A nation going up in smoke
Cigarettes have become deeply interwoven into the mainland's culture and economy, making the push by activists to cut consumption harder
Only a strong political will, higher cigarette taxes, a blanket ban on their promotion and advertising, the extension of a smoking ban to more areas and a new moral consensus can save the mainland from its tobacco epidemic.
That is the conclusion of Dr Judith Mackay, one of the world's leading experts on smoking in China, in a major speech to be delivered yesterday to the United States-China Institute at the University of South California in Los Angeles.
While smoking is declining in the developed world, it is growing on the mainland and causes the deaths of at least one million people a year from smoking-related diseases. The mainland has 350 million smokers - almost a third of the global total - of whom 311 million are men, and 540 million "passive smokers".
"The Chinese government is the world's largest tobacco company," Mackay said. "The industry is seen as supporting the economy and employing large numbers of people. Political will is the key ingredient to tobacco control. The government must raise tobacco taxes, ban all promotion, including of brands, and extend smoking bans to more areas.
"It must make tobacco control a just and noble cause, worthy of Confucius and Sun Tzu," she said. "The central government can, with political will, effect change rapidly."
A medical doctor and long-term resident of Hong Kong, Mackay has been campaigning against tobacco in Asia since 1984. She works for the World Lung Foundation, part of an initiative backed by philanthropist and New York Mayor Michael Bloomberg to reduce tobacco use in low- and middle-income countries.
The state-owned China National Tobacco Corporation (CNTC) has a 32 per cent share of the global market, ranking top, and almost as much as the second two - Philip Morris International and British American Tobacco - put together. The mainland grows 2.4 million tonnes of tobacco leaf, ranking first, and more than the next three producers - Brazil, India and the US - put together.
The CNTC is strongly opposed to controls on its products and has a powerful economic argument to back its case. More than 20 million farmers earn their living from growing tobacco and millions work in factories to produce cigarettes and in the distribution and retail sale of them. In the first half of last year, the industry produced 1.19 trillion cigarettes, a year-on-year increase of 42 billion, and exported 6.39 billion cigarettes, up 36 per cent.
In 2006, tobacco accounted for 49 per cent of the provincial revenue of Yunnan, 29 per cent in Hunan, 23 per cent in Guizhou and more than 10 per cent in Anhui, Hubei, Henan and Jiangxi.
"Many male health professionals smoke," Mackay said. "Research on the health risks of tobacco is not disseminated to all the public and there is no single tobacco-control law. Policymakers see the revenue from tobacco, not the spending on related diseases. The health profession, as everywhere in the world, focuses on curative medicine."
In addition, smoking is an integral part of the fabric of social and professional life. Offering a cigarette is a way to start a conversation in a restaurant or a train, just as it is a form of politeness at dinners and wedding banquets. You want to give a present - how about one of the most prestigious brands, Panda and Zhonghua? A gift package of five packets of Panda, plus lighter and crystal ashtray costs 1,500 yuan. Zhonghua sell for between 40 and 70 yuan a package. Both make excellent presents to a superior in your company or an official from whom you need a favour.
Analysts estimate that 12 per cent of smokers do not buy their cigarettes - they receive them as gifts. This has led to the adage - "those who buy do not smoke and those who smoke do not buy".
"The national tobacco companies are very strong and significant contributors to state taxes," Mackay said. "They are increasingly exporting cigarettes. They are challenging the evidence of risks to health.
"In addition, multinational tobacco companies are involved in joint ventures and help the CNTC produce cigarettes for export and help it in its internet site," she said.
But Mackay also found reasons to be optimistic. "China signed the Framework Convention on Tobacco Control (FCTC) of the World Health Organisation (WHO) in 2003 and ratified it in 2005. The WHO's China office is active in the fight against tobacco and the World Bank's China office is also engaged on this issue. She sees the ratification of the FCTC as the most important step. It was adopted by the World Health Assembly on May 21, 2003 and has been signed by 168 countries and organisations. It calls for price and tax measures to reduce demand, protection from exposure to smoke, regulation of packaging, education, control of promotion and sales to minors, and support for economically viable alternative activities.
One clause, which the CNTC was supposed to implement on January 1 last year, was pictorial warnings on packets to alert smokers of the risks, covering no less than 30 per cent of the entire package. In Australia, they show the black and yellow teeth of a smoker and in Brazil a heart operation. Since 2006, Hong Kong has carried six pictorial health warnings covering 50 per cent of the pack. But packets sold on the mainland do not carry such pictures - only a verbal warning that `smoking is harmful to your health' in Chinese and English, which few mainlanders understand.
Packets for export do carry such pictures, to meet the demand of local markets. For example, to meet the requirements of the Hong Kong government, a packet of Yuxi cigarettes sold in the city, for example, has a fearsome picture of an X-rayed lung with a large patch and 'smoking causes lung cancer' in English and Chinese. The same packet sold on the mainland does not have this picture.
Despite the reluctance of CNTC to change, Mackay sees the FCTC as the key moment to change social norms of smoking. "It wants to take its place on the international stage. Its leaders no longer smoke in public, as Chairman Mao and Deng Xiaoping used to do. Among the civil society, there is growing awareness of the harmfulness of smoking."
On the mainland, there is a dedicated community of doctors, public health workers, scholars and activists who have campaigned for tougher controls. It was due to their persistent efforts that Beijing was persuaded to sign the FCTC, despite the strong opposition of the CNTC and the powerful tobacco lobby.
Chinese doctors made recommendations for action against tobacco as early as 1979. In 1984, three scholars presented the first national study on tobacco, which found that 34 per cent of the population smoked, including 61 per cent of men and 7 per cent of women, figures very similar to those of today.
This community has long argued that the costs of treating tobacco-related diseases exceed the revenue which the government collects from profits and taxes from the industry.
A report by six specialists from the Chinese Academy of Preventive Medicine found that, in 1989, the costs of such treatments were 27 billion yuan, of which seven billion were direct costs and 20 billion indirect costs. In 1992, the industry provided 31 billion yuan to the state, a four-fold increase since 1981. The problem for the campaigners is that the costs are scattered across thousands of hospitals, clinics and homes, while the CNTC can present its taxes and profits on a single sheet of paper to the State Council.
One result of this contradiction is the silence about the industry in the media. Magazines, television stations and newspapers have long and detailed analyses of industries - including cars, televisions, mobile telephones and furniture - with accounts of the latest designs, trends and prices.
But they rarely report about the tobacco industry and even less discuss this Faustian bargain of money against public health. Millions of Chinese, especially the poor and less educated, are unaware of the risks when they light up a cigarette.
Aware of this contradiction, the CNTC keeps a low profile. Its website has lengthy reports on the profitability of its companies, new equipment and technology, expansion of their plants and activities of its workers - but avoids this critical issue.
What is missing is the moral consensus against smoking which has driven on tobacco in the developed world. "How do we make this a just and noble cause?" asked Mackay.
"How do we link tobacco control with Confucius and Sun Tzu?"
Source: www.scmp.com
