Society

Pictorial Health warnings on Tobacco Products in India

Rannojoy Middya, in this article, deliberates upon the importance and impact of pictorial health warnings on tobacco products.

According to the 2010 US Surgeon General’s Report:

There is no safe level of exposure to tobacco smoke. Any exposure to tobacco smoke even an occasional cigarette or exposure to second hand smoke is harmful and that damage from tobacco smoke is immediate.”

Paying attention to the above mentioned, a much required implementation took place in a way of introducing the warning massages on the packaging of cigarettes and other tobacco products with the aim of enhancing the public’s awareness of the harmful effects of smoking.

According to the 2009 review, there is clear evidence that tobacco package health warnings increase consumer’s knowledge about the health consequences of tobacco use.” The warning messages, ‟contribute to changing consumer’s attitude towards tobacco use as well as changing consumer’s behavior.”

Different countries implement different ways of packaging the warning massages but in every where the efforts have been considering to emphasize the same massage.

But such warning labels don’t serve positivity among the people and as a result it does get criticized by the people in the same run. So the smokers having lack of quitting power start paying much less attentions to such labels and that caused it to be reimplementation of more effective methods of behavior change with the pictorial effects on the packaging of tobacco products.

With the reference of the article shown by Luk Joossens Advocacy Officer, Association of European Cancer Leagues (ECL), Dublin, 29th May, 2008, the introduction yielded a perfect outcome for the aforesaid re-implementation.

INTRODUCTION:

In accordance to the aforementioned article it had been seen that world-wide 15 countries made their recognition on pictorial health warning labels. After such initiatives by countries worldwide it had been approved that full-colored picture based health warnings labels are way more effective than the initial text-only warnings. This proposition might have been introduced by ECL but later WHO (World Health Organization) also stood for it. After WHO’s arrival into such proposition, the first principal guideline made its existence with its own hands of Framework Convention on Tobacco Control (FCTC). Under Article 1 and of FCTC every person should be informed of the health consequences, addictive nature and mortal threat posed by tobacco consumption and exposure to tobacco smoke.

In order to spread negative vibe in the midst of smokers around the globe, the importance of pictorial health warnings on tobacco product has been illustrated along with the informative justification on such warnings. The illustrations are as follows-

  • Eye catching:

We people more likely to get affected by the things which are being portrayed in pictorial ways because it has been a general belief among us that an image can be more effective than the words on page.

  • Informative:

Pictorial warnings on tobacco products draw out the information about the risk of various diseases which include impotence, cancer etc and by such pictorial affects the smokers do pay three times more attentions to agree the bitter truth of using tobacco based products. Later,  a  research  took  place  among  four  countries  including  Canada  which stepped forward to follow the same among its people for the first time ever under such proposition.

  • Additional motivation:

It does help few smokers who are trying to quit such addiction in terms of motivating them with pictorial warnings on tobacco products. The percentage has been encountered around 44% smokers in Canada getting relief from such evil addicted habits.

  • Less attractive appearance wise:

Few Belgian youngsters aged around 15 to 17 feel this pictorial effect on the packaging makes the package less attractive so using such product with such packages make them look less attractive as well so they put themselves away from using such products having disaster pictorial warnings on its packages.

  • Adds to improvements on the tobacco advertising ban:

Initially at time of pre-implementation of such pictorial warnings the tobacco packs were used as promotional vehicles but after the implementation of the pictorial warnings the tobacco products have been considered as a generic packaging (packs without the promotion) worldwide. All such approaches have been put in line with the aim of banning the usage of such tobacco products.

  • Vehicle to quit:

Australia, Brazil, New Zealand and Singapore popped up with the quit line telephone number on the packages. In most European countries the quit line numbers had been come up to its existence in one of 14 health warnings on tobacco products. Few Belgian already has shown their positive nods on the provision of printing the quit line number on tobacco products. But in Switzerland this approach serves the mandatory approval of including the national quit line number on all packages of tobacco products.

