Plain packaging of tobacco products — plainly a success

From 1 December 2012, Australia will be the first country in which plain packaging is mandatory for all tobacco products. “Plain packaging” is almost a misnomer: packs will have to show government-mandated warnings and images. They can carry only information mandated by the government, will show product names only in understated template form, and will be in “nappy-brown” colouring, chosen (based on research) to be as unattractive as possible.

Plain packaging is an important component of the comprehensive approach required to further reduce smoking among adults and children. It deprives tobacco companies of their last opportunity to promote their products in the community. When the National Preventative Health Taskforce, whose recommendations1 prompted the introduction of plain packaging, sought public comment, the tobacco industry advised that “there is already a significant amount of regulation on tobacco products and there may now be the risk of too much, with unintended consequences of progressing further”2 and “Australia has passed the limit of the ability of regulations on tobacco advertising, marketing, sales and public smoking to advance health objectives”.3 Their submissions provided helpful confirmation of the likely impact of plain packaging by identifying it as their greatest concern.

There are four key reasons why the tobacco industry opposed plain packaging more fiercely than any other measure since tobacco advertising was banned. Tobacco packaging is a potent means of promoting industry-preferred messages. Plain packaging will enhance the well deserved public perception of tobacco companies as less reputable and more harmful than any other industry. Introducing plain packaging will also play an important role in both reducing the uptake of smoking among children and encouraging adults to quit. And the industry is rightly concerned that this measure, once implemented in one country, will be adopted elsewhere. It was clear from the 2012 Singapore World Conference on Tobacco or Health that plain packaging has captured the imagination of governments and health groups and regenerated enthusiasm for action against smoking around the world.4

The tobacco companies’ efforts to oppose plain packaging have failed, culminating at the political level in all-party support for the legislation, at the legal level in a conclusive High Court defeat, and at the community level in further exposure of their industry as so desperate that it created organisations such as the Alliance of Australian Retailers as a front to carry its messages.5 Industry executives in London, New York and Tokyo, who drive the actions of their Australian subsidiaries, may not appreciate how low their industry’s reputation has sunk here, but presumably concluded that attack was their only option. They will doubtless seek to undermine the plain packaging initiative as best they can, from renaming brands to reducing prices: this ever-ruthless industry may decide that taking a hit in Australia is worthwhile if it helps to counter the impact of plain packaging.

Around the world, six trillion cigarettes are sold each year,6 causing more than five million deaths — at an estimated profit for tobacco companies of US$6000 per death.7 Australia’s lead is all the more important as a demonstration of “the art of the possible” — in particular, for governments of developing countries where tobacco companies now aggressively market their wares.

Tobacco company board members and executives know exactly what they are doing, but continue regardless of the consequences — exemplified by the cynical comment from a Philip Morris spokesperson that “There is no doubt that tobacco is a very harmful product that’s addictive and it kills people . . . It’s very, very sad that people do get sick from smoking . . .”.8 Companies and individuals who knowingly promote a lethal product should expect to be treated with as much disdain as those who peddle other drugs.

Despite this powerful industry’s efforts, in Australia there are encouraging trends in tobacco use among children, adults and, importantly, disadvantaged groups9 — but it is 63 years since the emergence of unequivocal evidence about the dangers of smoking. Since then, a million Australians have died because they smoked. Children are still taking it up, smoking remains the biggest single killer of Aboriginal people and it is the cause of some 15 000 Australian deaths each year.10 We know how to reduce smoking yet further: plain packaging should not be cause for complacency, but should rather be a trigger for governments at all levels to redouble their efforts. It is barely credible that at this time the governments of New South Wales and Victoria are actually reducing their commitment to tobacco control.11,12 We could and should do more. As former federal Health Minister Nicola Roxon said at the launch of the National Preventative Health Taskforce report, “we are killing people by not acting”.13

Plain packaging owes much to the efforts over many years of health organisations, campaigners, researchers and bureaucrats; but legislation does not happen without legislators. Great credit rightly belongs to Nicola Roxon for pressing ahead with this landmark measure, and to her Parliamentary colleagues in all parties for supporting her.

December 1 is a landmark in Australian and global public health history. Australia has successfully taken on the powerful and massively resourced global tobacco industry. There is much work ahead, but this is also a time to take pride in a stunning success for public health.