PLAIN PACKAGING – WHY IT MATTERS, AND MAKING IT HAPPEN

Professor Mike Daube AOCurtin University, Perth, Western Australia

Slide acknowledgements - many colleagues

Australia’s #1 cigarette and World’s #1 cigarette: before and after

Imperial Brands Investor Day8 June 2016

“Australia is the darkest market in the world, and from a distance it’s easy to get dispirited by that.”

A long history

• 1950 – Doll and Hill (BMJ), Wynder and Graham (JAMA)

• 1962 – First report of Royal College of Physicians of London

• 1964 – First report of US Surgeon General• 1971 - First WHO report• 1981 – Hirayama (BMJ) on passive smoking• And continuing streams of evidence

WE HAVE KNOWN WHAT TO DO FOR FORTY YEARS

COMPREHENSIVE APPROACH

•No one magic bullet – but all recommended measures contribute, and reinforce

•Now strong evidence for all components of WHO-recommended approach

•Confirmed and reinforced by FCTC

•Australia – Federal system (national and state/territory governments)

•Progressive action over time

EARLY AND CONTINUING ADVOCACY

• Strong, cohesive coalitions

• Maintaining a high profile for the tobacco problem

• Emphasis on magnitude of problem, new evidence, need for action

• Exposing and opposing tobacco industry

• Innovative approaches

HIGH-REACH MASS MEDIA CAMPAIGNS

Research-based

Well evaluated

Excellent outcomes

National Tobacco Campaign

Hard-hitting

Opportunistic

Advertising bansFrom the late 80s/early 90s

Even younger adults have never been exposed to significant tobacco promotion

POINT OF SALE DISPLAY BANS

TAXATION

• Progressive increases over time

SMOKE-FREE

COMPLEMENTARY ACTIVITY

• Cessation supports• Programs for disadvantaged groups• Continuing research and evaluation• Media, media, media

HEALTH WARNINGS

AND THEN…..FROM 2008…. THE NATIONAL PREVENTION TASKFORCE AND PLAIN PACKAGING

(A personal perspective)

Chair:

Professor Rob Moodie (Chair, Alcohol c’ttee)

Deputy Chair:

Professor Mike Daube

(Chair, Tobacco C’ttee)

Members:

Professor Paul ZimmetProfessor Leonie SegalDr Lyn Roberts (Chair, Obesity C’ttee)Mr Shaun LarkinMs Kate CarnellDr Christine ConnorsDr Linda Selvey

The Taskforce was announced on 9 April 2008.

Develop targets and strategies for the nation.

TOBACCO CONTROL AUSTRALIA in 2008 – Over-simplified summary (Note - mix of Federal and State activity)

Tobacco advertising bans since late 80s/early 90sHealth warnings since 1973, increasing strength every decade – 1973, 1987, 1995, 2006Continuing State legislation/action (leapfrog effect)Bans on point-of-sale promotionStrong measures to protect non-smokers – cars around kids, bars and restaurants, other public places (including some beaches)National and State media campaignsStrong, cohesive advocacy organisations, individuals, coalitions – Cancer, Heart, AMA, AMA, ASH, ACOSH, PHAA – and many othersContinuing new approaches to media and media coverageCessation support – NRT, Quitlines, etc

(Industry last 10 – 15 years – much lobbying and working through others but staying below parapet )

WHERE NEXT?

Consultation

• Many submissions

• Consulted widely – but Minister clear that we did not need to consult with the tobacco industry (FCTC Article 5.3)

• Tobacco industry submissions kindly offered assistance

“BAT believes there is already a significant amount of regulation on tobacco products and there may now be a risk of too much, with unintended consequences of progressing further.”

BATA submission to Taskforce

“Australia has passed the limit of the ability of regulations on tobacco advertising, marketing, sales and public smoking to advance health objectives.”

Philip Morris submission to Taskforce

Discussion Paper

PLAIN PACKAGING - PASSING THE SCREAM TEST

Plain packaging/pack display – part of multi-focused Discussion Paper

Industry responses (BAT, Imperial, Philip Morris) – 43 out of 142 pages

Continuing research

• Australia (Wakefield et al)• Canada (Hammond et al)• New Zealand (Hoek et al)• US (FDA et al)• UK (Various….)

FCTC

• Articles 11 and 13 (inc. guidelines)

Parties should consider adopting measures to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style (plain packaging). This may increase the noticeability and effectiveness of health warnings and messages, prevent the package from detracting attention from them, and address industry package design techniques that may suggest that some products are less harmful than others

Parties should consider adopting plain packaging requirements to eliminate the effects of advertising or promotion on packaging. Packaging, individual cigarettes or other tobacco products should carry no advertising or promotion, including design features that make products attractive.

