Scare Them To Quit: Use Repulsive Pictorial Health Warnings On Tobacco Packs

[Hindi] Come December 1, 2011, and all chewing and smoking tobacco packs sold in India will hopefully carry stronger and more effective pictorial health warnings, as per the new notification issued by the Ministry of Health and Family Welfare, Government of India, vide Gazette of India notification dated 27 May 2011, to implement pictorial warning sections of the Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003).

However there are serious concerns that the tobacco industry may try to continue the sale of tobacco products with old warnings even after 1st December 2011, in the garb of exhausting past stocks. Fears and doubts about postponement/weakening of the new rule are also rife (and rightly so) in the minds of anti tobacco activists. In the past, our government has held the dubious distinction of deferring and/or diluting these warnings, not once but several times under immense lobbying/pressure from the tobacco industry.
We must remember that India became a signatory to the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC) in February 2005, and is required to comply with pictorial warnings' protocols as per the global tobacco treaty. The use of pictorial warnings on tobacco product packets is one of the six "M POWER" effective tobacco control strategies - clubbed as 'MPOWER' –declared by WHO in 2008 to help its member countries to control tobacco use. In this acronym, W stands for 'warn' about the dangers of tobacco use. According to the WHO, putting large and strong graphic health warning labels on tobacco packages is a good public health strategy which costs the government and the public nothing because the cost of the colourful package warnings is borne by the tobacco companies.
Under its Cigarette and Other Tobacco Products Act (COTPA) 2003, statutory warnings were introduced by the Indian government on all tobacco products in 2005. But evidently, this measure alone was not sufficient to reduce the use of tobacco. Consequently, the first government rules on mandatory pictorial warnings were notified on July 5, 2006. However, the actual implementation of these rules was postponed repeatedly, apparently because of pressure exerted by the tobacco companies. The first pictorial health warnings, consisting of pictures of scorpion and cancer infected lungs, eventually came into being on May 31, 2009, and were ridiculously mild and ineffective.  So it will be after more than two and a half years that these will hopefully be replaced by more grotesque pictures of cancer stricken mouths (on chewing tobacco packs), and diseased lungs (on cigarette/bidi packs). As per the COTPA 2003, tobacco packets should have new pictorial health warnings every year. Many activists, including the medical fraternity, seriously doubt the efficacy of even the new pictures—especially those of the diseased lungs on a man’s chest, as it is difficult for smokers to visualise the gory nature of tobacco-related diseases and fatalities from them. Those to be used on chewing tobacco packs look more effective, and are likely to scare the user.

It is said that a picture can speak a thousand words. Various studies outside India, especially in countries where large and strong graphic warnings pictorial warnings on packages of tobacco products have been implemented, have revealed that such warnings play a significant role in informing consumers about the health risks of tobacco use, motivating smokers to quit and discouraging non-smokers, including children, from taking to this habit. Graphic warnings have a greater impact than written ones, and can be recognized by illiterate audiences and children-two vulnerable population groups.  As of now, 40 countries across the globe are using this tool to curb the menace of tobacco with Uruguay in the lead, having the toughest pictorial warnings covering 80% of the surface area of cigarette packs.

In a country like India with its multilingual and multicultural communities, a pictorial warning can break cultural, regional and language barriers. Moreover, when a large proportion of the population is illiterate, written warnings may be ignored, but not strong pictorial warnings which, if implemented properly, can go a long way in reducing the number of tobacco users and tobacco related deaths, and help India reduce its ever increasing number of tobacco users. WHO’s latest  report on the "global tobacco epidemic", released this year, says that while 33% adult Indian males and 18.4% adult Indian females use smokeless tobacco, the corresponding figure for those taking a puff stands at 24.3% males and 2.9% females. Among the youth, 19% males and 8.3% females use some form of tobacco.

It is hoped that this time our government will not succumb to any pressures from any quarter, to weaken and/or stall implementation of effective pictorial warning labels on tobacco/cigarette packs, which should be strong enough to repel the users, thus showing them the option to lead a healthy life. It must also be ensured that these pictorial warnings are also depicted on packs of foreign brands of cigarettes, which are sold in the country.

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" published in November 2011. Email:, website:

Published in:
Citizen News Service(CNS), India/Thailand
CNS Tobacco Control Initiative, India
Elites TV News, California, USA