  • Legal feasibility:

 Tobacco Products Directive (2001/37/EC) made the provision for the EU member states by allowing all of them to use pictorial health warnings on tobacco products. The Commission Decision of 5th September 2003 (2003/641/EC) spoke for few mandatory guidelines regarding on the usage of color photographs or other illustrations as health warnings on tobacco packages.

Why are governments so inclined to make pictorial health warnings obligatory on all tobacco products?

 Earlier the governments were so reluctant to make its ascendance with the facts of using shocking images which didn’t serve the best way to inform smokers but gradually as the day passed  by the  government  realized  with  referring  the  qualitative  research  in  UK which had shown importance of such images. As per the research, such images tended to be highly effective only when it succeeded to convey the shock, immediacy and empathy.

IMPLEMENTATION OF LARGER PICTORIAL WARNING IN INDIA:

 With the aid of WHO, India too had emerged themselves with such initiative to implement rules on printing larger health warnings on cigarette and other tobacco packages just after few days of reduction by the Parliamentary panel regarding to the proposed warning size for protecting the industry. The government last year already delayed in implementing such new rules by which the manufacturers were asked to cover 85 percent of a cigarette pack’s surface in warnings, up from 20 percent now just because the panel sought time to assess how the industry would be impacted. Given ample respect to the urge raised by WHO the health ministry soon decided to implement the rules from April this year but after such implementation the panel came up last week by issuing a report saying that the size should be reduced to 50 percent in the interest of the industry and tobacco farmers.

WHO’s India representative, Henk Bekedam considered the current debate on the topic of reducing in size of tobacco health warnings in India was “worrisome”. According to   Bekedam, ‟any reduction in size of pack warnings will be a great setback for public health in the Southeast Asia region,” and also he believed such larger pack warning were the most cost effective way of reducing the tobacco consumption in the country.

As per the BMJ Global Health, so far the estimation of casualties has been crossing the amount of 1 million people each year due to heavy tobacco consumption in the way of smoking. On the basis  of  research  executed  by the  Canadian  Cancer  Society,  India  ranks  136th  out  of 198 countries that use pack warnings to deter smokers, and the lagging nations like Australia and Thailand made their country proud by topping the list.

The new pictorial health warning, covering 85% of all tobacco packs, was notified in October 2014 for implementation from April 1, 2015. However, the government delayed its implementation indefinitely, after a parliamentary committee directed the Health Ministry to keep the notification in abeyance. The Rajasthan High Court had in September 2015 directed the Union Ministry to take immediate steps for the implementation of pictorial warnings from April 1, 2016 and along with that also ordered that there shouldn’t be any delay in such implementation. The ministry then issued a public notice informing all tobacco product manufacturers, distributors and retailers about the new arrival of pictorial health warnings for mandatory display of new specified health warnings on all tobacco product packages.

FRESH GUIDELINES ON PICTORIAL STIPULATION:

 As per the article published on Hindustan Times and Economic Times, the Punjab government initiated an issue regarding fresh guidelines by relying on the notification issued by Centre for pictorial warnings on tobacco packs. Such proposal to all the Officials of the department of factories at district levels aiming for their guaranteed approval was to ensure that no tobacco products would be manufactured without the 85% of the principal display area of the packs containing the health warning. The same instructions had been believed to be maintained by all deputy commissioners, police commissioners and SSPs to make sure the strict compliance of the orders.

With such statement the principal secretary health Vini Mahajan said that as per the notification, ‟the specified health warning will cover at least 85% of the principal display area of the package of which 60% will cover pictorial health warning and 25% textual health warning and will be positioned on the top edge of the package and in the same direction as the information on the principal display area.” She also believed that the notification of larger pictorial health warnings did create tremendous outcome and would be a major reason for the tobacco users to gain positive behavioral change.

Just to let the tobacco users aware about its ill effective sensitizing truth, the ministry of health and family welfare has issued a notification dated September 24, 2015 in regards to the  increase in size of such pictorial stipulation. The ministry had also made a commitment on Rajasthan High Court on March 28 that such implementation of rules would be taken places from April 1, 2016. 

