Cigarette Stick Health Warnings Bill [HL]

Eren Waitzman

The Cigarette Stick Health Warnings Bill [HL] is a private member’s bill sponsored by Lord Young of Cookham (Conservative). It was introduced in the House of Lords on 14 June 2021.

Why has this bill been introduced?

Setting out the purpose of the bill, Lord Young stated that:

Smoking is a leading cause of premature death killing over 90,000 in the UK in 2018 and is likely to have killed more people last year than Covid-19. In 2019, one in seven of the UK population were smokers, and in England alone, around 280 children under 16 started smoking for the first time each day. Smoking is highly addictive and only one in three smokers are able to quit before they die.

My Cigarette Stick Health Warnings Bill will increase the impact of health warnings through the addition of warnings on individual cigarette sticks and cigarette rolling papers. This will make cigarettes less attractive to adolescents and young people and help to deliver the Government’s ambition to make England smokefree by 2030. Cigarettes are ‘cancer sticks’ and consumers should be warned on the product, not just on the packaging.

What would the bill do?

The bill comprises of five clauses and one schedule.

Clause 1 (subsection 3) of the bill would restrict a person from either producing or supplying cigarette sticks and rolling papers unless it carried one of the text warnings detailed in schedule 1, subject to certain conditions, including: the colour of the warning; font used; and its appearance on the cigarette.

The clause would also permit that the only colour or shade on or for the paper, casing, filter or other material forming the cigarette or rolling paper is plain white with a matt finish. Clause 1 also notes that the secretary of state may by statutory instrument amend or make provision about the conditions under subsection 3 or the text warnings specified in schedule 1.

Schedule 1 provides a list of eight different warnings to be used in rotation on individual cigarette sticks and rolling papers. This includes information detailing:

the health effects caused by smoking, such as lung cancer and heart disease (eg “Smoking causes lung cancer”);
the financial cost of smoking one pack of cigarettes per day (eg “Smoking one pack per day costs over £3,000 a year. What could you buy instead?”); and
who to contact for advice to quit smoking (eg “You don’t need me anymore. You can stop now. Search NHS Smokefree for advice”).

Clause 2 details the range and rotation of health warnings on cigarette sticks and rolling papers. The clause would require a tobacco producer to select the warning used: from the set of warnings set out in schedule 1 (subsection 1a); and that each of the warnings appear on a “specified proportion” of the total number of packs under each brand name produced within that production year (subsection 1b). The clause also provides the secretary of state with powers to use statutory instrument to specify the proportion.

Clause 3 sets out the offences and penalties under the bill. It states that a person is guilty of an offence if they breach either clause 1 or 2 of the bill. A person guilty of an offence is liable:

on summary conviction: in England and Wales, to imprisonment for a term not exceeding three months, or a fine, or both; or in Scotland, to imprisonment for a term not exceeding a year, or a fine not exceeding level 5 on the standard scale, or both; or
on conviction on indictment to imprisonment for a term not exceeding two years, or a fine, or both.

Clause 4 states that a statutory instrument containing regulations under the bill may not be made unless a draft of the instrument has been laid before and approved by resolutions of both Houses of Parliament.

Lastly, clause 5 contains the commencement provisions, and states that the act would extend to England, Scotland and Wales.

What are the smoking habits of adults in the United Kingdom?

Since 2011, the proportion of adult smokers in the United Kingdom (UK) has fallen. In its latest statistical release on adult smoking habits in the UK in 2019, the Office for National Statistics (ONS) reported that 14.1% of adults (those aged 18 years and over) were smokers. The ONS noted that this equated to around 6.9 million people in the population. The figure also represented a decrease in the number of adult smokers compared to 2011, whereby 20.2% were smokers. Of the constituent countries of the UK, Northern Ireland had the highest proportion of adult smokers in 2019 with 15.6% (215,000 people; a decrease from 18.9% in 2011). In contrast, England had the lowest proportion of adult smokers in 2019 with 13.9% (5.7 million people; a decrease from 19.8% in 2011). In Wales and Scotland, the proportion of adult smokers was 15.5% (372,000 people; representing a decrease from 22.3% in 2011) and 15.4% (638,000 people; compared to 23.4% in 2011), respectively.

