At a typical Chinese wedding ceremony, instead of handing out candy, the
bride will go from table to table offering each male guest a "wedding"
cigarette, often an expensive brand to light up as a mark of the new couple's
hospitality. Even non-smokers are expected to not turn down the gesture.
It is a simple example of how smoking is ingrained in modern-day Chinese
culture. The World Health Organization (WHO) estimates that China has 350
million smokers, accounting for more than a quarter of the world's 1.3 billion
In China, smoking claims one million lives every year. According to WHO
estimates, if the rate of smoking remains unchanged, the death toll is likely to
climb to 2.2 million a year by 2020, with cancer, cardiovascular and respiratory
diseases the big killers.
According to a study published in the 2005 Chinese Journal of Epidemiology,
more than 460 million Chinese are regularly exposed to secondhand smoke, the
majority being women and children.
Research in Shanghai showed that in families where one partner smokes, the
risk of a child contracting cancer is 50 percent higher than for one whose
parents don't smoke, a figure the WHO calls "substantial".
A report released this week by the Ministry of Health said 100,000 Chinese
people die every year from tobacco-related illnesses caused by passive smoking.
Though estimates vary, it is clear that far more men smoke than women. The
smoking rate among men (aged over 15) is about 57 per cent, compared to only 3.1
per cent for women.
Experts believe a shift in male attitudes will be key to reducing smoking
"Controlling smoking among males is 100 times more difficult than the AIDS
prevention work I was involved with six years ago," Jing Jun, a sociology
professor at Tsinghua University and a heavy smoker, said.
He said he had tried to quit several times but always failed.
"It tortures my mind when I am not smoking. More importantly, a smoking
culture makes it difficult for smokers like me to be completely isolated from
tobacco," he said.
Jing seldom buys cigarettes as many people send him tobacco as gifts. At many
social functions, offering cigarettes is considered a goodwill gesture and a
Fang Yuting, a family medical practitioner at Hemujia Hospital in Beijng,
said many of her foreign patients who quit smoking before coming to China,
picked up the habit again.
"It is difficult for my patients to find a smoke-free place to conduct
business discussions," Fang said.
"Particularly, Chinese businessmen tend to offer cigarettes to them as a
courtesy most of time, and it is difficult to refuse."
Fang believes that having a smoke-free working and living environment is
particularly important for one to quit smoking. She has compiled a list of
smoke-free restaurants in Beijing, and gives it to her patients.
According to Xu Guihua, deputy director of the Chinese Association on Smoking
Control, the smoking rate is commonly in "reverse ratio" to the education level
of social groups. Smoking is much more prevalent among poor people in China.
However, interestingly, the smoking rate among male doctors is very high
compared to other countries, about 60 percent.
Xia Yang, a doctor at Beijing Shijitan Hospital, a non-smoker, said many of
his colleagues smoke.
"I think it is quite normal," he said.
"Although they have more health knowledge, doctors are no different from
Many doctors start to smoke when they are medical students, Xia said.
According to Xu, the smoking rate among young women, particularly
white-collar workers, and adolescents has climbed in recent years.
The WHO estimates that because of the growing population and the increase in
smoking among 15-24-year-olds, the total number of smokers in China rose by 30
million between 2002 and 2006.
Cigarette stores are ubiquitous and the choice of brands is huge. Stores even
sell candy and fruit-flavored cigarettes, perhaps to lure kids and young women
Also, most cigarettes stores have ice cream and soft drinks on sale either in
the window or directly outside the shop.
Despite an official ban on cigarette sales to anyone under 18, children can
still easily buy them.
Cigarettes in China are relatively inexpensive - the cheapest ones seeling
for 2 per pack - compared to in Western countries, which often levy high taxes
on the tobacco industry, in some cases as much as 66 percent of the retail
Xu said the tobacco industry sells pro-smoking images to kids via movies -
that it is cool, grownup and sexy. The WHO believes tobacco advertising has
become "sneakier" and more subtle.
Comparatively, the rising smoking rate among white-collar young women is
largely contributed to a desire to be more fashionable, Xu said.
One company employee surnamed Wang said she believed smoking rates among
women was underestimated.
"I started smoking out of curiosity. Besides a comfortable feeling from
smoking, I feel it is cool and sexy."
She said she preferred cigarettes with a slight mint flavor, and that she
would never smoke in front of men or in public. Smoking she reserves for when
she's alone, or with female friends, she said.
Although the government has said it wants to make the 2008 Summer Olympics in
Bejiing smoke-free, getting just some of the country's smokers to kick the habit
will be a huge challenge.
In 2003, the government signed the WHO Framework Convention on Tobacco
Control, which formally came into effect in January last year.
The convention states that China must undertake steps to implement effective
legislative or administrative measures to reduce smoking in indoor workplaces,
public transport, indoor public places and other places, where appropriate.
Ministry of Health spokesman Mao Qun'an said revised regulations on health
management in public areas with a new clause on smoking control had been
submitted to the central government for examination and approval.
The new regulation states that "Smoking Forbidden" signs should be posted in
public spaces and anyone who breaks the law should be fined.
The WHO signaled the urgent need for countries to make all indoor public
places and workplaces 100 percent smoke-free with the release of its new policy
recommendations, ahead of World No Tobacco Day, today.
Henk Bekedam, the WHO representative in China is pleased with progress so
far, yet frustrated at its lack of speed.
"If I reflect on the past five years I've been here, I'm very excited about
China signing and ratifying the Framework Convention on Tobacco Control,"
"We are at this very moment quite concerned in the sense that we had hoped
for more progress."
The WHO wants more progress in a number of areas including stronger health
warnings on cigarette packs, a complete ban on tobacco advertising and for the
government to raise taxes on tobacco products.
China's tobacco industry is government-owned and operated.
"One of the concerns for the government is the potential loss of revenue from
increased tobacco taxation - based on the assumption that reduced demand will
mean less revenue," Bekedam said.
"This is not the case," he said.
"We know globally and also within China that if you raise taxation by 10
percent, then normally what happens is that demand (for cigarettes) will go down
by 4-6 percent."
Bekedam called this a win-win situation, as revenue gains will still outstrip
losses in cigarette sales. Lives will also be saved, and therefore lower public
Despite the WHO's relatively simple formula for success, more public
education is needed to get the anti-smoking message across.
"We do not yet have enough change in behavior as a society. We need to do an
awful lot more in order to get there," Bekedam said.
With such a large smoking population, a smoke-free China seems a long way
off, but for many anti-smokers, the Olympics could be a positive catalyst for
Yang Yan, a research fellow with the smoking control office of the Chinese
center for disease control and prevention, said all Olympic stadiums, the
Olympic village and all restaurants with BOCOG contracts should be smoke-free.
Also, other restaurants in Beijing should have at least 75 percent of their
area designated as non-smoking, which Yang believes will be the most difficult
part to achieve.
In February, the Beijing municipal bureau of health sent a notice to the
owners of 40,000 restaurants in the capital of its new smoking-control campaign.
However, few took notice as they believed banning smoking would be bad for
"The smoking and drinking culture in restaurants is too deep to change for
Chinese people," Li Deyi, owner of Lilaodie Hotpot Restaurant, said.
"Offering cigarettes to others when having meals is as common as shaking
hands. Unless there is a law to ban smoking in restaurants, I would not forbid
my visitors from smoking."
Yang said that they would continue to educate and negotiate with restaurant
owners on the smoking issue.
"The Olympics is a really good opportunity to change foreigners' impressions
of the Chinese smoking culture," she said.
"After the Olympics, we hope all smoking control policies will be
(China Daily 05/31/2007 page4)