BANGKOK, Thailand — One out of every five Filipino adults is a smoker, despite disturbing photographic images ranging from different types of bodily cancers to impotence, stroke, and even stillbirth, on every pack of cigarette available in the market.

Republic Act 10643 or The Graphic Health Warnings Law, stemming from the World Health Organization’s Framework Convention on Tobacco Control (FCTC), aims to inform the public of the “health consequences of tobacco consumption and exposure to tobacco smoke” and reduce tobacco use especially among the youth.

While many may squirm, squint or completely shut their eyes so that no image of a tobacco-related disease may linger in their consciousness, a survey of different graphic health warnings around Southeast Asia actually show that the Philippines’ warnings is one of the smallest and least strategically positioned.

ONLY HALF OF THE PACK

Signed into law in 2014, The Graphic Health Warnings Law requires full-color photo and textual warnings on every outer label of locally manufactured or imported tobacco products.

Warnings and their accompanying text must be simple and worded in a manner that is easily understandable by ordinary citizens. But an expert says it is much more than this. Size and positioning also play a big part on its effectiveness according to Dr. Prakit Vathesatogkit, Vice Chair of the SEATCA Foundation and Special Adviser  to the International Network of Health Promotions Foundation.

“If you go to read the FCTC guidelines, under Article 11 it’s spelled out explicitly that the effectiveness of the warning increases with size,” he said.

In the Philippines, graphic health warnings are to occupy 50% of the principal display surfaces of both the front and back of tobacco product packages. A graphic photo occupying half of a cigarette pack may be enough to prove a point. But the fact remains that the upper half of the pack is an attractive color with big bold letters of a well-known brand.

Based on data collected by SEATCA in 2022, only five ASEAN countries require health warnings with sizes that are considered international best practice or around 75 percent of the total packaging — Thailand, Singapore, Myanmar, Brunei and Lao PDR.  Thailand’s cigarette packs are mostly covered by health warnings with only 15 percent allocated for the display of the cigarette brand.

The Philippines and Vietnam are have the smallest health warning sizes, both 50% of the packaging, just slightly higher than Indonesia which only requires warnings to cover 40 percent of the entire front and back of the pack.

Except for the Philippines,  all ASEAN countries must place health warnings at the top portion of a cigarette pack.

According to FCTC guidelines, aside from being clearly visible, such warnings should ideally be placed on the upper half of the pack for increased visibility.

“Research shows, by nature people read from top-down. Then the graphic warning should be on top, not bottom. By logic when you see advertising in the billboard or newspaper you pay more for the big size so it’s more effective.”

Most countries in Southeast Asia have also adopted standardized or plain packaging for tobacco products. Under Article 11 of the WHO FCTC guidelines, plain packaging is a measure that aims to “restrict or prohibit the use of logos, colors, brand images or promotional information on packaging with brand or product names displayed in a standard color and font style.”

“Standardized packaging should be part of a comprehensive approach to tobacco control as it reduces demand by reducing the appeal of tobacco products, as well as enhancing the noticeability and effectiveness of graphic health warnings,” SEATCA said in its report.

TIME TO ENLARGE HEALTH WARNINGS IN PH

While graphic health warnings in the Philippines are visible, Health Justice Philippines, a group which has been pushing for stricter tobacco control measures, says it is time to take things a notch higher.

“it’s high time to amend and improve our policy on graphic health warnings on tobacco and e-cigarette products. It’s important for our policymakers to improve our policy, update it, make it bigger and shift to plain packaging,” its officer Ralph Degollacion said.

However, a bill that aims to update or improve the country’s graphic health warnings, according to Degollacion, has yet to be filed in Congress.

“There are already policy makers planning to file these bills. This is something we as advocates we want our lawmakers to prioritize. If not this year, we are hoping that the succeeding Congress will file and pass this.”

Experts agree that graphic health warnings and the imposition of sin taxes are just one of the many different ways the public can be spared from the long-term health effects of tobacco smoking. To further reduce the number of people who may develop an addiction to such products, advocates are also pushing for an increase in the age of accessibility to 21 years old instead of the currently implemented 18-years.

The fight against addiction to such substances, unfortunately, will not end soon if not at all. Joining tobacco products are the more popular flavored vapor and e-cigarettes where access is much easier through online merchants.

“We are calling on the Food and Drug Administration to take the lead in regulating these products. We respect that the DTI is leading the regulation of vapor products. But that is something that we need to consider and seriously make the FDA be involved in regulating this,” Degollacion said.