An international report released on Feb. 6, 2024 by the Canadian Cancer Society (CCS) reveals ongoing advancements in tobacco plain packaging worldwide. Presently, 42 countries and territories are actively moving ahead with plain packaging, with 25 having adopted the measure, 3 having it in practice, and 14 in the process of implementation. The CCS report, titled Cigarette Package Health Warnings: International Status Report, details global progress on plain packaging, ranks 211 countries and territories on the size of their health warnings on cigarette packages, and lists the 138 countries and territories that now require graphic picture warnings.
The report also features the new Canadian requirement for a warning directly on every individual cigarette. This world precedent setting measure will start to appear on cigarettes in Canada by April 2024. Australia is in progress to become the second country to adopt the measure. progressing
Plain packaging – global progress
“There is a strong global trend for countries to implement plain packaging,” says Rob Cunningham, Senior Policy Analyst, CCS. “Australia was the first country to implement plain packaging in 2012, followed by France and the U.K. in 2016, and now more and more countries are implementing the measure. These developments are very encouraging as plain packaging is a key measure to protect youth and to reduce tobacco use.”
There are now 25 countries and territories that have adopted plain packaging, up from only 9 countries in 2018 and 21 countries in 2021.
Guidelines under the international tobacco treaty, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), recommend that countries consider implementing plain packaging. Plain packaging includes health warnings on packages and prohibits tobacco company branding such as colours, logos and design elements. It also requires the brand name to be a standard font size, style and location on the package and the brand portion of each package to be the same colour, such as an unattractive brown. Finally, the package format is standardized. Plain packaging regulations put an end to packaging being used for product promotion, increase the effectiveness of package warnings, curb package deception and decrease tobacco use.
Plain packaging has been implemented in Australia (2012), France (2016), United Kingdom (2016), Norway (2017), Ireland (2017), New Zealand (2018), Saudi Arabia (2019), Turkey (2019), Thailand (2019), Canada (2019), Uruguay (2019), Slovenia (2020), Belgium (2020), Israel (2020), Singapore (2020), Netherlands (2020), Denmark (2021), and Guernsey (2021), Hungary (2022), Jersey (2022), and Finland (2023), with implementation in progress or pending in Mauritius, Myanmar, Oman and Georgia. Plain packaging has been implemented in practice in 3 countries where packages are imported from a country with plain packaging: Monaco (from France), Cook Islands (from New Zealand), and Niue (from Australia). Plain packaging is currently under formal consideration in at least 14 countries: Armenia, Botswana, Colombia, Costa Rica, Côte d’Ivoire, Czechia, Fiji, Hong Kong, Iran, Malaysia, Mexico, Panama, Russia and South Africa.
Graphic picture warnings continue to increase
The report reveals there are now 138 countries and territories that require picture health warnings on cigarette packages, an increase from 117 in 2018 and 134 in 2021. This represents 66.5% of the world’s population. Canada became the first country in the world to require picture health warnings in 2001.
“There is continuing progress for countries to use graphic pictures on cigarette packages to show the lethal health effects of smoking,” says Cunningham. “It is extremely positive for global public health that more than 130 countries and territories have required picture health warnings and have increased warning size, and that so many are moving toward plain packaging. The international trend will reduce global tobacco industry sales and will save lives lost to cancer and other tobacco-related diseases.”
In total 127 countries and territories have required warnings to cover at least 50% of the package front and back (on average), up from 107 in 2018 and 24 in 2008. There are now 76 countries and territories with a size of at least 65% (on average) of the package front and back, and 11 with at least 85%. The top countries ranked by warning size as an average of the front and back of the package are:
1. 92.5% East Timor (Timor-Leste) (85% of front, 100% of back)
1. 92.5% Turkey (85%, 100%)
3. 90% Maldives (90%, 90%)
3. 90% Nepal (90%, 90%)
3. 90% Vanuatu (90%, 90%)
3. 90% Benin (90%, 90%)
7. 90% Mauritius (80%, 100%)
8. 87.5% New Zealand (75%, 100%)
9. 85% Hong Kong (S.A.R., China) (85%, 85%)
9. 85% India (85%, 85%)
9. 85% Thailand (85%, 85%)
The United States ranks 173 in the world, tied for last.
Cigarette package warnings are a highly cost-effective way to increase awareness of the negative health effects of smoking and to reduce tobacco use. Picture-based warnings convey a more powerful message than a text-only warning and their effectiveness increases with size.
Guidelines under the FCTC recommend that warnings should:
be as large as is achievable; include a rotated series of graphic pictures; be at the top of both the front and back of packages.
Picture warnings are especially valuable for low- and middle-income countries where there are higher rates of illiteracy and where governments may have few resources. Health departments determine the content of warnings and the tobacco industry is responsible for printing the warnings on packages. Examples of graphic picture warnings include a diseased lung or mouth, a patient with lung cancer in a hospital bed and a child being exposed to second-hand smoke.
The release of today’s report aligns with the 10th session of the Conference of the Parties to the WHO FCTC, taking place February 5-10 in Panama City, Panama. The report supports the FCTC’s implementation, which mandates that all parties have health warnings covering at least 30% of the principal display areas and should cover at least 50% of the display areas, and may include picture warnings. Currently, the FCTC has 183 parties.
This marks the 8th Canadian Cancer Society international report on cigarette package health warnings, following previous publications in 2008, 2010, 2012, 2014, 2016, 2018 and 2021.
