Plain packaging of cigarette packs to reduce consumption Ann McNeill, Professor of Tobacco Addiction Institute of Psychiatry, Psychology & Neuroscience, King s College London
Content Why plain/standardised packaging? Challenges Regulatory barriers Tobacco industry opposition How do you implement innovative populationlevel policy for the first time? What is the evidence? Science, advocacy and politics how law was passed
Why standardised packaging?
UK Tobacco Advertising & Promotion Act 2002 Health Act 2009 Industry marketing point of sale? internet sponsorship cinema point of sale press billboards pack free samples brand stretching product placement
Pack as silent salesman (Wakefield et al, Tobacco Cotnrol 2014) Remain on the consumer Taken out several times a day, often in social situations B&H Silver slide pack increased market share by ~ 60% (~ 120m) within 18 months (The Grocer, 2007)
Challenges
Regulatory barriers One In, Two Out (OITO) Regulations amounting to twice the cost to business of the new regulation (not necessarily from the same business area) would have to be removed Any benefit to smokers or society would not be counted as a benefit
Tobacco industry opposition (ASH Standardised packaging briefing, March 2015) regulations have to date neither undermined industry profitability nor led to commoditization of the cigarette category. However, a ban on conventional packaging graphics could prove to be a very different matter. They base challenges on alleged contraventions of national and international legal obligations on free trade and the protection of trade marks
Tobacco industry opposition (Japan Tobacco International)
Tobacco industry opposition
Slippery slope
Tobacco industry opposition
How do you justify implementing a national level policy for the 1 st time? Impossible to do randomised controlled studies at population level Evidence based public health What evidential hurdle is needed?
Evidence base: study types Experimental Intervention (RCTs/quasi-RCTs) Cross-sectional Cohort Qualitative Mixed-methods Physiological (e.g. eye tracking, neuroimaging)
Conclusions: Building an evidence base: Tobacco packaging is attractive to children 1 st Systematic Review Tobacco packaging makes the health warnings less salient Tobacco packaging misleads consumers about the relative risks of different tobacco products, which are in fact all equally deadly
Standardised packaging in Australia: Introduced December 2012
UK: Science vs politics In 2012, UK governments launched a joint public consultation on the issue using our systematic review (>2000 responses), but Plain packaging not in Queen s speech, 2013 Possible influence of Conservative campaign strategist, the Australian, Lynton Crosby who owns PR and lobbying firm with links to both tobacco and alcohol industries
UK: Science vs politics Obviously we take very seriously the potential for standardised packaging to reduce smoking rates, but in light of the differing views, we have decided to wait until the emerging impact of the decision in Australia can be measured, and then we will make a decision in England David Cameron
Advocates and researchers collaborate Building swarm effect Smoke Free Action Coalition Framing the argument Building and measuring public support Developing political champions and building political support Developing media interest and coverage
Evidence base: popularity with Parties
Endorsed earlier review I am satisfied that the body of evidence shows that standardised packaging, in conjunction with the current tobacco control regime, is very likely to lead to a modest but important reduction over time on the uptake and prevalence of smoking and thus have a Advocacy, Science & Politics House of Lords about to embarrass government; new amendment to Children & Families Bill and 2 nd evidence review
Science in politics Eg Research report quoted by Baroness Tyler during the standardised packaging debate in the UK House of Lords on March 11 2015.
Conclusions Need for innovation, courage etc to implement a policy for the first time against heavy opposition RCTs rarely possible for such policies, so need to use other research designs Yet research critical and played a key role right up until the point that a policy becomes law Advocacy vital Combination helps to sway politics But the battle continues..
UK implementation date: 20 th May 2016 Acknowledgements: Olivia Maynard, Linda Bauld, Deborah Arnott ann.mcneill@kcl.ac.uk Thank you! Questions?