The Parliamentary Committee had shown their negative nod towards the Subordinate Legislation by describing the government’s proposal regarding the 85% of the packaging surface carrying pictorial warnings as “too harsh” and recommended the massage to be occupied 50% of the space. Not only the committee but also the MPs and health experts aired criticism on such proposal. Committee chairman Dilip Gandhi raised his voice along with the report submitted to Lok Sabha on which the main  agenda has been the justification of afore mentioned committee‘s proposal by showing negativity towards the size of the warnings getting increased from the present 40% to 50%. The Health Minister even assured Rajasthan High Court that the observation or recommendation raised by the Parliamentary committee on Subordinate Legislation is being seriously examined by its legislative authority. But later on, one of the senior officers confirmed that all the tobacco products would be carrying large pictorial health warnings on the both of their sides as the rules framed previously by the ministry and also ensured April 1 as the commencing date of such implementation mandatorily.

RULES FORMULATED BY UNION MINISTRY:

 Meanwhile, the Union Healthy Ministry has popped up with rules to be strictly imposed upon all the government departments. These rules are as follows;

  • The ministry officials strictly mandated that the tobacco packets without bearing the prescribed pictorial warnings would be seized by the concerned authorities before reaching the market and not be considered to be one of the
  • Every department including revenue, commerce, external affairs, labor, civil aviation and tourism have been strictly ordered by the health ministry to propagate the recently enforced implementation of new specified health warnings on cigarettes and other tobacco products. Along with that the health warnings has to cover 85% of the packages and that too covering the both side of the packages and that rule has stood applicable for all tobacco product produced, supplied or distributed in.
  • Even the field formations of Customs and Excise under the strict order of health ministry must be duly informed about the new warnings and it should also ensure all the products packed after April 1 must be leaving the factory with the new pictorial
  • Airlines, shipping lines, freight forwarders and consolidators should also be sensitized to check whether the tobacco consignments destined for India comply with this law. The sales affected through the duty free shops in India, would also be complied by these.

CONSEQUENTIAL OUTCOME:

Cause of the newly implemented rules of pictorial warning on tobacco products by health ministry, major cigarette manufacturers have concluded by closing all their factories and stopping all their manufactures. One of the leading Fast Moving Consumer Goods (FMCG) companies, ITC recently made a statement through its spokesperson that the company still has loads of cigarette stocks available in the market despite shutting all its manufacturing in the wake of the government rule containing larger pictorial warnings on the packages. The company on  the date of April 2 revealed its status of not being ready to print any larger pictorial warnings on its cigarette packs, hence the company made the shutter down by stating until the date of emerging clarity on the mentioned matter, it will remain shut.

The company even argued that the required rule is more than the average global warning size of 31%. As per the statement made by the spokesperson is such, ‘’the warning size in India is much larger than the average of 20 percent among the top five tobacco producing countries which are China, Brazil, USA, Malawi and Zimbabwe, comprising around 90 percent of global tobacco production and the global average warning size of 31 percent,”

The Director of Tobacco Institute of India (TII), Syed Mahmood Ahmad raise his voice on the date of April 1 towards the Ministry of Health for the clarification of recently passed ambiguous policy related to the revision of Graphic Health Warnings on tobacco product packs. As a result of which all the companies under the membership of TII, which include ITC, Godfrey Phillips and VST Industries, have decide to shut their factories with the fear and potential violation of rules by continuing production. Such companies accounting more than 98 percent of the country’s domestic sales of duty-paid cigarettes, made the estimated production revenue loss at over Rs 350 crore per day for the tobacco product manufacturers. TII also claimed it’ll promote illegal cigarette trade and also affect 45.7 million people depended on tobacco like farmers, labor workers etc, it further claimed illegal cigarettes account for 1/5th of the total cigarette industry resulting in annual revenue loss of Rs 9,000 crore to the national exchequer.

 The Maharashtra Food and Drug Administration (FDA) has also put an end on the production of cigarettes worth Rs 273 crore from several parts of the state because of the fear of causing violation of the Centre’s new rule on the size of pictorial health warnings on packets. Harish Baijal, the FDA joint commissioner, claimed the seizures as the cause of a series of coordinated raids across Maharashtra. As the result of such raids FDA found the pictorial warnings covered only 45 percent of the surface area but according to the directives issued by the Union Health Ministry the warnings supposed to be 85% covered with pictures and texts on the packages.

