1. PLAIN PACKAGING – WHY IT MATTERS,
AND MAKING IT HAPPEN
Professor Mike Daube AO
Curtin University, Perth, Western Australia
Slide acknowledgements - many colleagues

2. Australia’s #1 cigarette and World’s #1 cigarette:
before and after

3. Imperial Brands Investor Day
8 June 2016

4. “Australia is the darkest market in
the world, and from a distance it’s
easy to get dispirited by that.”

5. A long history
• 1950 – Doll and Hill (BMJ), Wynder and
Graham (JAMA)
• 1962 – First report of Royal College of
Physicians of London
• 1964 – First report of US Surgeon General
• 1971 - First WHO report
• 1981 – Hirayama (BMJ) on passive
smoking
• And continuing streams of evidence

6. WE HAVE KNOWN WHAT TO DO FOR
FORTY YEARS

7. COMPREHENSIVE APPROACH
•No one magic bullet – but all recommended measures contribute, and
reinforce
•Now strong evidence for all components of WHO-recommended approach
•Confirmed and reinforced by FCTC
•Australia – Federal system (national and state/territory governments)
•Progressive action over time

8. EARLY AND CONTINUING ADVOCACY
• Strong, cohesive coalitions
• Maintaining a high profile for the tobacco problem
• Emphasis on magnitude of problem, new evidence, need for action
• Exposing and opposing tobacco industry
• Innovative approaches

14. HIGH-REACH MASS MEDIA
CAMPAIGNS
Research-based
Well evaluated
Excellent outcomes

16. National Tobacco Campaign

17. Hard-hitting

18. Opportunistic

19. Advertising bans
From the late 80s/early 90s
Even younger adults have never been exposed to significant tobacco
promotion

20. POINT OF SALE DISPLAY BANS

21. TAXATION
• Progressive increases over time

22. SMOKE-FREE

23. COMPLEMENTARY ACTIVITY
• Cessation supports
• Programs for disadvantaged groups
• Continuing research and evaluation
• Media, media, media

24. HEALTH WARNINGS

25. AND THEN…..FROM 2008…. THE NATIONAL
PREVENTION TASKFORCE AND PLAIN
PACKAGING
(A personal perspective)

26. Chair:
Professor Rob Moodie
(Chair, Alcohol c’ttee)
Deputy Chair:
Professor Mike Daube
(Chair, Tobacco C’ttee)
Members:
Professor Paul Zimmet
Professor Leonie Segal
Dr Lyn Roberts (Chair, Obesity C’ttee)
Mr Shaun Larkin
Ms Kate Carnell
Dr Christine Connors
Dr Linda Selvey
The Taskforce was announced on 9 April 2008.
Develop targets and strategies for the nation.

27. TOBACCO CONTROL AUSTRALIA in 2008 – Over-simplified
summary (Note - mix of Federal and State activity)
Tobacco advertising bans since late 80s/early 90s
Health warnings since 1973, increasing strength every decade – 1973, 1987,
1995, 2006
Continuing State legislation/action (leapfrog effect)
Bans on point-of-sale promotion
Strong measures to protect non-smokers – cars around kids, bars and
restaurants, other public places (including some beaches)
National and State media campaigns
Strong, cohesive advocacy organisations, individuals, coalitions – Cancer,
Heart, AMA, AMA, ASH, ACOSH, PHAA – and many others
Continuing new approaches to media and media coverage
Cessation support – NRT, Quitlines, etc
(Industry last 10 – 15 years – much lobbying and working through others but
staying below parapet )

28. WHERE NEXT?

29. Consultation
• Many submissions
• Consulted widely – but Minister clear that we
did not need to consult with the tobacco
industry (FCTC Article 5.3)
• Tobacco industry submissions kindly offered
assistance

30. “BAT believes there is already a significant amount of regulation
on tobacco products and there may now be a risk of too
much, with unintended consequences of progressing further.”
BATA submission to Taskforce
“Australia has passed the limit of the ability of regulations on
tobacco advertising, marketing, sales and public smoking to
advance health objectives.”
Philip Morris submission to Taskforce

31. Discussion Paper

32. PLAIN PACKAGING - PASSING THE
SCREAM TEST
Plain packaging/pack display – part of multi-
focused Discussion Paper
Industry responses (BAT, Imperial, Philip
Morris) – 43 out of 142 pages

34. Continuing research
• Australia (Wakefield et al)
• Canada (Hammond et al)
• New Zealand (Hoek et al)
• US (FDA et al)
• UK (Various….)

35. FCTC
• Articles 11 and 13 (inc. guidelines)
Parties should consider adopting measures to restrict or prohibit the use of logos, colours,
brand images or promotional information on packaging other than brand names and
product names displayed in a standard colour and font style (plain packaging). This may
increase the noticeability and effectiveness of health warnings and messages, prevent the
package from detracting attention from them, and address industry package design
techniques that may suggest that some products are less harmful than others
Parties should consider adopting plain packaging requirements to eliminate the effects of
advertising or promotion on packaging. Packaging, individual cigarettes or other tobacco
products should carry no advertising or promotion, including design features that make
products attractive.