In the same publication, the ONS noted that the largest fall in smoking prevalence in the UK since 2011 had been amongst those aged between 18 and 24 years from 25.7% to 16%. Over the same period, those aged between 25 and 34 years continued to have the highest proportion of smokers (from 25.8% to 19%) despite the proportion decreasing.

Public Health England (PHE) reports that smoking-related mortality has also declined in recent years. In its latest report, PHE estimated that 74,600 deaths in 2019 could be attributable to smoking. In contrast, it estimated that the number of smoking-related deaths in 2009 was 82,000.

What has the reaction been to the individual tobacco products health warnings idea?

Anti-smoking charities, health organisations and academics have welcomed the idea of placing health warnings on individual cigarettes and rolling papers.

Deborah Arnott, the chief executive of Action on Smoking and Health (ASH), praised the idea. In an article on ASH’s website, she said that “cigarettes not cigarette packs kill smokers, so obviously the sticks themselves are where health warnings are most needed”. Discussing Lord Young’s bill, Ms Arnott stated that all that is needed for the bill to progress is the “support of Government and Britain can become the first nation in the world to put ‘Smoking Kills’ where it belongs, on the cigarette itself”. The All-Party Parliamentary Group on Smoking and Health, for which ASH provides the secretariat, has also recommended legislating for “‘dissuasive’ cigarettes carrying simple warnings ‘Smoking Kills’ or ‘Smoking causes cancer’ on cigarette papers as well as in packs”.

The director of policy at Cancer Research UK, Emlyn Samuel, said that the Government needed to “continue to explore innovative methods” to deter young people from using cigarettes and “ensure that youth smoking rates continue to fall”. Mr Samuel argued that such tactics “like making the cigarettes themselves unappealing” could be an “effective way of doing this”.

A 2019 study by researchers at the University of Stirling’s Institute for Social Marketing examining smokers’ perceptions of health warnings on cigarettes found that individual messages had the “potential to discourage” smoking among: young people; those starting to smoke; and non-smokers. Reporting on the study’s findings, Dr Crawford Moodie, the research team leader, stated that there was “consensus” that individual cigarettes containing the warning ‘Smoking Kills’ would be “off-putting” for all three groups.

However, there has also been opposition to putting warnings on individual cigarettes and rolling papers. Simon Clark of the Freedom Organisation for the Right to Enjoy Smoking Tobacco (FOREST), a smokers’ rights group, criticised the idea. He stated that:

Everyone is aware of the health risks of smoking. There are huge, impossible-to-miss health warnings on every pack of cigarettes, including grotesque images of smoking-related diseases. Tobacco is sold in standardised packing and banned from display in shops. Enough is enough. If adults still choose to smoke that is a matter for them, not the government.

In a debate in the House of Commons in June 2021 on the forthcoming tobacco control plan, Ian Paisley Junior (Democratic Unionist Party MP for North Antrim) also criticised the idea. He stated that the idea was “minor tinkering” and that “when the cigarette is in a person’s mouth”, it is “too late to put such a warning to them”.

What is the Government’s stance on the idea?

The Government has not dismissed the proposal but called for more evidence to support the introduction of such a measure. For example, in October 2021, a cross-party group of MPs tabled an amendment to the Health and Care Bill at committee stage seeking to make health warnings on individual cigarettes and cigarette papers mandatory. During the committee stage, the Shadow Minister for Health and Social Care, Alex Norris, said that such warnings were already being considered around the world and that a study from France had found that warnings on cigarettes “increased negative health perceptions, reduced positive smoker image and the perceived pleasure of smoking, decreased the desire to start smoking, and increased the desire to quit”. Responding, the Minister for Health, Edward Argar, stated that the Government was “sympathetic” to the aims of the amendment but believed that it needed to conduct some further research and “build a more robust evidence base in support of such additional measures before introducing them”. Following the debate, the amendment was withdrawn.

