Thank you, Madam Chair and members of the committee. My name is Geoffrey Fong. I am a professor of psychology at the University of Waterloo. I am also senior investigator of the Ontario Institute for Cancer Research. Eight years ago, I and my colleagues created the international tobacco control policy evaluation project, or the ITC project, to evaluate the impact of tobacco control policies of the WHO Framework Convention on Tobacco Control. Since 2003, 172 countries, including Canada, have become parties to the FCTC.
The ITC project is currently evaluating the impact of FCTC policies, such as health warning labels, smoke-free laws, higher taxes, and policies to reduce contraband across 20 countries using state-of-the-art longitudinal surveys of adult smokers. In Canada we have conducted the ITC survey for seven annual survey waves since 2002. The ITC project is recognized throughout the world as a leading source for evidence on the effectiveness of tobacco control policies. Last year the ITC project was honoured by CIHR and the CMAJ with a top Canadian achievement in health research award.
I am grateful for the opportunity to speak to you today about health warnings and to present evidence from our ITC project, showing definitively that the Canadian warnings have become less effective over time and that there is an urgent need to revise them now.
The overall objective of health warnings is to inform and educate people about the harms of tobacco products to inspire smokers to quit and to convince non-smokers, especially youth, not to start. The health warning is a health communication very much like an advertisement for public health, and as Gar has mentioned, a potentially powerful one, given the number of exposures, all in the right place, that is, on the pack.
Therefore, governments should endeavour to make the health warnings as strong as possible and to follow the principles of good communication and advertising in their design and implementation. I would like to highlight two such principles.
First, it is clear from many studies, including those conducted by Health Canada itself, that when it comes to warnings, size matters. Warnings will have more impact if they occupy 75% of the pack than if they occupy 50%. In fact, even from Health Canada's own studies, they looked at 90% warnings, and those were significantly more effective than the 75%.
Second, health warnings, like any other communication or advertisement, become less effective over time. This phenomenon--a very intuitive phenomenon--is known as “wear-out”. Thus, health warnings, like any other advertisement, must be revised on a regular basis to maintain their effectiveness. FCTC guidelines suggest that warnings be revised every one to three years. But 10 years, by any stretch of the imagination, is way too long. What would a marketing expert say about an ad campaign that was running unchanged for 10 years straight?
In October 2002, about two years after Canada introduced the graphic warnings, we began the ITC Canada survey, a nationally representative sample of 2,000 adult smokers throughout Canada.
I have prepared a document here--there will be a test on this later--showing how seven key indicators of health warning effectiveness have changed from 2002 to 2008. The ITC survey shows that every indicator of label effectiveness has declined dramatically.
Chart 2, on the first page, shows that the percentage of Canadian adult smokers noticing the warnings labels a lot declined from 60% in 2002 to 42% in 2008.
Chart 4, on the first page, shows that the percentage of smokers reporting that the warnings made them think about the health risks of smoking dropped from 17% to 12%.
On the second page, on the last row, chart 7 shows that the percentage of smokers reporting that the warnings made them forgo a cigarette fell from 18% to 13%. This is an important indicator because it is linked to future quit attempts.
Finally, chart 8, which summarizes all of the seven key indicators of label effectiveness, displays, of course, the steep decline.
These findings show clearly that the effectiveness of what once were the world-leading warnings labels from Canada have declined dramatically. In terms of odds ratios, I would say the effectiveness of the Canadian warnings has declined by 30% to 60% over the past six to seven years.
But it's not just the decline in effectiveness that has occurred. Today we know a lot more about the health consequences of cigarettes and how to communicate those risks. In 2000, many of the images that are still on the packs were of disembodied brains and hearts and lungs.
There are other effective ways of creating warnings that could create powerful emotions, which is a key ingredient of label effectiveness. For example, Health Canada has considered using the photo of Barb Tarbox as a way of depicting the human tragedy of cigarette use. By doing so, Canada would reassert its claim to be a world leader in health warnings.
As the ITC findings show, Health Canada's delay is having a pronounced detrimental effect on the tobacco control policy that is the key to informing the Canadian people. From these ITC charts I have presented, we can estimate that over three-quarters of a million Canadian smokers are no longer reading the warnings closely. From these results, we know that for over a quarter of a million smokers, the warnings are no longer making them think about the health risks of smoking.
If the warnings are not revised, fewer smokers will be inspired to quit, and greater numbers of youth will start smoking, undeterred by the stale 10-year-old warning labels. And in the future, the consequences of today's inaction and delay will result in many additional Canadian deaths from tobacco, which still, of course, is the number one preventable cause of death and morbidity in our country.
From the evidence, from state-of-the art longitudinal surveys of the evaluation of the Canadian warnings, there is no justification for delaying the revision of the health warnings and there is every reason for moving ahead quickly on the revision process.
I would like to thank the committee for this opportunity to speak on this matter.