The double standards of Canada’s tobacco control

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By now, Canadians are used to seeing the gruesome pictures on cigarette packages of diseased lungs, rotting gums and emaciated patients dying from smoking-related diseases.

Except for a period in 2010 when the federal government briefly considered abandoning plans to strengthen cigarette warning labels (an idea that was scuttled when media reports emerged of federal lobbying by cigarette manufacturers), Canada has been a world leader when it comes to requiring large, graphic warnings on cigarette labels.

But what about other tobacco products such as cigars, cigarillos, smokeless tobacco, roll-your-own-tobacco, bidis, kreteks … the list goes on. Canada's record on tough health warnings for tobacco suddenly looks a lot less stellar. Instead of being a leader, Canada is actually in contravention of an international treaty that requires participants to ensure all tobacco products come with appropriate warnings. And despite passing federal legislation to prevent small, candy-flavoured little cigars or "cigarillos" from being marketed to teens, manufacturers have used a loophole to get around the rules, leaving the market wide open for the products many critics dub "starter cigarettes."

To people like Rob Cunningham, senior policy analyst at the Canadian Cancer Society, it's a double standard that detracts from Canada's once solid reputation as a leader in the field of tobacco control.

"We need to complete the job that's already begun," he says.

In 2000, Canada became the first country to force cigarette-makers to include full-colour health warnings about the dangers of cigarettes that covered at least 50 per cent of package labels. In June, 2012, after some foot dragging by the federal government that earned it extensive criticism from tobacco-control advocates, stronger warnings were introduced that required the warnings to cover at least 75 per cent of cigarette-package labels.

But for some reason, other tobacco products were largely exempt. Individually packaged cigars, for instance, are typically sold without any health warning. The same is true for water-pipe tobacco, which has been growing in popularity, particularly among young people. Other products, such as chewing tobacco, carry a text warning but no graphic pictures. When warnings are present for cigars that come in a package and for pipe tobacco, they are often small and only on one side of the package.

The failure to require those warning labels means Canada has broken the World Health Organization Framework Convention on Tobacco Control, an international treaty that requires, among other things, health warnings to be displayed on all tobacco products covering at least 30 per cent of the package front and back.

In 2011, Health Canada said it would be phasing in new warnings for those products, but so far nothing has happened.

Although inadequate health warnings on tobacco products are, in general, concerning to tobacco-control advocates, they single out cigarillos as the most troubling.

Cigarillos come in a wide variety of candy and fruit flavours and are often sold individually or in small packages, making them particularly attractive to youth. After complaints that cigarillos were turning adolescents and teens on to smoking, the federal government passed legislation in 2010 banning their sale.

The problem is that the legislation banned cigarillos that were of a certain size – 1.4 grams or less – or cigarillos that had a filter. So manufacturers simply changed their products so they weighed more and contained no filter. Now the federal legislation, however well-intentioned, is essentially meaningless. Since then, Alberta has passed legislation banning all flavours in all tobacco products and Manitoba is considering a ban on flavoured cigarillos. Ontario had been looking at similar measures before the recent provincial election was called.

The federal government doesn't appear to have plans to close this loophole, which means that, for the foreseeable future, candy-flavoured mini-cigars will still be widely available to young people without so much as a warning label to remind them of the deadly dangers of tobacco.

To some, health warnings on tobacco products are evidence of a nanny state that doesn't trust people to make their own good choices.

But considering that tobacco products are highly addictive, are directly linked to cancer, heart disease and numerous other deadly health problems and are often marketed (whether overtly or subliminally) to young people to get them hooked, the argument for using graphic warnings on the entire range of tobacco products seems more than justified.

This is especially true considering how many young people are using those tobacco products. According to Health Canada's 2012 Tobacco Use Monitoring Survey, 4 per cent of Canadians 15 and older had smoked any type of cigar or cigarillo in the previous 30 days. Many of those who had smoked were under the legal purchasing age. Similarly, 10 per cent of those 15 and older said they had tried a water pipe and 8 per cent admitted they tried smokeless tobacco.

The health warnings work. Numerous studies, such as one published last year in the journal PLoS ONE, have found that picture-based warnings have a much stronger impact on smokers than text-only versions and that they encourage them to quit.

The federal government has done a good job of putting the dangers of cigarettes in the face of smokers. But there are plenty of other tobacco products on the market that can kill. It's time to send that message loud and clear.