Evidence-Based Policy Making: The Case for Plain Cigarette Packaging

Nov 15
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This is an excerpt from Professor Simon Chapman’s book, ‘Removing the emperor’s new clothes: Australia and tobacco plain packaging’.

“At its simplest, the story is one of the public good against commercial evil – governments and health authorities introducing an evidence-based measure in the face of ferocious opposition from a lethal and discredited, but still powerful industry.”

Why plain packs?

Globally, tobacco claims more than five million deaths a year. Many smokers suffer for years from wretched diseases like emphysema which eventually makes taking a few steps a major effort. Thousands of previously private internal tobacco industry documents read like recipe books from crack cocaine labs, detailing how the cigarette can be better engineered as a nicotine delivery device to ‘make it harder for existing smokers to leave the product.’

In August 2007, we were part of a research team working on a three year National Health and Medical Research Council (NHMRC) grant examining various options for ‘the future of tobacco control’. Being a very advanced nation in global tobacco control, Australia had fully implemented almost all of the planks of a comprehensive tobacco control policy platform. But smoking prevalence remained at just under one in five adults, and our project sought to focus on some of the less developed or more contentious issues where Australia (and indeed most nations) had not advanced very far.

Plain packaging was one such issue, and along with Matthew Rimmer, a legal scholar in intellectual property from the Australian National University, we published an online review, later peer-reviewed, on the concept of plain packaging and the evidence and arguments for it.

Researchers are often asked to nominate papers they have produced which they believe have been influential in ‘real world’ settings. This was one such paper. Our review was cited by numerous other researchers who went on to conduct experiments that clearly demonstrated that removing the design elements of packaging sharply reduced product appeal and increased consumer attention to health warnings. Our review has been steadily cited by other researchers (Google Scholar shows 111 citations by October 2014, easily the most for any paper yet published on plain packaging) but by far the most important outcome was the timing of its publication and the role it played in shaping the wording of the background and recommendation on plain packaging in the reports of Australia’s National Preventative Health Taskforce.

It won’t work, so don’t do it!

Let us start with the most bizarre argument of all those used to oppose plain packs. This was the ‘poacher turned gamekeeper’ spectacle of those in the tobacco industry telling the Australian and later the Irish, British and New Zealand governments that they knew that plain packs would do nothing to decrease tobacco sales in children or adults, and that therefore the government should abandon the policy.

This was always going to be a highly fraught strategy for the industry. It is axiomatic that the tobacco industry wants as many people to smoke as much as possible. That is what all its employees understand as their collective key performance indicator as they arrive at work each day and what shareholders expect from their company.

So when we hear anyone from the tobacco industry intoning earnestly that they believe that plain packaging ‘won’t work’, and explaining that it would be sensible for government to abandon it, it is always sensible to decode such statements through a commercial reality checker. What possible motivation would anyone profiting from selling tobacco have to urge governments to not pursue strategies that supposedly would not impact on sales? 

Equally bizarrely, the industry thought it was onto a winning argument by repeatedly emphasising that no nation had ever introduced plain packaging.

And because no country had ever introduced such legislation, another taunt therefore became available: there was of course no evidence to be found anywhere that plain packaging would achieve what it was meant to achieve. This evidence-free zone in turn allowed the industry to hitch a ride on the evidence-based policy mantra that has swept through governments over the last 15 or so years. How could the government possibly promote a policy for which there was no evidence? They were onto a winner, surely?

In fact, there was a good deal of published evidence. This was gathered together under the one cover in a review by Quit Victoria and the Cancer Council Victoria in August 2011. Angela Pratt emphasised the importance of the assembling of this research:

“the amassing of the evidence base. I mean, the number of times that was in all of our talking points. That was incredibly, incredibly important because it enabled Nicola to make the case publicly that this was something that had an evidence base.”

Hear more on the role of evidence-based policy in plain cigarette packaging from Professor Simon Chapman at the Strengthening Evidence-Based Policy Conference in February. Book your place by November 20th to save $500 on ticket prices.

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Submitted by Professor Simon Chapman

Professor Simon Chapman

Simon Chapman AO PhD FASSA Hon FFPH (UK), is Professor in Public Health at the University of Sydney. He has published over 500 original articles, editorials and commentaries in peer reviewed journals and 19 books and major reports. His latest book (with Becky Freeman) Removing the emperor’s clothes: Australia and tobacco plain packaging was published by Sydney University Press in 2014.

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