Push for plain packaging to save lives

Recent moves to introduce plain, standardised packaging of tobacco products can save lives by reducing demand for tobacco products, say the World Health Organisation (WHO) and the WHO Framework Convention on Tobacco Control Secretariat (WHO FCTC).

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.

In December 2012, Australia became the first country to fully implement plain packaging. On May 20, 2016, France and the UK began implementation of plain packaging. Ireland is also preparing to introduce the measure, while other countries are exploring the option.

In India, the Supreme Court recently ordered tobacco companies to have at least 85 percent of the packaging covered with health warnings. The order specified that 60 percent should be pictorial health warning while 25 percent should cover textual health warning.

“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 Margaret Chan. “It restricts tobacco advertising and promotion. It limits misleading packaging and labelling. And it increases the effectiveness of health warnings.”

Plain packaging is recommended by WHO as part of a comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.

Smoking in Australia has been steadily declining for years. Australia introduced plain packaging, in conjunction with new and enlarged health warnings, in 2012. Between December 2012 and September 2015, there was an additional 0.55 percentage point fall in smoking prevalence among those aged 14 and above attributable to the packaging changes, according to Australia’s post-implementation review. This equates to more than 108,000 people quitting, not relapsing or not starting to smoke during that period.

Oleg Chestnov, WHO’s assistant director-general for Non-communicable Diseases (NCDs) and Mental Health, says Australia’s plain packaging results demonstrate the great potential of the measure. “Plain packaging can reduce demand for tobacco products as clearly seen in Australia. It offers a powerful tool to countries as part of a comprehensive approach to tackling the scourge of tobacco use,” says Chestnov.

“Plain packaging is going global as more and more countries seek the important health gains it can bring to communities,” says Bettcher. “The tobacco industry has been getting ready for plain packaging for some time, conducting massive misinformation campaigns to block the measure.”

“So it is encouraging to see more and more countries defy the industry’s tactics and implement plain packaging to reduce demand for tobacco products and put the health of their populations first.”

To mark World No Tobacco Day, WHO is launching a new guide to plain packaging of tobacco products, which gives governments the latest evidence and guidance on implementing the measure.

India’s health system is overburdened with tobacco-related diseases like cardiovascular diseases (heart disease and stroke), a range of cancers, respiratory illnesses, diabetes, asthma, and tuberculosis (TB) among others.

  “Tobacco-related diseases are preventable, avoidable and evidence-based measures are already known to avert this public health disaster. Why is the sense of urgency not driving our public health programmes?” comments Rama Kant, former president of Association of Surgeons of India. 

Tobacco use is the second leading cause of cardiovascular diseases in India, claims a civil society report. “Tobacco use is estimated to cause nearly 10 percent of cardiovascular diseases (CVDs). Nearly six million people die from tobacco use or passive exposure to smoke, accounting for 6 percent of female and 12 percent of male deaths worldwide, every year,” says Rishi Sethi of Department of Cardiology, King George’s Medical University.

“There is no risk-free level of exposure to tobacco smoke. Non-smokers who breathe second-hand smoke have 25–30 percent higher risk of developing a CVD,” adds Sethi.

In Uttar Pradesh, heart disease rates have shot up along with rising tobacco use. Sethi claims that over 4,500 angioplasty procedures and almost 2,000 lifesaving pacemaker implantations have been performed in 2011-2012 in the state. The number of these procedures has increased by almost 30 per cent over previous year.

 A parliamentary panel has recommended that tobacco consumption should be reduced gradually and efforts should be made to use it as a pesticide and other things. The panel noted that tobacco curing and cultivation are destroying forests and contributing to the greenhouse effect.

A parliamentary standing committee headed by MP Renuka Chaudhury had tabled a report on May 10.Stating that the financial benefits accruing due to tobacco cultivation were negligible as compared to losses suffered in terms of deaths and the huge expenditure on treatment of tobacco-related problems, the committee recommended that the cultivation of tobacco needed to be discouraged.

It also recommended providing incentives to farmers for shifting to other crops and disincentivising the production of tobacco gradually, but definitely.

Effective awareness campaigns were needed to discourage the consumption of tobacco in any form, the report read. It added that better-coordinated efforts were required by the ministries of health, agriculture, finance, commerce and industry, human resources development, information and broadcasting and environment to tackle the problem.

The panel recommended that the environment ministry, in coordination with other government agencies, should take necessary measures and devise ways to minimise fuel consumption by regulating the area under flue-cured Virginia tobacco cultivation using innovative and fuel-efficient designs, thereby reducing the impact of tobacco curing on the environment.

“The committee recommends that an Environmental Impact Assessment of cultivation of tobacco needs to be undertaken by the concerned agencies of Government of India in order to know its harmful effects on the environment. The Ministry of Environment, Forests and Climate Change should find out the estimated felling of trees for curing of tobacco and its effect on forests,” the report read.

The panel said that the effect of chemical pesticides in tobacco cultivation and its effect on crops grown in and around tobacco fields needed to be reviewed. It further recommended that tobacco farmers needed to be educated about the effect of chemical fertilisers and pesticides on the soil quality. They should be encouraged to use organic manures/fertilisers, the report added.

It said that the environment ministry should put in place an institutional mechanism in coordination with other concerned ministries to alleviate soil and environmental degradation caused by tobacco cultivation.