Department of Health: Consultation on standardised packaging of tobacco products Thank you for the opportunity to comment on the above consultation. I endorse the Government s explicit public health goal of reducing the uptake of smoking by young people and see these proposals as key to progressing this goal. I have restricted my comments to those questions which focus on the protection of children from harm and other children s rights issues. My office was established by the Commissioner for Children and Young People (Scotland) Act (2003) which lays out the general function of the Commissioner to promote and safeguard the rights of children and young people. In particular, I must review law, policy and practice relating to the rights of children and young people with a view to assessing their adequacy and effectiveness. Specific regard must be had to relevant provisions of the United Nations Convention on the Rights of the Child (UNCRC). The UK ratified this Convention in 1991 and committed itself to bringing its law, policy and practice in line with the Convention. An essential part of my role is thus holding the Government to account in line with the commitments made. I view the standardisation of tobacco packaging as a children s rights issue and as part of a comprehensive tobacco control strategy. The proposals contained within this consultation will help to reduce the opportunities available to tobacco companies to promote and target their products at children and young people. This should reduce tobacco use and promote the health of children in Scotland and across the UK. A number of UNCRC rights are worth underlining and are pertinent to these proposals: article 3: the best interests of the child (article 3), a general principle of fundamental importance and one which underpins the whole Convention. This notes that in all actions concerning children, whether undertaken by public or private social institutions, courts of law, administrative or legislative bodies, the best interests of the child shall be a primary consideration. Because of the potential for harm to children from tobacco use and exposure, States have a clear duty to take all necessary legislative and regulatory measures 1
to protect children from this. The best interests of the child should take precedence over the interests of tobacco companies and the standardisation of packaging is an important step in this regard. article 6 (1) States have a responsibility to ensure the survival and development of the child The Committee on the Rights of the Child, the UN body which monitors implementation of the UNCRC has specifically addressed the need to regulate the marketing and advertisement of tobacco because of the effect of tobacco on the health and development of children and adolescents, urging State Parties to regulate and prohibit information on and marketing of substances such as alcohol and tobacco, particularly when it targets children and adolescents. 1 article 12: calls on State Parties to assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child; I would be interested in hearing how the Government sought to involve children and young people in this consultation, in line with article 12 of the Convention. They are clearly affected by these proposals and should be provided with the information to allow them to express their views freely, particularly given the Government s stated goal of reducing the uptake of smoking by young people. article 17 calls for State Parties to provide children with accurate and objective information and encourage the development of guidelines to protect children from information and material that could be harmful to his or her well being. In this regard, children should be provided with information about the tobacco industry and the manner in which tobacco products are produced, promoted and marketed. The 2011 WHO report on the global tobacco epidemic also states that consumers of tobacco products have a fundamental right to accurate information about the risks of smoking and that a basic requisite for reducing tobacco use is that every person be informed of the health consequences, addictive nature, and 1 Committee on the Rights of the Child, General Comment No. 4, Adolescents health and development in the context of the Convention on the Rights of the Child, UN Doc. CRC/GC/2003/4, 1 July 2003, para. 25 2
potential for disability and premature death posed by tobacco consumption and exposure to tobacco smoke. 2 article 24 of the UNCRC focuses on the right of the child to the enjoyment of the highest attainable standard of health In concluding my opening remarks, I wish to note that the systematic review of the evidence on plain tobacco packaging commissioned by the Department of Health and supported through the Public Health Research Consortium has been particularly instructive in developing my response as has the evidence which supported the call for the Australian plain packing legislation which was passed in November 2011 and will come into force in December 2012. Question 1 Which option do you favour? Do nothing about tobacco packaging (ie maintain the status quo for tobacco packaging; Require standardised tobacco packaging of tobacco products or A different option for tobacco packaging to improve public health I favour the standardised packaging of tobacco products. I have consistently supported measures that reduce the appeal of tobacco products to children and young people and believe that this option will help to do this. It will also help to protect children from harmful and misleading information and maximise the effectiveness of health warnings on packages. Question 2 If standardised tobacco packaging were to be introduced, would you agree with the approach set out in paragraphs 4.6 and 4.7 of the consultation? Yes The approach set out in paras 4.6 and 4.7 is an important start, but the proposals could go much further. I would align myself with comments made by ASH in their 2 WHO (2011). WHO Report on the Global Tobacco Epidemic. Warning About the Dangers of Tobacco. Geneva: World Health Organization, p.18. 3
