Hong Kong must adopt plain tobacco packaging, say health advocates

Three-quarters of Hongkongers support restrictions on logos, colours and brand images on cigarette and other tobacco product packs in a bid to further reduce smoking

PUBLISHED : Tuesday, 31 May, 2016, 5:47am
UPDATED : Tuesday, 31 May, 2016, 2:20pm

We’ve all chosen products purely based on packaging – a bag of chips at the supermarket, a novel at the bookstore, a photo of a dish on a menu. Even when dealing with people, we tend to let first impressions guide our future interactions with them.

The power of packaging to directly influence one’s perception of something or someone is so strong that it’s no surprise the World Health Organisation advocates plain packaging for tobacco products, which kill almost six million people every year.

Momentum for plain packaging has steadily gained in the past few years, starting with Australia’s implemention in December 2012, and now the measure looks to be gaining traction worldwide.

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“We’re beginning to see the globalisation of plain packaging,” says Benn McGrady, a legal adviser to the WHO’s Framework Convention on Tobacco Control.

Plain packaging of tobacco products restricts or prohibits the use of logos, colours, brand images and promotional information on packaging other than brand and product names displayed in a standard colour and font style.

Earlier this month on May 20, France and Britain each began implementation of plain packaging. Ireland is also preparing to introduce the measure this year; Hungary and Norway are in the process of developing laws to implement plain packaging; Singapore is undertaking a public consultation with a view to introducing plain packaging; and several other countries, including New Zealand, South Africa and Turkey, have either expressed an intent to implement the measure or are in the policy development process.

Will Hong Kong be next? Antonio Kwong, chairman of the Council on Smoking and Health (Cosh), says Cosh has been advocating the government implement plain packaging since 2012.

About three-quarters of Hongkongers have expressed support for plain packaging, Kwong says, citing results from the 2015 Tobacco Control Policy-related Survey commissioned by Cosh and conducted by Hong Kong University’s School of Public Health to collect public opinion towards current and future tobacco control policies.

Time for Hong Kong to introduce plain packaging for cigarettes

“In view of the global successful examples and WHO’s appeal, Cosh recommends the government to actively consider adopting plain packaging in two to three years,” says Kwong.

The WHO is stepping up its drive for plain packaging by making it the theme of this year’s World No Tobacco Day, held annually on May 31 since 1988. WHO has launched a new 86-page guide to plain packaging of tobacco products, which gives governments the latest evidence and guidance on implementing the measure.

“Plain packaging reduces the attractiveness of tobacco products. It kills the glamour, which is appropriate for a product that kills people,” says WHO director-general Dr Margaret Chan, a former Hong Kong director of health. “It restricts tobacco advertising and promotion. It limits misleading packaging and labelling. And it increases the effectiveness of health warnings.”

McGrady says there’s a “strong evidence base” supporting the implementation of plain packaging, including more than 80 peer-reviewed empirical studies, three systematic reviews of the evidence, and an official post-implementation review from Australia.

“As a whole, this body of evidence points in one direction, which says plain packaging is an effective public health intervention,” says McGrady.

Smoking prevalence has been steadily declining in Australia for years and, even if plain packaging hadn’t been introduced the rate, was projected to be 17.77 per cent among those aged 14 and older in 2015. However, research shows that between December 2012 and September 2015, there was an additional 0.55 percentage point fall in smoking prevalence attributable to the packaging changes – meaning a 17.21 per cent prevalence – McGrady says.

This equates to more than 108,000 fewer smokers in Australia as a consequence of plain packaging – a “very big” number, says McGrady. “Plain packaging has decreased tobacco use in Australia beyond trend; it has increased the speed of the downward trajectory.”

Plain packaging reduces the attractiveness of tobacco products. It kills the glamour, which is appropriate for a product that kills people
Margaret Chan, WHO director-general

Tobacco packs act as a prominent form of tobacco advertising and promotion, not only at the point of sale, but also after, says the WHO report. Tobacco products are “badge products”, meaning they have a high degree of social visibility and that consumers identify with the brand image cultivated on product packaging.

“As internal tobacco industry documents recognise, packaging plays an increasingly important role in promoting tobacco products as other restrictions on tobacco advertising and promotion are tightened,” the report says.

In the evidence gathered in the report, studies show that packaging – in particular colour – affects consumers’ perceptions of risk. Early evidence of this can be found in internal tobacco industry documents released to the public through litigation, the report says.

For example, a 1990 tobacco industry document recognised that so-called “lower delivery products” were featured in lighter packs because they have a clean healthy connotation. Other studies tested consumer reactions to ultra-light products packaged in different colour packs. Consumers ranked the perceived tar level of products in different colour packs and commented on factors such as the harshness and strength of the flavour of different colour packs with otherwise identical products inside them.

There’s also evidence that plain packaging influences the intention and increases the urgency of smokers to quit. It also reduces active smoking and the display of tobacco packs in outdoor settings.

Plain packaging also prevents misleading packaging, the report says, such as labels like “light”and “mild”, which suggest products are less harmful to health than regular brand variants when this is not the case. Rather, consumers compensate for the lower tar and nicotine yields in these products, including by smoking more of a cigarette and taking deeper puffs.

With all this compelling evidence, why aren’t more governments rushing to implement plain packaging?

“I think the resistance to tobacco control and plain packaging are driven by the tobacco industry using its deep pockets to oppose implementation of good public health policies. It’s political; it’s nothing to do with evidence or public policy,” says McGrady. “That’s what’s slowing down tobacco control globally.”

Tobacco industry opposition to plain packaging dates back more than 20 years, McGrady says. Most recently the world’s top four tobacco companies challenged Britain’s new plain packaging law, arguing that it unlawfully took away their intellectual property. The High Court struck down the challenge and the law came into effect on May 20.

“It is wrong to view this issue purely in monetised terms,” the ruling said. “There is a significant moral angle embedded in the regulations, which is about saving children from a lifetime of addiction, and children and adults from premature death and related suffering and disease.”

One person dies from a tobacco-caused disease approximately every six seconds according to the WHO. Annual deaths are forecast to rise from 6 million to more than 8 million by 2030.

In Hong Kong, the prevalence of daily cigarette smokers among persons aged 15 and over has decreased steadily from 23.3 per cent in 1982 to 10.5 per cent in 2015 (except for years from 2000 to 2002). Still, a Chinese University study last year found that smoking costs the city HK$11.3 billion each year, in health care expenses and productivity losses related to tobacco.

The WHO recommends implementing plain packaging as part of a comprehensive approach to tobacco control that includes large graphic health warnings and comprehensive bans on tobacco advertising, promotion and sponsorship.

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Says Kwong: “Through the implementation of a comprehensive and multipronged strategy, including a policy of long-term tobacco tax increases to reduce affordability, expansion of statutory no-smoking areas, restriction of tobacco promotion and packaging, the banning of tobacco product displays at points of sale, raising the minimum age to buy cigarettes to 21, increasing resources for smoking cessation services, strengthening smoke-free education and promotion, placing responsibility on venue managers for smoking offences in their premises etc, we hope the smoking prevalence will drop to below 5 per cent in the near future.”