Smoking a big drag on tobacco control
A young man walks into the lobby of a five-star hotel in Shijiazhuang , Hebei carrying a shopping bag in one hand and a lit cigarette in the other. He asks the receptionist for directions and is shown to the lift. He gets in, taking a drag on his cigarette. Neither the receptionist nor those in the lift seem bothered.
This is China, seven months before its deadline to honour a commitment to the World Health Organisation for a 'thorough indoor smoke-free environment' by January 9, 2011.
So far, a national ban on smoking in public places - integral to the campaign - is yet to appear on the legislation agenda.
Instead, more than 100 mainland primary schools sponsored by tobacco companies bear names such as Tobacco Hope School. Slogans like 'Talents are brewed by intelligence; tobacco helps you grow up and become accomplished' appear in school grounds. And a book outlining how to get around the WHO Framework Convention on Tobacco Control, which Beijing ratified in 2005, has won a national publishing award.
Beijing made the pledge when it ratified the framework five years ago, but today advocates of the smoking ban say they see no sign that the mainland will reach the target by January - and that could damage China's image.
'There will not be any punitive action from other WHO members. The actual blow will be to China's international standing,' Yang Gonghuan, deputy director general of the Chinese Centre for Disease Control and Prevention and director of the National Office of Tobacco Control, said. 'The WHO evaluated members' implementation of a non-smoking environment last year and China scored one point, the lowest score on a 10-point scale. The embarrassment is obvious.'
Behind this embarrassment are two powers at odds with each other and a failed inter-government agency system on tobacco control that has put financial gain before health.
The Ministry of Industry and Information Technology was tapped to implement the WHO framework and eight government agencies were involved, including the National Development and Reform Commission, the State Tobacco Monopoly Administration and the Ministry of Health. But the industry ministry also governs the State Tobacco Monopoly Administration, which controls China National Tobacco Corp, a state-owned monopoly and the largest single manufacturer of tobacco products in the world.
'Since the Ministry of Industry and Information Technology took charge of tobacco control in 2008, the issue has been in a stalemate,' said Xu Guihua of the Chinese Association on Tobacco Control.
The State Tobacco Monopoly Administration is responsible for policy and enforcing regulations, such as warnings on packaging. But the health ministry, a strong advocate of tobacco control, does not have a say in policy-making on the issue.
'The Ministry of Health is in a very weak position. It does not have the final say,' said Li Xinhua , a community health department chief under the ministry.
Earlier this month, the health ministry announced all hospitals would be tobacco-free next year, a statement the media took to mean the whole country would be smoke-free indoors by then. The ministry issued a clarification, reinforcing fears it is fighting a lone battle.
'The Ministry of Health is not the one making decisions with regards to fulfilling the promise,' Li said. 'All it can do is set a good example itself by banning smoking in hospitals.'
Under the WHO convention, health warning images should cover 50 per cent of cigarette packets, along with information on the hazards of smoking. But in China, only 30 per cent of the packet must carry images, and cigarettes carry only mild messages such as 'Smoking harms your health' in tiny print.
A refusal by tobacco companies to increase cigarette prices after the Ministry of Finance raised the tax on tobacco was also a setback for the campaign.
Smoking is deeply entrenched in Chinese life. Cigarettes are still considered an important part of socialising and are given as gifts to family, friends and officials. In some places it is common for doctors to smoke in front of patients, or for officials to smoke during meetings.
Former leader Deng Xiaoping apparently smoked 50 cigarettes a day - including in front of foreign leaders - before he quit.
With 40 per cent of the world's tobacco consumed in China, cigarette sales have been the country's top source of tax revenue since 1987 and those earnings have grown at a double-digit pace since 2003.
But as tax revenue from cigarettes reached 500 billion yuan (HK$569.24 billion) last year, one million people died of smoking-related diseases and passive smoking was responsible for more than 10,000 deaths.
Anti-smoking activists, academics and public health experts warn that treating smoking-related illnesses will come at a hefty price. Separate studies by the WHO, World Bank and Peking University have found the health costs of smoking far exceed tobacco industry profits, but policymakers have so far been unmoved by the research.
The number of smokers on the mainland peaked in 1995 at 63 per cent of men - with relatively few women smokers - and smoking-related deaths in the country are expected to see a spike between 2025 and 2030. At present, about 58 per cent of Chinese men smoke.
A decade from now, two million people are expected to die every year from diseases caused by smoking.
'It is clear the central government is in favour of tobacco companies, and the argument that tobacco control will affect tax revenue and employment within the industry is at the front of policymakers' minds,' said Tao Ming , an associate professor at Fudan University, who wrote a book on China's tobacco industry based on five years of research.
Tao said tobacco control should be co-ordinated by a higher level system and the ministry in charge of tobacco production should not also be in charge of its control.
Yang said Beijing's most pressing tasks are to separate the State Tobacco Monopoly Administration and the tobacco firms and to pass national legislation banning smoking indoors.
Only a few cities - including Shanghai, Guangzhou and Hangzhou - have banned smoking in public places, but no single mainland city has achieved a complete ban on smoking indoors.