Smoke-free China a marathon challenge
Gates Foundation helping push for healthful cultural revolution in nation that smokes one-third of the world's cigarettes.
Seattle Times staff reporter
Smoking in China• One of every three cigarettes consumed worldwide is smoked in China.
• Smoking will kill about a third of all young Chinese men alive today (under 30 years).
• More than 3,000 people die every day in China due to smoking, about 1.1 million each year.
• More than 350 million Chinese are smokers — more than the entire U.S. population. They consume an estimated 1.7 trillion cigarettes per year.
Source: World Health Organization, 2002, 2005
BEIJING — Chinese fans are watching the Olympics on TV, puffing on cigarettes in a smoke-filled bar. Suddenly, when the Chinese team scores, they crush out their cigarettes and jump up to cheer.
"Love China," says a message on the screen. "Increase patriotism even more. Love a smoke-free Olympics."
That public-service advertisement was funded by the Bill & Melinda Gates Foundation, targeting TV viewers in China during the Olympics. It's part of a new initiative to cut tobacco use in the country that's home to 350 million smokers and more than a third of the world's cigarette production.
While it was once common to see thick clouds of smoke in China's trains, restaurants and even offices, the government has joined the effort to crack down on smoking.
"I think this is a magic time for people to get behind the anti-tobacco work," Bill Gates said last month in launching the initiative. "It will be a tough fight and a long-term fight, but a very important one."
Together the Gates Foundation and New York Mayor Michael Bloomberg's foundation have pledged $500 million around the world to reduce tobacco use, fighting a habit that kills more people than AIDS, tuberculosis and malaria combined.
China has the largest number of smokers in the world, and its annual production exceeds the next seven largest tobacco-producing nations combined.
In Beijing, a new government directive went into effect May 1 that bans smoking in most indoor areas, such as schools, hospitals, movie theaters and gyms, as well as on public transportation. The directive was intended to ensure a "smoke-free Olympics" but will remain in effect after the Games are over.
Smoke-free public places
The policy restricts smoking in bars, restaurants, public parks, waiting rooms and hotels. Restaurants are required to set aside at least 50 percent of their space for nonsmokers. Smoking is banned in offices, and the creation of "smoke-free work units" is encouraged.
Fines range from about $1.50 for individuals caught smoking in nonsmoking areas, to $30 for taxi drivers smoking in their cars, to about $200 for allowing smoking in venues that are supposed to be smoke-free.
China doesn't have a national law banning smoking in public places, but more than 150 local governments have instituted smoking bans. Many local bans passed in the 1990s are now being revised and strengthened.
How well the new policy is working in Beijing depends on where you go.
Corinne Leuenberger, a Swiss translator, stopped for a smoking break in a designated area near the Olympic Green. She said she hasn't seen much of a smoke-free Olympics at all, and no change in the amount of smoking in Beijing's popular bars and restaurants.
"It's not a surprise they tried — that's the tendency around the world," she said. "It would have been a surprise if it worked."
National law bans cigarette sales to minors, but enforcement is weak and there's no stated penalty for violations. Cigarettes are sold almost everywhere. Smoking is so much a part of dining culture in China that cigarettes are frequently on restaurant menus.
Habit on the rise
The focus on China comes at a time when young people here are starting to smoke more.
More than 32 percent of young people between the ages of 13 and 18 in China have tried smoking, and 11 percent are currently smokers, according to the 2008 China Tobacco Control Report.
The report blames exposure to tobacco advertising and images of smoking in movies and TV programs, as well as easy access to tobacco products, for drawing in young people.
For Miki Xiong, 23, an assistant manager of a spa in Beijing, it was stress.
"I saw many young people start smoking right now," she said. "I think the reason is they want to show they think smoking is very nice. Some people are maybe stressful, like me."
Originally from Singapore, Xiong has been living in China for less than two years. She noticed that more people in China smoke because the rules aren't as strict.
In China, almost 8 percent of the central government's revenue comes from the state-owned tobacco industry, said Susan Lawrence, director of China programs for the nonprofit Campaign for Tobacco-Free Kids. The most effective way to cut tobacco use is to sharply raise the price by increasing cigarette taxes, she said. Higher taxes would boost government revenue even as they drive down smoking rates.
But changing an entrenched cultural habit remains the biggest hurdle.
"In China, there's a real tradition of men giving cigarettes to each other at social gatherings," Lawrence said. "Everybody is offering cigarettes to everybody else, and nobody feels they can refuse them."
Years ago, a bottle of cognac was the gift of choice, but these days it's an expensive carton of cigarettes. "That's a real status symbol," she said.
Cigarettes in the U.S. cost between $3.50 and $8 a pack. In China, they cost as little as 22 cents and as much as $157. The most popular high-end brands are Zhonghua, which means "China," and Huanghelou ("Yellow Crane Tower") 1916.
The most expensive brand is Panda, Chinese leader Deng Xiaoping's personal favorite.
At the low end, though, cigarettes are so cheap that even a major tax increase isn't going to make them unaffordable.
Chinese leaders are reluctant to make cheap cigarettes more expensive because they worry about adding to the economic burden of poorer citizens.
Lawrence and others argue that keeping cigarettes so cheap already adds to the burden on the poor because they become addicted and spend money on tobacco that they could spend on education and food. When they get sick from tobacco use, their medical bills can easily bankrupt them.
Chinese cigarettes come in decorative boxes, often with gold leaf and unique designs. What they lack are clear warnings about tobacco's health risks. Packs carry only a small-print warning on the side saying, "Smoking harms health."
That's about to change. China joined the Framework Convention on Tobacco Control, a global agreement among 157 countries, which requires China to have new health warnings on its packs by Jan. 1.
China's plan for that remains weak, using a small, 6-point typeface on a background the same color as the rest of the package. Public-health advocates had pressed for larger text and a more obvious message on health risks, but they were overruled by China's State Tobacco Monopoly Administration.
"We're trying to tell people when they're giving cigarettes, they're giving a cancer-causing substance," Lawrence said. Warnings on packages about smoking's real risks "would do a lot to persuade people that it wasn't such a beautiful gift."
More television ads around the Olympics will bring that message home directly.
Another ad the Gates Foundation sponsored features a Chinese gymnast competing on the balance beam as a little girl and her parents watch at home.
The father goes outside to light up a cigarette. "2008: our heroic year," the message says. "You can also become our hero. To protect our loved ones, please smoke outside."
Copyright © 2008 The Seattle Times Company
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