Smoking: Shock and trauma as public policy
20 JUL 2015 (SOUTH AFRICA)
By IVO VEGTER
The department of health wants to force tobacco firms to sell their wares without branding, in plain paper packaging, decorated only with graphic and distasteful pathology images. This is nanny-statist, bureaucratic over-reach which limits the freedom people have as adult citizens to make their own choices in life.
Some time ago, I pointed out that the decline of honeybees has been substantially overstated. Aaron Motsoaledi, the chief nanny in the health department, provides an excellent example. He has a bonnet full of them.
One of his bonneted bees is to interfere in the everyday lives of people, to make sure they keep healthy lifestyles. If they don’t, he’ll pass laws that scold, tax, badger, sermonise and humiliate them.
Among his recent initiatives are laws to force tobacco companies to package their products in unbranded packaging, festooned with gory images of diseased lungs, tracheotomies, and cancerous tumours.
This law will not affect me directly. I am an ex-smoker, with no intention of ever taking up the habit again. I do not intend to defend smoking here, but to defend the rights of smokers as equal to the rights we all enjoy as human beings and adult citizens of South Africa.
If Motsoaledi has his way, South Africa will be one of the first countries (after Australia, the UK and Ireland), to implement the World Health Organisation’s draconian guidelines on tobacco product packaging and labelling.
While the Netherlands has been relaxing its tobacco control regulations, on the grounds that it is patronising and illiberal to dictate healthy choices to citizens, Motsoaledi holds the exact opposite view. In his eyes, it is the government’s job to protect citizens from themselves. To quote him: “We are not doing this because we are a nanny state, but because we are concerned about the health of the nation.”
I fail to see the distinction, and moreover, I cannot tell the difference. Nannies are paid to be concerned about the health of their charges. If Motsoaledi claims to be concerned about the health of the nation, he is acting like a nanny to the people.
If you’re unsympathetic to the plight of smokers, you’re not alone. That’s why Motsoaledi is starting there. Smokers are easy targets. The cigarettes that they find relaxing and enjoyable are unpleasant to many others, and are clearly harmful to their health.
But Motsoaledi has also declared war on alcohol, salt, sugar, fat, fast food, baby formula and anything else that might under some circumstances be described as unhealthy, or less healthy than alternatives.
Motsoaledi has built the mother of all slippery slopes to nanny-state fascism, and it starts with tobacco products. Once the precedent is set, he can do this with anything, on almost any grounds.
Before you know it, he’ll be whining that people who don’t go to gym every day cost the government healthcare system too much money, so regular exercise will henceforth be mandatory.
The point is not that he is wrong. Smoking is bad for you. Moderation in most things (and abstinence in some) is good advice, especially if you suffer from high blood pressure, obesity, heart disease or diabetes. But we do not all suffer these conditions. By contrast, the burden on producers to comply with the nanny in chief’s dictats does affect us all.
‘Gore’ is the popular term for uncensored and graphic imagery of medical procedures, deadly accidents or dread diseases. Gore was once safely contained in the seedy corners of the Internet. You had to go looking for pictures of gross diseases, horrifying injuries or corpses, if you wanted to be shocked. Motsoaledi wants to make gore available to everyone, by slapping it on every cigarette pack you happen to see, whether it be yours or not.
Should automobiles be fitted with graphic images of mutilated and burnt bodies, to discourage their users from abusing them? Should your bottle of table wine be adorned with images of cirrhotic livers, flaccid penises or nasty tumours? “Oh, waiter, I’ll have that delightful Sauvignon Blanc with the inflamed pancreas on it.”
It may well prove to be unconstitutional to deprive companies of valuable brands through legislation. If a brand is an asset, then legislation that destroys it is tantamount to expropriation without compensation.
In the US, similar regulations were struck down on the grounds that they infringe on the right to free speech.
Even if you do not smoke and dislike smokers, these are rights most of us can get behind. One can only hope the tobacco industry takes Nanny Motsoaledi to the cleaners in court.