Why Plain Packaging?• Not a magic bullet• Not in isolation – next step in comprehensive approach• Research evidence – impacts of packaging on children, young

people, adults, smokers, non-smokers• Primary focus long-term – children and young people• Removes last form of direct tobacco advertising• Industry’s own research• Sends out important signal• Supports rest of program• FCTC and international implications• Industry opposition – passes the Scream Test

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1 Make tobacco products significantly more expensive

2. Increase the frequency, reach and intensity of social marketing campaigns

3. End all forms of advertising and promotion of tobacco products

4. Eliminate exposure to second hand smoke in public places

5. Regulate manufacturing and further regulate packaging and supply of tobacco products

6. Ensure all smokers in contact with health services are encouraged and supported to quit

7. Work in partnership with Indigenous groups to boost effort to reduce smoking and exposure to tobacco among Indigenous Australians

8. Boost efforts to discourage smoking in other highly disadvantaged groups 9. Assist parents and educators to discourage tobacco use and protect young people from second hand smoke

10. Ensure the public, media, politicians and other opinion leaders remain aware of the need for sustained and vigorous action to discourage tobacco use

11. Ensure implementation and measure progress against and towards targets

Infrastructure recommendations also included: Establish a National Preventive Health Agency

Tobacco – Comprehensive approach11 components

PACKAGING - ACTION PROPOSED

• REQUIRE ALL TOBACCO PRODUCTS TO BE SOLD IN PLAIN PACKAGING, THE EXACT APPEARANCE OF WHICH (PRECISE COLOUR, PAPER FINISH, SHAPE OF PACK, ETC.) COULD BE PRESCRIBED IN REGULATIONS UNDER THE TRADE PRACTICES ACT 1974.

• COMMISSION RESEARCH TO DETERMINE EXACTLY HOW PACKS SHOULD BE DESIGNED TO MINIMISE APPEAL TO YOUNG PEOPLE.

GOVERNMENT

• Release September 1st 2009

• Minister Roxon – “By not acting we are killing people”

Action On Tobacco After Report

Current/further action at national and state levels, including dealing with

• loopholes in ad ban legislation (e.g. internet advertising); •Further bans on any display at point of sale; •further protection for non-smokers; •Funding for media campaigns; •specific education and support for disadvantaged groups;•Tackling Indigenous Smoking Initiative;•Cessation supports (e.g. NRT, Quitline)

•But plain packaging? Heavy industry campaigning•And a ‘phone call

APRIL 29, 2010

INDUSTRY APPROACH

• INSTANT AND CONTINUING ATTACK

• MOST FEROCIOUS I HAVE SEEN IN 44 YEARS

• BEST INDICATOR OF CONCERN – COMPANIES THEMSELVES GO PUBLIC

THE RESEARCH

• Meticulous – all aspects of the pack, design, colour, etc.

• Primarily from Melanie Wakefield and colleagues

• Essentially not challenged

• Minister’s only mistake – “olive brown”

THE POLITICS• Minority Government – needed support of Independents in Lower House

• Majority in Senate, with strong support from Greens

• Opposition oppositional….Opposing everything

Massive industry campaigns

• Media – press, radio, TV• Public relations – direct, indirect• Social media• Retailers• Lobbying• Dirty tricks• Industry spend unknown – certainly tens of

millions

Industry Arguments

• It won’t work• It will put us out of business• End to freedom• Illegal• International agreements• It’s never been done before• And so on……..

Legal arguments

Front Groups

Midnight Emails

Health Coalition• Government, Minister, Minister’s office• Major health groups and experts working nationally as cohesive

coalition• Cancer Councils, Heart Foundation, Australian Medical Association,

QUIT campaigns, ASH, ACOSH, Public Health Association, and other health organisations

• Prominent experts, health/medical leaders• Media, media, media - Proactive, reactive• Responding to industry campaigns, exposing industry tactics,

research, reports, surveys, advertisements…• Active support from politicians of all parties• Lobbying, lobbying, lobbying – all parties, all members

• WORK BY GOVERNMENT

• STRONG, DETERMINED MINISTER

• SYMPATHETIC MPs FROM ALL PARTIES

• MORE INNOVATIVE ADVOCACY (e.g. plain packaging professors)

• PUBLIC AND MEDIA SUPPORT

• Need for all-party support

• Many good supporters from all sides

• Another ‘phone call – and a robust Australian politician

......Liberal MP Mal Washer ...... who spent 26 years as a medical practitioner before moving into federal politics, gave a blunt assessment of the tobacco industry's strategy.

