Smoking in China

Smoking in China is prevalent, as the People's Republic of China is the world's largest consumer and producer of tobacco:[1] there are 350 million Chinese smokers,[1] and China produces 42% of the world's cigarettes.[1] The China National Tobacco Corporation (中国烟草总公司 Zhōngguó Yāncǎo Zǒnggōngsī) is by sales the largest single manufacturer of tobacco products in the world and boasts a monopoly in Mainland China generating between 7 and 10% of government revenue.[2] Within the Chinese guanxi system, tobacco is still a ubiquitous gift acceptable on any occasion, particularly outside urban areas. Tobacco control legislation does exist, but public enforcement is rare to non-existent outside the most highly internationalized cities, such as Shanghai and Beijing. Outside the mainland however, enforcement is strong in the Hong Kong special administrative region. Furthermore, outside the largest cities in China, smoking is considered socially acceptable anywhere at any time, even if it is technically illegal.

The Chinese Association on Tobacco Control (中国控制吸烟协会 Zhōngguó kòngzhì xīyān xiéhuì) is engaged in tobacco control by members of the voluntary sector, including academic, social and mass organizations,[3] as strong enforcement of existing tobacco control laws is not supported by the Chinese Government.[2]

Yang Gonghuan, deputy director of the National Center of Disease Control of China, said that progress on tobacco control is not moving quickly because the government derives large tax revenues from tobacco sales, and the industry employs a large workforce.[4] The Ministry said that as a "mid-term goal, all health administrations and half of the country's healthcare facilities should be smoke-free by the end of 2010".[4] Nearly 60% of male Chinese doctors are smokers, which is the highest proportion in the world.[4] China does not have laws to punish health care facilities, medical workers and health officials who violate smoking bans, and is instead relying on the Chinese media to act as a watchdog.[4]

Smoking is a social custom in the PRC,[1] and giving cigarettes at any social interaction is a sign of respect and friendliness.[1]

Tobacco control legislation

No smoking symbol
The universal no-smoking symbol is frequently ignored in mainland China

On May 20, 2009, the Ministry of Health of China issued a formal decision to completely ban smoking in all health administration offices and medical facilities by the year 2011.[5] With an ever-increasing Chinese smoking population of over 350 million, the enactment of the May 20 initiative represents an important landmark in China's commitment to tobacco control. However, due to the Chinese government's complex relationship with tobacco policy (for instance, many localities rely upon tobacco tax revenue as a substantial source of income),[6] there have been many concerns about the practicality of the national policy's enforcement.

In addition to the May 20 measure, numerous provincial and city-level administrations in China have also enacted policies to control the prevalence and health impacts of smoking within the last decade.

Impact of the WHO Framework Convention on Tobacco Control

On October 11, 2005, China became the 78th country in the world to ratify the WHO Framework Convention on Tobacco Control (FCTC), an international treaty intended to reduce tobacco-related disease and death.[7] Under the conditions of the FCTC, China is required to completely ban "promotion and sponsorship on radio, television, print media and the Internet within five years," [8] as well as to prohibit tobacco companies from sponsoring international events or activities.[9] China has also resolved to ban all tobacco vending machines,[9] as well as smoking in indoor work places, public areas, and public transportation vehicles.[10]

Despite China's own widespread and complex smoking issue, the ratification of the FCTC in China represents a significant commitment to tobacco control in international public health policy. According to Dr. Shigeru Omi, the WHO Regional Director for the Western Pacific region, "implementing the Convention will not be easy, as smoking is an ingrained habit in China ... but the Government has made clear its commitment to take action." [8] In light of the FCTC, concerns about international image, and strong support from both citizens and domestic health authorities, the Chinese government has become increasingly involved in tobacco prevention and tobacco-related health promotion programs.

Ministry of Health Report

Prior to enacting the nationwide smoking ban, the Ministry of Health had already maintained active involvement in decrying the negative effects of smoking and striving toward decreased prevalence of tobacco use. On May 29, 2007, the Ministry released a report (2007 年中国控制吸烟报告—The 2007 China Smoking Control Report) detailing alarming levels of secondhand smoke exposure (affecting over 540 million Chinese citizens), recommendations for legislation to reduce harm from secondhand smoke, and the feasibility of implementing public smoking bans based upon polling data.[11] Notably, the report agreed with international scientific consensus about secondhand smoke, citing numerous findings from public health authorities in other countries[12] to assert the conclusion that "there is no safe level of exposure to second-hand smoke",[11] that ventilation equipment is ineffective in reducing the harm from exposure to second-hand smoke, and that the most effective protective public health measure against smoking is a legislative ban of smoking in public places.[11] With an explicitly stated objective of "building smoke-free environments for the sake of enjoying healthy life",[12] the report has received strong support and praise from the Campaign for Tobacco-Free Kids, a U.S. health advocacy group based in Washington, D.C.[11]

