China's battle against smoking

Lou Yi
is a writer for Caijing magazine in Beijing and is working at The Inquirer as part of the Alfred Friendly Press Fellowships program.

One day in early December, Damon Moglen and his colleague went into a restaurant in Beijing and found themselves in a weird situation: They were at a no-smoking table, but almost all the people around were smoking.

Wondering if the restaurant had a no-smoking area or only a no-smoking table, Moglen's colleague picked up the no-smoking sign on their table and studied it. Suddenly a waitress ran over, grabbed the sign out of his hands, and immediately put an ashtray on their table.

"Her immediate assumption was that we were upset because there was a no-smoking sign on the table, which was, of course, the opposite to what we thought," recalls Moglen, vice president of the international program for Campaign for Tobacco-Free Kids, a tobacco control advocacy organization in Washington. He says that, when the two men asked for the no-smoking sign back, the waitress looked confused.

In fact, Moglen and his colleague were on a trip to discuss tobacco control with government officials and nonprofit organizations in China - the country that suffers most from smoking.

According to a report released by the Chinese Center for Disease Control and Prevention, the Cancer Foundation of China, and the Chinese Association on Tobacco Control, about 350 million people smoke in China - 37 percent of the entire population and about one-third of all the smokers (estimated at 1.1 billion) in the world. Among other startling facts: Half of male doctors and teachers smoke; 1.6 trillion cigarettes are sold each year, amounting to one-third of total sales on this planet.

Even worse, every year, 1 million Chinese die of smoking-related diseases, 2.5 times more than in the United States, the New England Journal of Medicine says. The death toll in China from tobacco is expected to double by 2020, the Chinese Center reports.

But after a long-running back-and-forth between controlling smoking for the sake of public health and encouraging the tobacco industry for the sake of the economy, the Chinese government seems at last to be moving in the right direction. The milestone is China's ratification of the World Health Organization's Framework Convention on Tobacco Control in 2005, committing itself to becoming a leader in the global effort in tobacco control.

Some government restrictions exist on tobacco ads, youth smoking, and smoking in public. But those regulations are neither fully observed nor effectively enforced. The institution that controls all tobacco production, sales and trade in China has two names. The first is the China Tobacco Corporation, the second is the State Tobacco Monopoly Administration. By any name, it is both a politically powerful government organ and a profitable giant, holding the largest cigarette monopoly in the world, churning out insanely huge profits each year. The annual pre-tax profits from China's tobacco industry - the annual pre-tax profits, namely, from this single company - amount to about 10 percent of China's pre-tax profits annually in the last 10 years. In 2006 alone, the company's tax bill was more than 290 billion renminbi, or $37.17 billion.

That is one reason the Chinese government was long reluctant to be really harsh toward the tobacco industry.

But the biggest reason is that so many jobs depend on tobacco. About 3.6 million farmers plant tobacco in the fields, and 500,000 people work in production. Industry advocates always ask: Where else could all those people possibly find a living?

Thus, China is reluctant to lift its duty on foreign tobacco. The government worries that such a move would jeopardize the Chinese tobacco industry, now confronted with huge challenges from international tobacco companies since China's entry into the World Trade Organization.

Smoking is deeply woven into Chinese culture. That is yet another reason neither government nor society has fully acknowledged the health dangers of smoking or the seriousness of the national problem. There is even a traditional saying that "You are as happy as God if you smoke a cigarette after dinner." Cigarettes also are symbolic gifts in social situations. One traditional practice in Chinese weddings is that the bride lights the cigarettes of each male guest.
Reflecting this important social role, cigarette packs in China feature beautiful things, such as pandas, dragons and flowers. The packs are so fancy that collecting them rivals stamp collecting in China. Even brand names reflect the close identification between tobacco and the national culture. One brand of cigarettes is called Zhonghua - literally, "China" - and another is named Zhongnanhai - literally, "The Central and Southern Seas" - which is the name of the residence of Chinese central government, the "Chinese Kremlin" to Westerners. In the United States, a rough equivalent would be naming a cigarette America or The White House.

The cultural impact of smoking follows Chinese people all over the world - including here in Philadelphia. A study of the Chinese community in Philadelphia by Temple University's Center for Asian Health shows that Chinese Americans have a higher rate of smoking than white people, largely because of the cultural importance of tobacco.

So what changed in China? Why is the country at last tightening controls and educating its people about the dangers? The main reason is the recognition, at long last, of the costs of smoking-related illnesses in China. Smoking is the main cause of lung cancer, from which nearly 1 million people die every year. The result is a huge burden on an already inadequate health-care system, especially with regard to poor rural families, whose members are usually the major consumers of cigarettes. A report released by the China Center for Economic Research at Peking University shows that the cost of medical care for smoking-related diseases in 2005 (the last year for which data are available) was more than $31.25 billion - $1.25 billion more than the tax and profits the tobacco industry created that year.

Tobacco control thus has tightened noticeably since 2005. Tobacco ads, which used to be everywhere, are disappearing from the streets, replaced by a growing number of posters on the harm of smoking. There is also some talk of forbidding "soft" tobacco ads. But lifting the tobacco duty is not yet on the table - the tobacco industry is still too strong, as is the government's concern over jobs and the economy.

The next two years could offer even better motives for change. China is due to submit its first tobacco-control progress report in 2007. To fulfill the convention, China is planning to publish rules forbidding public smoking; it will also require bigger and clearer warnings on cigarette packs. And 2008 will bring the Olympic Games, and since the games are tobacco-free, public smoking will be forbidden at the six major urban sites of the Games. True, 18 days of smoke-free Olympics won't change the longtime cultural and economic dependence on tobacco. Think of the more-than-20-year tobacco control effort in the United States!
Contact Lou Yi at lyi@phillynews.com.