A Cochrane Review published today finds standardised tobacco packaging may lead to a reduction in smoking prevalence and reduces the appeal of tobacco.
According to the World Health Organisation, tobacco use kills more people worldwide than any other preventable cause of death. Global health experts believe the best way to reduce tobacco use is by stopping people starting to use tobacco and encouraging and helping existing users to stop.
The introduction of standardised (or ‘plain’) packaging was recommended by the World Health Organisation, Framework Convention on Tobacco Control (WHO FCTC) guidelines. This recommendation was based on evidence around tobacco promotion in general and studies which examined the impact of changes in packaging on knowledge, attitudes, beliefs and behaviour. Standardised tobacco packaging places restrictions on the appearance of tobacco packs so that there is a uniform colour (and in some cases shape) with no logos or branding apart from health warnings and other government-mandated information, and the brand name appears in a prescribed uniform font, colour and size.
From next month, UK legislation on standardised packaging for all tobacco packs comes into full effect.
A team of Cochrane researchers from the UK and Canada have summarised results from studies that examine the impact of standardised packaging on tobacco attitudes and behaviour. They have today published their findings in the Cochrane Library.
Tobacco companies want to sell you cigarettes – today, tomorrow and for the foreseeable future. Whether you’re at the tobacco counter or out with friends, glitzy cigarette packaging is a really important part of their sales pitch. Tobacco companies are aware of this. It’s why they are so opposed to their cigarettes being put in plain packaging.
But why would these organisations lobby against plain packaging? On looking into these opposition groups, our recent research gives a clear answer. Opponents of plain packaging tend to have links to the tobacco industry. So much so that three-quarters of organisations identified in our study had financial links to tobacco companies.
Perhaps we shouldn’t be surprised. Decades of research into political activity by the tobacco industry has shown that “third parties” are used to campaign against tobacco-control policies. Health advocates are aware of this. In 2005, the World Health Organisation’s Framework Convention on Tobacco Control committed the countries that signed the convention to protect tobacco policy from interference by the tobacco industry and, crucially, groups linked to them. In response, in 2011, the UK government committed to publishing details of any policy meetings with tobacco companies and the Department of Health routinely requests disclosure of tobacco industry links. So far so good. In doing so, the UK sets a strong example.
Third party interference
But our research shows how “third party” opposition to tobacco control policies extends tobacco industry interference beyond this realm of government. In a three-year period which included the 2012 government consultation on plain packaging, 88% of research and 78% of public communications opposing plain packaging were carried out by organisations with financial links to tobacco companies (see figure 1). And public and retailer campaigns funded by tobacco companies to mobilise opposition to plain packaging generated 98% of the more than 420,000 negative postcard and petition submissions to the consultation.
In this way, ideas and arguments that come from tobacco companies and their research spill into public spaces. Once there, they can influence the public and political mood on life-saving tobacco control policies and create a misleading impression of diverse and widespread opposition. This is known in the world of political science as “conflict expansion”. And the potential effects are significant. When widespread, these “third party” activities can work to delay and even prevent policies: it took four years to get from consultation to implementation in the UK.
This wouldn’t be so serious if organisations and tobacco companies were open about their relationships. But, in many cases, links were not easy for the research team to detect. Of 150 examples of public communications, less than 20% explicitly acknowledged tobacco industry connections. And, while academics and research consultants tended to clearly report funding sources, “third parties” promoting their research in press releases, news stories and letters to government, frequently did not.
If they were open about their financial relationships with tobacco firms, business and civil society organisations would give the public, politicians and officials the opportunity to scrutinise their arguments and evidence in context. In the case of plain packaging, a lack of openness masked these links and lent credibility to claims that the policy lacked evidence and would increase the trade in illicit cigarettes – claims which have been shown to be unfounded by both peer-reviewed research and by the High Court in Britain. Now, as more countries move to introduce plain packaging, “third party” transparency remains an issue.
In order to help countries guard against tobacco industry interference, awareness can be raised of the effects of their activities on public and political debates. And steps could be taken to make their relationships with tobacco companies clearer. A compulsory register of tobacco companies’ memberships, political activities and associated spending would be a strong first move.
There is strong global commitment to addressing the problem of tobacco industry interference. Parties to the framework convention meet in India in November amid concerns about this issue, and the message to the tobacco industry from the WHO is clear: “The world understands who you are and what you do, and is determined to stamp out the global plague which you do so much to spread.”
Every year in the United Kingdom around 200 000 children start smoking. Half of those who try a cigarette will become regular smokers, putting themselves at risk of tobacco related diseases that can shorten their lifespan by at least a decade. Because of this, the UK and other governments have implemented a range of tobacco control measures over many years, which are intended to both prevent smoking uptake and encourage smoking cessation. Key among these have been measures to restrict the ability of the tobacco industry to market their products to new and existing smokers.
Firstly, traditional forms of advertising such as TV and billboards were banned, followed by sports sponsorship, and, most recently, point of sale displays in shops. All that was left was tobacco packaging: a way to communicate to consumers the appeal of the product and to promote different brands.
My team at the University of Stirling has conducted research on tobacco marketing for many years, funded by Cancer Research UK. Most recently we undertook our own studies on tobacco packaging, and then in 2011 were commissioned by the Department of Health to review all the evidence on plain or “standard packs.” Our review provided the basis for a UK consultation on the issue. At the time we found 37 studies, conducted in different countries and using a variety of research designs. Their findings were consistent. The studies showed that standard packs are: less appealing, increase the visibility and effectiveness of health warnings, and reduce the ability of packaging to mislead people about the harms of smoking.
Implementation of plain packaging for cigarettes and loose tobacco will go ahead on schedule today (Friday, 20 May 2016) after yesterday’s ruling from the UK High Court, which found in favour of the Department of Health.
The ruling relied partly on two key pieces of peer-reviewed research from the Tobacco Control Research Group at the University of Bath to conclude that evidence submitted by the tobacco industry to the public consultation on plain packaging ‘generally fell below best practice’ as it was not peer-reviewed, benchmarked against internal documents, did not make use of global literature and was not verifiable.
The research papers, published in BMJ Open and PLOS Medicine in 2014, had found that tobacco industry evidence:
Was of significantly lower quality than research supporting the measure.
Used techniques, such as misquoting, to encourage government and the public to question the quality of the evidence supporting standardised packaging;
Failed to include evidence showing the central importance of packaging in marketing their products; evidence which is present in internal tobacco company documents made public via litigation; and
Did not consistently and transparently disclose their links to the evidence they cited.
Lead author of one of the papers, Dr Jenny Hatchard, said ‘Our research showed that tobacco company claims that plain packaging “wouldn’t work”, would increase the illicit trade in tobacco and would damage the economy were largely unfounded and based on low quality research.
‘Yesterday’s High Court decision is an important moment for plain packaging and the positive impacts it will have on health. However, it also sends an important message that public health legislation cannot and should not be undermined by the poor quality evidence and opposition tactics of powerful corporations whose products damage our health.’