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Government

Puffing Away in China

Young Chinese man smoking
Young Chinese man smoking / photo: ernop, flickr

As I read a news piece on smoking in China on the website of a Finnish newspaper I thought, for a brief second, that it was April Fool’s. This was a joke, right?

The article said the provincial government in Hubei in China had set a quota for civil servants to smoke at least 230 000 packs of local cigarettes a year. And if they did not reach this quota or decided to smoke another brand instead, they would be fined.

Enforcement issues aside, this is clearly a move that is aimed at shoring up treasury coffers and is done with wanton disregard for some major public health concerns. To illustrate how big this public health issue is in China, let’s list some rather shocking statistics from the Middle Kingdom.

  • An estimated 350 million people smoke in China. The vast majority are men.
  • China consumes 30 percent of the world’s cigarettes, while it has 20 percent of the population. The vast majority of these cigarettes are produced in China; only 10 percent are imported.
  • Currently about 1 million people a year die of smoking related illnesses. This is estimated to double or triple in the coming decades.
  • Recent studies, by British, Chinese and US medical professionals have estimated that out of today’s young men in China, a third will be killed by tobacco. This is because it takes an average of 50 years for the full effects of smoking to show in mortality rates and in the society at large and it is in the younger groups that the full impact will show as they age, continue to smoke and get sick.

There are some interesting peculiarities about the tobacco debate in Asia and the specific dynamic that drive it in China. Firstly, as China was a relative latecomer to the world of cigarette smoking, its public health consequences have only started to show in the past decade or so. Extensive studies have started coming out, many of them highlighting the massive public health emergency China faces if smoking is not curbed. The worst-case scenario involves up to one half of Chinese men dying of smoking related illnesses in the future.

Secondly, tobacco seems to impact Asian and Chinese populations differently than Western ones. While tobacco is most often linked to lung cancer and heart disease in the West, in Asia it seems to be much more involved in respiratory problems and even liver cancer. Deaths from tuberculosis in China are reportedly much higher because of smoking. The key to this disparity, apparently, is that tobacco tends to exacerbate the illnesses that most commonly kill in a given country. Add to this China’s pollution problem and you are faced with a truly scary picture.

But the worst thing is- people do not seem to know. Nearly 60 percent of Chinese people do not think cigarettes do much harm.

This seems to be a lethal combination: ignorance and governmental willingness- at least on the local side- to ignore such dangers and instead focus on the money stream. Now, although there’s no doubt about the fact that many of these provinces are in desperate need of revenue for developmental projects (particularly in the time of an economic slowdown), is this not an unwise and unethical bargain?

And of course this is not merely a problem in China. The same issue- namely of balancing current revenue streams with the future costs of health care for the sick and dying smokers- has been a part of the smoking ban debate in many European countries. I remember debating the ban with friends who smoke and they argued that the government had too much to lose in terms of revenue by banning smoking in public places. But governments all over Europe did it and continue to do it (including soon in Switzerland); is there any chance that China will follow suit? And will the central government start prioritizing health over money?

UPDATE: The local government in Hubei has reportedly reversed this decision and will NOT be enforcing the 230 000 pack rule after all.

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