By CHOY WAI FONG 

Tobacco use is a global problem, resulting in a wide range of diseases and death and with great economic costs. By the year 2020, worldwide tobacco-related deaths are estimated to reach 10 million every year, two thirds of which will be in developing countries. Cigarette smoking is the main form of tobacco use in Malaysia. Annually about one-quarter of Malaysian deaths are attributed to smoking-related diseases.

Although tobacco is the leading preventable cause of the death among adults in Malaysia, the general public including tobacco users has little awareness about possible consequences of tobacco use. One way of bringing more awareness is to place more information on tobacco products in the form of pictorial warnings. In June 2009, strong pictorial warnings were mandated by the Malaysian government under the Control of Tobacco Products Regulation.


Health Minister Datuk Liow Tiong Lai showing some of the cigarette packs with warning pictures.

Under Article 11 of the global treaty, the WHO Framework Convention on Tobacco Control, to which Malaysia has been a party since 2005, the provision for pictorial health warnings on tobacco product packs is one of the many commitments that Malaysia must fulfil. The six images used for the Malaysian Pictorial Health Warnings (PHW) depict lung, throat and mouth cancer, foot gangrene, miscarriage and a premature baby. The pictures are taken from neighbouring countries; the cancer pictures are from Thailand and the remainder from Singapore.

Dr Zarihah Mohd Zain, senior principal assistant director at the Ministry of Health’s Disease Control Division, said that the onus is on manufacturers to provide information that is simple, clear and truthful about their products.

“PHW is a tool that is able to increase awareness among the main target group – the smokers. I was told by the ministry that the cost of printing PHWs is borne fully by the tobacco industry, saving the government money and getting anti-tobacco messages effectively and efficiently disseminated.

“Evoking smokers’ emotions through PHWs, be it fear, detest, anger, sad or regret, is very much the desired outcome, and we expect subsequent cognitive processes to occur, whether they are immediate or over a period of time,” she said.

“A 2004 survey in Singapore reported that 71 per cent of affected smokers said that they now knew more about the health effects of smoking, and 28 per cent said that they smoked less.

Fourteen per cent made it a point to avoid smoking in front of children, 12 per cent said that they avoided smoking in front of pregnant women and eight per cent said they smoked less at home,” said Dr Zarihah.

She added that the study noted that 46 per cent of non-smokers said they had advised smokers to quit as a result of seeing the health warnings.

In a survey by the ministry, 21.5% of the adult population or three million adults smoke and among teenagers, some 15% have indicated they have tried smoking and another 8% confessed to being regular smokers.

PHWs have been implemented in Canada, Thailand, Singapore and other countries, and have proven to be effective in tobacco control; having reinforced the clarity of health messages among smokers and non-smokers; changing their attitudes and motivating them to kick start the quit-smoking process.