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Mexico: backroom deal blunts health warnings
  1. University of California, San Francisco, USA; ernesto.sebrie{at}

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    Mexico signed the Framework Convention on Tobacco Control (FCTC) in August 2003 and the Senate ratified the treaty in May 2004. Although Mexico was the first country in the Americas to become a party to the FCTC, legislation to implement fully the provisions about packaging and labelling has not been passed. Some bills introduced by national legislators sought to increase the size of the warning labels up to 50% on both main faces, to print more rotating messages, to ban deceptive descriptors, and also to include large pictorial warning labels similar to those introduced in Brazil, Canada, Uruguay, Australia, and Thailand. None of these bills was passed.

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    USA:Sir Walter Raleigh, having returned from the dead and admitted that bringing tobacco back from the Americas had been a terrible mistake, hands it back to president George W Bush. The scene was part of a presentation at the world conference on tobacco and health in Washington DC in July by British health education specialist Cecilia Farren, with the help of a cardboard cut-out and a friend in costume.

    However, only three weeks after Mexico’s ratification, the Secretary of Health made an agreement with the two transnational tobacco companies that control the cigarette market in Mexico, Philip Morris and BAT. The agreement, whose title translates as, “Agreement to establish additional restrictions to the current regulations and legislation for advertising, marketing and warning labels of tobacco products”, did make some changes on tobacco packaging and labelling, among other measures. Tobacco companies agreed to increase the size of the three current health warning labels (“Smoking causes cancer and pulmonary emphysema”, “Smoking during pregnancy increases the risk of preterm delivery and low birth weight of newborn”, and “Stopping smoking reduces important health risks”) from 25% to 50% of the back face of the cigarette packages. The total size actually pertains to the frame that delimits the label, and not the label itself. The agreement avoids stronger and more effective pictorial labels on the front of the packages as recommended by the FCTC. In fact, it explicitly precludes “images or pictures”.

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    Health warning labels on a pack of cigarettes marketed in Mexico, where the larger warnings are restricted to the back of the pack (left). Images or pictures have been specifically precluded from the front of the pack (right).

    In addition, the tobacco industry voluntarily included a new warning label to be printed on the lateral side of the packs, which translates as, “Currently there is no cigarette that reduces the health risks” [of smoking]. This label has an ambiguous message, which holds out the promise that cigarettes could have either a protective effect against risks or even a health benefit in the future, just not yet—very different from Philip Morris’s warning in the USA, ‘There is no such thing as a safe cigarette, including this one”. At the same time, the inclusion of this label may be presented as an alternative to the banning (as required by the FCTC) of misleading or deceptive descriptors such as “mild” and “light” that continue to appear in print on Mexican cigarette packages. Although the intention of the message is not completely clear, it might be used to undermine the labelling policy.

    Philip Morris and BAT also agreed to include a leaflet tucked between the cigarette package and its cellophane covering, with “information” for smokers in 25% of the packages produced of each brand sold in Mexico. The leaflet size is between 38×63 mm and 50×76 mm, in Arial font sized between 6 and 8 points. The leaflet warns: “A message from the Secretary of Health. There are good reasons to quit smoking.” The first paragraph lists the main health outcomes of smoking using technical (medical) language. It reads: “Tobacco consumption causes different types of cancer, as well as heart disease or cerebrovascular disease such as embolism, chronic bronchitis and emphysema.” The wording is complex, misleading and incorrect—­the last two are respiratory diseases, not cerebrovascular diseases. More importantly, all of these disease terms are unlikely to be well understood by the general public. The second paragraph describes some of the effects of smoking during pregnancy (similar to one of the health warning labels already in force). A third paragraph tells some of the benefits of stopping smoking after three months, one year and 10 years. The leaflet ends with, “It is advisable to stop smoking. Request professional help by telephone …”, and provides a free hotline number. The reverse side of the leaflet has the same health warning label that is displayed on the back face of the pack.

    The leaflet is not only difficult to read and understand, but also its content is unlikely to be relevant to most of the smoking population in Mexico: one third of the leaflet (the same as one third of the warning labels) addresses the harms of smoking while pregnant, yet only a very small percentage of the smoking population in Mexico are pregnant women. In contrast, a health warning label about the harmfulness of secondhand smoke would be relevant to all smokers. It is likely that rather than convince people to stop smoking, both the lateral warning label and the leaflet will be used by the tobacco industry to defend itself from future lawsuits brought by injured smokers or their families as has happened in the USA.

    These actions appear to be innovations by the tobacco industry to circumvent the implementation of the FCTC in developing countries, such as Mexico, that have already ratified it.