SAY NO TO TOBACCO: Students in Wuji School of Rushan City, Shandong Province, stand in the pattern of a smoke-free sign on May 27 to mark World No Tobacco Day (LIU GUOXIAN)

On November 15, a new global report indicated that "efforts to combat the global tobacco epidemic are lagging, in spite of strong progress in some countries." The report was published by the Framework Convention Alliance, a coalition of more than 350 non-governmental organizations from over 100 countries.

The report was released during the Fourth Conference of the Parties to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), held in Punta del Este, Uruguay, on November 15-20 this year.

Although China was not included in this report, its fight against tobacco is in a similar situation. Progress has been made regarding tobacco control in China, said Yang Gonghuan, but China's efforts are not enough.

Yang is the director of China's National Office of Tobacco Control under the Chinese Center for Disease Control and Prevention (China's CDC). She also serves as deputy director general of China's CDC.

China ratified the WHO FCTC in 2005 and put it into force on January 9, 2006.

The convention includes measures to reduce tobacco consumption and supply. Parties to the convention are obligated to restrict or comprehensively ban tobacco advertising, promotion and sponsorship. They also will have to put proper warnings on tobacco packaging, protect people from exposure to secondhand smoking in public places, implement taxation policies aimed at reducing tobacco consumption and clamp down on illicit trade in tobacco products.

China is the largest consumer and producer of tobacco products. Statistics from China's National Office of Tobacco Control show China accounts for one third of the world's total smoking population, cigarette sales and cured tobacco output.

Currently, more than 300 million Chinese adults smoke, and about 540 million non-smokers are exposed to secondhand smoking, including 180 million children under the age of 15, according to China's Ministry of Health.

Every year, about 1 million people in China die of tobacco-related diseases, said the Ministry of Health.

Piecemeal progress

China has made great progress in controlling tobacco consumption, Yang told the Beijing-based Sanlian Life Weekly. Now, there is stronger political will, enhanced public awareness and increased media coverage on tobacco control in China, Yang said.

During the annual session of the National People's Congress and the Chinese People's Political Consultative Conference, dozens of bills and proposals related to tobacco control were put forward, Yang said. The number used to be very small, she added.

At the grass-roots level, many villages and counties hold smoke-free meetings, and citizens host smoke-free weddings. In this sense, the effectiveness of tobacco control is very obvious, Yang said.

On World No Tobacco Day, which falls on May 31, various activities are held nationwide to draw attention to the tobacco epidemic and to the preventable death and diseases caused by smoking.

Some localized or partial smoking bans have been put in place in China. Now, cities such as Beijing, Shanghai, Hangzhou, Guangzhou and Yinchuan have promulgated regulations banning smoking in public venues, Xu Guihua, Vice President of the Chinese Association on Tobacco Control, told people.com.cn.

To comply with the packaging and labeling requirement set forth in WHO FCTC's Article 11, in April 2008, the State Tobacco Monopoly Administration and the State General Administration of Quality Supervision, Inspection and Quarantine jointly issued a regulation governing the packaging and labeling of domestically produced tobacco products.

The regulation requires such warning messages as "smoking harms your health" and "quitting smoking early helps reduce the risk" be displayed on tobacco products' packaging, and the warnings should cover at least 30 percent of the display areas. Nonetheless, it does not mandate pictures or pictograms depicting the health hazards of tobacco use.

Formidable challenges

Despite the progress in tobacco control, China has a long way to go, said Xu. China does not have any comprehensive smoking ban at the national level, whereas 17 other countries have, she said.

The compliance rate of existing laws and regulations banning smoking is low, said Yang. Smoking at indoor workplaces and public places is still prevalent. The 2010 Global Adult Tobacco Survey (GATS) published in this August showed that in China, about one third of people noticed smoking in public transportation and health care facilities, six in 10 adults noticed smoking at the workplace, while almost nine out of 10 noticed smoking in restaurants.

Xu also pointed out despite China's regulation on tobacco packaging and labeling, the warning messages used are not effective in deterring people from smoking. Many people in China are not fully aware of the serious health risks of tobacco products and still send them to others as gifts, Xu said.

Meanwhile, tobacco companies target young people by sponsoring charity events, Yang told the WHO earlier this year. She said a primary school rebuilt after the Sichuan Wenchuan earthquake with funds from a tobacco company was named Sichuan Tobacco Hope Primary School, and the school walls are inscribed: "Talents are brewed by intelligence; tobacco helps you grow up and become accomplished."

Another perplexing issue about tobacco control in China is that although the WHO FCTC has been in force for several years, the number of smokers and the production and sales of tobacco products have increased over the years, said Xu.

Data from China's National Bureau of Statistics show that in the first half of 2010, the national wholesale volume of cigarettes reached 446.1 billion yuan ($65.6 billion), and the tobacco industry paid 325.2 billion yuan ($47.8 billion) in taxes, up 16.7 percent and 17.32 percent respectively from the same period last year.

The tax contribution by the tobacco industry to the Chinese fiscal revenue was 8 percent in 2009, said Zhang Xiulian, spokesman for the State Tobacco Monopoly Administration.

Tobacco is a lucrative industry, especially for big tobacco provinces such as Yunnan. Although a 2005 Peking University study found that the health costs of tobacco exceeded the profits from the tobacco industry, yet Yang told the WHO that the government is reluctant to relinquish the revenue.

"The workforce loss indicated by the study is a long-term problem, but most local government officials are focused on today's issues," Yang said.

The fundamental obstacle to tobacco control is institutional conflicts of interests, Yang said, as the organization in charge of the tobacco control policy making and enforcement is also in charge of tobacco production in China.

"It's like a bunch of foxes in a chicken coop discussing how to protect the chickens," Yang described the situation to Sanlian Life Weekly.

China's Tobacco Control Regulations

Since 1981, the Ministry of Education has enacted several regulations prohibiting middle school students from smoking.

In 1991, the National People's Congress of China passed a law on the protection of minors, prohibiting smoking in indoor public places where minors gather.

In 1994, China's Advertisement Law adopted by the National People's Congress outlawed tobacco advertising on radio, television and in newspapers.

In 1997, the Ministry of Health, jointly with the Civil Aviation Administration of China and some other government departments issued a regulation banning smoking on public transport.

In 2007, the Beijing Municipal Government banned smoking in taxis and in most indoor public areas the following year. Other cities, such as Shanghai, Hangzhou, Guangzhou and Yinchuan, have followed Beijing's example and promulgated regulations banning smoking in public venues.

On May 20, 2009, the Ministry of Health ordered a comprehensive smoke ban in medical institutions nationwide from 2011.

(Sources: Website of the Chinese Association on Tobacco Control and media reports as specified)