Health reforms to change China's smoking culture

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The emperor weighed the arguments and decided to end the ban -- although it failed to stop his throne being toppled in 1644 by the Manchu.

Today, tobacco is deeply entwined into the national culture from the compulsory cigarettes given to male guests at almost every wedding to the glossy images of national icons that adorn cigarette packets.

China's smokers puff their way through a bounty of cigarettes given as gifts on special occasions and holidays.

Like Chongzhen, modern China is also at war, but this time the enemy is tobacco and it is estimated to kill a million Chinese each year, says Yang Gonghuan, deputy head of China's National Tobacco Control Office.

And, like the old emperor, the government today must weigh up conflicting interests: as it extends healthcare insurance across the population, at what point do the economic and medical costs of smoking-related illnesses outweigh the financial benefits of the tobacco industry?

The number of deaths is expected to double by 2025 and triple by 2050 if China fails to reduce tobacco consumption, says Yang, also deputy head of the Chinese Center for Disease Control and Prevention (CDC).

A total of 301 million Chinese -- 28 percent of the population -- inhales a steady diet of cigarettes, according to a survey released by China CDC, the World Health Organization (WHO) and the US CDC in August.

The reduction in the number of smokers in China has been negligible, even in the five years since China ratified the WHO Framework Convention on Tobacco Control (FCTC), says Yang.

The number of smokers declined by 0.45 percent annually from 2003 to 2010, less than the 0.9 percent from 1996 to 2002, said Yang, citing a report to be published on Jan 9 next year.

Foxes vs chickens

China's tobacco consumption has been steadily growing, from 589.9 billion cigarettes in 1978 to about 2.3 trillion last year, according to the China National Tobacco Corporation (CNTC) website.

The most effective action to control tobacco consumption is to let the Ministry of Health or a new ministerial-level department take over the task of tobacco control, Yang says.

However, the ministry that sells tobacco also oversees the implementation of the anti-tobacco treaty, she says.

"It's like a bunch of foxes in the chicken coop discussing how to protect the chickens."

The CNTC, the world's largest cigarette maker, which produces more than 95 percent of China's tobacco products, is part of the State Tobacco Monopoly Administration (STMA), in turn part of the Ministry of Industry and Information Technology (MIIT).

The industry's political status, implied by the fact that the head of the STMA is also deputy head of the MIIT, allows it to influence public health policy in a way most other countries would not countenance.

The MIIT's attitude toward tobacco control was reflected in the words of Li Yizhong, the MIIT minister at the the National Tobacco Work Conference in January.

"It is our core task to control the tobacco leaf production scale," he said, before adding, "Great efforts must be taken to raise the efficiency of the tobacco industry and achieve good and fast development."

Tomorrow's burden

However, new studies are challenging the prevailing belief -- even among non-smokers -- that the tobacco industry is too important to the economy to discourage its development.

Tobacco generated 513.1 billion yuan ($77.3 billion) in taxes and profits last year, more than 7.5 percent of the total central government revenues, and employed 520,000 workers in 183 factories, said Zhang Xiulian, spokesman of the STMA, in a press conference in January.

Although the proportion of government revenues from the tobacco industry has been falling -- from 11.5 percent in 1995 to 7.5 percent last year -- Yang says the decline mainly stems from the growth of other industries.

The absolute production value of the industry rose from 100 billion yuan in 1978 to 513.1 billion yuan last year, and, she points out, "The economic cost arising from tobacco use has long been underestimated."

Citing the report to be released in January 2011, she argues the net contribution of tobacco to China's economy is about minus 20 percent.

That means the losses caused by smoking outweigh the taxes and profits it generates by about 20 percent, says Yang.

The calculation is backed by a study by the China Center for Economic Research at Peking University, Peking University's People's Hospital and the Department of Economics of Stockholm University in September 2008.

In 2005, tobacco caused direct medical costs of 166.6 billion yuan and indirect costs -- in the forms of productivity loss, years of potential life lost, and loss from fires and pollution -- of 120.5 billion yuan, resulting in a total loss of 287 billion yuan, 19.6 percent more than the 240 billion yuan in taxes and profits the industry generated.

Given that diseases and fatalities caused by tobacco use have a time lag of 20 to 25 years, it is not this government that will have to pay the medical bills for the mass addiction to the weed, says Zhi Xiuyi, head of the Lung Cancer Diagnosis and Treatment Center of the Capital Medical University in Beijing.

Cases of lung cancer in China have soared by 465 percent since 1980, and account for nearly a quarter of cancer deaths, says Zhi, also head of the department of tobacco control and lung cancer prevention at the Cancer Foundation of China.

In the past, when individuals, work units and companies covered health insurance and medical care, the nominal cost to the government was negligible, says Zhi.

However, the government is rolling out its own health insurance program across the country, so it will become more liable for the costs of smoking-related illnesses, he says. "At the end of the day, all Chinese, including non-smokers, will be burdened with the medical costs of smokers."

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