Question of the Week
November 16, 2004

It is now 2004. For decades, public health authorities have been telling people that cigarettes are bad. More recently, some have decided to show smokers just how bad the effects of smoking really can be.

Not everyone thinks this is a good idea.

"Swedish minister of health, Morgan Johansson, has rejected a new EU anti-smoking campaign that calls on governments to put photographic warnings on cigarette packs to deter people from smoking. 'I am sceptical towards the use of photos on cigarette packages and happy with the written warnings in place today,' the Svenska Dagbladet quoted her as saying. EU Health Commissioner David Byrne launched an anti-tobacco campaign last week including 42 graphic pictures to warn people against smoking. Canada has used similar graphic imagery and warnings on cigarette packs with some success since 2000. Brazil also has a similar scheme in place.",1574,1374184,00.html

In the beginning, EU Health Commissioner David Byrne didn't think that it was a good idea, either.

Four years ago (in the year 2000), the EU was still debating the issue:
"The European Union is moving closer to having bigger and bolder health warnings on cigarette packs and is considering adding pictures of rotting teeth and lungs. A directive, which goes before the European Parliament in Strasbourg on Wednesday, would also mean massive increases in the size of health warnings and descriptions like 'low tar' and 'mild' being banned. The new tobacco proposals could transform the way cigarette packets look, requiring up to 40% of the front and 50% of the back to be covered with a hard-hitting health warning. Some MEPs have proposed an amendment to the directive requiring graphic photos, including tar-stained teeth, to be added to packs. 'If vivid pictures of rotting teeth and blackened lungs bring home the true cost of smoking, print them on packs in the UK in full colour,' said Labour MEP and Health Spokeswoman, Catherine Stihler. But the proposal is opposed by EU Health and Consumer Protection Commissioner David Byrne."

In 2001, it was decided:
"Health warnings will cover 1/3 of the surface of Europe's cigarette packs from 2002, following a deal approved by Euro MPs last night. Key elements of the deal agreed between Euro MPs and EU Member State Governments include:
*Giant health warning labels on cigarette packs covering 30% of the front and back of the pack.
*A total ban the use of misleading descriptors such as 'mild' 'light" and 'low tar' (with no exemptions for existing brand names).
*New EU standards to apply to cigarettes exported from the EU from 2006.
*New rules on picture health warnings on cigarette packs by the end of 2002. Commenting on the deal, Euro MP Catherine Stihler, Labour's Spokesperson on Health in the European Parliament said, ;This is a huge breakthrough for public health. We will now have labels on cigarette packs which reflect the real cost of smoking.' ... On the use of graphic picture warnings 'Graphic health warnings pictures are a glaring reminder of what people do to themselves when they smoke. A picture says a thousand words and these pictures will save lives.'"

In 2002, it was reported:
"SAO PAULO, Brazil, Jan 28, 2002 (Reuters) - This week, Brazil will become the second country in the world to attach anti-smoking pictures to cigarette packages that will remind smokers of the damage they do to their health every time they light up. The move is the Brazilian government's latest tough stance against smoking. It made history by banning cigarette advertisements in newspapers and on television, and also made it illegal to smoke in public places. Brazil's 30 million smokers, out of its total population of 170 million, will see an array of small pictures and messages warning them against their vice. Included will be an image of a depressed couple in bed, whose sex life is suffering due to smoking, and a premature baby being kept alive with tubes as a reminder to parents who smoke. The existing warnings on packages will be highlighted."

Back to 2004:
The European Commission has launched a series of hard-hitting images to be used to show the damage smoking can do to people's health. The graphic images are part of a 72m euro campaign against smoking. The 42 images show pictures including rotten lungs and a man with a large tumour on his throat. Individual countries can decide whether or not to include the images on cigarette packs. The UK Department of Health has said it will consult over introducing them. The European Commission is also calling on member states to implement long-term measures, such as effective regulators, to tackle smoking levels. Its experts estimate the annual cost of tobacco related disease in the EU at 100 billion euros a year. The Commission says picture warnings are set to be introduced in a number of countries next year, including Ireland and Belgium. Launching the campaign, David Byrne, EU Commissioner for Health and Consumer Protection, said: 'People need to be shocked out of their complacency about tobacco. I make no apology for some of the pictures we are using.'"

There are still those who do not think that adding such graphic images is a good idea.

"Simon Clark, director of the smokers' rights group Forest, said: 'Smokers are well aware of the health risks of smoking. There's no need to rub their noses in it...."

And there are those who are concerned that smokers will find a way around it.

"Health experts point out that in Canada smokers took to using special hoods or covers for their cigarette packages."

There are arguments on both sides, and then there is the bottom line: "figures from Canada's Cancer Society showed that of all the smokers that quit in Canada in 2001, a third said they were influenced by the pictures."

So, what's next for 2005?

In Australia,
"Health groups have welcomed the release today of a proposal by the Federal Government to replace existing health warnings on cigarette packets. However, Quit Victoria say the proposed new warnings - including 14 new messages which would be accompanied by graphic pictures of the damages caused by smoking - need to be implemented much sooner than the Government‚s proposed date of 2005. Mr. Harper also welcomed the news that the Quitline number would be included on cigarette packs under the proposed new measures. 'We expect this initiative will result in more smokers seeking help to quit. This is a very effective way to provide information to smokers, because the average smoker would handle their cigarette pack up to 20 or 30 times a day. ... Smokers don't fully understand all of the health risks of smoking. It is absolutely vital that smokers have access to this information, which may help them make the decision to quit smoking.' Mr Harper said there was clear evidence that graphic warnings would help smokers quit, and would be supported by smokers. Mr Harper said research conducted by The Cancer Council Victoria in 2001 found that smokers themselves support the introduction of stronger warnings....
The survey also found:
* 90% of smokers approved of health warnings taking up the whole of the back of cigarette packets, and
* 56% of smokers said graphic warnings were more likely to make them quit smoking.

There are smokers and public health officials on both sides of the issue. Where do you stand? Before you decide, it may help to see some of the Brazilian images with their captions. You can go to the site listed with the following quote, but please keep in mind: while these images are shown smaller than the actual ones which will be included on cigarette packs in some parts of the world, some are still quite graphic. Among the new illustrations, the packs will also depict one mouth and one lung affected by the cancer, one fetus aborted, one necrosed leg, in addition to rats and cockroaches dead by arsenic and naphthalene, substances present in the cigarette. The resolution requires that the images have a black background.

Have the images changed your mind?

"The American Cancer Society (ACS) holds the Great American Smokeout each November to help smokers quit cigarettes for at least one day, in hopes they will quit forever. This year's event will be held on November 18, 2004."

Questions of the Week:
Should graphic images be included with the warnings on packs of cigarettes sold in your country? In your state? Do you think having these images on every pack would keep some people from starting to smoke in the first place? How do you think the addition of these images would affect any of your friends and/ or family members who currently smoke? How do you think the children of smokers would be affected by seeing these images? How would/ do these images affect you?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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