From Tobacco Info No. 3 - November 2010
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Federal government pulls new health warnings off the table

Health groups strongly opposed but tobacco industry supportive

By Joe Strizzi

In 2000, Canada was at the forefront of a key tobacco control strategy when its proposed 50% pictorial health warning regulations, appearing on packages in early 2001, were approved with all-party support.

Ten years later, after numerous requests from health groups and researchers to update the graphic images, the federal government announced that it was shelving the once-promised renewal of health warnings on cigarette packages and other tobacco products at a meeting with provincial health ministers in September.

The federal health department has said that the improvement to label warnings is not a dead issue, but for now, the government will refocus efforts on contraband — a move that will please tobacco companies.

“Health Canada continues to examine the renewal of health warning messages on tobacco packaging but is not ready to move forward at this time. Health Canada collaborates with provinces and territories to provide further support to cessation initiatives through its grants and contributions program,” said a spokesman for the federal health department in an email to Tobacco Info.

Ten years without change

During the last decade, negotiations, studies and plans were conducted by both levels of government, including focus groups and testing of new warning labels commissioned by the Harper government, which reportedly cost millions of taxpayer dollars.

“The current warnings have been in place for 10 years and are now extremely stale,” said Garfield Mahood, executive director of the Non-Smokers’ Rights Association and author of an expert report for the World Health Organization on tobacco warnings. “Smokers have now seen the same warnings 20 times a day, more than 60,000 times over the life of the current warnings, rendering them almost invisible for some and boring for others.”

Recent studies support Mahood’s statement. In a multi-country study published in the March 2007 issue of the American Journal of Preventive Medicine, researchers found that the effectiveness of warnings depended upon the design and the ‘freshness’ of the messages. Hammond, Fong et al. analyzed data from four surveys conducted from 2002-2005 on adult smokers in Canada, the United States, the United Kingdom and Australia. Almost 15,000 smokers were questioned on their awareness of the messages, any changes in understanding of the risk of smoking, their intention or motivation to quit and any behavioural changes they had noticed in themselves. They concluded that the more prominent written messages were more effective than their predecessors, and graphic pictures even more so, in affecting smokers’ behaviours. Recent changes in health warnings were also associated with increased effectiveness, while health warnings on US packages, which were last updated in 1984, were found to be least effective. The US health warnings are still text based, containing no images.

In Canada, the federal government reversed its stance on the revision of health warnings despite a plea by health groups over the past few months to move forward with the initiative. On June 15, a letter was sent to Federal Health Minister Leona Aglukkaq, signed by 11 tobacco control groups, asking the minister to “take rapid and effective action to implement enhanced picture-based health warnings on tobacco packages.”

“A well-designed package warning system is a key component of a comprehensive tobacco control strategy. Package warnings provide perfectly targeted health communication, reaching all smokers, as well as friends, family members, co-workers and others. And package warnings are exceptionally cost effective — Health Canada determines the warnings and the tobacco industry pays for the cost,” they wrote.  “Canada’s warnings have been on the packages since 2001, by comparison, no company would leave its advertising unchanged for a decade.”

Later, in a letter to all the provincial health ministers dated September 9, just prior to the closed door meeting held in Newfoundland, those same 11 health groups asked the ministers to use the gathering as an opportunity to push forward the pictorial warning revisions. Instead, it was announced by the federal government that updating the health warnings would be put on the back-burner.

“It was a bit of a disappointment,” said Ida Chong, BC’s Minister of Healthy Living and Sport, to the Globe and Mail. “We know that warning labels on tobacco packages do work. A number of us said we would have liked to move on these issues.”

Additional disappointment

According to reports, the renewed warning labels would cover 90% of the package with more graphic imagery, such as the picture of a dying Alberta cancer patient, Barb Tarbox, who spent the last months of her life campaigning about the consequences of smoking.

Minister Chong added that compounding her disappointment is the common knowledge that a quitline helps smokers quit and that part of the warning label revision would have included adding provincial quitline phone numbers to the packages as part of the larger message labels.

“The decision to cancel the refreshed warnings, including plans to add a toll-free, quit smoking number, is tragic,” said Geoffrey Fong, psychology professor at the University of Waterloo. “This decision has eliminated a critical opportunity to give strong warnings to kids and helpful advice to smokers through a toll-free quitline.”

