Ctc pak fact sheet why phw should be implemented without a delay

PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS IN PAKISTAN: Why Larger Warnings Should be Implemented Without Delay?

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PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS IN PAKISTAN

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Tobacco is the only product in the world that kills half of its users. Many people are not fully aware of, misunderstand or underestimate the risks for morbidity and premature mortality due to tobacco use and exposure to tobacco smoke. Well designed health warnings and messages on tobacco product packages have been shown to be a cost-effective means to increase public awareness of the health effects of tobacco use and to be effective in reducing tobacco consumption. Effective health warnings and messages and other tobacco product packaging and labeling measures are key components of a comprehensive, integrated approach to tobacco control.

KEY DATES FOR THE INTRODUCTION OF PICTORIAL WARNINGS 2002 Prohibition of Smoking and Protection of Non-Smokers Health Ordinance 2009 Pakistan introduced regulations that required picture-based health warnings on all cigarette packages

by May 31, 2010. Cigarette packages were required to display picture warnings covering 40% of both the front and back of all packages.

2015 Ministry of National Health Services, Regulations and Coordination announced new measures that will require the size of the warnings to increase from 40% to 85% of the package. Urdu text will appear on the front of the pack, and English text will appear on the back.

HARD FACTS ABOUT TOBACCO USE AND WHY IT NEEDS TO BE REDUCED 1) The Government of Pakistan has published several evidence-based reports and studies in collaboration with other agencies, which include: a. TCC Pretesting of PHW: Report – Pakistan 2009 1 b. WHO REPORT on the global TOBACCO epidemic 2008 2 c. Global Adult Tobacco Survey, Pakistan 2014 3 All these establish the close link between tobacco and cancer as well as other tobacco-related diseases.

There are several other studies available in the public domain.

2) Tobacco harms the health, the treasury, and the spirit of Pakistan. Every year more than 108800 of its people are killed by tobacco-caused disease, while more than 555000 children and more than 20400000 adults continue to use tobacco each day. Complacency in the face of the tobacco epidemic will ensure the

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Tobacco Control Cell http://www.tcc.gov.pk/Downloads/PHW-Pretest-Report-Pakistan.pdf

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World Health Organization http://www.who.int/tobacco/mpower/mpower_report_full_2008.pdf Survey findings and recommendations http://www.who.int/tobacco/surveillance/survey/gats/en/

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PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS IN PAKISTAN

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tobacco industry continues to run roughshod over the lives of Pakistan's citizens and ensure that tobacco's death toll will grow with each passing year. 4 3) According to GATS, there are currently 23.9 million adults who use tobacco in the country. Out of these 15.6 million smoke tobacco and 9.6 million use smokeless tobacco products, according to the survey conducted by the Ministry of National Health Services, Regulation and Coordination (NHSRC) in collaboration with Pakistan Bureau of Statistics (PBS) and the World Health Organisation.

4) Nearly 16.8 million adults who worked indoors were exposed to tobacco smoke at the workplace, 56.3 million at home, 21.2 million at restaurants and 49.2 million who used public transport.

5) The average amount spent on 20 manufactured cigarettes was Rs 40.9 while the same amount of rupees can buy approximately 1 kilogram (2.2. pounds) of potatoes or five eggs or one loaf of bread.

29% SMOKERS START SMOKING BEFORE THE AGE OF 17

6) On the other hand, 74.8% of adults favored increasing taxes on tobacco products. Around 85.8% adults believed smoking causes serious illness whereas 77% believed smokeless tobacco causes serious illness.

7) According to figures of the ministry of national health regulations of Pakistan, as many as 1,200 children between 6-15 years of age start smoking every day. Smoking causes cancer while non-smokers become victim of cardiovascular disease because of passive smoking.

8) According to WHO’s report on tobacco consumption in Pakistan, nearly 108,000 people lost their lives annually due to smoking only while 1200 youth and children suffered with tobacco related diseases daily.

WHY LARGE PICTORIAL HEALTH WARNINGS ON TOBACCO PACKS?  The WHO Framework Convention on Tobacco Control (WHO FCTC), a global convention enlists key evidence based strategies for reduction of demand and supply of tobacco. The Government of Pakistan ratified the WHO-Framework Convention on Tobacco Control in February 2005, and hence is legally obligated to take systematic legal, administrative and policy steps to reduce the demand and supply of tobacco. Article 11 of the WHO FCTC calls for signatories to implement large health warnings with strong pictures as they are more effective and should be positioned on both the front and back of each product package.  The Cigarettes and other Tobacco products (Prohibition of Smoking and Protection of Non-Smokers’ Health Ordinance 2002) Act has been enacted by the Government of Pakistan to discourage the use of tobacco products. Section 7 and 8 of the Act, mandate depiction of specified, rotational warnings including pictorial warnings, which are legible, prominent and conspicuous.