36. Why Plain Packaging?
• Not a magic bullet
• Not in isolation – next step in comprehensive approach
• Research evidence – impacts of packaging on children, young
people, adults, smokers, non-smokers
• Primary focus long-term – children and young people
• Removes last form of direct tobacco advertising
• Industry’s own research
• Sends out important signal
• Supports rest of program
• FCTC and international implications
• Industry opposition – passes the Scream Test

37. 37

38. 38

39.  1 Make tobacco products significantly more expensive
 2. Increase the frequency, reach and intensity of social marketing campaigns
 3. End all forms of advertising and promotion of tobacco products
 4. Eliminate exposure to second hand smoke in public places
 5. Regulate manufacturing and further regulate packaging and
supply of tobacco products
 6. Ensure all smokers in contact with health services are encouraged and supported to quit
 7. Work in partnership with Indigenous groups to boost effort to reduce smoking and exposure to tobacco among Indigenous Australians
 8. Boost efforts to discourage smoking in other highly disadvantaged groups
 9. Assist parents and educators to discourage tobacco use and protect young people from second hand smoke
 10. Ensure the public, media, politicians and other opinion leaders remain aware of the need for sustained and vigorous action to
discourage tobacco use
 11. Ensure implementation and measure progress against and towards targets
 Infrastructure recommendations also included: Establish a National Preventive Health Agency
Tobacco – Comprehensive approach
11 components

40. PACKAGING - ACTION PROPOSED
• REQUIRE ALL TOBACCO PRODUCTS TO BE SOLD IN PLAIN
PACKAGING, THE EXACT APPEARANCE OF WHICH (PRECISE
COLOUR, PAPER FINISH, SHAPE OF PACK, ETC.) COULD BE
PRESCRIBED IN REGULATIONS UNDER THE TRADE PRACTICES
ACT 1974.
• COMMISSION RESEARCH TO DETERMINE EXACTLY HOW
PACKS SHOULD BE DESIGNED TO MINIMISE APPEAL TO
YOUNG PEOPLE.

41. GOVERNMENT
• Release September 1st
2009
• Minister Roxon – “By not acting we are killing
people”

42. Action On Tobacco After Report
Current/further action at national and state levels, including dealing with
• loopholes in ad ban legislation (e.g. internet advertising);
•Further bans on any display at point of sale;
•further protection for non-smokers;
•Funding for media campaigns;
•specific education and support for disadvantaged groups;
•Tackling Indigenous Smoking Initiative;
•Cessation supports (e.g. NRT, Quitline)
•But plain packaging? Heavy industry campaigning
•And a ‘phone call

43. APRIL 29, 2010

45. INDUSTRY APPROACH
• INSTANT AND CONTINUING ATTACK
• MOST FEROCIOUS I HAVE SEEN IN 44 YEARS
• BEST INDICATOR OF CONCERN – COMPANIES
THEMSELVES GO PUBLIC

46. THE RESEARCH
• Meticulous – all aspects of the pack, design, colour,
etc.
• Primarily from Melanie Wakefield and colleagues
• Essentially not challenged
• Minister’s only mistake – “olive brown”

47. THE POLITICS
• Minority Government – needed support of Independents in Lower House
• Majority in Senate, with strong support from Greens
• Opposition oppositional….Opposing everything

48. Massive industry campaigns
• Media – press, radio, TV
• Public relations – direct, indirect
• Social media
• Retailers
• Lobbying
• Dirty tricks
• Industry spend unknown – certainly tens of
millions

49. Industry Arguments
• It won’t work
• It will put us out of business
• End to freedom
• Illegal
• International agreements
• It’s never been done before
• And so on……..

52. Legal arguments

56. Front Groups

59. Midnight Emails

64. Health Coalition
• Government, Minister, Minister’s office
• Major health groups and experts working nationally as cohesive
coalition
• Cancer Councils, Heart Foundation, Australian Medical Association,
QUIT campaigns, ASH, ACOSH, Public Health Association, and other
health organisations
• Prominent experts, health/medical leaders
• Media, media, media - Proactive, reactive
• Responding to industry campaigns, exposing industry tactics,
research, reports, surveys, advertisements…
• Active support from politicians of all parties
• Lobbying, lobbying, lobbying – all parties, all members

65. • WORK BY GOVERNMENT
• STRONG, DETERMINED MINISTER
• SYMPATHETIC MPs FROM ALL PARTIES
• MORE INNOVATIVE ADVOCACY (e.g. plain packaging professors)
• PUBLIC AND MEDIA SUPPORT

67. • Need for all-party support
• Many good supporters from all sides
• Another ‘phone call – and a robust Australian
politician

