THE health services ministry recently issued an SRO under which the pictorial health warning on a cigarette pack will be increased to cover at least 50 per cent of the packaging. This comes after the tobacco industry’s lobbying led to the withdrawal of an earlier SRO which would have increased the pictorial warning to 85pc.
The government’s retreat is being perceived as a major setback in our effort towards curbing smoking, considering that the WHO Framework Convention on Tobacco Control also encourages the printing of large pictorial warnings. On closer inspection, the retreat is not as bad as it first looks. A 25pc increase from 50pc to 85pc may have attracted smokers’ attention but, as a policy tool, would have had a limited impact in inducing behaviour change. To understand why, a short detour might be useful.
In neoclassical economics that dominated the late 20th century — around the same time when pictorial warnings became popular — the conventional view was that consumers are rational economic agents who act to further their individual self-interest. In markets where consumers lacked perfect information, however, this was not possible and so the government would intervene to correct the information asymmetry. A popular policy tool was a regime of mandatory disclosure that required sellers to make certain informational disclosures to buyers prior to sale.
The law has been rarely invoked to de-normalise smoking.
Since policymakers felt the market for cigarettes was beset by information asymmetry as the tobacco industry was working hard to suppress evidence of risks associated with smoking, governments responded by making pictorial health warnings on cigarette packaging mandatory. The solution was based on the (neo-classical) assumption that once smokers were informed about the risks associated with smoking, they would, as rational economic agents, stop engaging in the activity.
However, the warnings failed to induce the large-scale changes in smoking patterns that had been predicted. As it turns out, people do not always act rationally and the decisions they make may not necessarily be in their individual self-interest.
Humans suffer from what Sunstein and Thaler call bounded rationality and bounded willpower, a phenomenon that shows people often knowingly act in a manner that is inconsistent with their long-term interests. A typical example is smoking where the benefits are immediate but the costs deferred to the long run.
In that case, increasing the size of the pictorial warning serves a limited purpose only. It might help in changing some attitudes towards smoking but is not very effective as a behaviour-changing technique. Hence, policy prescriptions that solely focus on strengthening the regime of mandatory disclosure by reserving even greater space for pictorial warnings will not do the job. Any effort by the government to curb smoking should focus on addressing the underlying problem which has more to do with the bounded willpower of smokers than with their lack of information or the insufficiency of existing health warnings.
To this end, the government can utilise a number of other policy tools available and use them in conjunction with one another. For instance, it can nudge new smokers away from the activity by making tobacco products less salient in our everyday lives. Currently, many stores display cigarettes at the point of sale. The placement makes them more visible and salient which, as studies suggest, increases consumption. A decent policy intervention would prevent retailers from displaying cigarettes at the point of sale.
From the supply-side, salience can be reduced further by enforcing a licensing regime that restricts the number of stores that can sell tobacco products. The Tobacco Vendor Act, 1958, in Pakistan not only requires retailers to obtain a licence before selling tobacco products but also criminalises the illegal sale of cigarettes. However, governments have shown very little appetite for the proper implementation and enforcement of this law.
The Prohibition of Smoking and Protections of Non-Smokers Health Ordinance, 2002, appears to have met the same fate. Section 3 of the ordinance empowers the government to “declare any place of public work or use” to be a no-smoking place. This power has been rarely invoked even though it can potentially change social norms and de-normalise smoking.
Alternatively, the government can also raise taxes on the consumption of cigarettes. This option is perhaps the most effective way to reduce smoking among the young and the poor who are more sensitive to price changes.
To be sure, a successful campaign to curb smoking requires a multipronged strategy that utilises all the tools available at the government’s disposal. Focusing solely on increasing the size of pictorial warnings will not suffice. As in almost every other area in Pakistan, the laws are already there; it is only that the government will is lacking.
Published in Dawn, January 31st, 2018