submission. This draws attention to the extensive research conducted for the Australian Government which helped to develop a standardised design for tobacco packaging, aiming to both reduce the attractiveness of the product and also maximise its perceived harm. I would encourage the UK Government to follow Australia s lead and to include for example, much larger health warnings at the top of packs, graphic warnings on both the front and back of the pack as well as the inclusion of a Quitline number and web address on packs. I also support the view that detailed information on tar, nicotine and carbon monoxide content is misleading and can give the impression that one brand is less harmful than another. This should be replaced with more qualitative information about the risks of smoking or sources to be of help (such as Quitline). I am aware that many of the changes will need action at EU level and would urge the Government to seek to amend the EU Tobacco Products Directive which is currently under review. This will enable the UK to display larger health warnings along with picture warnings on the front and back of packs. Evidence shows that picture warnings in particular are seen to be effective with younger smokers. 3 Brand descriptors & Cigarette sticks I would also encourage the Government to address the issue of unhelpful brand descriptors which are misleading. I am of the view that the names of brand variants should be controlled along with the proposals set out in the consultation. This would help to move away from those which have positive connotations such as mild, smooth, gold. Such descriptors are misleading and should not be permitted. Cigarette sticks should also be standardised alongside moves to standardise packaging. This formed a key part of the Australian model of standardised packaging and evidence produced to inform this legislation illustrated clearly that the characteristics of the cigarette stick affect smokers' perceptions of the attributes of those cigarettes and thus are a potential means by which product differentiation can occur. 4 There were high levels of differentiation between the various cigarette stick types. White tipped cigarettes were seen to have a degree of sophistication and were linked to premium brands.slim stick cigarettes were 3 Borland R et al How reactions to cigarette packet health warnings influence quitting findings from the ITC Four Country survey. Addiction 2009; Apr; 104 (4) 669-75 Epub 2009 Feb 10 available at http://www.ncbi.nim.nih.gov/pubmed/19215595 4 Borland. R. Savva. S, Effects of stick design features on perceptions of characteristics of cigarettes Tob Control doi:10.1136/tobaccocontrol-2011-050199 (March 2012) 4
considered niche, highly feminine or effeminate. 5 The message was that a comprehensive policy to eliminate promotional aspects of cigarette design and packaging needs to include rules about stick design. Question 3 3. Do you believe that standardised tobacco packaging would contribute to improving public health over and above existing tobacco control measures, by one or more of the following: Discouraging young people from taking up smoking; Encouraging people to give up smoking; Discouraging people who have quit or are trying to quit smoking from relapsing; and/or Reducing people s exposure to smoke from tobacco products? Yes. I believe that standardised tobacco packaging would address all four of the above. The design and branding of packaging particularly affects young people. A vodcast conducted by the British Heart Foundation (BHF) (2011) with older young people illustrates the powerful influence of branding on their choice of product 6. I was particularly struck at comments from the young people about the type of package they wished to have on their person. I would choose *** over *** as I d prefer to have it in my bag.. When presented with plain packaging, the reactions were.. Urgh.. I wouldn t take that out of my bag I would not buy that..would you buy that! Even very young children are affected by the branding and design of packaging - as illustrated by interviews with primary school children conducted by Cancer 5 Parr. V, Tan. B, Ell. P, Miller.K, Market Research to Determine Effective Plain Packaging of Tobacco Products, gfkbluemoon (August 2011) (p 9) 6 http://www.bhf.org.uk/get-involved/campaigning/tobacco.aspx 5
Research UK. Packets were seen as being funky standing out from the crowd and (making) you feel like you are in a wonderland of happiness. 7 Much of the above detracts from the health messages on packs and can be hugely misleading to smokers. The results of a BHF survey on cigarette packaging supports this, illustrating that one in four smokers judged some brands as being healthier than others based simply on how they were packaged. 8 To suggest that packaging does not influence young people is simply disingenuous. Indeed one of the key findings of the Public Health Research Consortium report was that non smokers and younger people responded more negatively to plain standardised packs than smokers and older people (page 38), suggesting that this particular group would benefit most from standardisation. Given that no administration has yet standardised tobacco packaging and the Australian policy is still in its infancy, the scale of the impact of standardisation cannot yet be quantified. I am however of the view that because of the undisputed and overwhelming evidence of the harm caused by tobacco (both the impact of adult smoking on child health and on children taking up smoking), that any communication channels open to the tobacco industry to promote their product should be removed. Any means to reduce harm to young people should be supported. 4. Do you believe that standardised packaging of tobacco products has the potential to: a. Reduce the appeal of tobacco products to consumers? Yes The Public Health Consortium report demonstrates clearly that standardised tobacco packaging is less attractive to consumers than branded packaging. Packaging is the one area still open to the tobacco industry because of restrictions placed on advertising, promotions, displays and sponsorships: their focus is thus spent on making their products as appealing as possible, using 7 http://action.cancerresearchuk.org/ea-action/action?ea.client.id=149&ea.campaign.id=13114 8 Research by OnePoll commissioned on behalf of the British Heart Foundation, 2771 people in the UK aged 16-25 years polled online in October/November 2011 6
