Canadian regulators are considering “all elements of design, such as size, wording, font and colour” as they contemplate such a labeling scheme. Phrasing suggested in the paper could include “smoking causes cancer.” In addition to cigarettes, the labeling requirements could apply to cigarette tobacco, leaf tobacco, little cigars, kreteks (aka clove cigarettes), and tobacco sticks.

In 2001, Canada made it mandatory to label cigarette packages with photographs depicting cancer and disease. The dual-sided English-French labels on every package include a warning that cigarettes contain known carcinogens such as carbon monoxide, formaldehyde, hydrogen cyanide, nicotine, and tar. Benzene emissions numbers also appear on the side of packages.

Thanks to Canada’s leadership on labeling, other nations beyond North America now tend toward even more evocative warnings on tobacco packaging as well, including the use of imagery such as skulls or the use of all-caps phrases such as “SMOKING CAN KILL.” The U.S. does not use picture labels because of a free speech lawsuit tobacco companies won in 2012. If the tobacco companies had lost the suit, Americans might now be used to seeing cigarette packs featuring, for example, a smoker exhaling through a trach tube in his throat.

Tobacco use is the leading cause of premature death in Canada, with an estimated 45,000 Canadians dying annually due to smoking-related health issues. Currently, Canada only requires a warning label to be placed on or inside a cigarette package, requirements which have been in place since 2000.

The proposals for labeling every cigarette are open to public feedback until January 4, 2019.