In addition, the report suggested a strong likelihood of success for the implementation of complete public smoking bans in seven major urban areas on the basis of demonstrated widespread popular support for such measures.[11] According to an analysis by the Campaign for Tobacco-Free Kids, polling data in the Ministry of Health report revealed:

"Overwhelming public support for the enactment of totally smoke-free public spaces ... support for total smoking bans exceeds support for partial smoking bans ... Among smokers, the polls found that 93.5% support a total ban on smoking in all schools, 75.5% support a total ban in hospitals, and 94.3% support a total ban in all public transport. Among non-smokers, 95.1% support a total ban in all schools, 78.1% support a total ban in hospitals and over 93.8% support a ban in public transport. Some 70.6% of non-smokers support some type of smoking ban in bars and restaurants.[11]

Nationwide ban

Although China still lags behind many countries in implementing tobacco control policy, the Ministry of Health's May 20 initiative helped to establish more unified smoking controls and codify public health authority at broad administrative levels.[13] From 2009, Projects sponsored by Bloomberg Initiative and directed by Yang Tingzhong were designed as the first program to prohibit all forms of smoking in University campuses in China.[14] The Ministry's "Decision" formally requests local governmental units to "set up multi-agency FCTC Implementation Leading Small Groups"[5] to assist with regional strategies of enforcement, with the explicit goal that:

"by the year 2010, all health administration offices, both military and non-military, and at least 50% of all medical and health institutions should become smoke-free units, so that the goal of a total smoking ban in all health administration offices and medical and health institutions can be fulfilled by 2011."[5]

The "Decision" also encourages health administration offices to utilize mass media resources and draw upon large-scale publicity campaigns such as World No Tobacco Day in order to "actively promote the importance of implementing a total smoking ban in military and civil health administration offices and medical and health institutions."[5]

Popular opinion

As polls from the 2007 Ministry of Health report showed, there is widespread public approval of smoking bans among residents of urban areas.[12] Various health experts, activists, and public advocacy groups regard the Chinese government's escalating efforts toward tobacco policy as "surely good news for the country's smoking control progress."[10] Notable support also exists within the sphere of representative politics; allegedly, political advisors of the CPPCC have even gone so far as to call for smoke-free legislative sessions.[10]

However, widespread apathy and tacit acceptance toward smoking policy are likely to predominate within large portions of the Chinese population. China has a relatively low social disapproval rate of smoking—according to the International Tobacco Control Policy Evaluation Project (ITC), "only 59% of smokers think that Chinese society disapproves of smoking, the fourth lowest rate of 14 ITC countries surveyed."[15]

Dissent and unresolved issues

Given the complex and multifaceted nature of political agendas in China, governmental public-health related interests often clash with economic interests. Because tobacco remains a significant source of both health risks and revenue for municipal and national governing entities,[6] specific Chinese tobacco control policies in different contexts may betray an overall position of ambivalence or inconsistency. For instance, local exemptions to public indoor smoking bans are often made for small businesses, particularly in the restaurant and entertainment industries.[16] Such indeterminate enforcements of supposedly well-defined public health regulations in practice may limit the impact of de jure national smoking bans. In practice, it is often the case that only some government offices, schools, museums, some hospitals, and sports venues effectively function as smoke-free areas.[17] In addition, the cultural basis of smoking in China presents a significant barrier to de facto acceptance and integration of smoking control policies. According to Li Xinhua, an expert on tobacco-control publicity and education in the Ministry of Health, “about 60 percent of medical workers and professors are smokers [and thus in violation of the law calling for a complete public smoking ban] ... Some of them even smoke boldly in hospitals or schools.”[17] This is problematic because, regardless of whether these professionals continue to smoke out of habit, social custom, or "apparent disregard" for evidence of smoking risk, they are still expected to "behave themselves and set a good example for others in tobacco control," Li says.[17]

Also, enforcement of national tobacco-control policies is still largely sparse in rural areas, where the state-owned China National Tobacco Corporation exerts much of its influence in tobacco production and marketing. As a response to FCTC recommendations for reduction of access and supply-side tobacco regulation, the Ministry of Health is now targeting farmers to give up tobacco plantation and trying to “convince them that the tobacco industry can be replaced by other industries that are more healthy, sustainable and profitable.”[17]

Another potential obstacle is the Chinese tobacco industry's lack of complete compliance with nationally defined policies regarding the correct presentation of warning labels on cigarette packages, which must be readily visible and cover at least 30% of the visible area of the packaging.[12] Wu Yiqun, vice executive director with the Beijing-based Thinktank Research Center for Health Development, criticized China's tobacco industry supervisory administration for "[failing] to oversee Chinese tobacco producers" in this aspect.[10]

Furthermore, the International Tobacco Control Policy Evaluation Project brings up the following persistent smoking issues in its 2009 report focused on China:[15]

  • In addition to "strong social pressure placed upon Chinese men to smoke", it is also expected that female smoking will become "more socially acceptable as the tobacco industry increasingly targets female smokers."[15]

Current tobacco control legislation in China does not explicitly address gendered or social bases for smoking.

