addicts, who are disproportionately Maori or Pasifika, need much more help in quitting. Without that help, some will undoubtedly spend scarce family money on tobacco rather than food.

It is, after all, the poor who are the main target of the tax increases. Wealthy smokers won’t be affected, although wealthier people are much less likely to smoke. The middle classes are heading rapidly towards smoke-free status.

Quitlines make it easier for smokers to stop, although their success is modest because smoking addiction is so serious. The Government should be spending more and exploring more imaginative ways of helping addicts. Recent studies in the United States, for example, have explored the effects of simply paying people to quit.

Politicians like Winston Peters, on the other hand, need to be called to account. Is he saying the Government should scrap tobacco tax increases because they are “unfair”?

That would be a mistake.

Smoking, after all, wreaks havoc among poor families, killing and maiming productive family members. The war against smoking must continue.

FDA seizes Rs 124-crore worth cigarette packs for flouting pictorial warning norms

May 28th, 2016
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Manufacturers to be issued warnings to cover 85% of packet surface with visuals on adverse health effects.

http://indianexpress.com/article/entertainment/regional/fda-cigarette-packs-flouting-pictorial-warning-2822567/

According to the Food and Drug Administration, cigarette packets and other tobacco products, which should display pictorial warnings on 85 per cent of the packet surface about the adverse health effects as per the new law, are clearly flouting the rules in Pune district.

The FDA team conducted a massive operation beginning April this year and seized cigarette packets worth a whopping Rs 124.53 crore from 14 places across Pune district.

Joint Commissioner (FDA) Shashikant Kekare told The Indian Express that they have seized the packets worth Rs 124.53 crore from April till date. “We have decided to re-send the packets to the manufacturing companies, mainly ITC and Godfrey Phillips, and issue a warning to them to cover 85 per cent of the packet surface with large visual warnings within two months,” said Assistant Commissioner FDA Dilip Sangat.

In Pune district in the last four years, the FDA has also collected fines amounting to Rs 50,000 from 350 people, who were found smoking at public places and Rs 11,400 from 77 people who were found selling tobacco and related products within 100 metre distance of schools. The gutkha collected, however, has been phenomenal and packets worth Rs 8.68 crore have been seized from 638 places in the district.

As per the Cigarettes and Other Tobacco Products (Packaging and Labelling) Amendment Rules, 2014, the size of the pictorial warning was increased and were to come into effect from 2015 onwards. However, the Centre had on April 1, 2016 brought in the 85% pictorial warning rule. The Supreme Court too directed the tobacco manufacturing companies to comply with the rules to display the pictorial warnings across 85% of the surface of packets of cigarettes.

This year, the World Health Organisation (WHO) has stressed upon plain packaging of cigarettes and tobacco products on No Tobacco Day (May 31).

PACE team to reach out to more students, train medical interns

About one million people die each year from tobacco-related diseases. By 2020, that number is expected to touch 1.5 million, according to the World Health Organisation (WHO). May 31 is observed as No Tobacco Day to spread awareness on the harmful effects of tobacco consumption. The Association of Hospital (AOH) urges people to control and gradually reduce tobacco usage.

In Pune, the team of doctors at the Prevention of Addiction through Children’s Education (PACE) has actively reached out to more than one lakh students in the city and Mumbai. Dr Vandana Joshi, ENT surgeon, who heads PACE and is supported by a team of activists including Dr Neeta Ghate, Anuya Chabukswar and others, have now decided to focus on private schools this year. “We also want to train students of medical and dental courses so that they can take up the campaign to prevent gutka and smoking,” Joshi said.

Pictorial warnings welcome, but poor implementation: Docs

Cancer surgeons have welcomed the move to display pictorial warnings on cigarette packs but say it is poorly implemented. Dr Kamalesh Bokil, who is flooded with oral cancer patients at Ruby Hall Clinic, said the visual warnings really work.

“We need to sustain this movement. No firm can sell tobacco without displaying 85 per cent warning visuals on packs,” said Dr Pankaj Chaturvedi, head and neck cancer surgeon from Tata Memorial Hospital.