Plain packaging for cigarettes: Big Tobacco's loss is public health's gain

In politics, U-turns are typically seen as a sign of weakness or failure, but the UK government today performed one U-turn that is most definitely welcome: it reversed its position on plain packaging for cigarettes.

In fact, this decision was a U-turn of a U-turn (if that makes any sense), as the government had originally supported the idea of plain packaging, before backtracking on it last summer. At that time, it said it was “postponing” its decision on the matter, a move that attracted significant criticism after it emerged that the Tories’ influential election strategist, Lynton Crosby, had previously lobbied on behalf of a major tobacco company. The government then commissioned Sir Cyril Chantler to carry out an independent review of the evidence for the effectiveness of plain packaging, and it’s the conclusions of his review that led to today’s announcement.

But however it arrived at this point, the important thing is that the government has finally heeded the advice of countless public health experts and intends to press ahead with this eminently sensible regulatory measure. It is a welcome – and all too infrequent – triumph of public health priorities over big business interests. And it’s worth reiterating precisely why these priorities should trump those of profit-seeking corporations.

The World Health Organization estimates that, if current global rates of consumption continue, tobacco will kill roughly 1 billion people over the course of this century. It is the only legal consumer product that kills half its users when used as the manufacturer intended. Yesterday’s review stated that approximately 207,000 children aged 11-15 take up smoking annually in the UK, and that if this rate were reduced even by as little as 2%, it would mean 4,000 fewer children began smoking each year. All this makes a pretty convincing case for why tobacco should not be treated as an ordinary consumer good, and why it should therefore be subject to far stricter regulation.

Unsurprisingly, both the tobacco industry and the think tanks they fund don’t accept this case and have gone all out in their attempts to discredit the idea that standardised plain packaging is an effective form of regulation, questioning the evidence behind it and claiming it would have terrible knock-on effects. Although their arguments have been comprehensively debunked over the last couple of years, I’ll run through the main ones again.


An anti-plain packaging advert from Japan Tobacco International


1. There’s no evidence that plain packaging deters smokers

While it’s too early to assess the impact of plain packaging on rates of tobacco consumption in Australia (the only other country to already have adopted this measure, which came into effect there in December 2012), there’s ample evidence that it will deter smokers. This isn’t just a one-off finding: a systematic review (pdf) that looked at the results of 17 studies (all the relevant studies into this research question) concluded that standardised plain packaging would “reduce the appeal of cigarettes and smoking; enhance the salience of health warnings on packs; and address the use of packaging elements that mislead smokers about product harm.” Similarly, there is a wealth of evidence that exposure to general tobacco branding and marketing increases the likelihood that young people will take up smoking. According to the Chantler review, the tobacco industry argued that this latter evidence was irrelevant to the plain packaging debate, as tobacco advertising and promotion has been banned in the UK since 2004. Chantler (as most people would) took a different view, stating that, in his opinion, “the evidence that advertising and promotion increases likelihood is highly relevant to the question of whether packaging does too.” It seems tobacco companies don’t think that packaging designs constitute a form of advertising or promotion.   

Lots of cigarette packages with pretty pink designs that definitely aren't intended to (somewhat offensively) advertise to women


2. Plain packaging will make counterfeiting easier

The tobacco industry likes to imply that plain cigarette packaging means a completely blank cardboard box, which would enable counterfeiters to easily reproduce illegal copies of their products. In reality, the “plain” packs would have health warnings on, possibly including graphic images depicting the negative health effects of smoking, as well as holograms and other covert security markings – just like they do in Australia.


Top: what the tobacco industry likes to pretend plain packaging means
Bottom: what plain packaging actually looks like in Australia


3. Small retailers will be negatively affected by plain packaging

Although this argument is in direct conflict with number 1 (they seem happy to deploy the different arguments strategically, even when they are directly at odds with each other), tobacco companies claim that, because of the drop in sales that plain packaging will produce, newsagents and other small retailers will lose money and also be inconvenienced because it’ll take them longer to locate their customers’ desired brand of cigarettes. Firstly, the main impact of plain packaging will be to reduce the uptake of smoking among young people, so sales to current smokers probably won’t take too much of a hit – any change will be gradual and give retailers plenty of time to adjust. But even if they did, a reduction in business for newsagents doesn’t seem a particularly high price to pay for the health benefits that would result from fewer young people smoking (not to mention the financial savings this would entail for health services). Secondly, the claim that transaction times will increase seems pretty flimsy, mainly because this study in the British Medical journal found that plain packs actually reduced transaction times slightly.