More recently, on 16 November 2021, the House of Commons debated the delivery of the forthcoming plan. During the debate, Mary Kelly Foy (Labour MP for City of Durham) called on the Government to include health warnings on individual cigarettes and cigarette papers. Responding, the Parliamentary Under-Secretary of State at the Department for Health and Social Care, Maggie Throup, noted that governments had “invested in a range of interventions over the past two decades”, including “the introduction of standardised packaging, the end of tobacco displays, and protection from the harms caused by second-hand smoke”. She argued that “thanks to those interventions, smoking rates in England are down to a record low of just under 14%”. This view was previously echoed by researchers at the University of Bath’s Tobacco Control Research Group, who in July 2020 had found that cigarette sales had decreased in the UK by approximately 20 million per month since standardised packaging and tougher taxation on tobacco were introduced in 2017. Although, the group noted that cigarette sales were falling by about 12 million per month before the measures were in place.

On health warnings on cigarette sticks, Maggie Throup said that the Government was “exploring various regulatory proposals” and would therefore “conduct further research and build a robust evidence base in support of such measures”. She also stated that the Government would include the “strongest proposals” in the new plan.

What action has the Government taken to reduce the numbers smoking?

2017–22 Tobacco Control Plan for England

In 2017, the Government under then Prime Minister Theresa May published its Tobacco Control Plan for England. The plan set out several objectives to “create a smokefree generation”, which it defined as a smoking prevalence in England of 5 percent or below by 2030. Some of these objectives were to reduce:

smoking among adults in England from 15.5% to 12% or less;
the number of 15-year-olds who regularly smoke from 8% to 3% or less; and
the prevalence of smoking in pregnancy from 10.7% to 6% or less.

To achieve this, the 2017 plan included several actions around four areas. This included:

‘Prevention first’ through the effective operation of legislation such as the use of standardised packaging designed to reduce the uptake of smoking by young people.
‘Supporting smokers to quit’ by providing access to training for all health professionals on how to help patients—especially patients in mental health services—to quit smoking.
‘Eliminating variations in smoking rates’ by promoting links to “stop smoking” services across the health and care system and full implementation of all relevant NICE guidelines by 2022.
‘Effective enforcement’ by maintaining high duty rates for tobacco products to make tobacco less affordable.

The aim was to achieve these objectives by the end of 2022.

In 2019, the Conservative Government under Prime Minister Boris Johnson stated that achieving a smokefree 2030 would be “extremely challenging” and that “bold action” would be needed. This included considering a “‘polluter pays’ approach”, which requires tobacco companies to pay towards the cost of tobacco control. The Government also committed to setting out further proposals to move towards a smokefree 2030 at a “later date”.

Forthcoming Tobacco Control Plan for England

In December 2020, the Government announced that the Department of Health and Social Care was working with Public Health England to develop and publish a new Tobacco Control Plan for England. The Government stated that it expected the new plan to be published in July 2021. In June 2021, the House of Commons debated the forthcoming plan. During the debate, the then Parliamentary Under-Secretary of State at the Department for Health and Social Care, Jo Churchill, said that the new plan “builds momentum to support communities and groups where rates are not falling enough”.

Consultation on legislation concerning health warnings on tobacco packaging

In January 2021, the Government ran a consultation on the effectiveness of two statutory instruments concerning tobacco: the Tobacco and Related Products Regulations 2016 (TRPR); and the Standardised Packaging of Tobacco Products Regulations 2015 (SPoT).

The TRPR implement many of the provisions from the Tobacco Products Directive. This includes increasing the size of combined health warnings consisting of a text and photograph warning. As part of the consultation, the Government sought views on whether: such products should have health text and picture warnings on their packaging; such warnings had encouraged smokers to quit; and warnings deterred young people from smoking.

SPoT requires the use of specific standard colours for all external and internal packaging of cigarettes and hand rolling tobacco and permits only specified text (such as the brand and variant name) in a standard typeface. However, the regulations do not affect other labelling requirements for tobacco products, such as health warnings. Therefore, the consultation sought views as to whether: the requirements on the packaging and labelling of tobacco products had been an “effective way to protect young people from taking up smoking”; the requirements on the packaging and labelling of tobacco products have helped existing smokers quit; and the regulations should be restricted to cigarettes and hand rolling tobacco products.

The consultation closed on 19 March 2021. The Government is currently analysing the responses to the consultation.