Christopher Columbus would have never imagined that, shortly after he introduced tobacco into Europe, it would become one of the main threats to health in several Latin American and Asian countries, as opium did in the 19th century, particularly in China. Tobacco, one of the most addictive substances in the world, was introduced to China in the 1600s. By the end of the second opium war in 1860, not only was the import of opium legalised but cigarettes were allowed to be imported to China duty-free. By 1900, China was almost entirely permeated by foreign companies. In 1929, Fritz Lickint, a German scientist from Dresden, published the first statistical evidence linking tobacco use and lung cancer. Yet, only in 1999 did the Philip Morris tobacco company acknowledge that, "There is an overwhelming medical and scientific evidence that smoking causes lung cancer, heart disease, emphysema and other serious diseases." Today, while its use has diminished considerably in industrialised countries, it is having a devastating effect on the health of the Chinese population. As Dr Bernard Lown, a cardiologist and a Nobel Peace Prize recipient, wrote in 1997: "The struggle against tobacco is not being won, it is being relocated." The state-owned China National Tobacco Corporation, trading as China Tobacco, makes nearly all of China's tobacco products and dominates the global market. The company falls under the jurisdiction of the State Tobacco Monopoly Administration. The administration has been under constant pressure from the World Trade Organisation to loosen its monopoly. Since 2001, increased access has been granted to foreign companies. Today, although China Tobacco dominates the domestic market, foreign brands can be found in large cities in China. Tobacco smoking continues to place a heavy toll on the Chinese people's health. It is estimated that 1.2 million Chinese die each year from smoking-related diseases. According to a recent Brookings Institution report, the number could rise to 2 million a year by 2020. To combat smoking, it is necessary to mobilise communities, educate people about the health risks and high costs of smoking, impose punitive fines in class action suits and increase taxes on cigarettes. The Chinese government has indicated its intention to lower the negative impact of smoking on the Chinese people through a series of measures that still need to be fully implemented. Much more, however, needs to be done. Cesar Chelala, MD, PhD, is an international public health consultant and the author of "Tobacco or Health"