  • Smoking cessation is "relatively uncommon in China, and most smokers quit cigarette smoking because of chronic illness." Indeed, "awareness of the health risks of smoking is low in China. Only 68% of smokers believe that smoking causes lung cancer in smokers (compared to well over 90% in Western countries) and 54% believe that smoking causes lung cancer in non-smokers. Only 37% of smokers are aware that smoking causes coronary heart disease and only 17% are aware that smoking causes strokes."[15]

In order to maintain a robust, sustainable effort in tobacco control, China will particularly need to focus upon the role of public health education in smoking prevention and health promotion.

  • "Taxation is a very effective method of reducing tobacco use. However, very few smokers (5%) in the ITC China Survey reported thinking about price as a reason to quit smoking—a sign that prices are too low."

Current tax regulations in Chinese tobacco control policy are limited, inconsistent, and tied to the structural intricacies of domestic ownership and control of tobacco production and distribution.[18]

Restriction in electronic media

On February 12, 2011, State Administration of Radio, Film and Television, announced that it will ban inappropriate smoking scenes in movies and TV shows. The announcement said smoking scenes are out of line with the country's stance on tobacco control, and are misleading to the public, especially minors. Thus it is prohibiting scenes of cigarette brands, people smoking at smoke-free places, minors buying and smoking cigarettes, and other smoking scenes associated with minors. After the announcement was done, the ban was effective immediately.[19]

Regional and citywide initiatives

Shanghai

In light of its preparations to host the 2010 World Expo, the city of Shanghai had recently heightened its anti-smoking legislation. The Shanghai People's Congress issued the city's first smoking control law in March 2010. The law bans smoking in 12 types of public places including indoor smoking at schools, hospitals, sport stadiums, public transport vehicles and Internet cafes. Anyone caught smoking would first be given a warning and then face a fine of 50 to 200 yuan if they resist. According to Li Zhongyang, the deputy head of the Shanghai Health Promotion Committee, the smoking ban was enacted to protect citizens' health and also promote Shanghai's image as a cosmopolitan city.

According to a report by the Fudan University Media and Public Opinion Research Center, 93.5% of the 509 people they interviewed supported a smoking ban at all Shanghai Expo 2010 pavilions and also felt that smoking should not be allowed in restaurants or shopping centers near the Expo area.[20] Another survey done by public health experts from Fudan University which involved 800 hotel guests and around 4,000 patrons and employees of restaurants, shops and entertainment venues in Shanghai found that about 73 percent of the hotel guests said Shanghai should adopt a smoking ban in public areas, 84 percent of restaurant guests reported exposure to second-hand smoke, and 74 percent of them were annoyed by the fumes and support smoking controls.[21] While many interviewers found second-hand smoke itself toxic and damaging to citizen's health, a main reason behind popular support for the smoking ban relates to the citizen's concern for Shanghai's image. According to one citizen that the public health experts from Fudan interviewed, "Smoking has been banned in public places in several countries. We should do the same, at least during the Expo, since it is a cosmopolitan event. And of course, for the sake of the public who would be visiting." [20] For organizers of the Expo, there was also the issue of hypocrisy if they did not deal with China's smoking problem as part of their "Healthy Expo."

Despite the popular support for the Shanghai smoking ban, many also feel skeptical about the actual implementation of the law. Shanghai residents point out that despite the fact many shopping malls and all subways and subway stations actually already banned smoking prior to this law, there is low compliance and people often smoke directly in front of NO SMOKING signs.[22] One most basic concern Shanghai residents have regarding the ban is the lack of clarity regarding who will do the fining and who will report the offenses. Public health experts agree that it will be difficult to enforce a strict ban with the large number of smokers present in Shanghai.[20]

In addition to passing the smoking ban, Shanghai legislators have designed a website "Smoke Free Shanghai" [23] to raise anti-smoking awareness. Also, the most concrete measure that has been taken is that Expo organizers refused a 200 million yuan ($29.3 million) donation from the Shanghai Tobacco Company last year to maintain their "healthy Expo" stance.