various methods to great effect e.g. colour and structural packaging (eg shape/ opening method), helping to increase the attractiveness of cigarette packets and to generate a positive image of smoking. These methods are explored in detail in the Public Health Research Consortium report. 9 A key part of marketing and promotion is the development of brand identities and loyalties that can be sustained tobacco companies need to recruit 15,000 new smokers annually in Scotland to replace customers who either die or give up the habit 10. Smokers generally continue to buy the brand of cigarettes they chose when they first began smoking - the tobacco industry therefore specifically targets young people, in particular, in their use of packaging 11. b. Increase the effectiveness of health warnings on the packaging of tobacco products? Yes Colours and logos can detract from the health warnings displayed on packs and these warnings provide an essential and effective medium for communicating health risks. Removing logos and colour will maximise the impact of these health warnings and give them the prominence they deserve. The Public Health Research Consortium report echoes this approach, concluding that the standardisation of tobacco packaging tends to increase the recall of health warnings, the attention paid to them and their perceived seriousness and believability (page 51) c. Reduce the ability of tobacco packaging to mislead consumers about the harmful effects of smoking? 9 Moodie. C, Stead. M, Bauld. L, McNeill. L, Angusa. K, Hind. K, Kwan. I, Thomas. J, Hastings. G,O Mara-Eves. A. Plain Tobacco Packaging: A Systematic Review, Public Health Research Consortium, (2012) 10 Taulnut. M, and Gordon. D, Tobacco smoking in Scotland: an epidemiology briefing. Public Health Observatory Division, NHS Scotland (Feb 2008) 11 Vasek L., Australia s landmark tobacco packaging laws face world trade challenge, The Australian, 6th(April 2012) 7
Yes As illustrated by the BHF survey, differences in colour and branding of tobacco products give the impression that some brands are healthier than others. Brand descriptors such as slim or light are also misleading. The Public Health Research Consortium report demonstrates that colours of packs affect perceptions of product harm and strength. They note that in general, plain packs are perceived as more harmful than branded packs if in a darker colour such as brown and, conversely, less harmful than branded packs if in lighter colours such as white. Red packs are perceived to contain stronger cigarettes than light-coloured packs (page 58). Removing colour differentiation between different brands will eliminate this ambiguity. Colours of packs also affect perceptions of product. d. Affect the tobacco-related attitudes, beliefs, intentions and behaviours of children and young people? Yes I am persuaded by the overwhelming evidence on this, including the Public Health Research Consortium report which notes that, across the evidence, younger respondents were more likely than older respondents to perceive that plain packs would discourage the onset of smoking, encourage cessation or reduce consumption (page 78). 5. Do you believe that requiring standardised tobacco packaging would have trade or competition implications? I am aware of the legal actions brought against the Australian Government by tobacco companies arguing that the plain packaging law breaches international trade obligations. However I also note that international trade agreements specifically allow governments to legislate for public health, that the tobacco 8
companies have a history of opposing all legislative measures in the courts and that the Australian Government is confident that it will win 6. Do you believe that requiring standardised tobacco packaging would have legal implications? 7. Do you believe that requiring standardised tobacco packaging would have costs or benefits for manufacturers, including tobacco and packaging manufacturers? As the intention of plain packaging would be to reduce the number of young people taking up smoking, there will of course be cost implications to retailers and manufacturers as fewer people buy their products over time. However reducing the consumption of cigarettes is a valid public health policy and, as set out earlier, preventing the promotion of tobacco to young people has a firm grounding in children's rights. 8. Do you believe that requiring standardised tobacco packaging would have costs or benefits for retailers? See my answer to question 7. 9. Do you believe that requiring standardised tobacco packaging would increase the supply of, or demand for, illicit tobacco or non-duty-paid tobacco in the United Kingdom? No comment 9
10. People travelling from abroad may bring tobacco bought in another country back into the United Kingdom for their own consumption, subject to United Kingdom customs regulations. This is known as cross-border shopping. Do you believe that requiring standardised tobacco packaging would have an impact on cross-border shopping? 11. Do you believe that requiring standardised tobacco packaging would have any other unintended consequences? No comment 12. Do you believe that requiring standardised tobacco packaging should apply to cigarettes only, or to cigarettes and hand-rolling tobacco? Cigarettes only Cigarettes and hand-rolling tobacco Standardised packaging should apply to all tobacco products including cigarettes, hand-rolling tobacco. 13. Do you believe that requiring standardised packaging would contribute to reducing health inequalities and/or help us fulfil our duties under the Equality Act 2010? 14. Please provide any comments you may have on the consultation stage impact assessment 15. Please include any further comments on tobacco packaging that you wish to bring to our attention. We also welcome any further evidence about tobacco packaging that you believe to be helpful. 10