Background and challenges to implementation:
There is tremendous international momentum regarding package health warnings, with more than 110 countries/territories requiring picture warnings, and with countries significantly increasing warning size. Roughly 100 countries/territories require a size of at least 50% of the package front/back, more than 45 require a size of at least 65%, and more than 12 requiring a size of 75% to 90%.
Package health warnings are highly cost-effective. Package warnings provide educational messages that reach all tobacco consumers many times per day. Governments determine the messages, and tobacco companies pay the cost. This low cost is especially important in low and middle income countries.
Health warning effectiveness increases with size, as FCTC Guidelines recognize. Moreover, health warnings with graphic images of the health effects are far more effective than text-only warnings. A picture does indeed say a thousand words.

Intervention or response:
This presentation will report on dramatic worldwide progress at increasing package warning size, and requiring pictures. In part, this presentation will outline the results of the fifth edition of the Canadian Cancer Society report, Cigarette Package Health Warnings: International Status Report, as well as ongoing international developments.
This presentation will also report on innovations in health warnings, including regarding new message content on health effects, messages encouraging quitting to save money, and enhanced messages on lateral sides of packages. Also, more countries are requiring a minimum surface area for warnings (in square centimetres), in addition to a minimum percentage of the front/back, to increase size and impact.

Results and lessons learnt:
Global progress is being made despite continuing tobacco industry opposition including, in some countries, legal challenges.
Large picture health warnings are a highly effective measure, whether or not implemented with plain packaging.

Conclusions and key recommendations:
Countries worldwide should accelerate efforts to improve warnings by increasing size, by requiring pictures, and by implementing innovative approaches.