A12.1.2 Health warnings used in other countries

A health warning has been required to appear on the packaging of tobacco products in the US since 1966. By 1991, 77 countries required warnings, with the majority of countries requiring warnings by 1999.1 However, warnings have varied and still do vary greatly from country to country in both size and potency.

Canada introduced pictorial health warnings in December 2000 (updated from 50 to 75% of the front of the pack in 20112,3), closely followed by Brazil in 2002.

Since 2004, countries in the 27-member European Union have the option of requiring picture-based warnings, choosing from among 42 picture messages prepared by the European Commission.

As of December 2011, at least 46 countries or jurisdictions had in place or had finalised regulatory requirements for picture-based warnings: Argentina (from June 2012) Australia (2006, rotation of sets A, B every 12 months; strengthened from December 2012 ), Bangladesh (2009), Belgium (2006–rotation of sets 2, 3, 1 every 12 months from 2011), Bolivia (2011), Brunei (2008), Cayman Islands (2009), Chile (2006, 2007, 2008, 2009, 2010), Colombia (2009), Cook Islands (2008), Djibouti (2009), Egypt (2008), France (2011), Guernsey (2011), Hong Kong (2007), India (2009, 2010), Iran (2009), Jersey (from 2012), Jordan (2006), Kyrgyzstan (2008) Latvia (2010), Malaysia (2009), Malta (2011), Mauritius (2009), Mexico (2010), Mongolia (2010), New Zealand (2008–rotation of sets A, B every 12 months), Norway (2011), Pakistan (2010), Panama (2006, 2009), Paraguay (2010, 2011, 2012 on hold), Peru (2009), Philippines (2010 but pending a legal challenge), Romania (2008), Singapore (2004, 2006), Spain (2011), Switzerland (2010–rotation of sets 1, 2, 3 every 24 months), Taiwan (2009), Thailand (2005, 2007, 2010), Turkey (2010), Ukraine (from October 2012), UK (2008), Uruguay (2006, 2008, 2009a, 2009b, 2010), Venezuela (2005, 2009).

Many other countries/jurisdictions have stated that picture warnings are under consideration, including Guyana, Iceland, Ireland, Macao, Portugal, Slovakia, South Africa, Trinidad and Tobago, the US, Vietnam, the Gulf Cooperation Council (GCC: Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates and potentially Yemen), and the Caribbean Community (CARICOM, which includes Antigua and Barbuda, Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago).

China, Indonesia and Russia–three of the biggest tobacco markets in the world–have all yet to take decisive action.4 Germany is another country where pictorial warnings are yet to be introduced.5

Legislation passed in the United States in June 2009 required pictorial health warnings on 50% of the front and back of US cigarette packages within 24 months,6,7 in addition to a 15-month implementation window. The Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) required the Food and Drug Administration to finalise picture health warnings by June, 2011. The new health warnings were to consist of nine full-colour health warnings that cover the top half of the 'front' and 'back' of cigarette packages to appear on tobacco packages by September 2012. On the 7 November 2011 Judge Richard Leon of the District Court of Columbia granted a motion by major US tobacco companies for a preliminary injunction and ordered that 'implementation of the graphic image and textual warning requirements published at 76 Fed. Reg. 36,628 (June 22, 2011) and mandated by Section 201(a) of the Tobacco Control Act, and all related requirements, see Act 101(b), 301, 201(a) of the Tobacco Control Act' be 'stayed until 15 months after a final ruling from this Court on the Merits of the parties' claims'.8

At 80% of the back and front from March 2008, warnings in Uruguay became the largest anywhere in the world. Philip Morris International filed a claim against the Uruguay regulations in 20109 under the terms of an investment treaty between Switzerland and Uruguay.10 Strengthened health warnings proposed for introduction in Australian in December 2012 will comprise 75% of the front of the pack and 90% of the back or a total of 82.5% of the principal display areas.

For more detailed and current information on health warnings around the world see:


1. Aftab M, Kolben D and Lurie P. International cigarette labelling practices. Tobacco Control 1999;8(4):368–72. Available from: http://tc.bmjjournals.com/cgi/content/abstract/8/4/368

2. Paradis G. A public policy up in smoke. Canadian Journal of Public Health 2010;101(6) Available from: http://journal.cpha.ca/index.php/cjph/article/view/2666/2287

3. Tobacco Products Labelling Regulations (Cigarettes and Little Cigars) PC 2011-925. Canada Gazette, Part II 2011;145(21):1680-2141. Available from: http://www.gazette.gc.ca/rp-pr/p2/2011/2011-10-12/pdf/g2-14521.pdf

4. Selin H and Jones S. World No Tobacco Day: a picture paints a thousand words. International Journal of Tuberculosis and Lung Disease 2009;13(5):547. Available from: http://www.ingentaconnect.com/error/delivery?error=3&orderNum=50037564.1

5. Tuffs A. Images plus text work best to put people off smoking. BMJ (Clinical research ed) 2009;338:b2415. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19525312

6. Koh H. Graphic warnings for cigarette labels. The New England Journal of Medicine 2011;365(5):e10. Available from: http://www.nejm.org/doi/pdf/10.1056/NEJMp1108233

7. Hammond D. Tobacco packaging and labelling policies under the US Tobacco Control Act: research needs and priorities. Nicotine & Tobacco Research 2011;[Epub ahead of print] Available from: http://ntr.oxfordjournals.org/content/early/2011/10/24/ntr.ntr182.full

8. RJ Reynolds Tobacco company et al. v United States Food and Drug Administration et al 2011 United States District Court for the District of Columbia Document 19. Available from: http://law.justia.com/cases/federal/district-courts/district-of-columbia/dcdce/1:2011cv01482/149689/39

9. Peterson L. Uruguay: Philip Morris files first-known investment treaty claim against tobacco regulations. Investment Arbitration Reporter 2010;March 2 Available from: http://www.bilaterals.org/spip.php?article16921

10. Switzerland and Uruguay agreement on the reciprocal promotion and protection of investments (with protocol). October, 1988. Available from: http://untreaty.un.org/unts/120001_144071/26/2/00021341.pdf