The health department’s interventions have other impacts too, such as slashing employment at hard-hit firms, and reducing marketing or advertising revenue elsewhere in the economy.
Motsoaledi has said that he’d consider making up for the R400 million that the SABC claims it would lose in advertising revenue if alcohol advertising were banned, by simply paying the same amount out of the health department’s budget to flight public-service health advertising. Amid chronic pharmaceutical shortages and one of the world’s leading Aids and tuberculosis burdens, that’s a rather callous and manipulative way to spend taxpayers’ money. Besides, what’s stopping him from doing so now, and broadening public debate, rather than restricting it?
Even if he did pay off the SABC, what about the rest of the media, or the many arts, culture, sporting or civil society initiatives that are funded by the kind of marketing he wants to prohibit? These have already been hammered by tobacco advertising bans. Losing alcohol advertising, and having salt rubbed into the wound by seeing only the state-owned media being compensated for the loss, can only weaken the independent media further. Not even sugar can help that medicine go down. Who will be left to hold government accountable, or sing praise to Motsoaledi on Father’s Day?
Smokers have already been exiled from polite society. They cower outside in the wet and cold, forbidden shelter or entertainment. They spoil everyone else’s party with their frequent absence during social gatherings. They’re treated like lepers.
Does anyone really think that a graphic picture is going to make more difference than today’s ‘Smoking Kills’ labels? It isn’t like the message is unclear. Do you know any smokers who are not fully aware that smoking causes deadly cancers, and worse, will make them look ugly, blotchy, and wrinkly when they get older? I don’t. I can’t for the life of me think what a bigger, more graphic warning label will achieve in terms of consumer awareness of the dangers of smoking. Its sole purpose is to demonise and revile those who enjoy nicotine instead of caffeine.
There is limited and contradictory evidence for the benefits of plain packaging. In the US, the regulators estimated a decline in smoking of 0.01% as a result of such rules. This is, statistically speaking, equal to zero. Only Australia has implemented such a law. There, some evidence suggests that it encourages smokers to choose cheaper cigarettes, but that it does not decrease the number of cigarettes sold. It could also boost the sales of illegal, untaxed cigarettes, because plain packaging prevents consumers from using branding as a tool to make choices about the quality and authenticity of the cigarettes they buy.
Even if plain packaging is effective in reducing smoking that does not justify such an onerous imposition on liberty. Smoking is a risk some people are prepared to take, for their own pleasure and satisfaction. Taking risks is what makes a happy and eventful life. People eat rich meals, drink strong liquor, or indulge in decadent sweets, even though they know these to be bad for their health. Motsoaledi wants to crack down on all of them.
They go bungee jumping, bicycling, mountain climbing, driving, skateboarding, swimming in the sea, skydiving and listen to loud music, even though all those activities imply risk of injury, long-term harm or even death. No doubt Motsoaledi disapproves heartily of such health risks.
People have a fundamental right to enjoy life, while it lasts. How much risk is a reasonable trade-off for a full and exciting life is not a choice that ought to be made by a government bureaucrat on a moral crusade. Even if some people underestimate risk or engage in what is perceived to be reckless behaviour, it is not justified to restrict their liberties, and punish everyone else for their sins.
As much as cabinet ministers might believe themselves to be fathers and mothers to the nation, citizens are not children. The people’s rights supercede those of government, since government is the servant of the people.
If plain paper packaging for cigarettes doesn’t work, all Motsoaledi will have caused is unpleasantness, revulsion and probably some psychological trauma, not only to smokers, but also to the adults and children around them.
Motsoaledi disrespects the freedom an individual ought to have to be in control of their lives. As a precedent, his proposed measures takes us one step closer to a government that controls the production, packaging and sale of a wide range of consumer goods and services. This will leave products undifferentiated by brand or reputation, which means producers will need to meet only the lowest common denominator in standards.
