At a typical Chinese wedding ceremony, instead of handing out
candy, the bride will go from table to table offering each male
guest a "wedding" cigarette, often an expensive brand to light up
as a mark of the new couple's hospitality. Even non-smokers are
expected to not turn down the gesture.
It is a simple example of how smoking is ingrained in modern-day
Chinese culture. The World Health Organization (WHO) estimates that
China has 350 million smokers, accounting for more than a quarter
of the world's 1.3 billion total.
In China, smoking claims one million lives every year. According
to WHO estimates, if the rate of smoking remains unchanged, the
death toll is likely to climb to 2.2 million a year by 2020, with
cancer, cardiovascular and respiratory diseases the big
killers.
According to a study published in the 2005 Chinese Journal of
Epidemiology, more than 460 million Chinese are regularly
exposed to secondhand smoke, the majority being women and
children.
Research in Shanghai showed that in families where one partner
smokes, the risk of a child contracting cancer is 50 percent higher
than for one whose parents don't smoke, a figure the WHO calls
"substantial".
A report released this week by the Ministry of Health said
100,000 Chinese people die every year from tobacco-related
illnesses caused by passive smoking.
Though estimates vary, it is clear that far more men smoke than
women. The smoking rate among men (aged over 15) is about 57 per
cent, compared to only 3.1 per cent for women.
Experts believe a shift in male attitudes will be key to
reducing smoking rates.
"Controlling smoking among males is 100 times more difficult
than the AIDS prevention work I was involved with six years ago,"
Jing Jun, a sociology professor at Tsinghua University and a heavy
smoker, said.
He said he had tried to quit several times but always
failed.
"It tortures my mind when I am not smoking. More importantly, a
smoking culture makes it difficult for smokers like me to be
completely isolated from tobacco," he said.
Jing seldom buys cigarettes as many people send him tobacco as
gifts. At many social functions, offering cigarettes is considered
a goodwill gesture and a conversation starter.
Fang Yuting, a family medical practitioner at Hemujia Hospital
in Beijng, said many of her foreign patients who quit smoking
before coming to China, picked up the habit again.
"It is difficult for my patients to find a smoke-free place to
conduct business discussions," Fang said.
"Particularly, Chinese businessmen tend to offer cigarettes to
them as a courtesy most of time, and it is difficult to
refuse."
Fang believes that having a smoke-free working and living
environment is particularly important for one to quit smoking. She
has compiled a list of smoke-free restaurants in Beijing, and gives
it to her patients.
According to Xu Guihua, deputy director of the Chinese
Association on Smoking Control, the smoking rate is commonly in
"reverse ratio" to the education level of social groups. Smoking is
much more prevalent among poor people in China.
However, interestingly, the smoking rate among male doctors is
very high compared to other countries, about 60 percent.
Xia Yang, a doctor at Beijing Shijitan Hospital, a non-smoker,
said many of his colleagues smoke.
"I think it is quite normal," he said. "Although they have more
health knowledge, doctors are no different from anyone else."
Many doctors start to smoke when they are medical students, Xia
said.
According to Xu, the smoking rate among young women,
particularly white-collar workers, and adolescents has climbed in
recent years.
The WHO estimates that because of the growing population and the
increase in smoking among 15-24-year-olds, the total number of
smokers in China rose by 30 million between 2002 and 2006.
Cigarette stores are ubiquitous and the choice of brands is
huge. Stores even sell candy and fruit-flavored cigarettes, perhaps
to lure kids and young women into smoking.
Also, most cigarettes stores have ice cream and soft drinks on
sale either in the window or directly outside the shop.
Despite an official ban on cigarette sales to anyone under 18,
children can still easily buy them.
Cigarettes in China are relatively inexpensive - the cheapest
ones selling for 2 per pack - compared to in Western countries,
which often levy high taxes on the tobacco industry, in some cases
as much as 66 percent of the retail price.
