China
Overview
Prevalence of Tobacco Use
Cost of Tobacco Use
Tobacco-Related Health Information
Tobacco Use in the Workplace
Tobacco Cessation Treatment Options
Resources
Citations
Overview
More people in China use tobacco than in any other nation in the world. In fact, one out of every three cigarettes smoked in the world is in China.1 Chinese smokers spend an average of 60% of their personal income and 17% of household income on cigarettes.1 China is the world's largest tobacco producer, accounting for about a quarter of global tobacco leaf production.1 The tobacco industry holds a large amount of power in China's economic growth and financial income. In 2005, cigarette sales generated $32.5 billion in taxes and profits in China (7.6% of the government's total revenue).2
Although tobacco use is a significant public health challenge in China, there are very few tobacco cessation programs available to the public and even fewer offered in the workplace. Additionally, lack of tobacco policies, cultural norms around tobacco use, and government support makes change within Chinese society challenging. In 2005, the Chinese government spent only $31,000 on tobacco control.2 However, China is slowly taking steps towards promoting national tobacco cessation, as China declared the 2008 Beijing Olympics smoke-free.
Prevalence of Tobacco Use
China has 350 million smokers. This is a staggering number, as this is more people than the populations of Russia, Germany, and Japan combined.3 Smokers in China consume 3 million cigarettes every minute.1
- There is a strong negative cultural stigma associated with Chinese women who smoke. Women who smoke are thought to have bad morals. As a result, tobacco use is much more common among men than women.
- 67% of men use tobacco.1
- 3% of women use tobacco.1
- Children in China begin smoking at a young age. Peking University conducted a survey of over 100,000 students which revealed that middle school smokers (on average) took their first puff before age 11.4
Smoking has become a very dominant and important social activity in daily Chinese life. It is believed by many that "a cigarette after a meal makes you happier than gods in heaven."4
Boxes of cigarettes are common gifts to friends, family, professors, and people in government jobs.4 When a man visits friends, family or colleagues at home, it is customary to offer him cigarettes. To decline a cigarette in such circumstances is seen as socially inappropriate.
In addition to cigarettes, smokeless tobacco is commonly used in China, especially among youth. Common types of smokeless tobacco in China include:
Cost of Tobacco Use
In 2000, smoking cost China US$5 billion in healthcare costs and lost productivity. During that year it is estimated that China spent over US$1.7 billion in direct health costs related to smoking.5
Tobacco-Related Health Information
About 3,000 people die every day in China from smoking-related illnesses, translating into over 1 million deaths per year.1,2 This is 2.5 times the rate of death from tobacco in the United States.2 Furthermore, the death toll in China will double by 2025 if smoking rates are not reduced.2
Over two-thirds of all deaths related to smoking in China are attributed to lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD).6 It is estimated that 25 million people die each year from COPD in China, of which 72% were smokers.6 By the year 2030 the number of years of productive life lost to cardiovascular disease (CVD) will increase by 57%.7
Tobacco Use in the Workplace
The largest cigarette manufacturer monopoly in the world is in China. As a result, the tobacco industry influences China's health and policy. Thus, the Chinese government is reluctant to promote smoking cessation because it will suffer economic losses as a result.
- China is the world's largest tobacco producer, accounting for about a quarter of global tobacco leaf production.1
- There are very high taxes on foreign cigarettes because the Chinese government wants people to buy local brands and support the local economy.
- In 2005, cigarette sales generated $32.5 billion in taxes and profits in China (7.6% of the government's total revenue).2
- About 100 million Chinese depend directly or indirectly on the tobacco industry.8
- Millions of tobacco farmers are employed by the tobacco industry. In some rural areas tobacco farming is the only industry.2
- In some remote, poor sections of China, local governments depend on tobacco sales for more than 50% of their revenue.2
- A ban on smoking would require a re-adjustment of the internal industrial infrastructure.
- Reduced tobacco consumption would cause an increase in unemployment among many low-income earning and unskilled workers with limited options.
Although tobacco use is a public health challenge in China, there are few tobacco cessation programs available to the public and even fewer offered in the workplace. The Chinese government is beginning to implement laws and policies to reduce tobacco use. These include the World Health Organization Framework Convention on Tobacco Control, smoking bans, and cigarette warning labels.
- World Health Organization Framework Convention on Tobacco Control (FCTC)
- The first international treaty that aims to reduce death and disease caused by the global tobacco epidemic.
- China signed the framework on November 10, 2003.
- Currently, 168 countries have signed the FCTC.9
- As a part of the framework, all tobacco advertising and promotions will be banned by 2011 in China.10
- In an effort to reduce tobacco use, China declared the 2008 Olympic Games in Beijing as "non-smoking."