Motsoaledi is on record as saying, “We are now gunning for alcohol advertising.” This gives the lie to the argument that smoking is bad for your health in any amount, while alcohol is no risk when consumed in moderation. That doesn’t matter to the minister. In fact, he brags to international forums of unelected bureaucrats, like the World Health Organisation, about how far his legislative reforms go.
He has also declared that electronic cigarettes and water pipes (‘hubbly bubblies’) will be included in future tobacco control legislation. This puts to rest the argument that smoking is a fair target because it is unusually unhealthy by comparison with other trappings of a pleasurable life, such as wine, coffee or crisps. Motsoaledi is strict, like an old-timey pastor or headmaster. He won’t let any wanton enjoyment of life happen right under his nose.
If we don’t oppose this sort of draconian, illiberal law, which harms both individual freedom and economic activity, we’ll end up wondering how we ended up in a totalitarian nanny state so quickly. To adapt Pastor Martin Niemöller:
First they came for the Smokers, and I did not speak out-
Because I was not a Smoker.
Then they came for the Drinkers, and I did not speak out-
Because I was not a Drinker.
Then they came for the sugar and salt, and I did not speak out-
Because I already avoid sugar and salt.
Then they came for me – and there was no one left to speak for me. DM
Getting People to Behave: Research Lessons for Policy Makers
1.R. Kent Weaver
Article first published online: 14 JUL 2015
DOI: 10.1111/puar.12412
Abstract
Many government policies attempt to change the behavior of individuals and businesses. This article argues that policy makers and administrators should (1) think comprehensively about the barriers that may keep target populations from complying with government policies, (2) match policy instruments to the most important barriers that inhibit compliance, and (3) take into account heterogeneity within the target population. Relatively nonintrusive strategies such as social marketing, providing resources to targets to help them comply, and manipulating options and defaults (choice architecture) are politically attractive but unlikely to secure compliance when incentives for noncompliance are high. Based on the three basic principles outlined in the article, the author recommends strategies to increase compliance, including the use of leverage points and secondary targets, adjusting for unanticipated behavioral responses, and employing long-term, multiphase strategic management of behavior change initiatives.
If tobacco gets plain packets will junk food be next?
11 March 2015
by Marion Nestle
The tobacco industry is fighting moves to sell cigarettes in plain packs by claiming food manufacturers will be hit next. Will they?
ANTI-SMOKING advocates will be delighted. MPs have today voted in favour of introducing uniform packaging for cigarettes in the UK. That plain wrappers will undoubtedly further reduce smoking, especially among young people, is best confirmed by the tobacco industry’s vast opposition to this government measure and positive evidence from Australia, the first country to adopt it.
Along with lobbying and appeals to the World Trade Organization, the tobacco industry, when under attack, inevitably wheels out well-worn arguments about the nanny state, personal freedom, lack of scientific substantiation, and losses in jobs and tax revenues.
So to perk up its tired and thoroughly discredited campaign, the tobacco folks have added a new argument. Requiring plain wrappers on cigarettes, they say, is a slippery slope: next will be alcohol, sugary drinks and fast food. This argument immediately raises questions. Is it serious or just a red herring? Should the public health community lobby for plain wrappers to promote healthier food choices, or just dismiss it as another tobacco industry scare tactic?
Let me state from the outset that foods cannot be subject to the same level of regulatory intervention as cigarettes. The public health objective for tobacco is to end its use. So for cigarettes the rationale for plain wrappers is well established. Company logos, attractive images, descriptive statements, package colours and key words all promote purchases. Plain wrappers discourage buying, especially along with other measures such as bans on advertising, smoke-free policies, taxes and health warnings.
Australia’s pioneering law specified precise details of pack design, warning images and statements. The result: cigarette brands all look much alike. Most reports say plain packaging boosts negative perceptions of cigarettes among smokers and increases their desire to quit. Australia expects plain packaging to further reduce its smoking rate, which, at 12.8 per cent, is already among the world’s lowest. Along with the UK, New Zealand and Ireland are well on the way to adding plain packaging to their anti-smoking arsenal. More nations are considering it.