Xu said the tobacco industry sells pro-smoking images to kids
via movies - that it is cool, grownup and sexy. The WHO believes
tobacco advertising has become "sneakier" and more subtle.
Comparatively, the rising smoking rate among white-collar young
women is largely contributed to a desire to be more fashionable, Xu
said.
One company employee surnamed Wang said she believed smoking
rates among women was underestimated.
"I started smoking out of curiosity. Besides a comfortable
feeling from smoking, I feel it is cool and sexy."
She said she preferred cigarettes with a slight mint flavor, and
that she would never smoke in front of men or in public. Smoking
she reserves for when she's alone, or with female friends, she
said.
Although the government has said it wants to make the 2008 Summer Olympics in Bejiing smoke-free,
getting just some of the country's smokers to kick the habit will
be a huge challenge.
In 2003, the government signed the WHO Framework Convention on
Tobacco Control, which formally came into effect in January last
year.
The convention states that China must undertake steps to
implement effective legislative or administrative measures to
reduce smoking in indoor workplaces, public transport, indoor
public places and other places, where appropriate.
Ministry of Health spokesman Mao Qun'an said revised regulations
on health management in public areas with a new clause on smoking
control had been submitted to the central government for
examination and approval.
The new regulation states that "Smoking Forbidden" signs should
be posted in public spaces and anyone who breaks the law should be
fined.
The WHO signaled the urgent need for countries to make all
indoor public places and workplaces 100 percent smoke-free with the
release of its new policy recommendations, ahead of World No
Tobacco Day, today.
Henk Bekedam, the WHO representative in China is pleased with
progress so far, yet frustrated at its lack of speed.
"If I reflect on the past five years I've been here, I'm very
excited about China signing and ratifying the Framework Convention
on Tobacco Control," Bekedam said.
"We are at this very moment quite concerned in the sense that we
had hoped for more progress."
The WHO wants more progress in a number of areas including
stronger health warnings on cigarette packs, a complete ban on
tobacco advertising and for the government to raise taxes on
tobacco products.
China's tobacco industry is government-owned and operated.
"One of the concerns for the government is the potential loss of
revenue from increased tobacco taxation - based on the assumption
that reduced demand will mean less revenue," Bekedam said.
"This is not the case," he said.
"We know globally and also within China that if you raise
taxation by 10 percent, then normally what happens is that demand
(for cigarettes) will go down by 4-6 percent."
Bekedam called this a win-win situation, as revenue gains will
still outstrip losses in cigarette sales. Lives will also be saved,
and therefore lower public health expenditures.
Despite the WHO's relatively simple formula for success, more
public education is needed to get the anti-smoking message
across.
"We do not yet have enough change in behavior as a society. We
need to do an awful lot more in order to get there," Bekedam
said.
With such a large smoking population, a smoke-free China seems a
long way off, but for many anti-smokers, the Olympics could be a
positive catalyst for change.
Yang Yan, a research fellow with the smoking control office of
the Chinese center for disease control and prevention, said all
Olympic stadiums, the Olympic village and all restaurants with
BOCOG contracts should be smoke-free.
Also, other restaurants in Beijing should have at least 75
percent of their area designated as non-smoking, which Yang
believes will be the most difficult part to achieve.
In February, the Beijing municipal bureau of health sent a
notice to the owners of 40,000 restaurants in the capital of its
new smoking-control campaign.
However, few took notice as they believed banning smoking would
be bad for business.
"The smoking and drinking culture in restaurants is too deep to
change for Chinese people," Li Deyi, owner of Lilaodie Hotpot
Restaurant, said.
"Offering cigarettes to others when having meals is as common as
shaking hands. Unless there is a law to ban smoking in restaurants,
I would not forbid my visitors from smoking."
Yang said that they would continue to educate and negotiate with
restaurant owners on the smoking issue.
"The Olympics is a really good opportunity to change foreigners'
impressions of the Chinese smoking culture," she said.
"After the Olympics, we hope all smoking control policies will
be maintained."
(China Daily May 31, 2007)