1. Mrs Vinoda Pitchamootoo Vythelingam Focal Point for Tobacco Control Health Information Education and Communication Officer Ministry of Health and Quality of Life Mauritius

2. Situation Analysis High prevalence of NCDs (diabetes, hypertension and cardiovascular diseases 50% death due to heart diseases High prevalence of male adult smoking: 40% High prevalence of youth smoking (13- 15 yrs) : 13.7% High exposure to tobacco smoke: 45.6%

3. Health warning on package of cigarette (PHA 1999) One text-based message: GOVERNMENT WARNING: Smoking causes cancer, heart disease and bronchitis side of the pack No requirement regarding font, background, colour, etc Warning : NOT NOTICEABLE (blending background)

4. Topics retained 1. Addiction 2. Heart disease 3. Lung cancer 4. Mouth cancer 5. Stroke 6. Second hand smoke 7. Impotence 8. Death

5. Total area to be covered by phw Front display area : 60% Back display area: 70% 2 side text messages Le tabac tue Tobacco kills Total surface area: 65% Language: English & French

6. Steps in developing pictorial health warnings Contracted specialised advertising agency NOT AFFILIATION WITH THE TOBACCO INDUSTRY Tasks: conception and design of health warnings Technical input from Ministry of Health Arrange for taking of photographs (Health system) Resizing of the health warnings (package)

7. Issues Be culture sensitive Secure written consent of people which appeared in the PHWs In case of children under the age of 18 yrs, consents of both parents are needed Ownership of the photographs Proper coordination between the Ministry and the State Law Office

8. Pre-testing of health warnings Pre-testing by the Ministry of Health (targeted audience, scientific approach) Bring necessary amendments to the PHWs 2 nd pre-testing exercise Finalise the health warnings Approval of Ministry of Health

9. Promulgation of the FCTC- compliant legislation Prescribed the text messages Prescribed the pictorial health messages Surface to be occupied Evenly distributed in tobacco consignment when imported* Template as approved by the Minister Date of enforcement Phase out period*

17. Evaluation of PHWs International Tobacco Control (ITC) Mauritius National Reports Pre-wave 1: (before implementation of phw) : Text-only warning : limited effectiveness Wave 2: Dramatic increases in smokers awareness of health warnings (10-11 mths post-implementation) Wave 3: DECLINE IN EFFECTIVENESS (20- 21 mths post–implementation) NEED TO RENEW PHW (>24 mths)

18. Strength Great political commitment and political will of the Government of Mauritius Weakness Lack of competency in interpreting legislative text (loopholes)

19. Challenges Tobacco industry interference Delaying tactics of the TI To illustrate/obtain photograph of specific disease like mouth cancer To get testimonials from local people

20. In progress.... Development of new set of pictorial health warnings Considering to implement plain packaging - Text messages finalised - Procurement stage - Implementation: May 2013

21. Thank you