What the eye doesn’t see, the mind doesn’t know: Pictorial health warnings

Dr Richa Sharma, CNS Correspondent, India
The first thing that crosses my mind on seeing smokers is whether they are aware of what that one cigarette stick is doing to their health and to the health  of others. Very often their argument is that, well it is their life and others should mind their own business. But they naively forget that their addiction is affecting other people’s health too and so it is very much their business.

Perhaps some of them do identify tobacco as a harmful product but do not have the will power to get rid of the addiction—nicotine present in tobacco is a stimulant and highly addictive. It is known to activate the reward pathway in the brain which is the brain circuit that regulates feeling of pleasure. The pharmacokinetics properties of nicotine lead to its rapid distribution to the brain, peaking within 10 seconds of inhalation. However, these effects dissipate quickly, and so does the associated feeling of rewards, causing the smoker to pick up the next cigarette.

Karan (name changed) talks about smoking the way someone would talk about a close friend, “One normally needs people to go out with or talk to. But when you smoke, it is like being with a friend, somebody who would be always there, someone you do not have to talk to and still makes you feel lighter and brighter. Somehow you stop needing people once you start smoking.” This description is enough to send a chill down the spine of any public health professional or for that matter, any human being who is fully aware of the implications of tobacco use. Mark Twain famously said “Giving up smoking is the easiest thing in the world. I know because I have done it thousands of times.”

Tobacco kills more than 5 million people globally. Almost, 800 million men and 200 million women smoke cigarettes worldwide, with the majority of them belonging to the low income countries. 1 trillion is the estimated global economic cost of tobacco consumption per year.

So what can we do to curb this menace? The global treaty WHO Framework Convention on Tobacco Control (WHO-FCTC) was formulated with the aim of addressing this issue. Dr. Tara Singh Bam, Regional Advisor for Tobacco Control at the International Union Against Tuberculosis and Lung Disease (The Union) highlighted, during the webinar hosted by CNS, that the most cost effective ways to curb smoking are to introduce plain packaging of cigarette packs with bigger pictorial health warnings (PHWs) and to increase tobacco taxes. He also stressed that we need to take steps to protect the youth and children from smoking and also implement measures to support smokers who want to quit.

On World No Tobacco Day 2016, the UN-Secretary-General Ban Ki-Moon called on governments around the globe to implement plain packaging of tobacco products as a simple measure to reduce tobacco consumption.

So what does plain packaging mean? It prohibits the use of logos, colours, brand images or promotional information on tobacco packs, other than brand names and products names displayed in a standard colour and font style. Plain packaging makes the packets less appealing to the buyer and also increases the noticeability of health warnings. Additionally, PHWs are more efficacious in promoting awareness, by acting as a visual aid to the population that is illiterate and has low access to health information, as noted by Dr.Tara Singh Bam.

There is a body of evidence backing the fact that PHWs are much more scary and intimidating than plain text messages. They help in promoting awareness about the ill effects of tobacco among the people, motivate the people to quit the habit and also encourage adoption of a smoke free life. Following the lead of Nepal (90% pictorial warnings), Myanmar (75%) and Sri Lanka (80%) , the Supreme Court of India announced pictorial health warnings to cover 85% of tobacco/cigarette packs (May 4, 2016). This long awaited decision was lauded by anti tobacco bodies but a major setback for the tobacco companies.

The sad part is that the government that should be unanimously supporting this decision stands divided on the decision. A committee on subordinate legislation last year halted the drive for larger pictorial warnings on tobacco products. It again came up with opposing views regarding the 85% rule, giving misleading and false statements that it is harsh, may promote illicit cigarette trade, harm government revenue and put at stake thousands of lives dependent on the industry. This was more controversial as the committee had representatives who were directly or indirectly associated with tobacco firms. It would be pertinent to mention here that Article 5.3 of the FCTC (to which India is a signatory) clearly states that “In setting and implementing their public health policies with respect to tobacco control, Parties shall act to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law”.

The importance of political will in curbing the menace of tobacco consumption, cannot be over emphasized. With help from civil society organisations and the public health bodies we can together ensure that this evil is done away with permanently.

Dr Richa Sharma, Citizen News Service - CNS 
14 June 2016