For many years, the corridors of power in Brussels, the Belgian capital, seemed to be peopled almost exclusively by tobacco lobbyists. It was not the Belgian parliament that they stalked, but the European Commission, secretariat of the European Union (EU). Their mission was to try to prevent the development of EU directives that would in due course require each member state to enact effective tobacco control legislation in its own parliament. Sometimes the industry lobbyists’ stalking would turn into a downright stampede, on occasions, the overwhelming majority of people packing out committee rooms would turn out to be doing the industry’s dirty work. Now that the EU has been expanded to 27 countries, it is easy to see why so much effort was poured into the resistance movement, and conversely, how much is owed to politicians and officials who fought it all the way on behalf of health.

Around the world, from Canada to Australasia, Brazil to Thailand, pioneering health ministries have researched, designed, tested and introduced various series of graphic warnings. These have been busy playing their part, millions of times a day, in eroding the lingering air of luxury and bravado that manufacturers still try so desperately to convey to their cigarettes via pack design and whatever other promotional tricks they can get away with.

Belgium never used to be high on any list of tobacco control success or determination by its government, but today it has earned a refreshingly different connotation in public health circles - top of the league in Europe, in fact. Last December, it made cigarette manufacturers print graphic health warnings on tobacco packaging, the first EU member state to do so. The United Kingdom is to follow suit later this year and Romania in 2008. However, considering the scale of the battle that was fought to add such an important element to European tobacco control policy, whose final clearance was issued more than three years ago, it is extraordinary how slow other EU states have been to do the same.

Perhaps the government’s zeal is catching: recently a school in the busy port city of Ostend was the centre of a national media frenzy when its plan to force pupils caught smoking to wear a badge was publicised. The badge, whose message was along the lines of, “This is what my lungs look like now, for all I care,” also pictured a full colour, graphic image of a smoker’s lungs in an apparently advanced state of disease. However, following protests around the country, the scheme was dropped. There were, of course, sound arguments against an approach that pointed the finger of blame and shame entirely at the unlucky young smokers, but the new health warnings have the potential to do the same education job on all smokers, children and adults alike, smoking openly or in secret. The challenge is to keep researching images that will maximise the effect.

Belgium: one of the new graphic health warnings in the first European Union member state to implement them.