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As Beijing marked the first anniversary of China's toughest anti-smoking measures, experts called for stronger regulations to safeguard the population.

Written warnings are used on cigarette packages in China, instead of images. [Photo/China Daily]

The World Health Organization and leading health experts in China are calling for the country to follow the global trend and promote plain packaging and graphic warnings on cigarette packs to reduce tobacco use.

The organization's call for all countries to prepare for plain, or standardized, packaging of tobacco products came as Beijing marked the first anniversary of an anti-smoking law, which came into force on June 1 last year, and World No Tobacco Day, which fell on May 31.

"Plain packaging is an evidence-based measure that can save lives and protect public health," said Bernhard Schwartlander, the organization's representative in China. "Plain packaging makes tobacco products less attractive, stops tobacco companies using the pack as a marketing tool, and increases the effectiveness of health warnings.

"WHO recommends plain packaging as part of a comprehensive approach to tobacco control: it works best alongside other tobacco-control measures, including comprehensive anti-smoking laws, bans on tobacco advertising, promotion and sponsorship, raising tobacco taxes and large, graphic health warnings," he said.

Wu Yiqun, vice-director of the ThinkTank Research Center for Health Development, an NGO in Beijing that is committed to tobacco control, said: "China lags behind many other countries in promoting plain packaging and graphic warnings.

"Most major countries require graphic warnings to be printed on tobacco packs, but there is no sign that similar measures will be adopted in China anytime soon. We cannot wait. We must take action right now."

China is the world's largest producer and consumer of tobacco products, and has the world's largest population of smokers－more than 300 million people. Tobacco-related illnesses cause more than 1 million deaths every year in the country, and more than 700 million people are exposed to second-hand smoke, which poses a health risk, according to the National Health and Family Planning Commission.

Stringent regulations

Beijing's anti-smoking regulations, the toughest among the 18 Chinese cities in which controls have been implemented, ban smoking in all indoor public areas and workplaces, and in a number of outdoor spaces, such as areas near children's hospitals.

Violators face fines of up to 200 yuan ($30), 20 times higher than those levied under a less-stringent regulation adopted in 1996.

Fang Laiying, director of the Beijing Municipal Commission of Health and Family Planning, said smoking in some public places, such as restaurants, has decreased greatly over the past year. Moreover, the city's health authorities have imposed fines totaling more than 1 million yuan on premises and individuals who violated the regulations.

Meanwhile, a recent survey found more than 46 percent of smokers plan to quit, compared with less than 12 percent before the capital implemented the smoking ban, Fang said.

Mao Qun'an, a spokesman for the National Health and Family Planning Commission, the nation's top health authority, said the measures have won great public support, produced satisfactory results in terms of tobacco control and paved the way for national tobacco-control regulations.

Other important steps in the past year include a rise in tobacco tax, and therefore retail prices, announced by the Ministry of Finance in May last year, which has resulted in a reduction in overall tobacco consumption. In addition, stronger restrictions on tobacco advertising came into effect in September.

Global measures

Plain packaging refers to "measures to restrict or prohibit the use of logos, colors, brand images or promotional information on packaging other than brand names and product names displayed in a standard color and font style", according to WHO.

In December 2012, Australia became the first country to fully implement plain packaging, while France and the United Kingdom began the process on May 20. New Zealand and Norway have also announced that they will remove branding from cigarette packs. Ireland is also preparing to introduce the measure, while other countries are exploring the option, WHO said.

"Plain packaging is fast becoming a global trend," Schwartlander said.

"There is an opportunity for China to take a step in the right direction toward plain packaging with the adoption of a strong, comprehensive national smoke-free law, including the introduction of graphic health warnings."

The National Health and Family Planning Commission proposed a national tobacco control regulation in 2014, which was submitted to the State Council for approval in the same year.

"The legislation is at the end stage and may be completed before the end of the year," said Mao, the commission's spokesman, at an international conference in Beijing on May 30 to mark World No Tobacco Day.

Wu Yiqun, who participated in the revision process, said the latest draft has not yet been released to the public, but it is more lenient than the measures adopted in Beijing, and plain packaging or graphics warnings were not mentioned in the paper.

Reducing consumption

Wu Ming, a professor of public health at Peking University's Health Science Center, said putting images on tobacco packs that depict the downside of smoking, such as cancer-ridden lungs and yellowed teeth, can greatly reduce tobacco consumption and is a highly effective measure to help prevent young people from picking up the habit.

"However, at present cigarette packs only carry a few small characters that read 'smoking is harmful to health'," she said.

Graphic warnings have been adopted in more than 80 countries and regions, including the Hong Kong Special Administrative Region, and in many countries images cover more than half of the surface area of the packs, she said.

WHO's Schwartlander said it is crucial to make the warnings more hard-hitting: "The current warnings on packs in China are woefully inadequate: they are ineffective at informing smokers about the harm caused by smoking and do little to warn young people off taking up the habit."

According to Wu Yiqun from ThinkTank, compared with plain packaging, which prevents tobacco companies from promoting smoking through the designs on packaging, graphic illustrations of the damage caused by smoking have a greater effect on smokers, regardless of origin or culture, and is effective with less-educated or illiterate people.

In addition, the photos also reduce sales of tobacco products bought as gifts, which is one of the major reasons for their overwhelming prevalence in China, she said.

"Printing graphic health warnings is the most economic and effective way of generating publicity for tobacco-control measures," she added.

However, she conceded that it's highly unlikely that legislation to enforce plain packaging or the inclusion of warning graphics will be implemented in the near future. The biggest obstacle has been resistance from the nation's powerful tobacco industry, which contributes more than 6 percent of China's annual tax revenue.

"The government may think a decline in tobacco sales will affect economic development," she said. "But we cannot rely on money that is generated at the cost of people's health. We hope the government will continue to promote tobacco control for the public good."

Standardized packs save lives

・ Plain packaging refers to "measures to restrict or prohibit the use of logos, colors, brand images or promotional information on packaging other than brand names and product names displayed in a standard color and font style".

・ In December 2012, Australia became the first country to fully implement plain packaging. On May 20, France and the United Kingdom both began implementation of plain packaging. On Tuesday, New Zealand and Norway became the latest countries to announce they will remove branding from cigarette packs.

・ By the end of last year, graphic warnings on packaging had been adopted in 85 countries and regions.

・ Studies undertaken after the implementation of pictorial package warnings in Brazil, Canada, Singapore and Thailand consistently show that they significantly increase people's awareness of the damage caused by tobacco use.

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