Which is all bad news for the tobacco industry. So it ramps up the slippery slope argument, hoping the food industry will support its fight against plain wrappers. It cites examples such as the regulation of infant formula in South Africa, where pictures of babies on labels are forbidden; that’s a big problem for the Gerber food brand ? Gerber’s company logo is a smiling baby.
But those peddling the slippery slope idea ignore the fact that the health message for tobacco is simple: stop smoking. But beyond tobacco, it is more complex. For alcohol it is a little more nuanced: drink moderately, if at all. For food it is much more nuanced. Food is not optional; we must eat to live. Nutritional quality varies widely. Foods are spread across a spectrum from unhealthy to healthy, from soft drinks (no nutrients) to carrots or fish (many nutrients). Most fall somewhere in between. What’s more, an occasional soft drink is fine; daily guzzling is not. So the advice is to choose the healthy and avoid or eat less junk, both in the context of calorie intake and expenditure.
Is there any evidence that plain packaging for unhealthy foods would reduce demand? Research has focused on marketing’s effect on children’s food preferences, demands and consumption. Brands and packages sell foods and drinks, and even very young children recognise and desire popular brands. When researchers compare the responses of children to the same foods wrapped in plain paper or in wrappers with company logos, bright colours or cartoon characters, kids invariably prefer the more exciting packaging.
But the problem is deciding which foods and beverages might call for plain wrappers. For anything but soft drinks and confectionery, the decisions look too vexing. Rather than having to deal with such difficulties, health advocates prefer to focus on interventions that are easier to justify ? scientifically and politically.
We know that some regulations and market interventions ?analogous to, if not the same as those aimed at smoking cessation ? are essential for reducing the damage from harmful products. If not plain packaging, then what? Studies suggest small benefits from a long list of interventions such as taxes, caps on portion size, front-of-package traffic-light labels, nutrition standards for school meals, advertising restrictions, and elimination of toys from fast food meals and cartoons from packaging. Rather than dealing with the impossible politics of plain wrappers on foods, health advocates increasingly favourwarning labels.
These first appeared on cigarette packs in the 1960s and have been considered for food products since the early 1990s. Heart disease researchers suggested that foods high in calories and fat should display labels such as: “The fat content of this food may contribute to heart disease.” More recently, health advocates in California and New York proposed warning labels on sugary drinks. The Ontario Medical Association takes a similar view: “To stop the obesity crisis, governments must apply the lessons learned from successful anti-tobacco campaigns.” It has mocked up examples of warnings on foods.
Although no warning label law has passed so far, such messages are the logical next step in promoting healthy food choices, in the same way that plain wrappers are the next logical step for all cigarette packages. Health advocates should recognise the slippery slope argument for the typical tobacco ploy that it is.
This article appeared in print under the headline “The plain truth”
Marion Nestle is the author of Food Politics and What to Eat and is the Paulette Goddard professor of nutrition, food studies, and public health at New York University
Junk Food and Booze Could Follow Tobacco in Plain Pack Push
Jan 23, 2015
By Matthew Boyle
Plain packaging laws for cigarettes have thrown the Marlboro Man off his horse in Australia and now the U.K. is set to follow. Junk food and alcohol could be next.
The U.K.’s plan to force tobacco companies to sell their wares in standardized packs starting next year has revived concern among consumer-product makers that other goods deemed unhealthy by health campaigners could face similar legislation. Alcohol inIndonesia, infant formula in South Africa, and fatty foods in Chile are among the items already being targeted.
The food and drink industries may have to consider adopting new marketing strategies for well-known international brands if the World Trade Organization rules in Australia’s favor in cases challenging the country’s 2012 plain packaging law for cigarettes. Such a development would be far reaching for consumer-goods makers, one industry group has said.