4. Plain packaging will lead to an increase in tobacco smuggling

Again, even if this claim were true, it’s debatable whether the potential public health gains from plain packaging should be sacrificed because of it. But even so, the available evidence from Australia doesn’t demonstrate a causal link between plain packs and higher rates of tobacco smuggling. British American Tobacco have jumped on the fact that the number of illicit cigarettes seized by Australian customs in 2012-13 was the highest for three years. But they don’t mention that the number of illicit cigarette seizures has increased dramatically each year since at least 2009-10 (i.e. long before plain packaging came into effect). So although they talk about 2012-13 being a “record year” for seizures of illicit cigarettes, every year has effectively been a “record year”. For instance, 69 million cigarettes were seized in 2009-10 (pdf, p. 84), 82 million in 2010-11, 141 million in 2011-12, and 200 million in 2012-13 (pdf, p. 91). This points to either a general, progressive increase in illicit tobacco smuggling that is unrelated to plain packaging, improvements in enforcement techniques, or it could be due to the tax increase on tobacco products that was phased in over the same period; smuggling is primarily about tax avoidance: the more there is to avoid, the bigger the incentive to smuggle. But whatever's behind the increase in seizures, it’s almost certainly not plain packaging: a spokesperson for the Australian customs service has even said that it doesn’t seem to have had any impact on smuggling.  


5. Plain packaging impinges on freedom

A more philosophical argument against plain packaging is that it represents an unwarranted restriction of certain important freedoms. This libertarian / classical liberal view is also often held by those involved in the debate about the regulation of currently illegal drugs. Proponents of this perspective typically argue that we should a) respect people’s freedom to choose to consume drugs such as tobacco and b) respect the “free speech” of private companies that wish to promote the drugs they sell.

Plain packaging barely impinges at all on the first of these freedoms: yes, smokers’ freedom to purchase cigarettes in nice, shiny coloured packets has been restricted, but their freedoms to purchase the same brands of cigarettes they’ve always smoked, to buy them from the same retailers, and to smoke as many of them as they like remain intact. Some may argue that, with its prominent health warnings and grisly images, plain packaging impacts on smokers’ freedom by stigmatising them for engaging in what is, after all, a consensual adult activity. But plain packaging isn’t going to suddenly mark smokers out as unhealthy and therefore worthy of stigmatisation – the vast majority of people are already aware that smoking is unhealthy. If people want to use a cigarette case, or conceal the pack in a designer pouch they are free to do so. The point of the health warnings and imagery is essentially to nullify the subconscious appeal that cigarette packaging can have – especially to children and young people.


Think your personal freedoms are being trampled on by plain packaging? Here's a complex solution: put them in another container


As for the freedom of tobacco companies to market their products in an attempt to increase consumption of their products (and therefore their profits), I’m quite happy to curtail it. As mentioned, the main effect of plain packaging will likely be to prevent more children and young people from taking up smoking. I’d rather respect their freedom to live healthy lives unbothered by tobacco marketing than respect the freedom of tobacco companies to promote their potentially lethal products to them.

Tobacco companies, along with many of those who take a libertarian / classical liberal stance on drug control, like to contend that in free markets, rational actors make unrestrained yet informed choices about their purchases, and that advertising and other forms of promotion are merely communicative practices, telling the public what goods are available, in what varieties and at what prices. But people don’t consistently make such rational choices, and this state of affairs is exacerbated by the fact that direct and indirect marketing techniques, in reality, are designed precisely to influence and distort individual decision-making processes.

The claim that plain packaging or other promotional bans amount to unjustified meddling in people’s personal choices makes little sense because people’s choices are already constantly being influenced by factors beyond their control. In fact, an argument could be made that strict regulation of all marketing activities is more in keeping with a libertarian / classical liberal position, as it would go further towards ensuring that people’s choices are subject to as little unwanted influence as possible. Contrary to the arguments advanced by those who hold this position, restrictions on tobacco packaging, while limiting commercial freedom of expression, can therefore be seen as protecting personal freedom of choice. Even libertarians acknowledge that freedoms have some limitations; the debate is about where we draw those lines and how we balance freedoms against other priorities like public health and child protection. In this case, we are balancing a negligible impingement on personal freedoms against a potentially massive public health gain. Viewed like this, no liberal red lines are being crossed.


Plain packaging for all drugs – legal and currently illegal

The issues raised by the implementation of plain tobacco packaging are clearly relevant to the debate about if and how we should regulate currently illegal drugs. It is of course entirely consistent to call for the legalisation and regulation of drugs that are presently prohibited and to call for tighter restrictions on those drugs, like tobacco, that are already legal. Indeed, Transform have for a long time advocated both types of drug policy reform. We have also explored in detail the issues around the packaging and marketing of the currently illegal drugs, most recently in ‘How to Regulate Cannabis: A Practical Guide’. In this publication and others, we have made the case for a comprehensive ban on all forms of drug advertising, promotion and sponsorship. Plain packaging for tobacco sets an excellent precedent for the regulation of other drugs, and the UK government should be applauded for its boldness.


Graphic adapted from original work by Dr John Marks