The 2009 Health Bill - Tobacco Control

Introduction

Each day another 450 young people across the UK begin smoking The new Health Bill offers an unprecedented opportunity for parliament to give greater protection to children from tobacco marketing and the health risks of smoking. Smoking remains the single largest preventable cause of cancer in the UK. Together, smoking-related illnesses kill 87,000 people a year in England alone, causing tremendous suffering for individuals and families and placing an enormous burden on the NHS.

At present, 21% of adults are regular smokers. However, this figure obscures the fact that 80% of those who smoke become addicted before the age of 19. An average of 450 young people begin smoking each and every day in the UK. More worryingly over 190,000 11 to 15 year olds smoke.

The Health Bill was introduced in the House of Lords in January 2009 and completed its journey through the Lords on May 12, 2009. The Bill passed its Third Reading/Report Stage on 12th October. During this debate the Government also agreed to prohibit tobacco vending machines following an amendment by Ian McCartney MP. The Bill now returns to the Lords for their consideration of this and other amendments made in the Commons.

Table of contents

On 25th March 2009, Cancer Research UK held a  parliamentary reception for the  Out of Sight, Out of Mind campaign in the House of Commons. This reception provided the opportunity for MPs and peers to find out more information about what steps could be taken to further protect children and young people from tobacco marketing as the Health Bill progresses through Parliament. Watch a short video of Professor Gerard Hastings OBE of the Cancer Research UK Centre for Tobacco Control Studies telling the BBC’s Jon Sopel why the legislation is necessary.</>

 What are we asking for?

Cancer Research UK’s Out of Sight, Out of Mind campaign, launched this past summer, calls for the Government to introduce a comprehensive tobacco control strategy that will take action to:

  • close the loophole which allows tobacco to be displayed at the point of sale
  • prohibit the sale of cigarettes from vending machines
  • require the use of plain packaging for tobacco products

So far our petition in support of these measures has received over 50,000 signatures. In the Department of Health’s recent consultation over 80% of the nearly 100,000 respondents supported the introduction of all three measures.

 What is the evidence base?

Point of Sale displays as marketing tools aimed at young people Point of sale (PoS) displays are used to develop relationships between brands and customers and to deliberately increase the prominence of the packs themselves. Research into the impact of PoS displays by Professor Gerard Hastings OBE, Director of Cancer Research UK’s Centre for Tobacco Control Research at the University of Stirling, has concluded:

  • International evidence suggests that removing packs from sight at PoS could reduce adolescents’ exposure to cigarette brand impressions in stores by as much as 83%. It would also help adults to quit.
  • Since the implementation of the Tobacco Advertising and Promotions Act (2003), PoS has become the most important method for marketing tobacco to young people. In 2006, almost half (46%) of UK teens were aware of tobacco marketing at PoS.
  • The odds of a young person professing an intention to smoke may increase by 35% with every brand that they can name as having seen advertised at PoS. [1]

Tobacco industry documents obtained by the House of Commons Select Committee on Health and analysed in the report Keep Smiling: No One's Going to Die clearly demonstrate that tobacco companies place a high value on PoS displays and product packaging as a vehicle for tobacco marketing. Examples discussed in the report include:

“...the easiest way to communicate with current smokers is through the pack and through our extensive direct communications activities...”[2]

“Utilise modern printing techniques to the full by coming up with ways to use the pack outer as an advertising medium for Lambert and Butler. Make the L& B pack really stand out at point of sale against the competition.”[3]

More recently, Japan Tobacco International (JTI) has been quite open about the importance that it gives to packs as a tool of marketing. In a September 2008 statement on the launch of a special edition of Benson and Hedges Gold Brand, a JTI spokesperson stated that the packs’ “striking designs will only serve to further enhance retailers' profits with their eye-catching appeal.”[4]

Impact of removing Point of Sales displays on youth smoking rates Using data from the ongoing European School Survey Project on Alcohol and Other Drugs (ESPAD), the Public Health Institute of Iceland (a statutory body of the Icelandic Government) also found that youth smoking rates fell significantly after Iceland removed PoS displays in 2001, dropping from 18.6% in 1999 to 13.6% in 2003 - twice the rate of decline compared to the previous four-year period. Similarly, in Canada where such legislation has now been implemented in nearly all provinces, surveys show that banning point of sale displays, as part of a range of tobacco control measures, has coincided with a fall in smoking prevalence rates amongst 15 to 19 year olds from 22% in 2002 to 15% in 2007. [5]

