China cannot breathe easy about smoking. Research published Wednesday in the Journal of the American Medical Association said the number of smokers around the world grew by more than a third from 721 million in 1980 to 967 million in 2012, with China the country most at risk.
The research, by the Institute for Health Metrics and Evaluation at the University of Washington, found that smoking prevalence — the percentage of the population that smoked every day — went down during the period, but the overall number rose because of population growth.
There were declines in prevalence between 1996 and 2006; then the decline slowed because of an increase in the number of smokers in several large countries, including China.
“Tobacco control is particularly urgent in countries where the number of smokers is increasing,” University of Melbourne laureate professor Alan Lopez said. “Since we know that half of all smokers will eventually be killed by tobacco, greater numbers of smokers will mean a massive increase in premature deaths in our lifetime.”
The report said the greatest health risk for both men and women is likely to occur in countries where smoking is pervasive and where smokers consume a large quantity of cigarettes. China is the country most at risk. In 2012, it had more than 300 million smokers, up from fewer than 200 million in 1980, the research found.
The Chinese-language Tobacco Atlas published in Beijing last month by the World Lung Foundation and the American Cancer Society said that 38 per cent of all cigarettes consumed in the world are smoked in China, more than the other top-four countries combined, and that 50.4 per cent of all men smoke. This means that about 340 million people are at significant risk of death from tobacco-related diseases.
Judith Mackay, a senior adviser to the foundation, has been working on tobacco control in Asia, and in China in particular, since 1984. She said that unless China takes firm action now it will incur massive costs, such as medical and health costs, costs of premature death and the costs of second-hand smoke to the health of non-smokers, including children.
“[There are also] environmental costs such as fires caused by careless smoking; the cleaning up of the litter of millions of cigarette ends, packets, matches, lighters; damage to buildings and fabric; the costs to China of the use of land that could [be used to] grow food; the costs of the diversion of family income to buy cigarettes that could otherwise be spent on education, health and leisure pursuits; and many other costs,” Mackay said.
“This paper shows the tobacco epidemic in China is going to get worse before it gets better, with increasing number of smokers for decades to come.”
She said there is an urgent need in China “to separate responsibility for tobacco control from the state tobacco monopoly, to pass national smoke-free legislation, to introduce pictorial packet warnings, to develop a public health orientated tobacco taxation policy, and to expand mass media campaigns and assistance for quitting smoking.”
This message is finally being heard at the top levels of the government. In late December, the State Council and the Central Committee issued a ban on officials smoking in schools, hospitals, sports venues, public transport and other public places and during official activities, including meetings and business dinners.
“We must turn government and party organisations into non-smoking places,” the announcement said. “Inside them, tobacco products cannot be sold or provided. Anti-smoking notices must be put up in meeting rooms, corridors, canteens, toilets and other places. All organisations must encourage their staff to stop the habit … and create in the whole society a good atmosphere where cigarettes are banned.”
In addition, a document written last year by the Central Party School proposed the establishment of a National Tobacco Control Office to take charge and supervise the control of tobacco in all processes from production to sales. It would become the regulator, taking over from the State Tobacco Monopoly Administration.
The drive against corruption and conspicuous consumption launched by President Xi Jinping last year has badly hit demand for luxury brands widely used as gifts and bribes to officials. For example, the price of a carton of Huanghelou 1916 has fallen from a peak of nearly 2,000 yuan (US$327) in 2012 to 600 yuan.
The best gifts were brands with limited production and availability; the scarcity drove up the price.
But smoking is too deeply embedded in social and official life to be stopped by edicts from Beijing.Ye Qing, vice director of the Hubei Statistical Bureau, said 61 per cent of male Chinese civil servants smoke and of those 52.7 per cent had never tried to stop. But 37.3 per cent had expressed a desire to quit.
He said controlling smoking and expenditure among civil servants was an important part of the overall tobacco control campaign. “The announcement by the State Council was absolutely good news for local cadres who do not smoke. In the past, governments of even poor counties and townships had to spend on liquor and tobacco. Now they cannot serve or provide them; this will reduce their expenditure.”
Ye said that in 2010 the tobacco industry paid 498.8 billion yuan in taxes, accounting for 6 per cent of national revenue for the government. The highest proportion is in Yunnan, where tobacco taxes have since the early 1990s accounted for 75 per cent of the provincial government’s income.