Beijing

In light of the passage of national tobacco initiatives and international publicity for the 2008 Summer Olympics, the Beijing city government extended a public smoking ban on May 1, 2008 to include sports venues and all indoor areas of government offices, transport stations, schools and hospitals.[24] The ban had a generally strong impact, with poll results suggesting that a majority of Chinese residents (69% out of over 10000 respondents) are "not only aware of a smoking ban in Beijing, but [95% of respondents] also hope that the authorities promote the move nationwide."[24]

According to China Daily News:

"The survey also showed that 81.6 percent of respondents were eager to stop smoking, or had heard of family members and friends who were considering kicking the habit. 'I am delighted by such encouraging support from the public, it will help to promote legislation to control tobacco use,' [said] Jiang Yuan, vice-head of the tobacco control office under the Chinese Center for Disease Control and Prevention."

[24]

The Beijing government has also adopted a policy of persuasion, combined with a fine of up to 5,000 yuan ($730) for violating the ban, in an attempt to further encourage citizens to curtail public smoking.[24]

A direct positive public health impact of the Beijing smoking ban has manifested in the arena of fire prevention.[25] According to People's Daily,

"The smoking ban has cut the number of fires in the city sparked by cigarette butts by more than half ... In the first week of this month, the Beijing fire brigade put out eight cigarette-related fires, an average of 1.14 per day ... The new daily average [after the extended smoking ban] was less than half of what was reported in the first four months of this year, when the city's firefighters had to put out 325 fires caused by cigarette butts, or 2.7 per day."

Guangdong Province

In 2007, Guangzhou and Jiangmen became Guangdong's first two cities for experimental enforcement of total smoking ban at some public places.[26] The public places for smoking ban included restaurants, entertainment outlets, schools, supermarkets, and governmental offices. However, by March 2010, the Guangzhou Municipal People's Congress prepared to lift the smoking ban in work places, including offices, conference rooms and auditoriums.[27]

Hubei Province

In 2009, the authorities of Gongan County attempted to increase consumption of locally produced cigarettes, by demanding that local officials smoke up to 23,000 packs of Hubei-branded cigarettes per year. This measure was intended to bring much-needed revenue to local enterprise; quotas were issued by county authorities to offices under its jurisdiction, which in turn were fined if they failed to consume the demanded quota of cigarettes, or if they were found purchasing other brands of tobacco products. This decision was reversed after public outcry and coverage by international press.

Other cities

Hangzhou's people's congress had approved to ban smoking in public and working places in the beginning of 2010; smoking may be prohibited in some places and violators may be fined up to 3000 yuan.[28] Yang Tingzhong from Zhejiang University undertook campaigns and project sponsored by Bloomberg Global Initiative to ban smoking in university campuses at a nationwide scale.

According to Medical News Today, seven provincial capitals in China are taking steps to ban smoking in workplaces and public places. The seven cities are Tianjin, Chongqing, Shenyang, Harbin, Nanchang, Lanzhou and Shenzhen. Although there are already some smoking bans in places in these cities, government officials have realized that compliance rate is low and plans to issue a strict ban.

The new ban will be run as a pilot project under the joint auspices of the Chinese Center for Disease Control and Prevention (CDC) and the International Union against Tuberculosis and Lung Disease(UNION). Responding to criticism about the current legislation not being well enforced, Wang Yu, director of the China CDC explained that "This project would create strict legislation to guarantee 100-percent smoke-free public venues and workplaces and figure out a feasible and forceful working mechanism to enforce the smoking ban." [29]

Chinese physicians and smoking

Tobacco use has been identified as an increasingly popular phenomenon in China, and Chinese physicians have been found to exhibit high smoking rates as well. The practice is controversial because some believe that medical professionals should serve as role models of healthy behavior to their patients, while others believe that doctors should have the right to smoke because it is a personal matter.

Prevalence

A 2004 study conducted among 3,500 Chinese physicians found that 23% were regular smokers. There was a significant gender difference, with 41% of male physicians reporting to be smokers but only 1% of female physicians. More than one third of current smokers had smoked in front of their patients and nearly all had smoked during their work shift.[30]

Male surgeons were found to smoke more than any other specialty.[30] A study conducted among 800 Chinese male surgeons in 2004 found that 45.2% were smokers and 42.5% had smoked in front of their patients.[31]

The smoking rates from these independent studies are lower than those reported by China's state-run newspaper. An article published in 2009 interviewed a source who claimed that 60% of Chinese male doctors were smokers, a percentage higher than any other country's doctors in the world.[32]

Comparison to other populations

Smoking rates among Chinese male physicians are comparable to the country's general population, although overall physician rates are lower. Chinese physicians have a substantially higher smoking prevalence than doctors in the United States (3.3%) or United Kingdom (6.8%). They have a slightly higher rate than Japanese physicians (20.2%) and Japanese physicians have a smaller gender discrepancy with 27% male and 7% of female doctors smoking.[30]