“I think it’s highly likely that plain packaging extends into other categories, especially alcohol and junk food,” said Erik Bloomquist, an analyst at Berenberg. “By the time tobacco plain packaging is established, it will be too late for the others to push back as the precedent will be set.”
Food and beverage companies are aware of this. In 2012, closely held candy maker Mars Inc. wrote to the U.K. Department of Health, saying the consequences of tobacco plain packaging would be “dramatic” as it would “set a key precedent for the application of similar legislation to other industries.” A spokeswoman for Mars, the maker of M&Ms; and Snickers chocolates, declined to comment further.
‘Catastrophic Effects’
The U.K.-based Consumer Packaging Manufacturers Alliance, which represents brand owners and packaging companies, has said plain packaging would have “catastrophic effects,” shifting investment and manufacturing jobs outside of Britain. Marques, a European body representing companies such as Unilever (UNA) and Anheuser-Busch InBev NV, (ABI) said “any plain-packaging requirements would be setting a precedent for other products.”
“Tobacco was the focus of regulators and now there will be more attention on the next wave of products seen as less healthy,” Richard Webster, a partner at management consultancy Bain & Co., said in an interview in London. “Plain packaging would remove the incentive to innovate, if all the packages looked the same. It would be a race to the bottom.”
Companies also contend that plain packaging violates their intellectual property rights, which are laid out in an international treaty commonly known as Trips. While Article 20 of Trips says the use of trademarks “shall not be unjustifiably encumbered,” a separate part of the agreement, Article 8, says countries can amend laws to “adopt measures necessary to protect public health and nutrition.”
Graphic Warnings
“If you can come up with a justifiable reason for public health, that will give a government allowance to restrict intellectual property,” says Sarah Wright, a partner specializing in intellectual property at law firm Olswang in London. “Article 8 is an exception to Article 20.”
Governments are already acting upon that exception. Indonesia, Southeast Asia’s largest economy and home to the world’s biggest Muslim population, last year proposed legislation that would require alcohol manufacturers to either use plain packaging or place graphic warnings on labels to curtail consumption. Indonesia, a big exporter of cigarettes, is one of the five countries challenging Australia’s plain packaging of tobacco at the WTO. A decision is expected next year.
South Africa
Diageo Plc (DGE), the world’s biggest distiller, has targeted Indonesia as a key growth market, and net sales there last year grew by more than 10 percent, boosted by growing demand for Guinness stout.
“Alcohol and tobacco are very different products and warrant different approaches,” Diageo spokeswoman Cecilia Coonan said in an e-mail. “But plain packaging strips legitimate companies of their ability to brand and market their products. In the case of alcohol, there is no evidence that it would reduce harmful drinking.”
In December 2012, South Africa prohibited “aggressive or inappropriate marketing of breast milk substitutes” such as formula milk. The regulations allowed company and brand logos, as long as they did not contain a picture of an infant “or other humanized figure.”
That would prohibit the logo of Nestle SA’s (NESN) Gerber brand, which depicts an infant with mouth agape. The world’s biggest food company does not sell infant formula in South Africa due to “the recently revised codes that govern” the industry, spokesperson Ravi Pillay said via e-mail.
Stop Signs
Chile has proposed regulations that would place images of “Stop” signs on food high in fat, sugar and salt. Higher taxes, additional nutrition information and restrictions on the marketing and display of products are among other measures governments can impose short of plain packaging.
The U.K. in 2007 banned the advertising of unhealthy foods during children’s television programs, and the U.S. has removed such ads from schools. Advocacy groups including the U.K.’s Alcohol Health Alliance have proposedminimum pricing for a unit of alcohol, not plain packaging.
“Plain packaging is a very extreme course — there is a whole range of possible interventions legislators could take,” Wright, the intellectual property lawyer, said. “It’s unlikely they would go there unless they have exhausted other options.”
