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LAST WORD: Public Health and State - Run Tobacco - China’s Lethal Catch-22
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altThe first day of January is a day for new beginnings, many westerners ritualistically ring in the New Year by making personal vows for self-improvement. One of the most popular resolutions is to quit smoking. Regardless of success rates (which I reckon isn’t very high), the fact that this vow is made so frequently, in itself, shows awareness that smoking is not a healthy lifestyle choice. Many people struggle for years to quit smoking; I tried unsuccessfully for several years before I finally kicked the habit three years ago.  
 
Oddly, of all of the Chinese smokers I’ve met, I don’t recall any of them ever considering to quit; my curiosity was piqued. How did smoking become such a fundamental element of Chinese life and perhaps more importantly, why are the Chinese so unremorseful about this habit while much of the western world is becoming increasingly smoke free? As I dug deeper, the information I came across was staggering – smoking in China isn’t just a harmful 老毛病 (bad habit), it’s a full-blown public health crisis. 
 
Take a look at some of the more telling figures, which I pulled from smokingstatistics.org:
1. In China approximately two thirds of men smoke; only 4% of women smoke but that figure is rising, especially amongst young women.   
 
2. China is the world's largest consumer of cigarettes, the number of smokers in China is estimated to be above 300 million, which is approximately the United States’ population. 
3. Every day, 3,000 smokers or past smokers in China die from tobacco related causes, this number is estimated to increase to 8,000 per day by 2050. That’s 1 million smoke related deaths per year, which will increase to about 3 million per year by 2050.  
4. The number one cause of mortality in China is lung cancer. 
5. China consumes a third of the world's tobacco but has only one fifth of the world's population. 
6. There is no age limit on the sale of tobacco products in China. 
 
Let’s start by asking, “Why is smoking so prevalent in China?” The answer isn’t hard to find; taxes on cigarettes are a multi-billion dollar source of revenue for the Federal government, reportedly generating 7% to 10% of their total tax intake. The revenue earned from state-run tobacco outweighs the additional burden on the healthcare industry by a five to one margin.  The Federal government controls the production, marketing and sale of tobacco and clearly has a vested interest in making cigarettes cheap and readily available to the public.   
 
altHowever, if one were to argue that public officials have a responsibility to protect their citizens and avert crises; one might find a conflict of interests here, especially in light of the health epidemic, that’s unfolding across the country.  In twenty years, one third of all Chinese males will die as result of tobacco related illness.  
 
This is where things start to get complicated. The China National Tobacco Corporation is under the jurisdiction of the State Tobacco Monopoly Administration. The deputy director of the STMA is Li Keming, the brother of China’s next premier Li Keqiang. China’s new president, Xi Jinping is a former smoker and his wife, the famous folk-singer Peng Liyuan is an ‘Anit-smoking Ambassador’ for the Chinese Association on Tobacco Control.  Both Xi and Li Keqiang are taking the reins of a Chinese economy which is entering an uncertain time; presumably they would be hesitant enacting any restrictions on tobacco that might have a negative impact on economic stability.  
 
Cheng Li, a senior fellow at the Brooking Institution in Washington D.C. brought these facts to light in a report issued in late 2012; he argues, “Paradoxically, Li’s personal/family ties with the tobacco industry might have prevented him from making a real effort to constrain cigarette production and consumption in the country”.  
 
Furthermore, public education about the dangers of smoking is practically non-existent. BBC News cited a study that evolved from a collaboration between Oxford University, the Chinese Academies of Preventative Medicine and Medical Sciences in Beijing and Cornell University in New York: “surveys showed that two-thirds of Chinese people think smoking does little or no harm, 60% think it does not cause lung cancer and 96% do not know that it causes heart disease.” 
 
In fact, the STMA website proudly lists the many virtues of smoking, claiming that cigarettes are an excellent way to prevent ulcers, boost your brain cells, speed up thinking, improve reaction time and increase working efficiency.  Chinese smokers often say that smoking fends off colds, increases immunity and keeps mosquitoes away; some even cite the longevity of Deng Xiaopeng and Mao Zedong, both heavy smokers who lived to 92 and 82, respectively, as a defence of smoking. About half of Chinese doctors smoke.  
 
In addition to the lacklustre efforts to educate the population about the dangers of smoking, the political will to make any changes is piecemeal at best. Laws were passed in 2011 which were supposed to bring the country in line with its commitment to the World Health Organisiation’s Framework Convention on Tobacco Control, but they are rarely enforced.  Additionally, the laws which forbid smoking in indoor public spaces were passed, without any penalty for infraction. This puts the burden of enforcement squarely on the owner of the establishment, meanwhile, most businesses either claim ignorance to the laws or argue that enforcing them would be detrimental to their business, therefore they aren’t worth the trouble.  
 
The other factor at play here of course is the cultural aspect. “A smoke after dinner is better than life after death.”  This famous Chinese saying paints a fairly precise picture of the attitude towards smoking in the Middle Kingdom. While non-smokers warn of the dangers from prolonged exposure to second-hand smoke, most smokers argue that it’s not only their right to light-up, but also deeply entrenched in their culture. Cigarettes are offered to new acquaintances to break the ice; smoking together helps build social bonds and cigarettes are frequently given as gifts to celebrate a special occasion or when a business deal is closed.  
 
These excuses are often voiced by smoking advocates; many say any reform can never take hold here because of the time-honoured cultural significance of cigarettes.  Spain’s successful public smoking-ban would suggest otherwise; the Iberian state is another country which has a deep cultural affection for smoking. Furthermore, the successes in Hong Kong and Taiwan to ban smoking in public indoor spaces demonstrate the feasibility of such measures on the mainland.    
 
The 2011 smoking-ban, although imperfect, could be seen as a step in the right direction. As with any problem in China, one of the biggest challenges is making changes that can be enforced amongst such a large population. Progress can’t happen overnight, so perhaps this is just one of several stages yet to come. That said, the clock is ticking, in the time it took to read this article, six Chinese people have died of smoke-related illness. With that in mind, I’d say it’s time for priorities to be re-evaluated, the fortitude to make real changes will show a lot of courage by the newly appointed leaders of the CPC. Perhaps they can learn a lesson from the great Chinese author Lu Xun, who begs, “Does force of habit blind a man to what is wrong?”
 

by Christopher Ribeiro 
 
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