Causes and influences

High tobacco use among physicians may be attributed to several factors. In Chinese culture, smoking is connected to masculine identity as a social activity that is practiced among men to promote feelings of acceptance and brotherhood, which explains why more Chinese male doctors smoke than females. Furthermore, physicians in particular may resort to tobacco as a coping mechanism to deal with the day-to-day stress that is associated with long work hours and difficult patient interactions.[33]

One surgeon in Kunming (Yunnan province) described smoking as a phenomenon that is an integral part of Chinese medical culture and one that improves job performance:

Smoking is such a big part of being a doctor here. The director of our hospital smokes. The party-secretary smokes. The chair of my department smokes. And whenever I walk into the duty office, most of my colleagues are smoking. And to tell you the truth, with such a pressure-filled job, smoking is extremely helpful, at times soothing, at times energizing, at times helping me focus my attention when preparing for a complex surgery or facing a stack of paperwork 10:30 at night.[33]

Effect on patient care

A physician's personal smoking habits have been shown to influence his or her attitudes toward the dangers of tobacco. Doctors who smoked were less likely to believe that smoking has a harmful effect on health compared to nonsmokers.[30] Fewer smokers also believed that physicians should serve as role models for their patients and that indoor smoking in hospitals should be prohibited.[31] Nearly all Chinese physicians (95%) believed that active smoking causes lung cancer and most believed that passive smoking causes lung cancer (89%), but current smokers were less likely to hold these health beliefs than nonsmokers were.

Arguments in favor of physicians' choice to smoke

It may be argued that as responsible and informed adults, Chinese physicians should be given the choice of whether or not to smoke. Their backgrounds in science and medicine enable them to know more about the effects of smoking on the body compared to the general public, so a decision they make about tobacco may be more educated.

Furthermore, smoking can be considered a personal matter that should not be relevant to the workplace. Some have suggested that so long as a cigarette does not interfere with a physician's ability to diagnose and treat patients, smoking should be permitted among health care practitioners. In fact, Chinese physicians who smoke may be able to form closer relationships with patients because of tobacco's role in the local culture as a commodity that promotes unity and friendship.[33]

Arguments against physicians' choice to smoke

Others may argue that since physicians influence the well-being of the general population, their high smoking rates serve as an unhealthy role model to Chinese citizens. Many believe that doctors should serve as exemplars, as sources of information about quitting, and as providers of support and encouragement for those who are trying to live healthier lives by giving up cigarettes.[34]

Physicians who smoke may also have a bias that prevents them from giving accurate information regarding the negative health effects of tobacco to patients. Alternatively, smoking cessation advice offered by a doctor who smokes may seem hypocritical to the patient trying to quit.

An economic motivation against physician smoking may be the societal loss that is caused by tobacco use. The resources that are spent on medical school and hospital training might not be realized fully if physicians die prematurely from higher smoking rates.[31]

Gender

As of 2014, two thirds of Chinese men smoked. Women smoked much less. In 2010, smoking caused nearly 1 million (840 000 male, 130 000 female) deaths in China.[35]

China remains one of the three leading countries (along with India and Indonesia) in total number of male smokers, accounted for 51.4% of the world’s male smokers in 2015.[36] China also remains one of the three leading countries (along with India and the United States) in total number of female smokers, although these three countries accounted for only 27.3% of the world’s female smokers, indicating that the tobacco epidemic is less geographically concentrated for women than for men.[36]

Smoking in Hong Kong

Smoking in certain public places in the Hong Kong Special Administrative Region has been banned from 1 January 2007 under the government's revised Smoking (Public Health) Ordinance (Cap. 371), first enacted in 1982 with several amendments subsequently. The latest amendment enlarges the smoking ban to include indoor workplaces, most public places including restaurants, Internet cafés, public lavatories, beaches and most public parks. Some bars, karaoke parlors, saunas and nightclubs were exempt until 1 July 2009. Smoking bans in lifts, public transport, cinemas, concert halls, airport terminal and escalators had been phased in between 1982 and 1997. The ban in shopping centres, department stores, supermarkets, banks and game arcades has been in place since July 1998.

The overall daily smoking rate in Hong Kong is 11.8% (HK Department of Census and Statistics Household Thematic Survey 36) with 25% of males smoking whereas in China 63% of males smoke.

The government has mentioned a full-ban of tobacco import and smoking is technically possible in Hong Kong upon the release of the budget in 2009. However, as the decreasing daily smoking rate in recent years mainly due to increasing tobacco tax, the government currently has no further plans to control sales of tobacco other than by adjusting taxation.

