Health Service Focus

The plain packaging of cigarettes: triumph or tyranny?

2020health.org founder and chief executive Julia Manning, who sits on NHE’s editorial board, as well as the think tank’s research assistant Charlotte Morris, report back from a debate it hosted on plain packaging for cigarettes.

Since the introduction of the smoking ban in public areas in 2007, many have said the war on smoking has been won. Health campaigners however are now pressing for the plain packaging of cigarettes. The Australian Tobacco Plain Packaging Act 2011 requires all tobacco products sold in Australia to have standard ‘plain’ packaging that limits the brand size and predominately consists of health warnings. New Zealand has recently announced similar plans.

Is this a policy we need to consider in the UK, and what would it mean for society? Whilst evidence is clear that cigarettes are bad for our physical health, the legal and policy questions are not so clear. Are there limits to what government can and should do to limit access to things some may enjoy, if even unhealthily? Are the claims a corporation makes about its products protected by its free speech rights as a legal person?

On the day that the Scottish Government banned tobacco vending machines and the display of tobacco in shops, 2020health held a debate, hosted by Professor David Napier from the University College London (UCL) and sponsored by Cancer Research UK, which proposed the motion ‘Introducing plain, standardised packaging will benefit the health of the nation’.

Speakers for the motion were Professor Robert West, Professor of Health Psychology and Director of Tobacco Studies, UCL, and the Rt Hon Kevin Baron MP. Speakers against the motion were Ian Paisley Jr MP, Junior Minister in the Offi ce of the First Minister and deputy First Minister, Northern Ireland, and Claire Fox, Director of the Institute of Ideas.

Professor Robert West spoke first, for the motion, arguing that to introduce plain, standardised packaging of cigarettes “is a very modest proposal in light of [the]... circumstances” and that if we were starting from a blank canvas no “government would allow such a product to be marketed”. After all, this is a product that is highly addictive – 90% of serious quit attempts fail in a year – and lethal – smoking cuts lives by around 20 years and it does not take the unpleasant years at the end of life, but the middle, healthy years.

First he put forward a moral argument, saying that it cannot be ethical to allow an industry to promote “an addictive product that causes suffering and death on a scale that, let’s face it, terrorists can only dream of” that only “by historical misadventure” they are allowed to sell. Second, he also put forward a cost-benefit argument. That is, even if we make a very conservative assumption that introducing the plain packaging of cigarettes will only persuade 5% of the predicted number of people who start smoking in a year not to smoke, we could save 2,000 lives a year. And that is a number of lives worth saving.

Ian Paisley Jr MP had different concerns, unsurprisingly perhaps as the strident leader of the anti-plain packaging movement in Parliament. He emphasised the lack of evidence that the packaging of cigarettes in itself directly encourages people to start smoking. He argued that peer pressure is far more infl uential and is the main cause of what encourages children to start smoking at school, and that he said this despite confessing that he is anti-smoking, he doesn’t smoke and he doesn’t want his children to smoke and that “if it’s shown that the policy works then I’ll support it. But until there is evidence, we cannot go down that road.”

To introduce plain packaging would be to patronise the public and to fool ourselves we were doing something to save lives in the UK. Not only would we not be saving lives, but, he argued, we would be harming lives by making it easier for those who smuggle counterfeit cigarettes into the UK. 

He argued that it is not just the tobacco industry saying this but also senior officials of HMRC such as Mike Norgorve, as well as 22 senior police officers from the ‘flying squad’, various chief constables across the UK and the head of the Serious Organised Crime Agency. Alan McQuillan, lead assistant boundary commissioner at the Boundary Commission for England has said: “This will be a smuggling nightmare.”

Claire Fox, director of the Institute of Ideas, added that plain, standardised packaging isn’t healthy for society. For her, it undermined a number of principles that our democratic society was founded on. The motion itself, she said, presumed “that physical health is such an important end point that other values can be compromised” for its achievement, and this isn’t a good thing. In this case the value being compromised is freedom, and Claire would rather be free than healthy. To be healthy and live under a tyranny is not an aspiration of hers: “I believe that a democracy means treating adults as free competent citizens, and I think it’s galling that in a democracy we have got ourselves in to such a place with plain packaging...our freedom to choose is curtailed because we’re assumed to be impressionable incompetents who are deemed to be incapable of resisting the lure of a prettily branded packet.”

She also sees plain packaging as a free speech issue. It sets a dangerous precedent when the state decides what images, slogans or logos we are allowed to see and “bans those it arbitrarily decides are bad for our health...In a democracy we should be free to read what we want [and] to make up our own minds.” She agreed with Ian that it is just not true that the only reason people take up smoking is because of the well-designed brand.

To assume so is patronising and demeaning, she asserted: “I want rebels who don’t smoke, but I’m perfectly happy to sanction rebels who do. What I don’t want is dull conformity, lack of freedom and being treated like a moron by the public health advocates.”

Finally, the Rt Hon Kevin Barron MP first made the point that counterfeiting standard cigarette packs is not as easy as some, like Ian Paisley Jr, suggest.

What’s more the World Health Organisation has recently agreed that every legitimately produced cigarette pack should have a standard numerical code that will tell anyone with access to the system where and when it was produced as well as what its intended market was supposed to be.

Barron said that he hoped standardised packaging would tighten up the cigarette black market. What’s more, the scale of illicit trade of cigarettes is relatively low, and falling. A survey conducted in January-February 2013 showed that the proportion of smokers buying illicit tobacco has fallen from 25%-24% to 17%.

As he noted, this is “a substantial decline when considered against the backdrop of sustained economic hardship that would be expected to fuel the demand for cheap, illicit tobacco”.

Tobacco companies are guilty of effectively telling lies about the extent of illicit trade in cigarettes to make this seem like a bigger problem than it really is. His second point took us back to the strong influence, or not, that packaging has on consumers. He argued that packaging is powerful and manipulative. The proof? The fact that tobacco companies are spending so much money and effort on preventing the introduction of plain packaging. The audience took a vote on the motion ‘Introducing plain, standardised packaging will benefit the health of the nation’ and just under 70% voted in favour of introducing plain packaging.

However, there was a swing from the start of the debate when 76% voted for and 24% voted against. It seems this time the audience were swayed by the importance of their personal freedom – both freedom to information and freedom of choice. Yet questions remain unanswered. Is the purported dichotomy in this debate of freedom versus state control really true? Or is our freedom to make a rational choice to start smoking or not delusional against a back-drop of manipulative tobacco companies?

What’s more, those against the motion talked about a lack of evidence but others suggest strong evidence showing the effects of retail packaging are available. As Australia has introduced plain packaging we will soon be able to see the effects it has on smoking rates. As with smoking in public places, if it turns out to be a success, we can expect it to come to England as well.

Meanwhile, it was left out of the Queen’s Speech.