China is a nation in serious need of Nicorette. Taxi drivers light up when they drive and sometimes hand out cigarettes to passengers as a token of camaraderie. Construction crews puff away around highly flammable materials on the job. Business deals are sealed with the exchange of State Express 555s one of the country's most popular cigarette brands and doctors are given smokes as gifts for saving lives. "When I have meetings at work, a lot of my colleagues smoke, and the smell really bothers me," says Shi Haifeng, a 27-year-old nonsmoker who works in finance in Shanghai. "But if you ask them not to smoke, they'll think you are not one of them."
Given this deeply ingrained smoking culture, it should come as little surprise that China has failed in its five-year mission to enact a nationwide smoking ban in indoor public spaces by the start of 2011. The government made the pledge when the World Health Organization's Framework Convention on Tobacco Control went into effect in China in January 2006, but it did next to nothing to carry out the ban within the planned time period. In announcing the missed deadline in January, the state mouthpiece, Xinhua News Agency, meekly blamed "a lack of state-level legislation, ineffective administration, low-priced cigarettes and a deep-rooted tobacco culture."
But antismoking advocates say the real fault lies with China's powerful tobacco industry, and if the country's senior leadership does not make a more meaningful effort to combat the problem, the nation will face a serious health crisis. According to a harshly worded report released Jan. 6 by a panel of Chinese and international health experts and economists, an estimated 2 million Chinese people will die each year of tobacco-related illnesses by 2020 if current smoking rates continue, up from 1.2 million now. That figure is expected to rise to a staggering 3.5 million people by 2030 which would account for nearly half the world's annual smoking-related deaths.
The effect on China's booming economy could be enormous, with billions of dollars lost each year in the treatment of smoking-related diseases and decreased productivity in the workplace. "By the [panel's] calculation, there is a net loss to the economy from tobacco," says Dr. Sarah England, who runs the China office of the WHO's Tobacco Free Initiative, which aims to increase awareness of the dangers of smoking and help countries implement tobacco-control programs. "Consider the loss of the inventiveness and creativity of the knowledge-based workers who will leave the workforce decades early due to death and disease from tobacco."
So why isn't the government doing more to wean China's more than 300 million smokers the vast majority of whom are men off their State Express 555s? The main problem, experts say, is a deep conflict of interest within the government: the State Tobacco Monopoly Administration (STMA) is responsible for both running the world's largest cigarette maker, the China National Tobacco Corp., and carrying out the country's antismoking laws. As can be imagined, the STMA has little incentive to push through strict policies, improve health awareness or raise the price of cigarettes, when the business whose success it is charged with could be hurt.
In fact, China's tobacco industry has actively tried to thwart antismoking efforts. Jiang Yuan, a deputy director of the Chinese Center for Disease Control and Prevention, says that when the government approved a cigarette-tax hike in 2009, Chinese tobacco companies simply absorbed the cost to keep the price of cigarettes stable. The companies have also sidestepped a ban on tobacco advertising by donating money to charity. One school rebuilt with tobacco money in quake-ravaged Sichuan province now carries the name of a local cigarette brand: the Sichuan Tobacco Hope Primary School.
Despite these obstacles, there are small signs of progress and a growing indication that Beijing is aware of the severity of the problem. The fact that the 2008 Beijing Olympics and the 2010 Shanghai World Expo were smoke-free is a sign that the top leaders realize "smoking is not the most attractive and civilized behavior," says Dr. Ray Yip, director of the Bill & Melinda Gates Foundation's China program, which has provided $24 million in grants to groups working on tobacco-control efforts in the country. In a key move in cutting the strings of patronage between the government and cigarette companies, the Shanghai Expo organizers turned down a $30 million donation from the tobacco industry after health advocates advised that it would be a violation of the WHO's Framework Convention on Tobacco Control. "In order for the tobacco-control effort to be taken seriously and something meaningful to be done ... the highest leadership has to believe this would be good for China," says Yip.
Some cities have also outlawed smoking in indoor places, with varying degrees of success. In Shanghai which passed its ban last year ahead of the Expo schools, hospitals, shopping malls, indoor stadiums, banks and other public facilities are now largely smoke-free. "Look around you can see no one is smoking in here," says Huang Haibin, who owns a jewelry shop in an underground mall in the center of the city. "It's easier for people in big cities to accept the new rules. They are more educated."
The city's restaurants, clubs and bars, however, are another matter. In the few that have bothered to set up nonsmoking areas which all are required to do under the law it's difficult to escape the clouds of smoke wafting over from other areas. And while smoking has been stamped out on trains, taxi drivers break the law with impunity. Though there are nominal fines for violators, ranging from $7 to $30, enforcement by authorities is lax. Yip says the success of such laws depends on nonsmokers' asserting their right to breathe clean air in public places. "You can set up fines, but who's coming to levy the fine? Nobody," he says. "The truth is that the enforcement is public pressure. But China is the U.S. 30 to 40 years ago. Nobody will speak up."
As far as advocates like him are concerned, the health of the country depends on it.