See also

References

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  2. ^ a b Cheng Li (October 2012). "The Political Mapping of China's Tobacco Industry and Anti-Smoking Campaign" (PDF). John L. Thornton China Center Monograph Series. Brookings Institution (5). Archived from the original (pdf) on May 24, 2013. Retrieved November 11, 2012. ...the tobacco industry is one of the largest sources of tax revenue for the Chinese government. Over the past decade, the tobacco industry has consistently contributed 7-10 percent of total annual central government revenues...
  3. ^ Chinese Association on Smoking Control
  4. ^ a b c d Xin, Dingding (2009-12-11). "Smoke-free list extends to healthcare facilities". China Daily.
  5. ^ a b c d Middleton, J. From 2011, Smoking Will Be Banned Completely in the Medical and Healthcare System. Clear the Air. 23 May 2009.
  6. ^ a b Paddock, C. China To Ban Smoking In 7 Cities: Pilot Project. Medical News Today. 18 January 2010.
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  10. ^ a b c d Miao, X.; Cong, W. Ahead of World Expo, China acts to promote smoking controls. Xinhua News Agency. 10 March 2010.
  11. ^ a b c d e f Chinese Health Ministry Releases Landmark Anti-Smoking Report. Campaign for Tobacco-Free Kids. 29 May 2007.
  12. ^ a b c d (Simplified Chinese) 2007年中国控制吸烟报告发布 Ministry of Health of the People's Republic of China. 2006.
  13. ^ Walker, B. China tobacco: A tough habit to break. Global Technology Forum. 26 September 2007.
  14. ^ Yang T, Yang X, Lv Q, Zhao Q, Ke X. "Special communication: China's first historic efforts to develop a tobacco control advocacy workforce via schools of public health". Tob Control. 18: 422–4. doi:10.1136/tc.2009.031815. PMC 2745560. PMID 19622521.
  15. ^ a b c d ITC China Summary. International Tobacco Control Policy Evaluation Project. February 2009.
  16. ^ China relaxes smoking ban in Beijing restaurants. Thaindian News. 14 April 2008.
  17. ^ a b c d 60 percent doctors in China still smoke. Thaindian News. 27 April 2010.
  18. ^ Todd, A. Turning Over a New Leaf Archived 2007-05-29 at the Wayback Machine. USDA Rural Development. January 2007.
  19. ^ China moves to reduce smoking scenes on TV. China Daily. 12 February 2011. Retrieved 13 February 2011.
  20. ^ a b c Most hope for smoke-free Shanghai Expo. People's Daily. 22 January 2010.
  21. ^ Expert calls for complete smoking ban. China.org.cn. 27 February 2009.
  22. ^ Kurtenbach, E. Shanghai scrambles to implement ban on smoking in indoor public places ahead of World Expo. Taragana. 2010.
  23. ^ 无烟上海. Smoke-Free Shanghai. Retrieved 29 April 2010.
  24. ^ a b c d Chen, J. Smoking ban gains momentum. China Daily. 15 July 2008.
  25. ^ Smoking ban helps reduce fires in Beijing. People's Daily Online. 12 May 2008.
  26. ^ Guangdong to launch stricter smoking ban at public places 2007-04-10
  27. ^ Guangzhou lifts smoking ban in offices March 17, 2010 Global Times
  28. ^ 杭州控烟战:别处走过场 杭州则立法强力推行
  29. ^ [1]
  30. ^ a b c d Jiang Y, Ong M K, Tong E K, et al. Chinese physicians and their smoking knowledge, attitudes and practices. Am Journal Prev Med 2007
  31. ^ a b c Yao T, Ong M, Lee A, Jiang Y, Mao Z: Smoking knowledge, attitudes, behavior, and associated factors among Chinese male surgeons. World J Surg 2009
  32. ^ Dingding, Xin. Smoke-free list extends to healthcare facilities. China Daily. http://www.chinadaily.com.cn/life/2009-12/11/content_9161633.htm
  33. ^ a b c Kohrman, Matthew. Smoking among Doctors: Governmentality, Embodiment, and the Diversion of Blame in Contemporary China. Medical Anthropology 2008
  34. ^ Garfinkel L, Stellman SD. Cigarette smoking among physicians, dentists, and nurses. CA Cancer J Clin. 1986
  35. ^ Zhengming Chen; et al. (10 October 2015). "Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies" (Abstract). Lancet. 386 (10002): 1447–1456. doi:10.1016/S0140-6736(15)00340-2. PMC 4691901. PMID 26466050. Retrieved 13 October 2015. In 2010, smoking caused about 1 million (840 000 male, 130 000 female) deaths in China.
  36. ^ a b "Smoking causes 10% of deaths worldwide; even more in China". WebMD China. April 7, 2017.

