Thailand is world leader for size of health warnings

The Canadian Cancer Society states in new report

14 October, the CCS today, releases the fourth edition of its report, Cigarette Package Health Warnings: International Status Report

International report shows significant increase in number of countries with graphic picture warnings on cigarette packages

Thailand is world leader for size of health warnings

TORONTO, October 14, 2014 – An international report released today by the Canadian Cancer Society shows that 77 countries and territories have required picture health warnings on cigarette packages – up significantly from 55 in 2012.

The report – Cigarette Package Health Warnings: International Status Report – ranks 198 countries/territories on the size of their health warnings on cigarette packages, lists countries and territories that require picture warnings, and documents the global momentum towards implementation of plain packaging.

“The progress internationally has been outstanding and we commend the countries that have taken action on this important tobacco control issue,” says Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society. “There is clearly a strong worldwide trend for countries to use graphic pictures on cigarette packages to show the terrible health effects of smoking.”

Examples of graphic picture warnings include a diseased lung or mouth, a patient with lung cancer in a hospital bed and a child exposed to secondhand smoke. The report also shows that many countries have increased the size of picture warnings on cigarette packages – and these larger pictures are known to be more effective.

Cigarette package warnings are a highly cost-effective way to increase awareness of the negative health effects of smoking and to reduce tobacco use. Picture-based warnings convey a more powerful message than a text only warning and larger ones are more effective.

Guidelines under the international tobacco treaty – the WHO Framework Convention on Tobacco Control (FCTC) – recommend that warnings should be: as large as is achievable; include a rotated series of graphic pictures; and be at the top of both the front and back of packages. Picture warnings are especially valuable for low and middle income countries where there are higher rates of illiteracy and where governments may have few resources. Health departments determine the content of warnings and the tobacco industry is responsible for printing the warnings on packages.

”The international momentum in implementing picture warnings is all the more impressive given tobacco industry opposition,” says Cunningham. “If picture warnings did not work to reduce smoking, then the tobacco industry would not be opposed. The fact that more than 70 countries and territories have implemented picture health warnings shows that the momentum of this key tobacco control measure has become a powerful force.”

The report also documents the important global momentum to implement plain packaging. Since December 2012 Australia has had plain packaging to prohibit tobacco company colours, logos and design elements on cigarette packages. Ireland, New Zealand, the United Kingdom and France are in the process of implementing plain packaging. The European Union (EU) Directive provides that the 28 EU countries have the option to implement plain packaging. Plain packaging would end packaging being used for tobacco promotion, increase the effectiveness of package warnings, curb package deception and decrease tobacco use.

Other report highlights include:

  • 77 countries/jurisdictions have finalized picture warning requirements, an increase from the 55 that had been implemented by the end of 2012. In 2001, Canada was the first country to require picture warnings and to require a 50% size. 
  • 49% of the world’s population is covered by the 77 countries/jurisdictions that have finalized picture warning requirements. 
  • Thailand has the largest warnings in the world at 85% of the package front and back, surpassing Australia at 82.5% (75% front, 90% back).
  • 60 countries/jurisdictions have required warnings to cover at least 50% of the package front and back (on average), up from 47 countries in 2012, 32 in 2010 and 24 in 2008.
  • Progress since the last report in 2012 includes: Thailand increasing the size of picture warnings from 55% to 85%; Nepal implementing 75% picture warnings; Jamaica improving warnings from 33% text to 60% pictures; and, Uruguay implementing its 7th round of picture warnings (Uruguay’s warning size is 80%). In addition, the new EU directive will require picture warnings to cover the top 65% of the package front and back, effective May 20, 2016. (The Canadian Cancer Society report reflects existing EU requirements and does not include the EU’s pending 2016 improvements.)

The top countries ranked in terms of warning size (as an average of the front and back of the package) are:

1.   85% Thailand (85% of front, 85% of back)

2.   82.5% Australia (75%, 90%)

3.   80% Uruguay (80%, 80%)

4.   75% Brunei (75%, 75%)

4.   75% Canada (75%, 75%)

4.   75% Nepal (75%, 75%)

7.   65% Togo (65%, 65%)

7.   65% Turkey (65%, 65%)

7.   65% Turkmenistan (65%, 65%)

10. 65% Mauritius (60%, 70%)

11. 65% Mexico (30%, 100%)

11. 65% Venezuela (30%, 100%)

The Cigarette Package Health Warnings: International Status Report was released to support implementation of the WHO Framework Convention on Tobacco Control. The FCTC has an obligation for parties to require health warnings that “should be 50% or more of the principal display areas but shall be no less than 30% of the display areas” and may be in the form of, or include, picture warnings. There are now 179 countries that are parties to the FCTC.

The report released today is the latest of the Canadian Cancer Society’s reports previously published on this topic in 2008, 2010, and 2012. 

Cigarette Package Health Warnings report in English

Cigarette Package Health Warnings report in French

The Canadian Cancer Society is the leading non-government organization in Canada in the fight against cancer. The Society is a national, community-based organization of volunteers whose mission is to eradicate cancer and enhance the quality of life of people living with cancer. Thanks to our donors and volunteers, the Society has the most impact, against the most cancers, in the most communities in Canada. Building on our progress, we are working with Canadians to change cancer forever. For more information visit or call our toll-free bilingual Cancer Information Service at 1-888-939-3333 (TTY 1-866-786-3934).

For more information, please contact:
Rob Cunningham
Senior Policy Analyst
Canadian Cancer Society
Phone: +1-613-762-4624 (mobile)

Sasha Anopina
Bilingual Communications Specialist
Canadian Cancer Society
Phone:  +1-416-934-5338

Link to the report itself:


 Here is a link to the CCS international news release: