Policy progress of health warnings on tobacco products as per Article 11 of WHO FCTC: a global analysis

Background This paper evaluates the coverage and quality of global implementation of Article 11 of the WHO Framework Convention on Tobacco Control (WHO FCTC), for Cigarettes (CIG) and Smokeless Tobacco (SLT). Methods A cross-sectional database of policies with implementation dates in FCTC ratified countries (n = 179) was prepared. Information was validated by two sources. World Bank Income groups were used for categorizing countries. Notified warnings were scored according to topics specified at FCTC Warning database website. Data was analyzed using SPSS. Results By December 2016, of ratified countries, 94% and 48% population (≥15 years) were covered with ≥30% Health warning (HW) on CIG and SLT respectively. Population coverage by HW on CIG packages in high income countries (HICs), middle-income countries (MICs) and low-income countries (LICs) were 98.6%, 95% and 64% respectively, however, such coverage for SLT was < 50% population in all income-group countries. Global population coverage of Pictorial Health Warnings (PHW) (≥30% size) on CIG and SLT were 62% and 37% respectively. Global population coverage with 'high content' was 60% for CIG and only 5.2% for SLT. High content information on CIG covered 90%, 55% and 33% population in HIC, MIC and LIC respectively. However, this coverage for SLT in HIC, MIC and LIC was 4.6% 4.5% and 12% respectively. Conclusions There is unequal attention on implementation of Article 11 on different tobacco products. Countries need to provide quality information with equal focus on all tobacco products