Further reading

External links

China Tobacco

State Tobacco Monopoly Administration (Chinese: 国家烟草专卖局) and China National Tobacco Corporation (commonly known as China Tobacco, abbreviated as CNTC) (Chinese: 中国烟草总公司; pinyin: Zhōngguó Yāncǎo Zǒnggōngsī) is a Chinese government agency responsible for tobacco regulation and a state-owned manufacturer of tobacco products, operated by the Ministry of Industry and Information Technology of China. It enjoys a virtual monopoly in China, which accounts for roughly 40% of the world's total consumption of cigarettes, and is the world's largest manufacturer of tobacco products measured by revenues.

History of smoking

The history of smoking dates back to as early as 5000 BC in the Americas in shamanistic rituals. With the arrival of the Europeans in the 16th century, the consumption, cultivation, and trading of tobacco quickly spread. The modernization of farming equipment and manufacturing increased the availability of cigarettes following the reconstruction era in the United States. Mass production quickly expanded the scope of consumption, which grew until the scientific controversies of the 1960s, and condemnation in the 1980s.

Cannabis was common in Eurasia before the arrival of tobacco, and is known to have been used since at least 5000 BC. Cannabis was not commonly smoked directly until the advent of tobacco in the 16th century. Before this cannabis and numerous other plants were vaporized on hot rocks or charcoal, burned as incense or in vessels and censers and inhaled indirectly. Evidence of direct smoking before the 16th century is contentious, with pipes thought to have been used to smoke cannabis dated to the 10th to 12th centuries found in Southeastern Africa.

Previously eaten for its medicinal properties, opium smoking became widespread during the 19th century from British trade with China. This spawned the many infamous Opium dens. In the latter half of the century, opium smoking became popular in the artistic communities of Europe. While Opium dens continued to exist throughout the world, the trend among the Europeans abated during the First World War, and among the Chinese during the cultural revolution.

More widespread cigarette usage as well as increased life expectancy during the 1920s made adverse health effects more noticeable. In 1929, Fritz Lickint of Dresden, Germany, published formal statistical evidence of a lung cancer–tobacco link, which subsequently led a strong anti-smoking movement in Nazi Germany. The subject remained largely taboo until 1954 with the British Doctors Study, and in 1964 United States Surgeon General's report. Tobacco became stigmatized, which led to the largest civil settlement in United States history, the Tobacco Master Settlement (MSA).

Hongtashan

Hongtashan (simplified Chinese: 红塔山; traditional Chinese: 紅塔山; pinyin: Hóngtǎshān) is a Chinese brand of cigarettes, owned and manufactured by Hongta Group, formerly known as Yuxi Cigarette Factory. The brand was founded as a gift contributing to the 10th anniversary of the Chinese Communists winning the Chinese Civil War and the proclamation of the People's Republic of China.

Lung cancer

Lung cancer, also known as lung carcinoma, is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. This growth can spread beyond the lung by the process of metastasis into nearby tissue or other parts of the body. Most cancers that start in the lung, known as primary lung cancers, are carcinomas. The two main types are small-cell lung carcinoma (SCLC) and non-small-cell lung carcinoma (NSCLC). The most common symptoms are coughing (including coughing up blood), weight loss, shortness of breath, and chest pains.The vast majority (85%) of cases of lung cancer are due to long-term tobacco smoking. About 10–15% of cases occur in people who have never smoked. These cases are often caused by a combination of genetic factors and exposure to radon gas, asbestos, second-hand smoke, or other forms of air pollution. Lung cancer may be seen on chest radiographs and computed tomography (CT) scans. The diagnosis is confirmed by biopsy which is usually performed by bronchoscopy or CT-guidance.Avoidance of risk factors, including smoking and air pollution, is the primary method of prevention. Treatment and long-term outcomes depend on the type of cancer, the stage (degree of spread), and the person's overall health. Most cases are not curable. Common treatments include surgery, chemotherapy, and radiotherapy. NSCLC is sometimes treated with surgery, whereas SCLC usually responds better to chemotherapy and radiotherapy.Worldwide in 2012, lung cancer occurred in 1.8 million people and resulted in 1.6 million deaths. This makes it the most common cause of cancer-related death in men and second most common in women after breast cancer. The most common age at diagnosis is 70 years. Overall, 17.4% of people in the United States diagnosed with lung cancer survive five years after the diagnosis, while outcomes on average are worse in the developing world.

Madak

Madak was a blend of opium and tobacco used as a recreational drug in 16th- and 17th-century China. It emerged in southern coastal areas in the first half of the 17th century. In the last quarter of the 18th century madak was phased out by raw opium. The prohibition of madak in 1729 may have been a contributing factor to the increase in popularity of smoking pure opium.

