More than 100 countries now require graphic picture warnings on cigarette packs – UK goes further by requiring plain standardised packaging
10 November 2016. An international report released today by the Canadian Cancer Society shows that 105 countries and territories require picture health warnings on cigarette packages. This significant milestone in global public health will reduce smoking and save lives.
The UK is ranked 14th for its warning size of 65% of the front and back surface (along with all other EU countries) and is also one of five countries to pass laws for plain, standardised packaging. The others are Australia, France Ireland and Hungary. A further 13 countries are working towards implementing legislation.
The report – Cigarette Package Health Warnings: International Status Report – ranks 205 countries and territories on the size of their health warnings on cigarette packages, and lists countries and territories that require graphic picture warnings. 
Rob Cunningham, Senior Policy Analyst, at the Canadian Cancer Society, said:
“There is a powerful, worldwide trend for countries to use graphic pictures on cigarette packages to show the devastating health effects of smoking, and to require plain packaging.”
Sarah Williams, Director of Policy at health charity ASH said:
“This report shows that governments are increasingly standing up to tobacco industry attempts to fight laws which require large graphic health warnings and minimised branding on packs. The UK led the way in Europe in requiring standardised packs and since we passed the law we’ve been followed by another three European countries, with 6 more on the way.”
Examples of graphic picture warnings include a diseased lung or mouth, a patient with lung cancer in a hospital bed and a child being exposed to secondhand smoke.
The report also shows that many countries have increased the size of picture warnings on cigarette packages – and these larger pictures are known to be more effective. For example, the UK’s picture warnings were increased from 40% to 65% of the surface area as part of the EU Tobacco Products Directive which took effect on 20 May 2016. Additionally, picture warnings now appear on both the front and back of the pack, increasing their visibility.
Cigarette package warnings are a highly cost-effective way to increase awareness of the negative health effects of smoking and to reduce tobacco use. Picture-based warnings convey a more powerful message than a text-only warning, and larger ones increase impact.
Notes and Links:
 Cigarette Package Health Warnings: International Status Report. Fifth edition. Canadian Cancer Society, October 2016. Examples of pack images.
Guidelines under the international tobacco treaty – the WHO Framework Convention on Tobacco Control (FCTC) – recommend that warnings should:
- be as large as is achievable
- include a rotated series of graphic pictures
- be at the top of both the front and back of packages.
Picture warnings are especially valuable for low- and middle-income countries where there are higher rates of illiteracy and where governments may have few resources. Health departments determine the content of warnings, and the tobacco industry is responsible for printing the warnings on packages.
Guidelines under the treaty also recommend that countries consider implementing plain packaging. Plain packaging includes health warnings on packages, but prohibits tobacco company branding, such as colours, logos and design elements, and requires the brand portion of each package to be the same colour, such as an unattractive brown. The brand name would still appear, in a standard font size, style and location. The package format is standardised. Plain packaging puts an end to packaging being used for product promotion, increases the effectiveness of package warnings, curbs package deception and decreases tobacco use.
Plain packaging has been required in Australia (effective in 2012), the United Kingdom and France (effective May 20, 2016, at the manufacturer level) and Hungary (effective in 2018). The 13 countries working on plain packaging are: New Zealand, Norway, Canada, Slovenia, Uruguay, Thailand, Singapore, Belgium, Romania, Turkey, Finland, Chile and South Africa.
Other report highlights include:
- 105 countries and territories have finalised picture warning requirements, an increase from the 77 that had implemented these requirements by the end of 2014. In 2001, Canada was the first country to require picture warnings and to require a 50% size.
- 58% of the world’s population is covered by the 105 countries and territories that have finalised picture warning requirements.
- Nepal has the largest warnings in the world with picture warnings covering 90% of the package front and back. Vanuatu will also require 90% picture warnings in 2017. India and Thailand have the next largest warnings at 85% of the front and back.
- 94 countries and territories require warnings to cover at least 50% of the package front and back (on average), up from 60 countries in 2014 and 24 in 2008.
- The implementation by most European Union (EU) countries of the new EU requirement for 65% picture warnings was an important development contributing to the increase since 2014 in the number of countries requiring picture warnings.
The top countries ranked by warning size, as an average of the front and back of the package, are:
1. 90% Nepal
1. 90% Vanuatu
3. 85% Thailand
3. 85% India
5. 82.5% Australia (75% front, 90% back)
6. 80% Sri Lanka
6. 80% Uruguay
8. 75% Brunei
8. 75% Canada
8. 75% Laos
8. 75% Myanmar
(In this list, the warning size is the same on the front and back, except in Australia).
The Cigarette Package Health Warnings: International Status Report was released today in Delhi, India, at the 7th session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control (FCTC), being held November 7–12. The report is intended to support implementation of the FCTC. The FCTC has an obligation for parties to require health warnings that “should be 50% or more of the principal display areas but shall be no less than 30% of the display areas” and may be in the form of, or include, picture warnings. There are now 180 countries that are parties to the FCTC.
This is the 5th Canadian Cancer Society international report on cigarette package health warnings. Previous reports were published in 2008, 2010, 2012 and 2014.