Cigarette smoking kills one out of two long-term users globally, making tobacco consumption one of the most important public health issues for nations all over the world. At the same time, addiction to tobacco products has made transnational tobacco one of the most profitable industries in the global economy.

Policy makers and public health officials are faced with questions about how to monitor and control the tobacco industry marketing on one hand, and how to inform consumers about these critical health issues on the other. In the last two decades as more information has been exposed about the explicit efforts of transnational tobacco corporations (TTCs) to suppress health information on the harmful effects of consuming tobacco industry products, class action litigation and proactive public policies have had some success in restricting many of the more harmful marketing tactics of the TTCs. Still, years of deception and misinformation by the tobacco industry have created a huge gap in public awareness of the harmful effects of tobacco products that is difficult to overcome. In 2004, the Surgeon General reported a causal link between smoking and 28 individual diseases, including the leading causes of death in the Western world and harm to every major organ in the human body. Public health warnings, however, have not expanded to give consumers access to this information, leaving most smokers extremely uninformed. This gap in public awareness about the severity of the health consequences of consuming tobacco products is even greater among working class and immigrant communities throughout the United States. These communities are at once targeted by the tobacco industry as consumers, and often barred from access to public health warnings as a result of Englishonly text-based warning labels. One of the most successful and cost-effective policy initiatives to eliminate this gap in public awareness about the harmful effects of tobacco is the use of picture-based tobacco warning labels.

Picture-based tobacco warning labels cover the outside of tobacco packages with simple and direct warnings about the harmful effect of tobacco consumption. Since their introduction in Canada in 1994, picture-based tobacco warning labels have proven to be more accessible and effective than English-only text-based warning labels, such as those used in the United States. In the last five years, eight countries, including Australia, Belgium, Brazil, Canada, Singapore, Thailand, Uruguay, and Venezuela, have passed laws requiring picture-based warning labels on tobacco products. Another fourteen countries are in various stages of consideration and implementation of similar requirements. The European Union has recommended that all member countries implement picture-based health warnings and has provided sample guidelines and a series of labels for rotation on tobacco packaging. This paper is intended to describe the core problem of inequality that the use of English-only text-based tobacco health warning labels in the United States both reflects and sustains. Our research has shown that language discrimination in tobacco health warnings is undeniable. The use of English-only text-based warning labels has created a grave divide in public knowledge about health impacts of smoking for non-English speaking people and people with limited literacy. The consequences of this barrier to information for these communities are deadly. This report consists of three sections. Section one summarizes the history and current status of tobacco warning labels in the United States and describes the problem of language discrimination. The second section describes the international trend toward picture-based warning labels. The last section details our recommendation for legislative action that could resolve the current problem of language discrimination and unequal protection under the law.