NOT EVERYONE realizes the power of a cigarette pack to influence the public on its actions and decisions related to smoking. While some people claim that the decision to smoke is the result of a person’s informed choice, the fact that smokers underestimate or have “unrealistic optimism” (Weinstein, N. et al 2005. Retrieved March 20, 2014 from Tobacco Control: http://tobaccocontrol.bmj.com/content/14/1/55.full.pdf) about their risks may perhaps signal that health warnings are not properly communicated.
That smoking is a leading cause of preventable death in the Philippines gives a strong reason for government to step up from simply reminding through text that cigarette smoking is dangerous to health. After all, how accurate are the current textual warnings in painting the word “dangerous”? Ask around and you’ll learn that most, if not all smokers, take that warning as ineffective.
Almost every smoker I meet shares that they think they’re “astig” (tough) (especially with strong flavors) or “sosyal” (high class) when smoking. Packaging elements like the fonts, imagery, and colors red (for filter variants), green (for menthol variants), blue (for lights variants), and white (for mild) tend to support such attitudes. Together with other marketing forms, they have spelled the difference in demand for cigarettes because brand elements intend to massage perception, mislead smokers into thinking that cigarettes may be safer (Wakefield, et al 2002) and appeal especially to the youth (Germain, D. et al 2009).
Do Filipino smokers truly understand risk of a long list of diseases — such as bronchitis, impotence, lung cancer, mouth diseases, heart diseases, stroke — that cigarettes put them under every time they puff a stick? Do pictures automatically pop in the layman’s mind when they are warned that they are risking atherosclerosis or emphysema? I doubt it.
So the government shouldn’t leave the avenue of packaging unregulated because the same package elements will be useful in reducing tobacco consumption and making people fully aware of the risks.
Legislators have filed 11 House Bills and Senate Bills on cigarette health warnings in the 16th Congress alone, meant to change the way cigarettes are packaged and sold, and to expose the concealed truths about this undeniably harmful product. Proposed bills range from imposing additional textual warnings to imposing graphic health warnings that will cover up to 85% of cigarette pack display areas.
The combination of photograph and accompanying text has been proven to be “60 times more effective in terms of encouraging cessation and prevention than text only labels” (Applied Economics 2004. Retrieved March 20, 2014, from https://www.google.com.ph/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCoQFjAA&url=http%3A%2F%2Farchive.treasury.gov.au%2Fdocuments%2F794%2FDOC%2FCost_Benefit_Analysis.doc&ei=EVwrU6KNLOXoiAfqjoGoDQ&usg=AFQjCNHnVLmDwbrJvTpQEKYjuRN7Rv3JpQ&sig2=ig5-gQaKm-3).
While among the arguments used by the cigarette industry to dilute graphic health warning is lack of data on how, say, a graphic health warning that covers 85% of display areas is better than 50%, studies point that the bigger the area allotted, the more effective these warnings are (Hammond, D. et al 2006. Retrieved March 20, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593056/pdf/iii19.pdf).
Aside from this, health advocates also target the removal of descriptors such as “mild” or “low tar” that imply false messages about the safety of cigarettes. A majority of graphic health warning bills filed recommend the Department of Health as the implementing agency as it is uninfluenced by the tobacco industry and is, of course, biased in favor of health.
The designs of cigarette packs today show the industry’s intense efforts to make up for lost marketing opportunities due to existing laws, i.e. the Philippine Tobacco Regulation Act of 2003 that ban advertising on television, radio, and other media, and the Sin Tax Law of 2012 that pushed cigarette prices up.
Furthermore, local policies called for by the World Health Organization’s Framework Convention on Tobacco Control (WHO FCTC), which was ratified in the Philippines in 2005, will become more comprehensive to strengthen the implementation of various government agency orders and local government unit ordinances (Quimbo, S. et al 2012).
With these “threats” to the size of the market, cigarette industry players have gone into intensified competition and all-out spending for advertising specifically channeled to points-of-sale. Print ads and sponsored store signage are on many sari-sari stores and groceries. PMFTC brands have reinvented their packages or cigarette stick designs for a more modern look to be more attractive and to compensate for the unattractiveness of cigarettes due to increased prices. These include Philip Morris (which changed its pack to a less plain blue-green design), Fortune International (which designed sticks and changed its pack from a plain green/red to one with a white combination) as well as the discount ones such as Champion and Jackpot. Smaller companies such as Mighty Corp. have also improved their packaging and also circulated printed publicity materials.
As of February this year, after the two waves of increases in sin taxes, the average price of cigarettes now ranges from P1 to P2.75, almost doubling the prices in 2006 when cigarettes were sold at around P0.48 to P1.44 per stick, according to data from the National Statistics Office. The unitary tax system by 2017 and automatic adjustments to inflation thereafter can make us expect that prices of cigarettes will still continue to increase. Since informed decision entails internalization of costs, both monetary and non-monetary, high prices and graphic health warning on cigarettes are going to be an effective tandem to help reduce tobacco consumption.
A picture-based health warning, the public’s counterpart of the cigarette industry’s marketing arm, is going to truly empower people when it comes to their right to information and right to health.
(The author is a researcher of and a member of the Sin Tax team of Action for Economic Reforms.)