''All this talk of chop chop and crime gangs sounds like bullshit to me. The tobacco industry is jumping up and down because they're worried about their businesses. I support these reforms unequivocally and whatever my party decides to do, I don't give a shit,'' Dr Washer said.

He said smoking killed about 19,000 Australians each year, and governments had a moral responsibility to implement any measure that could stop young people from taking up the habit

The Age, May 22, 2011

FROM DECEMBER 2012

Ppublic health England

Source – Public Health England

Australian Government, Department of Health 2015

Percentage of ever-smokers who have quitAustralians 14 and over, 1991―2013

AIHW National Drug Strategy Household Survey, Tobacco Tables, Table 1

Tobacco plain packaging report released by Australian government

• Plain packaging responsible for 25% of the decline in smoking prevalence from Dec 2012 to Sept 2015

• These effects are likely to grow over time

And industry claims of doom and disaster? - 1PP would be rejected by Australian courts as being unconstitutional, with huge consequential costs for the Federal Government. Outcome: The High Court rejected the industry's arguments, awarding costs to the Australian Government

There would be significant problems for retailers in identifying the newly packaged brands, with consequent delays in serving customers. Outcome: Peer-reviewed research shows no such problems.

There would be a shift in sales of tobacco products from small retail outlets to supermarkets. Outcome: Peer-reviewed research and independent data show that there has been no such shift.

Smokers would cover up the plain packs with newly purchased special covers. Outcome: Peer-reviewed research shows minimal use of any such covers.

There would be a massive increase in the illicit tobacco trade. Outcome: Government reports and peer-reviewed studies show no such increase.

Doom and disaster - 2There would be an increase in counterfeiting of the new plain packs. Outcome: Independent reports and Customs statements show no such increase, and evidence from British American Tobacco to the Chantler review in the UK confirmed no increase.

There would be a substantial drop in prices. Outcome: Industry financial data show no such drop; indeed, because of the introduction of plain packaging, tobacco companies have reportedly aggressively increased prices.

There would be a shift to low-cost Asian brands of cigarettes. Outcome: Peer-reviewed research shows no such shift.

Tobacco sales would increase (although the rationale for this claim was never clearly articulated). Outcome: Official data and industry data show a decline in sales.

There would be in-store crime, as shop staff would take so long to identify specific brands that they would not be able to observe shoplifting. Outcome: There is no evidence for this having occurred.

And Now.....• Industry litigation – but so far losing all cases

• Australia, Ireland, UK, France, Hungary, Uruguay, Norway have legislated

• At least 14 further countries on the way

• Governments (both sides) committed to substantial regular annual tax increases

• Strong and increasing public and bipartisan political support

• Continuing developments from tax to smoke-free

Tobacco taxation

• 25% increase in 2010

• 12.5% increase in each of 2013 to 2020

• Increases the price* of Winfield Blue 25 packs from $12.95 in 2010 to $42.50 in 2019

• Especially effective policy to tip lower SES smokers towards quitting

*In current dollar prices

Plainly a success

So what have we learned? What made it happen?

1. Magnitude of problem – and continuing new ways of presenting the evidence.2. Constant and continuing advocacy over decades from health organisations and

professionals3. Comprehensive approach4. Work as coalitions - consensus is crucial5. Recognise that it doesn’t all happen at once6. Evidence-based recommendations and meticulous science7. Seize the hour; be open to opportunity when it arises (good Minister; good timing;

all-party support); make the case, encourage – and work at it!8. Recognise that it is a battle with tough, ruthless opposition. 9. Play to your strengths (magnitude of problem, protecting children, evidence,

credibility, international support (especially WHO); identify and expose the opposition; and campaign hard and professionally.

10. Plain packaging has generated a new sense of excitement globally – and shown that we can win battles that would once have seemed impossible.

What else have we learned - 1?

• Success is popular

• Strong and increasing public support

• Prime Minister Turnbull – “One of the big public health successes…..” (June 2016)

The war is never over

Major cigarette brands on sale around schools surveyed -From Big Tobacco, Tiny Targets – Tobacco industry targets schools in Africa ATCA 2016

What else have we learned – 2?

• There is never room for complacency

• The glass is still only half full

• Keep setting new targets

AUSTRALIAN HEALTH POLICY COLLABORATION – TARGETS NOVEMBER 2016

And finally

• Overnight success takes time

• There are real heroes who deserve the credit, from early leaders to politicians

• It can be done

FROM DECEMBER 2012

“Australia is the darkest market in the world, and from a distance it’s easy to get dispirited by that.”