China Struggles to Curtail Public Smoking

BEIJING (Oct. 12) -- It's no longer cool to light up in many public places in China, but the country still faces a massive challenge getting its men in particular to kick the habit.

In July, Beijing authorities announced tougher bans on smoking in kindergartens, as well as in elementary, secondary and vocational schools, and prohibited tobacco advertising and told teachers not to smoke in front of students. The new measures are only the latest in a series of anti-smoking measures municipal and national officials have taken in recent years.

Yet as the fact that smoking in kindergartens is still an issue suggests, China has a long way to go to curtail smoking. There are 301 million adult smokers in China, overwhelmingly men, and their habit affects the health of another 540 million people passively exposed to cigarette smoke.

The World Health Organization has estimated that a third of the world's cigarettes are smoked in China. A study released this month by the International Tobacco Control Policy Evaluation Project found that 1.1 million Chinese die annually from tobacco-related illnesses, a toll that is expected to rise to 2 million by 2020.

The International Tobacco Control study also found that Chinese cigarettes contain three times the levels of lead, cadmium and arsenic as cigarettes in Canada.

Despite government education efforts, only 68 percent of Chinese smokers recognize a link to lung cancer, and just 36 percent know that it contributes to coronary heart disease.

It has taken the U.S. decades to move from the surgeon general's 1962 report that smoking could cause serious health problems to broad enforcement of no-smoking rules in public places. China still has much of that trajectory ahead.

A few large cities like Beijing have already successfully banned smoking in subway stations, indoor markets and theaters. But restaurants, some workplaces and hospitals -- where visitors, patients and doctors routinely light up, especially in rural locales -- remain problem areas.

A current regulation requires restaurants in the capital to have separate areas for smokers and nonsmokers. But most neighborhood eateries ignore the rule, and many diners don't hesitate to light up regardless of what the sign on the wall says.

Nonsmokers who lodge complaints usually get nowhere.

Rob Hemsley, a 27-year-old nonsmoker from Britain, has occasionally complained to managers in Beijing restaurants whenever someone smokes in a nonsmoking area.

He spoke up one July evening at a restaurant in a local shopping mall after a patron at the next table lit up despite several "no smoking" signs. The manager told Hemsley the restaurant could not stop people from smoking.

"She said, 'Our customers do what they want. People smoke anywhere in the mall, and we can't stop them,'" Hemsley recalled.

Nevertheless, China is moving on many fronts to police its smoking public and change their habits.

The Chinese government is working on a national smoking regulation to meet an early January deadline for an international WHO anti-tobacco agreement it signed five years ago to fully ban indoor smoking in all public venues nationwide as well as tobacco product-related advertising, promotion and sponsorship.

It's not the first time the Chinese have tried to impose a smoking policy. In 1995, Beijing officials enacted a ban on smoking inside several public buildings, including hospitals, elementary and secondary schools, museums, libraries, post offices, banks, theaters, stadiums and public transportation vehicles. Several other cities did the same, but all of them came up short on enforcement and punishment.

In 2008, the government tried hard to comply with its promise for a smoke-free Summer Olympics. When bar and restaurant owners opposed it, fearing it would drive away their customers, a revision was issued requiring separate areas for smokers and nonsmokers. Yet restaurants that failed to comply largely went unpunished.

Dr. Sarah England, who oversees the Tobacco Free Initiative at the WHO in China, wrote in an e-mail that there likely will be a slight delay in China's implementation of the new smoking ban because the Ministry of Health has been wrapped up in an overhaul of the country's health sector for the past two years.

But she added, "We expect that China will comply in due course and in good faith."

Many of those familiar with the issue say the government must commit to enforcing a 100 percent ban -- not a partial one -- inside all public buildings and impose clear-cut fines and penalties on restaurants, offices and other venues that break the rule.

Other possible barriers abound, including an apparent conflict between the state's ongoing restructuring of its tobacco industry -- a key pillar of China's economy -- and its commitment to smoke-free indoor public places.

The tobacco industry's total profit, including tax revenue, hit $76.1 billion last year, a 12 percent increase over the 2008 figure, according to Euromonitor International. The boost mainly came from a significant hike in the excise tax on tobacco products, so the double-digit rise won't repeat itself this year, said Kevin Zhu, a Euromonitor analyst based in Shanghai.

Nevertheless, several municipal governments in large cities other than Beijing have taken recent actions to create smoke-free environments in public venues.

• Earlier this year, Shanghai prohibited smoking in a dozen kinds of public places during the run-up to the World Expo.
• A similar law went into effect in Hangzhou, capital of Zhejiang Province, forbidding smoking in hospitals, supermarkets, bars, cinemas and public transportation.
• In September, a law took effect in Guangzhou city in southern China, prohibiting smoking in most public places, while allowing larger businesses to designate separate areas for smokers, before the start of the Asian Games in November.

The burgeoning municipal movements to get a handle on smoking have left some optimistic that the new national legislation will make real headway.

"As home to one-third of the world's smokers and the biggest tobacco company in the world, China has the potential to change the global course of the tobacco epidemic and prevent millions of needlessly premature deaths, suffering and economic losses," England wrote.