Importantly, the ESPAD evidence from Iceland, which was gathered using a survey of all 10th graders in the country, contradicts a claim made by the Tobacco Retailers Alliance that youth smoking rates in Iceland were sustained or increased after PoS displays were removed. The Alliance’s claim was based on a survey size of less than 350 young people, and the Public Health Institute has advised that the ESPAD survey gives a more accurate view. Moreover, in Saskatchewan, Canada, many of the statements suggesting that smoking rates rose following the removal of PoS displays are based on smoking prevalence rates for adults, not youth.

Removing PoS displays of tobacco may also help those who are trying to quit smoking to avoid the impulse to smoke. A survey of smokers has found that almost 1 in 3 (31%) felt that the removal of PoS displays would help them to quit. [6]

Vending Machines Vending machines are little used by adult smokers, but 17% of underage smokers say that they are their usual source of cigarettes. [7] The WHO recommends a complete ban on tobacco vending machines and 22 European countries, including France, Belgium and Norway as well as many other countries across the world do not allow such machines.

Plain Packaging Tobacco companies use their packs to build relationships between brands and potential new customers, who are nearly always children and young people. Young people’s awareness of brands is so strong that it predicts future smoking more strongly than even peer influence. [8] Companies invest considerable resources to make tobacco packaging attractive, eye-catching and appealing but packaging can also convey misinformation about a deadly product. Young people believe that cigarettes branded as ‘smooth’ or ‘silver’ are safer than regular varieties. [9] Although no jurisdiction has yet introduced plain packaging, doing so could result in fewer teenagers starting smoking, because smoking would lose some of its appeal, and pack health messages would be more prominent. [10]

International Support In Canada, 12 of the 13 provinces and territories, together representing over 98% of the country’s population, have now passed laws requiring the removal of PoS displays. [11] Display bans have been in place in Iceland and Thailand since 2001 and 2005 respectively, and Ireland’s ban will come into force on 1st July 2009. The removal of PoS displays in the Australian state of Tasmania will take effect in 2011.

Recently agreed guidelines to the WHO Framework Convention on Tobacco Control define retail display, vending machines and tobacco packaging as forms of advertising and promotion and recommend that Parties to the FCTC, which include the UK, ban retail display and sale of tobacco products from vending machines and consider the adoption of plain packaging.

 How will it affect retailers?

Cost of refit Despite some reports quoting much larger figures, a quote from a Canadian shopfitter to Action on Smoking and Health and the Department of Health indicates that it could cost less than £200 to refit a typical small retailer display. [12] Moreover, international evidence suggests that most of the costs of re-fitting were borne by tobacco wholesalers, and the tobacco industry continued to pay retailers for handling and selling their products. [13]

The Health Bill also allows retailers adequate lead in times of 2011 for large retailers and 2013 for smaller retailers to ensure stores have the opportunity to prepare and adjust to the proposals

Impact on store revenues No evidence has yet been presented to suggest that retailers have experienced reduced patronage or profits as a direct result of the removal of PoS displays. It is also highly unlikely that 11 other Canadian provinces and territories would have voted for and followed the example of Saskatchewan in removing PoS displays had shops in that province been negatively affected.

Impact on counterfeiting Counterfeiting technology has advanced to the point that counterfeited products cannot be distinguished by sight. Instead, covert marks now exist on all genuine tobacco packs so that law enforcement and trading standards officers can identify counterfeit packages from genuine cigarettes. Consequently, the removal of PoS displays should not hamper anti-counterfeiting efforts.

 Strengthening the Bill

As currently drafted, the proposed Health Bill will take several important steps towards better protecting children from tobacco marketing. These measures include:

  • Removing displays of tobacco products at the PoS, starting with large shops in 2011 and then small shops in 2013.
  • Restricting access to tobacco vending machines to stop underage access and the powers to remove such machines completely if restrictions prove ineffective.