Paying attention to another tobacco product named beedi which is a poor man’s smoke, the much required concern had been raised by a CPI-M MP over the plight of one crore poor workers due to the closure of all beedi manufacturing units after the government’s new directive pictorial stipulation. Just because the whole issue presented during the Zero Hour in Rajya Sabha, Tapan Kumar Sen considered the issue to be looked into by taking human concern into consideration as it affected the livelihood of all the poor workers whose financial background has been sourcing from this units. He also added that from last 10 days all beedi manufacturing companies have closed down their production in order to protest against the Health Ministry’s directive pictorial stipulation to increase the warnings on tobacco packets from 40% to 85%. According to him nearly one crore beedi workers are losing earnings as it is linked to piece- rate production. 

For such particular matter Sen placed a proposal in front of the government asking them to call the manufacturers and let their factories reopen. By placing such he added one crore beedi workers and five crore other backward, under privileged were involved in this  job or depended on the trade for their livelihood cannot be left in lurch. Noting the heath issue and human concern apart from scientific concern such cases need to be taken note of. Approving such large pictorial stipulation on cigarette packs Sen added it was unfair for beedi packs to have the same as these were smaller in size. In December last year, Karnataka High Court granted interim stay on the notification after the Karnataka Beedi Industry Association had stood up against just because it’s quashing on the grounds of impossibility for introducing pictorial warnings on beedi packets.

According to AIBIF (All India Beedi Industry Federation), the Beedi companies also follow the same pathway towards shutting their company because of the enforcement of new warnings. Such move has been taken place just because of the government’s recent pictorial stipulation on the tobacco packages.

AIBIF, a well known body of over 240 manufacturers controlling over  two third of the total branded beedi production, revealed by its Member Arjun Khanna that the outcome of such production stoppage would be introduced by the way of suffering loss of around 200 crore daily. On that note AIBIF Member said, ‟as per the notification, beedi cannot  be produced without this new enhanced pictorial warning from April 1, 2016. It is not possible to print the warnings as the curved area and wrapping paper edges prevent printing on a reasonably large area of the curved surface.” The federation also considers the beedi industry implementing the new warnings in its present form as the practical impossibility. Along with that the federation added there is no possibility of producing beedi without violating the law hence being a law abiding industry they have no option but to stop production of their company.

CONCLUSION:

 The pictorial warnings are effective in promoting smoking cessation as shown by research in the developed and undeveloped country as well. Nearly one million tobacco related deaths take place in India every year. And in 2011 the total health expenditure burden of all the diseases causing from the usage of tobacco products had been estimated more than Rs 1,00,000 crore which is 12% more than the combined State and Central government expenditure on health in 2011-2012. Especially among the minorities, majority goes for the usage of beedi and chewing tobacco instead of cigarettes as cigarettes stand expensive as compare to other tobacco products. Besides being unaware of all the risks associated with tobacco use, a vast majority of consumers in India of Beedi and chewing tobacco are poor and less exposed to awareness campaigns. Hence it stands mandatory for the Ministry to implement larger images on both sides of tobacco packages which are supposed to be the most effective way to communicate health risks to this population, provoke a greater emotional response, decrease tobacco consumption and increase motivation to quit.

While a comprehensive approach that includes education and awareness generation should be adopted, there is no evidence to back the committee’s claim that education and awareness generation are “more effective” than other methods. Even California looking for the same status what Canada achieved by creating awareness through pictorial warnings at a very little cost but the whole effort has been very expensive for them as it has already cost millions of dollars.

Bigger graphic based pictorial warnings are easy to enforce and have the highest impact on tobacco consumption. Considering the huge public health benefits, it is believed to be imperative that the Health Ministry ignore the recommendation of the committee and enforce such pictorial stipulation by keeping every single matter of it on card. Any dilution  in the size of warning would entail a delay of several months and cost thousands of lives. Such pictorial stipulation might be causing tobacco companies to be shut but it does carry a positive vibe along with it in terms of aiming a better future of various countrymen.

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