Tough habit to stub out

One of the most striking things foreign visitors going to a Chinese city for the first time may notice is the prevalence of smokers. It is nearly impossible to go to any public space or business meeting without being forced to inhale copious amounts of secondhand smoke. Smoking is cheap and socially accepted, and the government has thus far made little attempt to persuade people otherwise, but Australia’s tough regulatory approach may become increasingly attractive to the Chinese government. 

China is the biggest manufacturer, grower and consumer of tobacco in the world. The state-controlled China National Tobacco Corporation manufactured approximately 2.5 trillion cigarettes in 2013 alone. A staggering 7 percent of China’s state revenue comes from tobacco sales. With such lucrative returns, those in office and in the industry consider the costs of reducing the country’s smokers too high.

Until now that is. It is rapidly becoming apparent that the health and financial costs of having so many Chinese addicted to smoking are enormous. Last week, a new study published by The Lancet revealed that an estimated 2 million Chinese people will die by 2030 from smoking-related illness. It also showed that Chinese men, 68 percent of whom are smokers, now comprise a third of the total amount globally.

Based on two nationally representative studies spaced 15 years apart, the study shows that smokers are also getting younger. Those born after 1970 tended to start smoking by the time they were 20, while those born in the 1930s generally only started aged 25 years or older.

The study also notes that while uptake rates among women have been decreasing and only 3.2 percent of Chinese women are now smokers, they are increasingly exposed to the dangers of secondhand smoke. The authors write that government cannot become complacent, and must develop strategies to preserve the low number of female smokers.

The report concludes that in order to tackle the problems presented by the growing number of male smokers in China, the government should extend and intensify smoking cessation programs. The best cure is prevention; cessation offers China one of the most effective, and cost-effective, strategies to avoid disability and premature death over the next few decades.

In terms of its achievements in smoking reduction, Australia stands out as a strong example for China to follow. According to the Australian Bureau of Statistics, between 2001 and 2012, male smoking rates steadily declined from 27.2 percent to 20.4 percent. The rate for women also fell from 21.2 percent to 16.3 percent.

Australian regulations replacing branding on cigarette packaging with graphic depictions of the consequences of smoking – from various cancers to emphysema and potential harm to unborn children – present a confronting deterrent for consumers. The results have been very effective in increasing cessation rates and decreasing tobacco sales.

Although the tax on cigarettes in China more than doubled from 5 percent to 11 percent in March 2015, this increase was still well under the WHO recommended taxation rate of 70 percent. In Australia, taxes on cigarettes amount to around 60 percent of their total cost. To put this in context, in Australia, a pack of Marlboro cigarettes costs AU$23 on average; in China a pack can sell for as low as AU$1.95 (9 RMB). This makes smoking an affordable habit for even the poorest consumers.

A new joint report with the National Australia Bank and The George Institute for Global Health, to be launched at the China Study Centre’s 2015 Sydney China Business Forum on 2 November, explores some of the health issues that China is grappling with as it seeks to achieve its goal of creating a ‘middle income country’ in the next five years.

In order to do so, China will need to address its myriad challenges, including smoking. The Chinese government cannot afford to allow its concern for lost revenue from tobacco sales to prevent it from curbing the devastating consequences of its high population of smokers. Australian government and health professionals are well positioned to contribute to a common goal of improving the health of China’s population.

Professor Kerry Brown and Simone Van Nieuwenhuizen are from the University of Sydney’s China Studies Centre. First published in the China Daily on 23 October 2015.