- The Global Health Benefits Institute (GHBI) of the National Business Group on Health is supporting a smoke-free worksite initiative. This initiative seeks to have employers to sign a declaration to make worksites in Beijing smoke-free by 2010.
- The city of Hong Kong banned smoking in restaurants, workplaces, schools, and public parks on January 1, 2007. People who violate this law could pay up to a $644 fine.11
- At the end of 2007, all cigarette manufacturers were required to put mandatory new images on their packages. These images visually illustrate the impact of smoking and include a cancerous lung and diseased gums.
- Smoking is allowed in nightclubs, bars for those 18 and above, mahjong parlors, bathhouses, and massage establishments until July 1st, 2009.
Tobacco Cessation Treatment Options
Although smoking cessation programs are not strongly promoted or widely used, there are various treatment options available to smokers. Quitlines were the first smoking cessation project in China. Smoking cessation telephone services are offered free of charge. The successful quit rates through this service are similar to those used in Westernized countries.12
Medications are also available to those who want to quit smoking. The non-nicotine drug, bupropion SR (trade name Wellbutrin® and Zyban®), is available with a prescription. In addition, nicotine patches and nicotine replacement drugs are available in China and are growing in popularity. However, cost is sometimes a deterrent. As a result, many customers with tight budgets look online for cheaper alternatives. Unfortunately, nicotine replacement drugs purchased online are often counterfeit. Counterfeit drugs ineffectively treat symptoms and possibly cause hazardous health risks to the user.
The Hospital Authority Smoking Counseling and Cessation Centres were initiated in Hong Kong as part of an effort to start smoking cessation programs. They include counseling by health care professionals, nicotine replacement therapy, and cessation services at 16 different centers.13 In addition, these centers provide information and support for smoker's family and friends. Furthermore, in 1987, Hong Kong followed the WHO's recommendations and formed a group to focus on lowering tobacco use.14 This group is called the Hong Kong Council on Smoking and Health.
Resources
Citations
1 World Health Organization. Regional office for the western pacific. Smoking statistics. Available at: http://www.wpro.who.int/media_centre/fact_sheets/fs_20020528.htm. Accessed October 30, 2007.
2 Wright A, Katz I. Tobacco tightrope-balancing disease prevention and economic development in China. NEJM. 2007;356:1493-1496.
3 Lawrence D. Ban smoking in China? A state-run industry has objections. International Herald Tribune. 2007 Mar 14. Available at: http://www.iht.com/articles/2007/03/14/business/tobacco.php. Accessed March 19, 2008.
4 Lost in the haze. People's daily online. 2007 Oct 10; Available at: http://english.people.com.cn/90001/90782/6280090.html. Accessed December 11, 2007.
5 Campaign for Tobacco-Free Kids. China tobacco burden facts. Available at: http://tobaccofreecenter.org/files/pdfs/reports_articles/China_tob_burden_en.pdf. Accessed June 10, 2008.
6 Zhang H, Cai B. The impact of tobacco on lung health in China. Respirology. 2003;8(1):17-21.
7 American Heart Association. International cardiovascular disease statistics. Available at: http://www.americanheart.org/downloadable/heart/1140811583642InternationalCVD.pdf. Accessed November 6, 2007.
8 Zhong W. China: A smoker's paradise. Asia Times. 2006 Jul 11. Available at: http://www.atimes.com/atimes/China_Business/HG11Cb01.html. Accessed March 19, 2008.
9 World Health Organization. WHO Framework Convention on Tobacco Control (WHO FCTC). Available at: http://www.who.int/fctc/en/. Accessed July 23, 2008.
10 Beijing taxis to become smoke-free. Tobacco Journal International. 2007 Sept 21.
11 Hong Kong wakes up to new smoking ban. MSNBC: Asia. 2007 Jan 2. Available at: http://www.msnbc.msn.com/id/16440509/. Accessed December 11, 2007.
12 Abdullah ASM, Lam T-H, Chan SSC, and Hedley AJ. Which smokers use the smoking cessation Quitline in Hong Kong, and how effective is the Quitline? Tobacco Control 2004;13:415-421.
13 Tobacco Control Office Department of Health. Smoking cessation clinics. Available at: http://www.tco.gov.hk/textonly/english/quitting/quitting_scc.html. Accessed June 9, 2008.
14 Hong Kong Council on Smoking and Health. Available at: http://www.smokefree.hk/cosh/ccs/index.xml?lang=en. Accessed June 9, 2008.
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