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China Faces Growing Health Crisis from Prevalent Tobacco Use

May 31, 2010 at 12:00 AM EDT
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In the first of three global health reports from China, Ray Suarez examines the work of anti-tobacco advocates in China, where the government -- which is a huge producer of tobacco products -- has done little to quash the deadly smoking epidemic.
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GWEN IFILL: Next: the first of three reports about China from our Global Health Unit. This is World No Tobacco Day, when anti-tobacco advocates around the world hope to draw attention to the health risks of smoking.

As Ray Suarez reports, they have their work cut out for them in China.

RAY SUAREZ: No nation on Earth has more smokers than China — 350 million people here light up regularly, meaning China has more smokers than the United States has people. While warnings of dire health risks have pushed smoking rates down across the globe, tobacco consumption in China has quadrupled since the 1970s.

How is business? You selling more of — of expensive brands?

MAN (through translator): The living standard in China has improved. And it is easier to sell cigarettes, even sell expensive cigarettes. This one is a common gift.

RAY SUAREZ: Smoking in China is so popular that cigarettes are often the gift of choice for special occasions.

MAN (through translator): This one is for a wedding, red color, double happiness. This is also for a wedding. It too is double happiness.

RAY SUAREZ: China doesn’t just have the most smokers. It also has become both the largest producer and manufacturer of tobacco in the world. The industry here is twice the size of international tobacco giant Philip Morris.

Susan Lawrence, an anti-smoking advocate working in China, says the homegrown product is marketed very well.

SUSAN LAWRENCE, Campaign for Tobacco-Free Kids: It’s the Chinese cigarettes that dominate. And they are beautiful. The tobacco industry has been very successful here at trying to make them part of Chinese culture. So, Chinese cigarette packs, they have appropriated a lot of cultural symbols, iconic cultural symbols, the Great Wall, the Tiananmen Gate, the Huangguoshu waterfall, dragons, pandas.

And they’re beautifully designed packs. They’re beautiful things to give as gifts.

RAY SUAREZ: And this huge and successful industry is owned and operated by just one organization: the Chinese government.

Lawrence heads the Chinese wing of the Campaign for Tobacco-Free Kids, an initiative that supports local efforts to reduce tobacco use. Given the country’s smoking statistics, the initiative faces an uphill battle. About 60 percent of Chinese males smoke.

SUSAN LAWRENCE: A lot of men start smoking in the workplace, because they get offered cigarettes by their bosses or by other colleagues. And it somehow seems very rude not to accept. So, in China, you don’t — you don’t — you don’t see so much people smoking a cigarette by themselves. It’s very much a social thing.

So, you know, you offer the cigarettes around to everybody. And then you take one yourself. But, when you’re offered — when your boss offers you, a young worker, a cigarette, you can’t say no.

MAN (through translator): I quit smoking three times. The last time, I quit for one year.

RAY SUAREZ: Do you want to stop again?

MAN (through translator): I really want to quit, but I have been smoking for 30 years. And it’s so difficult to quit.

RAY SUAREZ: One million deaths a year in China are now attributed to smoking-related illnesses. Cigarette use is even prevalent among medical professionals. One out of three are still smoking.

Urologist Yong Yeng recently quit after 20 years as a smoker. Yeng says health concerns about smoking have been woefully underplayed in China.

DR. YONG YENG, resident of China: Even as a doctor, I still have — a little bit confused about how bad is smoking.

RAY SUAREZ: And one year after quitting, Dr. Yeng still has an occasional smoke.

DR. YONG YENG: In China, it is still difficult to tell your friends or refuse — refuse your friends to smoking sometimes.

RAY SUAREZ: The government has taken steps toward tobacco control. Advertisements depicting diseased lungs have appeared on television. And the government has signed an international public health treaty calling for higher taxes on tobacco, no smoking in public places, and a ban on tobacco advertisements. But implementing those pledges, says Lawrence, has been slow.

SUSAN LAWRENCE: The tobacco monopoly is not at all keen on having higher taxes. And the tobacco monopoly is very politically powerful. It’s a government agency and a corporation. They’re one and the same. They share the same personnel. And so they — the industry is essentially represented by a government agency, which has a say in most big decisions that get made about tobacco.

RAY SUAREZ: Even China’s own director of the National Office of Tobacco Control, Dr. Yang Gonghuan, speaks frankly about the obstacles she faces within her government.

DR. YANG GONGHUAN, director, China National Office of Tobacco Control (through translator): Tobacco control in China is very complicated. Our health ministry is very weak, and the budget for tobacco control is not enough.

RAY SUAREZ: As deputy director of China’s Center for Disease Control, Dr. Gonghuan says it’s time for the government to get out of the tobacco business.

DR. YANG GONGHUAN (through translator): If China wants to build a modern economy, we need to break the monopoly system. There are only a few monopolies left in China, and tobacco is one. When it’s a monopoly, the government has its own interests, so they’re not willing to do tobacco control.

RAY SUAREZ: In Yunnan Province, China’s tobacco country, farmers are in this season’s early growing stages, after months of drought. Following a local lottery, farmers here are given a parcel of land on which to grow tobacco. Crops are then sold at fixed government prices.

Xian Xu is 50 years old. On this day, she and her son-in-law, Long Yousan, work that parcel, caring for the fragile new tobacco plants.

Is it very hard work?

XIAN XU, tobacco farmer (through translator): Yes, a lot of hard work. We need to water each plant and fertilize and spray pesticides.

RAY SUAREZ: Once harvest season comes, her entire family will come to work the field. Last year, they made just over 1,300 U.S. dollars for a family of six.

XIAN XU (through translator): Our family depends on the field, and the field depends on the tobacco, especially when there is no food and we need the money to buy food for the family.

RAY SUAREZ: Tobacco pays the highest return of any crop these Yunnan farm families can grow. But it’s vital in another way. More than half the revenue for the provincial government, paying for the services for more than 50 million people, comes from the taxes on tobacco.

Although the government tobacco company declined an interview, China’s government often cites the jobs and services tobacco revenues provide as a reason to continue production. But, for smokers, there’s a heavy price to pay.

How has this sickness changed your life?

NIU YANQING, emphysema patient (through translator): I walk much slower than other people. And I cannot take stairs to get up to my apartment. I will get too out of breath. I cannot do any physical labor. And the doctor says I have lost my ability to work.

RAY SUAREZ: Niu is just 52 and has no disability insurance. A former machine operator at a government-owned factory, he and his wife are now supported by their daughter.

SUSAN LAWRENCE: Most people don’t have health insurance. So, most of the costs of getting ill aren’t borne by the government. They’re borne by individuals — 87 percent of medical expenses in China are borne by individuals. So, it’s not really a big cost to government. And I think that’s partly perhaps why parts of government have dragged their feet on this.

RAY SUAREZ: Anti-smoking advocates say China has yet to hit peak mortality rates for tobacco-related deaths, projecting that, by 2020, two million Chinese will die annually from using tobacco.

GWEN IFILL: Tomorrow, Ray reports on another major health problem in modern China: obesity.