68. ......Liberal MP Mal Washer ...... who spent 26 years as a medical practitioner before
moving into federal politics, gave a blunt assessment of the tobacco industry's
strategy.
''All this talk of chop chop and crime gangs sounds like bullshit to me. The
tobacco industry is jumping up and down because they're worried about their
businesses. I support these reforms unequivocally and whatever my party
decides to do, I don't give a shit,'' Dr Washer said.
He said smoking killed about 19,000 Australians each year, and governments had a
moral responsibility to implement any measure that could stop young people from
taking up the habit
The Age, May 22, 2011

73. FROM DECEMBER 2012

74. Ppublic health England
Source – Public Health England

76. Australian Government, Department of Health 2015

77. Percentage of ever-smokers who have quit
Australians 14 and over, 1991―2013
AIHW National Drug Strategy Household Survey, Tobacco Tables, Table 1

78. Tobacco plain packaging report released
by Australian government
• Plain packaging
responsible for
25% of the decline
in smoking
prevalence from
Dec 2012 to Sept
2015
• These effects are
likely to grow over
time

82. And industry claims of doom and disaster? - 1
PP would be rejected by Australian courts as being unconstitutional, with huge consequential costs for
the Federal Government.
Outcome: The High Court rejected the industry's arguments, awarding costs to the Australian
Government
There would be significant problems for retailers in identifying the newly packaged brands, with
consequent delays in serving customers.
Outcome: Peer-reviewed research shows no such problems.
There would be a shift in sales of tobacco products from small retail outlets to supermarkets.
Outcome: Peer-reviewed research and independent data show that there has been no such shift.
Smokers would cover up the plain packs with newly purchased special covers.
Outcome: Peer-reviewed research shows minimal use of any such covers.
There would be a massive increase in the illicit tobacco trade.
Outcome: Government reports and peer-reviewed studies show no such increase.

83. Doom and disaster - 2
There would be an increase in counterfeiting of the new plain packs.
Outcome: Independent reports and Customs statements show no such increase, and evidence
from British American Tobacco to the Chantler review in the UK confirmed no increase.
There would be a substantial drop in prices.
Outcome: Industry financial data show no such drop; indeed, because of the introduction of plain
packaging, tobacco companies have reportedly aggressively increased prices.
There would be a shift to low-cost Asian brands of cigarettes.
Outcome: Peer-reviewed research shows no such shift.
Tobacco sales would increase (although the rationale for this claim was never clearly articulated).
Outcome: Official data and industry data show a decline in sales.
There would be in-store crime, as shop staff would take so long to identify specific brands that
they would not be able to observe shoplifting.
Outcome: There is no evidence for this having occurred.

84. And Now.....
• Industry litigation – but so far losing all cases
• Australia, Ireland, UK, France, Hungary, Uruguay, Norway have legislated
• At least 14 further countries on the way
• Governments (both sides) committed to substantial regular annual tax
increases
• Strong and increasing public and bipartisan political support
• Continuing developments from tax to smoke-free

86. Tobacco taxation
• 25% increase in 2010
• 12.5% increase in each of 2013 to 2020
• Increases the price*
of Winfield Blue 25 packs from $12.95 in
2010 to $42.50 in 2019
• Especially effective policy to tip lower SES smokers towards
quitting
*In current dollar prices

87. Plainly a success

88. So what have we learned? What
made it happen?
1. Magnitude of problem – and continuing new ways of presenting the evidence.
2. Constant and continuing advocacy over decades from health organisations and
professionals
3. Comprehensive approach
4. Work as coalitions - consensus is crucial
5. Recognise that it doesn’t all happen at once
6. Evidence-based recommendations and meticulous science
7. Seize the hour; be open to opportunity when it arises (good Minister; good
timing; all-party support); make the case, encourage – and work at it!
8. Recognise that it is a battle with tough, ruthless opposition.
9. Play to your strengths (magnitude of problem, protecting children, evidence,
credibility, international support (especially WHO); identify and expose the
opposition; and campaign hard and professionally.
10. Plain packaging has generated a new sense of excitement globally – and shown
that we can win battles that would once have seemed impossible.

89. What else have we learned - 1?
• Success is popular
• Strong and increasing public support
• Prime Minister Turnbull – “One of the big public health successes…..”
(June 2016)

90. The war is never over

91. Major cigarette brands on sale around schools surveyed -
From Big Tobacco, Tiny Targets – Tobacco industry targets schools in Africa ATCA 2016

92. What else have we learned – 2?
• There is never room for complacency
• The glass is still only half full
• Keep setting new targets

93. AUSTRALIAN HEALTH POLICY COLLABORATION –
TARGETS NOVEMBER 2016

94. And finally
• Overnight success takes time
• There are real heroes who deserve the
credit, from early leaders to politicians
• It can be done

96. FROM DECEMBER 2012

97. “Australia is the darkest market in
the world, and from a distance it’s
easy to get dispirited by that.”