Heart and lungs

Review recommends plain cigarette packs

“The government has announced its support for the introduction of standardised cigarette packets, following a review,” BBC News reports. The review concludes that plain packaging would have a positive impact on public health.

Who produced the review?

The review was commissioned by Jane Ellison MP, Parliamentary Under Secretary of State for Public Health, into whether the introduction of standardised cigarette packets would lead to a benefit in public health – specifically, in reducing the number of children who smoke.

The review was produced by Sir Cyril Chantler, who served as a Consultant Paediatrician at Guy's Hospital and is now an Honorary Fellow for University College London (and associated bodies).

What is meant by standardised packaging?

“Standardised packaging” means putting tobacco products in drab, purposefully unattractive packaging, devoid of branding (other than name) or promotional information. In Australia, which introduced standardised packaging in 2012, packs often contains stark health warnings and graphic images, such as a limb affected by gangrene (which can occur due to smoking-related peripheral arterial disease).

What are the arguments for standardised packaging?

Arguments for standardised packaging include claims it will:

  • discourage people, particularly children, from taking up smoking (particular emphasis is placed on this)
  • encourage current smokers to give up
  • discourage people who have given up from relapsing

In summary, proponents of standardised packaging believe that it will:

  • reduce the appeal of tobacco products to consumers
  • increase the effectiveness of health warnings on retail packaging
  • reduce the ability of retail packaging to mislead about the harmful effects of smoking or using tobacco products

What are the arguments against standardised packaging?

Arguments against standardised packaging include claims that: 

  • it will make counterfeiting easier
  • by removing branding, smokers will gravitate to the cheapest products, increasing the amount they smoke
  • smoking initiation and ongoing consumption are driven by factors unrelated to packaging
  • there is no empirical evidence – in the form of randomised controlled trials (RCTs) – that prove standardised packaging reduces smoking prevalence and uptake

What are the key findings of Sir Cyril’s review?

The key findings are that:

  • there is very strong evidence suggesting that exposure to tobacco advertising and promotion increases the likelihood of children taking up smoking
  • it is not plausible that the effect of branded packaging is only to encourage brand switching amongst adult smokers and never to encourage non-smokers (particularly children) from taking up smoking
  • there are limitations to the evidence currently available surrounding the likely effect of standardised packaging on tobacco consumption in terms of RCTs – however, it's not deemed ethical to undertake such a trial as this may expose children to potential harm
  • early evidence from Australia does not show falling tobacco prices, so the argument that standardised packaging will lead to cheaper tobacco products are unproven
  • there is no evidence that standardised packaging is easier to counterfeit – in Australia, hardly any counterfeit standardised packages have been found

The review concludes: "the body of evidence shows that standardised packaging, in conjunction with the current tobacco control regime, is very likely to lead to a modest, but important, reduction over time on the uptake and prevalence of smoking, and thus have a positive impact on public health."

What happens next?

Health Minister Jane Ellison told the House of Commons today that she was "minded" to introduce new regulations. Exactly when that would happen is unclear.

Newspapers report that tobacco companies may challenge the proposed legislation under European law.

NHS Attribution