China Tries to Kick the Public Smoking Habit

Smoker in Nanjing, China. Photo by Flickr user J. Unrau.

When the NewsHour’s global health team visited China last year for stories on tobacco, obesity and other health issues, they found a smoker’s paradise and an anti-tobacco advocate’s nightmare.

People lit up constantly in restaurants and parks, cigarettes made popular gifts for special occasions and business was hopping at tobacco shops. The country has an estimated 350 million smokers, more people than the entire population of the United States. More than half of adult men smoke.

“If you’re trying to quit, don’t come here,” wrote Ray Suarez. “The telltale odor of smoke, or a just-stubbed out butt, seems ever present.”

A new government policy banning smoking in public venues is now aiming to put a dent in the country’s smoking culture, or at the very least make smoking more inconvenient.

Watch the NewsHour’s 2010 report on tobacco use in China:

Starting this week, China’s Ministry of Health is strengthening its tobacco rules to require 28 types of businesses, including bars, coffee shops, hotels and stadiums to become 100 percent smoke-free. A notable exception to the regulation is office buildings.

“This is really an encouraging first step … it really sets a baseline for local governments and provincial governments,” said Kathy Chen, China director for the Campaign for Tobacco-Free Kids.

The government move is especially significant because the tobacco industry in China is a state owned and controlled monopoly. Cigarettes are big business, with taxes on tobacco products bringing in at least 5 percent of the government’s total revenue.

The decision brings China closer to fulfilling the tenants of the World Health Organization’s global anti-tobacco treaty, which the country backed five years ago but has been slow to implement.

“What is going to be key is public support and a social norm change where non smokers feel like they have the right to tell smokers ‘This is a non-smoking place, please put out your cigarette,'” said Chen.

The new policy requires business owners to post no smoking signs, and delegate staff to stop people from lighting up. Outdoor smoking areas must be away from sidewalks, and cigarette vending machines will no longer be allowed in public places.

Fines for business owners who violate the rules could range from 1,000 yuan (about $150) to 30,000 yuan (about $4,600), according to the new policy, but there are still questions about how the regulation will be enforced on a local level, and whether these fines will really be imposed.

“Publicizing a regulation is one thing, forcefully implementing it is another,” said Yuanli Liu, the director for the China Initiative at the Harvard School of Public Health who is serving as part of the health policy and management committee for the Chinese government. He warns the policy can be undermined easily if local governments, many of which benefit from the tobacco industry and sales, don’t buy into the regulation.

“This change will take a while, you don’t expect this new policy to become a panacea, a silver bullet to fix all the problems,” he said.

The tobacco industry and the government are intertwined in China but the policy doesn’t mean promotion of tobacco will stop. Liu noted tactical counter campaigns by the tobacco industry have already begun in response to these regulations, including promotion of new lower nicotine brands and publicizing charitable donations.

But unlike similar bans enacted in cities in the United States, there has not been an organized push-back from owners of bars and restaurants, said Chen, who has been monitoring media coverage in papers across China.

For the policy to make a real impact, Liu argued more needs to be done to educate the public and health workers about the real dangers of tobacco in tandem with new regulations.

“There is still a lack of strong belief in the harmful effects of smoking. People will cite examples of visible leaders who were chain smokers, like Chairman Mao, and lived a long life,” Liu said. Many doctors and medical students are also smokers, sending mixed signals to patients.

But the down-side to having so many people lighting up is also becoming evident. As Suarez reported last year, one million deaths a year in China are now attributed to smoking-related illnesses, and worker productivity is lost to these diseases as well.

“There is increasing awareness because of the alarming rates of growth of non communicable disease, of lung disease, stroke, cardiovascular disease,” Chen said. “You see the balance starts to tip.”

While many remain skeptical of how the new regulation will play out, Chen points to the recent push before the 2008 Beijing Olympics to make the city smoke free as an example that change is possible. Hotel lobbies in the city used to be wall to wall smoke, she said but since the efforts that has changed.

“Making it inconvenient and socially unacceptable to smoke does become a driver for people to quit,” she said.

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