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The Tobacco Atlas Fact Sheet – Pakistan http://www.tobaccoatlas.org/country-data/pakistan/

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PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS IN PAKISTAN

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 Graphic health warnings are very effective in creating awareness about the hazards of tobacco usage, especially among the youth, children, illiterate and semi-literate persons. They also encourage users to quit and prevent new users from initiating use.  Research5 shows that effective warning labels increase knowledge about risks associated with smoking and can influence future decisions about smoking. Large, graphic warnings are most effective at motivating smokers to quit, discouraging non-smokers from starting, and keep ex-smokers from starting again. They can also be recognized by low-literacy audiences and children – two vulnerable population groups.  The current health warnings of 40% size on one side of tobacco packages are weak and ineffective. They do not communicate the desired message to users and non-users. As per Cigarette Package Health Warnings - International Status Report (2014)6 published by Canadian Cancer Society, Pakistan is ranked 79, much below countries like Nepal, Turkey and Malaysia which have 90%, 65% and 55% warnings respectively. Nepal in implementing its new world’s largest warnings serve as an example for Pakistan, who is struggling to implement their health warning laws. Pakistan stands last in implementing larger pictorial health warning in her EASTERN MEDITERRANEAN REGION (EMRO).  A recent study in Pakistan found that 90 percent of Nepalese believe the warning labels are effective at preventing people from starting to smoke. Additionally, 95 percent of ex-smokers who participated in the study said the warning labels were effective at convincing them not to start again.

The time has arrived for prioritizing the health of our people, standing up to the tobacco industry and leading the world in taking strong action to reduce tobacco use.

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Campaign for Tobacco Free Kids http://global.tobaccofreekids.org/en/solutions/international_issues/warning_labels/ Cigarette Package Health Warnings – International Status Report http://www.tobaccolabels.ca/healthwarningsinfo/statusreport/ 6

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PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS IN PAKISTAN

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THE COALITION FOR TOBACCO CONTROL PAKISTAN PROJECT The aim of Coalition for Tobacco Control – Pakistan is to strengthen the development and implementation of policies based on the provisions of Framework Convention for Tobacco Control (FCTC) through advocacy campaigns and acting as a technical resource for the Ministry of Health.

Coalition for Tobacco Control – Pakistan (CTC-Pak) has been advocating for stronger measures for tobacco control by the translation and adaptation of FCTC provisions into national tobacco control laws and was successful in convincing the signing and ratification of the FCTC by the Government of Pakistan. This led to promulgation of the national tobacco control laws which ban smoking at public places and public service vehicles, restrictions on the advertising campaigns of the tobacco industry and bigger and clearer health warnings on cigarette packs.

Despite the introduction of these legislative measures, a comprehensive approach towards effective tobacco control is still lacking. These loopholes allow the tobacco industry to exploit an under regulated market.

There is a strong need to keep the issue of tobacco control on the agenda of the policy-makers. The prevalence of smoking in youth as well as adult is high in Pakistan and the loopholes in the existing laws provide an environment for the industry to exploit especially in areas where implementation of the law is not strong and the consumption of tobacco is high.

With support from Bloomberg Global Initiative for Tobacco Control, Campaign for Tobacco Free Kids and The Union Against Tuberculosis and Lung Diseases, CTC-Pak through its members is in the process of monitoring the implementation of the tobacco control statutes in Pakistan and advocating for demand in reforms within the existing tobacco control legislations highlighting the need for the following so that a holistic legislative environment can be created for tobacco control:     

Development and adoption of legislative measures for a comprehensive ban on tobacco promotion and advertisements Pictorial health warnings Raise in tobacco taxes Controlling smuggling of tobacco products Identifying issues related to tobacco cropping

The strength of CTC-Pak is its membership who is already engaged in tobacco control work. The partners of CTC-Pak bring a range of expertise to the coalition and together present a unified front which is dedicated to the control of tobacco consumption in Pakistan. CTC-Pak requires support and commitment from civil society organizations for effective advocacy campaigns for raising awareness among masses on the issue of tobacco control by building their capacity and knowledge base on the tobacco control issue.

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PICTORIAL HEALTH WARNINGS ON CIGARETTE PACKS IN PAKISTAN

For more information on the CTC-Pak Pakistan Project: Khurram Hashmi National Coordinator Tel: +92 321 6414375 Email: hashmi@ctcpak.org Qasim Ali Khawaja Communications Coordinator Tel: +92 333 8885455 Email: qasim@ctcpak.org Coalition for Tobacco Control – Pakistan 33 First Floor, Al-Anayat Plaza, G-11 Markaz, Islamabad, Pakistan

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