“The biggest loss here is for smokers themselves,” said David Hammond, psychologist and assistant professor in the Department of Health Studies & Gerontology, also at the University of Waterloo. “New warnings provide critical information about the risks of smoking and help make cigarettes less attractive to youth. Delaying the implementation of these warnings will cost lives.”

Tobacco industry reactions

Canoe.ca, the Quebecor media portal, reported that reaction from the tobacco industry has been supportive of the government’s new direction.

JTI-Macdonald said, “The priority is to attack the gigantic problem of contraband, where there are absolutely no health warnings on those packages.”

Eric Gagnon, a spokesman for Imperial Tobacco Canada, told the Globe and Mail that the warnings that exist now are sufficient in conveying the health risks associated with smoking. He said that everyone agrees the biggest issue related to tobacco is contraband. “So I think it would be important for Health Canada to put its efforts on the contraband issue.”

Why not both?

The question that many reports have been asking, including editorials that have appeared in Montreal’s The Gazette, The Vancouver Sun and the Edmonton Journal, along with health groups and provincial ministers, is why does it have to be either contraband or pictorial warnings? Why can’t the government focus on both?

Health groups can’t help but suspect that intense lobbying by the tobacco industry has influenced this new direction.

“I would expect that tobacco companies have been lobbying against these warnings just as they have lobbied against improvements to warnings on tobacco packages over the last 20 years,” said Rob Cunningham, a senior policy analyst with the Canadian Cancer Society. “Contraband must be reduced, but contraband should not prevent implementation of other tobacco control measures. In fact, reducing smoking will itself reduce the demand for contraband. Package warnings work to decrease smoking, the research is clear. They work 24 hours a day, seven days a week with incredible reach. There is no good reason not to move forward.”

Hammond seems to agree with Cunningham’s statement. “There is no real reason from an evidence standpoint or a public health standpoint to halt the warnings. Given that all of the work had been completed on the warnings, I don’t see any reason why the government could not implement the health warnings and tackle contraband.”

Government involvement in this process has been viewed critically by experts and others involved in the initiative.

 “That the only action [the government] is taking is to address the issue of contraband cigarettes clearly shows how this government is more concerned with the bottom line of tobacco companies than with the health and safety of Canadians,” said Megan Leslie, NDP health critic, in a press release. “The Conservatives [federal] have decided to put tobacco lobbyists’ concerns ahead of health concerns.”

Another puzzling component of the government’s decision is that Health Canada’s own research, as well as independent studies commissioned by Health Canada sub-contracted to firms such as Environics, and educational institutions such as the University of PEI and the University of Guelph, have clearly demonstrated that renewing warning labels and larger sized labels are more effective.

Health Canada, when contacted by Tobacco Info, confirmed that new warning labels were shelved for the moment, but they were not necessarily dead, and it did take the opportunity to reinforce tobacco initiatives that are still in place.

“The Government of Canada is committed to reducing youth smoking and helping Canadians quit smoking, as well as addressing the pressing issue of contraband tobacco. The Government has recently taken action on all fronts. For example, the Cracking Down on Tobacco Marketing Aimed at Youth Act, which came into force on July 5, 2010, will make it harder for industry to entice young people to use tobacco products.”

Minister Aglukkaq re-iterated this position in a television interview with the CBC, adding that she will re-examine the health warning initiative sometime in the future, no date determined just yet, as there are other initiatives that require her immediate attention. However, she added that the federal commitment to tobacco control has to be looked at as a whole and not judged on this one issue that has been shelved.

From leader to follower

Canada was the first country to require pictorial health warnings on cigarette packages sold within its borders back in December 2000. Over 30 countries have since followed suit, including, Australia, Venezuela, Jordan, Switzerland, Belgium and India. Panama and Singapore are already on its second round of pictorial warnings, Brazil and Thailand are on its third round and Uruguay is on its fourth round.

The World Health Organization Framework Convention on Tobacco Control, ratified by Canada, requires countries to affix health warnings covering at least 30% of package surfaces. However, the use of illustrations is optional.