People Have Tried to Make U.S. Cigarette Warning Labels More Graphic for Decades

On this day in 1964, the surgeon general officially said that smoking causes cancer. But warning labels in America still don’t show its effects

The warning label on cartons of duty-free cigarettes in Munich, Germany circa 2006. Wikimedia Commons

Health warning labels on tobacco products are just one more proof of the expression “a picture is worth a thousand words.”

It’s been 53 years since a surgeon general’s report unequivocally linked cigarettes and cancer. Today, that conclusion seems completely obvious. But in the past it wasn’t, and the cigarette lobby (as anyone who’s watched Mad Men knows) worked hard to keep it that way. Even when that link was publicly drawn, the industry has worked to downplay it as much as possible, writes the World Health Organization. Today, that’s by fighting to keep their names on packages—and graphic images of the consequences of smoking off them.

“If it has not been proved that tobacco is guilty of causing cancer of the lung, it has certainly been shown to have been on the scene of the crime,” wrote Charles S. Cameron in the January 1956 issue of The Atlantic. In that article, he talks about the dramatic rise in lung cancer  since 1900, and the potential reasons that have been advanced for it, but stops short of drawing the direct connection to cigarettes.

But the press of evidence grew, and talk of imposing health warning label requirements began in the U.S. in 1957, write researchers Heikki Hiilamo, Eric Crosbie and Stanton A. Glantz for the journal Tobacco Control. One 1959 bill in the South Dakota legislature would even have made tobacco producers put a skull and crossbones on their product, they write.

But eventually, the industry stopped blocking warning labels, as long as the labels carried only “vague health messages,” like that required by a 1965 Act: “Caution: Cigarette smoking may be hazardous to your health.” And through the rest of the twentieth century, successive generations of public health authorities and politicians around the world fought tobacco companies to place labels on more prominent areas of cigarette packs and make the labels larger and more eye-catching.

After European countries started talking about ways to make warning labels more effective in the 1970s and 1980s, in 1985 Iceland was the first to implement picture warning labels, according to a UC San Francisco press release.The tobacco industry worked hard to overturn those requirements, he writes, but the idea took off.

Picture warning labels could be as simple as an image associated with death, like a skull and crossbones, or as graphic as they are in many countries today: images of smokers’ lungs, decayed teeth, people dying of lung cancer and other images representing the suffering that can be caused—and to millions of people, has been caused—by smoking using tobacco products. No wonder they’re so effective.

People Have Tried to Make U.S. Cigarette Warning Labels More Graphic for Decades
This Canadian warning label was one of 16 that manufacturers were required to place on cigarette packs after 2000. Non-Smokers Rights Association

In 2000, our northern neighbor Canada became the first country to use these kinds of  upsetting photographs of cancer and disease on its cigarette warning labels, and other countries soon followed suit.

In 2011, writes UC San Francisco, it looked like the United States was going to join those countries, but a free speech-related lawsuit by tobacco companies and other factors have meant that to date, the change hasn’t happened.

“Health warning labels, especially labels with graphic elements, threaten the tobacco industry because they are a low-cost, effective measure to reducing smoking,” the researchers write.

Today, health advocates are fighting to have tobacco packaging be even less attractive using measures like requiring tobacco products to be sold in plain packaging and using the world’s ugliest color to turn people off.

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