We believe that young people should be given greater protection by including provisions in the Bill to remove tobacco vending machines from the outset and provide an enabling power to introduce plain packaging. These steps would form part of a comprehensive tobacco strategy to ensure that we do all that is possible to make smoking history for our children.

 Parliamentary debate on the Health Bill

House of Lords The tobacco related elements of the Health Bill received strong support at all stages of its progress through in the House of Lords. A large number of peers from across the political spectrum spoke about the need to protect children and their support for measures to prohibit the display of tobacco at the PoS. There were also debates on prohibiting tobacco vending machines and the plain packaging of tobacco products, although a move to add the former to the bill was not successful at this stage.

Most significantly, an amendment to remove the measures that would prohibit the display of tobacco at the PoS was soundly defeated at Report Stage by an overwhelming cross-party vote of 204 to 110. The Health Bill had its Third Reading in the House of Lords on May 12, 2009 and received its First Reading in the House of Commons the following day.

House of Commons The Second Reading debate for the Health Bill, which occurred on June 8, 2009, saw many MPs from all sides of the House call for tobacco vending machines to be either banned immediately or removed from all premises accessible by those under the age of 19. There was also a vigorous discussion of the need to further protect children by removing PoS displays of tobacco, and the role of tobacco control as a way to help reduce health inequalities.

The Committee stage debate on the bill was relatively brief as several MPs argued the tobacco clauses should be debated before the full House of Commons at Report Stage. However, support was again expressed for the addition of tougher restrictions on tobacco vending machines than were originally included in the Bill, and there was a thorough debate on whether it should be illegal for adults to purchase tobacco on behalf of those under 18. 

The Bill had its Third Reading and Report Stage on 12th October. The House supported the prohibition of Point of Sale displays by a majority of 108, whilst the Government agreed to prohibit tobacco vending machines following an amendment by Ian McCartney MP.

The House of Lords will now consider the Commons amendments, including the prohibition of tobacco vending machines, on Monday 9th November.

If you would like more information on the Bill's progress, please visit the  Health Bill 2009 page on the website of the Houses of Parliament.

 Further information

Commons briefing documents

Lords briefing documents

Background documents

Partner organisations

 Footnotes

  1. Hastings G, et al. (2008). Point of Sale Display of Tobacco Products. The Centre for Tobacco Control.
  2. Advertising Support For Gratis II Catalogue Agency Recommendation. Submission from CDP to the Health Committee House of Commons - Gallaher Strategic Analysis Papers 1995. Cited in Gerard Hastings and Lynn MacFayden. Keep Smiling - No one's going to die: An analysis of internal documents from the Tobacco Industry’s main UK advertising agencies. 2000.
  3. Mustoe Merriman Herring and Levy. Lambert and Butler: Creative Brief for Imperial Tobacco, 12 May 1999. Cited in Gerard Hastings and Lynn MacFayden. Keep Smiling - No one's going to die: An analysis of internal documents from the Tobacco Industry’s main UK advertising agencies. 2000.
  4. Benson & Hedges Gold now in special edition. Talking Retail. 1 September 2008. Read.
  5. Canadian Tobacco Use Monitory Survey 2000 - 2007.
  6. Wakefield M. 'The effect of retail cigarette pack displays on impulse purchase. Addiction Journal, November 2007.
  7. Fuller E. (2007). Smoking, Drinking and Drug Use Among Young People in England 2006. NHS Information Centre, Leeds.
  8. Grant IC, Hassan L, Hastings G, MacKintosh AM & Eadie D (2007). The influence of branding on adolescent smoking behaviour: exploring the mediating role of image and attitudes. International Journal of Nonprofit and Voluntary Sector Marketing.
  9. Hammond D, Dockrell M, Arnott D, Lee A, Anderson S, McNeill A. (2008). The impact of cigarette pack design on perceptions of risk among UK adult and youth: evidence in support of plain packaging regulations. Beyond Smoking Kills, ASH.
  10. Cunningham, R. & Kyle K. The case for plain packaging. Tobacco Control 1995; 4: 80-86.
  11. Ontario Tobacco Research Unit. Retail Display of Tobacco Products: Monitoring Update. 5 September 2008. Read
  12. Quote from a Canadian shopfitter provided to Action on Smoking and Health and the Department of Health’.
  13. Data provided to ASH by Health Canada.

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