China

By Jiang Yuan, Deputy Director, National Center for Chronic and NCD Control and Prevention, China


Tobacco was first brought to China more than 400 years ago. Tobacco production in China currently accounts for one third of world’s total production. There are about 350 million smokers in China, consuming one third of the world’s tobacco products.

Smoking prevalence has been falling in China for more than 20 years. The current overall smoking prevalence is 31.4%, compared to a previous high of 35.8%. Male smoking prevalence has fallen from a high of 66% to 57.4%. However, smoking prevalence is rising rapidly among adolescents and urban women. Successful quit rates are low. More than half of the population, in particular children, are exposed to secondhand smoke every day. The daily rate of cigarette consumption is increasing. Awareness of the adverse health effects of tobacco use is poor, even among medical professionals.

The mortality statistics for smoking related deaths in China are particularly alarming. It is estimated that about one million deaths each year can currently be attributed to smoking. This figure is expected to rise to three million by 2050 if current smoking patterns continue.

China does not have national laws or regulations specifically banning smoking in public places. The current provisions stipulate that smoking is banned in thirteen types of public places, including cinemas and theaters, music halls, sports arenas, libraries, museums, shops and waiting rooms for public transport⁽¹⁾ . China has ratified the WHO Framework Convention on Tobacco Control.

In 1991, National People’s Congress passed the Tobacco Monopoly Law of the People’s Republic of China. The General Principles of this law stipulate that “the State and society shall strengthen the publicity and education of the health hazards of smoking, and prohibit or restrict smoking in public transport and public places.” Legislation also prevents smoking in classrooms and other places where children and young people gather.⁽²⁾ Laws relating to smoking on public transport were strengthened in 1997.⁽³⁾

Local law enactment to ban smoking in public places first began in 1993. By October 2006 154 cities across China had enacted regulations to ban smoking in public places. However, several deficiencies remain:

Only 45.7% of prefecture-level cities and above in China have tobacco control regulations The remainder have no tobacco control regulations at all.

Where regulations exist, there are a limited number of places where smoking is banned (see above). Only Guangzhou and Shenzhen have banned smoking in air-conditioned restaurants. Workplaces such as offices are not included in any of the local regulations.

The restrictions are vague and difficult to implement, and the law enforcement body is unclear on the regulations. For example, some articles stipulate that those who violate laws will be given “administrative penalties” or will be “penalized according to related regulations”, but no detailed penalty is described.

As early as 1983, the Civil Aviation Administration of China enacted a ban on smoking on domestic flights in China. In 2003 it enacted a complete smoking ban on all domestic and international flights, which was the first ban on smoking across an entire industry. Most express trains to Beijing have become smoke-free, a prelude to a smoking ban for the railway industry. With the increasing speed and modernization of trains, express trains began enforcing comprehensive smoking bans in April 2007.

In 2005, the Chinese Center for Disease Control and Prevention (China CDC) surveyed the tobacco control situation in fourteen provincial CDCs, and found that only four (28%) had partial or complete bans on smoking. CDCs should be the model for tobacco control, but less than one third of the organizations have any regulations. It is safe to conclude that if this is the case with CDCs, and it is even more challenging to control tobacco in other industries.

The social norms in China do not support tobacco control measures. However, the Beijing Olympics in 2008 have been declared smokefree. This is significant as these are the first Olympic games since FCTC ratification. The tobacco industry provides the Chinese government with significant amounts of tax each year, so it is likely they will oppose measure to control tobacco use in China.

The Bloomberg Global Initiative can enhance the tobacco control network and capacity, and help move towards a smokefree China.

References
⁽¹⁾ The Ministry of Health’s 1991 Detailed Implementation Rules for the Public Place Hygiene Management Regulation.
⁽²⁾ Law on the Protection of Minors of the people’s Republic of China (27th article) 1991
⁽³⁾ Regulations on Prohibiting Smoking in Public Transport and Waiting Rooms (1997)- The National Patriotic Public Health Campaign Committee, Ministry of Health, Ministry of Railroads, Ministry of Communications, Ministry of Construction, and Civil Aviation Administration