In announcing its plans to roll out a public smoking ban across the country by the end of this year, China’s National Health and Family Planning Commission is taking on a Herculean task. Considering that China has one of the world’s most deeply ingrained and stubborn smoking cultures, getting 1.3 billion people to quit lighting up in public is going to take massive social and economic changes. If the central government’s plans do make headway, however, countless lives and could be saved from the ravages of tobacco. With 300 million smokers accounting for one in every three cigarettes smoked in the world, China’s tobacco problem is an epidemic.
At current rates, smoking will kill two million Chinese a year by 2020 and three million by 2050. Globally, one billion people could die from smoking this century. Because of the ingrained cultural practices of men using cigarettes to interact in their professional lives, the death toll will fall disproportionately on them: 68 percent of Chinese men smoke. Smoking bans on their own are not enough to change the culture of exchanging cigarettes like business cards or reluctance to endanger a business deal by “rudely” refusing to light up.
To give this nationwide policy the best shot at success, Chinese health officials should take a careful look at how local smoking bans have been faring to date. Shanghai decided earlier this month on its own anti-smoking regulations – to come into effect in March – in order to turn transport hubs, public buildings, and workplaces into smoke-free spaces. For China’s commercial capital, this is a tightening up of current legislation that lets restaurants and entertainment venues have segregated smoking areas and hotels offer smoking rooms.
Shanghai’s new law is obviously a positive and welcome step, but it is also not the first time the city has tried to cut back. Previous efforts to curb smoking in Shanghai have only lasted as long as foreigners happened to be in town: the last set of anti-smoking regulations was linked to the World Expo in 2010. Once the foreigners left, the “no smoking signs” were simply ignored and officials turned a blind eye as smoking became ubiquitous again. There were multiple reasons enforcement fell apart, not least of which was the fact that 12 separate agencies in the city were expected to coordinate in enforcing it. It shouldn’t come as a surprise that, five years later, only 26 percent of residents thought the rules were effective.
Beyond the cultural forces and weak enforcement, there is of course an enormous elephant in the room when it comes to smoking in China: tobacco, and specifically the China National Tobacco Corp, is a cash cow for the state coffers. The Chinese government is by far the world’s largest manufacturer of cigarettes, churning out 2.5 trillion of them in 2013. Philip Morris, the next biggest manufacturer, produced 880 billion. As a conglomerate, China National produces 160 brands of cigarettes (almost entirely for the Chinese market) and sustains 20 million jobs. 1.3 million tobacco growers and 5 million tobacco vendors depend on the state-owned company, with 500,000 people directly employed. This one corporation accounts for fully seven percent of China’s national GDP.
A company of such importance to the Chinese economy has little to fear from anti-smoking campaigners, and for good reason. Unlike its foreign competitors, which generally are private companies disconnected from the state, China National and the State Tobacco Monopoly Administration (the official industry watchdog) are for all intents and purposes the same entity. They share the same headquarters in Beijing, the same website and corporate structure, and even the same CEO. Needless to say, this poses a conflict of interest for the government: on the one hand, it says it is committed to reducing smoking with moves like the new national ban. On the other, the state-owned tobacco company was aiming to grow its contribution to the state’s budget by 8 to 10 percent every year.
With China’s smoking culture and state interests so intertwined, the new smoking ban will probably not achieve its objective of curbing smoking rates and saving lives. However, the sliver of good news comes from the many smokers who are opting to quit. Many are taking matters into their own hands (and lungs) by opting for a local invention: e-cigarettes. Modern e-cigarettes, invented in China in 2003 by a chemist named Hon Lik, give smokers a way of intaking nicotine without inhaling the more than 200 carcinogenic chemicals found in a conventional cigarette. The Royal College of Physicians in the U.K. found the practice is “unlikely to exceed 5 percent of the harm from smoking tobacco,” and further research has shown it to be a viable transitional aid toward quitting nicotine outright.
The number of Chinese switching to e-cigarettes is growing, but some global health bodies (like the World Health Organization) are actively discouraging the trend by taking a hardline stance on the technology. According to the WHO’s Framework Convention on Tobacco Control, which just concluded its biannual meeting in New Delhi, governments should do everything in their power to regulate vaping, and dispel notions that it can help smokers quit – in spite of both apocryphal and scientific evidence pointing to the contrary. Instead, the FCTC argues in favor of an approach dubbed “quit or die.” The body’s decision-making process has been repeatedly called out for a lack of transparency, which this year involved kicking out all journalists from the meeting, thus making it even harder to decipher how the FCTC arrived at their stance. The problem for China is that this selective approach could actively do harm by taking away a useful quitting tool.
Considering the sheer scale of the smoking crisis afflicting China, any and every method that reduces the harm done by tobacco should be under serious consideration. The National Health and Family Planning Commission’s nationwide smoking ban was overdue, but the central government (and some international bodies) will need to do some serious soul-searching about their priorities if they want to make real progress.
Grace Guo is a Vienna-based researcher and a program associate for a small NGO focused on Asian politics.