Raw opium was introduced in China by Arab merchants. Rather than taking bitter raw opium orally, the Chinese attempted smoking opium mixed with other substances. According to Dikotter et al., smoking opium blended with tobacco was introduced in China by the Dutch traders between 1624 and 1660. Madak was prepared by blending opium from Java with domestic Chinese hemp and herbs, boiling the mix in pans and, finally, mixing with tobacco. It was smoked in bamboo pipes with coir fibre filter. The new addiction was limited to coastal territories around Taiwan Strait; further spread was hampered by the civil war that accompanied the fall of the Ming Dynasty. The new Qing Dynasty government was not aware of madak until 1683. The lucrative opium business continued spreading along the coast of Southern China, although exact chronology of this spread remains unknown.By 1720 the government saw madak smoking as a social evil that has corrupted not just the lowest classes, but the "good families" too. Smoking dens, where people congregated at night, were deemed as dangerous as heretical cults and political conspiracies. In 1729 the Yongzheng Emperor banned recreational smoking of madak. Medicinal use remained permitted. According to Dikotter et al., the prohibition targeted madak smoking not as such, but as a dangerous form of unacceptable social life feared by the Forbidden City (and thus was akin to A Counterblaste to Tobacco written a century earlier by James I of England). Madak had a "very narrow consumer base" confined to Fujian, Guangdong and Taiwan. Peak consumption, according to Dutch records, was under 12 tonnes of opium per annum.The British East India Company complied with the ban until 1780; the Portuguese ships continued small-scale deliveries of "medicinal" opium. In 1780 the East India Company faced a dire financial crisis and resorted to opium smuggling . Their opium did not sell at all: only 15% of the English shipment found customers within China. However, in the next two decades consumption of opium rapidly grew. The Chinese replaced madak with raw opium; madak remained in limited use by the Malay people. In 1793 the British assumed a monopoly on now profitable opium trading. The Peking government banned opium in 1796, temporarily driving the market underground. Historian Xiao Yishan reasoned that the surge in opium consumption was directly influenced by the 1729 prohibition. According to Dikotter et al., exact causes of the change remain unknown.

Preventive healthcare

In general Healthcare can be classified into 2 categories (1) Curative healthcare and (2) Preventive healthcare. Curative healthcare is the commonest, most available and most expensive form of healthcare. Preventive healthcare on other hand is less known, less available and less expensive than Curative healthcare.

Preventive healthcare (alternatively preventive medicine, preventative healthcare/medicine, or prophylaxis) consists of measures taken for disease prevention. Just as health comprises a variety of physical and mental states, so do disease and disability, which are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices. Health, disease, and disability are dynamic processes which begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.Each year, millions of people die of preventable deaths. A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures. Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases. This same study estimates that 400,000 people die each year in the United States due to poor diet and a sedentary lifestyle. According to estimates made by the World Health Organization (WHO), about 55 million people died worldwide in 2011, two thirds of this group from non-communicable diseases, including cancer, diabetes, and chronic cardiovascular and lung diseases. This is an increase from the year 2000, during which 60% of deaths were attributed to these diseases. Preventive healthcare is especially important given the worldwide rise in prevalence of chronic diseases and deaths from these diseases.

There are many methods for prevention of disease. It is recommended that adults and children aim to visit their doctor for regular check-ups, even if they feel healthy, to perform disease screening, identify risk factors for disease, discuss tips for a healthy and balanced lifestyle, stay up to date with immunizations and boosters, and maintain a good relationship with a healthcare provider. Some common disease screenings include checking for hypertension (high blood pressure), hyperglycemia (high blood sugar, a risk factor for diabetes mellitus), hypercholesterolemia (high blood cholesterol), screening for colon cancer, depression, HIV and other common types of sexually transmitted disease such as chlamydia, syphilis, and gonorrhea, mammography (to screen for breast cancer), colorectal cancer screening, a Pap test (to check for cervical cancer), and screening for osteoporosis. Genetic testing can also be performed to screen for mutations that cause genetic disorders or predisposition to certain diseases such as breast or ovarian cancer. However, these measures are not affordable for every individual and the cost effectiveness of preventive healthcare is still a topic of debate.

Smoking

Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Smoking is primarily practiced as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gasses and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas into a form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to spiritual enlightenment.

Smoking generally has negative health effects, because smoke inhalation inherently poses challenges to various physiologic processes such as respiration. Diseases related to tobacco smoking have been shown to kill approximately half of long-term smokers when compared to average mortality rates faced by non-smokers. Smoking caused over five million deaths a year from 1990 to 2015.Smoking is one of the most common forms of recreational drug use. Tobacco smoking is the most popular form, being practiced by over one billion people globally, of whom the majority are in the developing countries. Less common drugs for smoking include cannabis and opium. Some of the substances are classified as hard narcotics, like heroin, but the use of these is very limited as they are usually not commercially available. Cigarettes are primarily industrially manufactured but also can be hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, and bongs.

Smoking can be dated to as early as 5000 BCE, and has been recorded in many different cultures across the world. Early smoking evolved in association with religious ceremonies; as offerings to deities, in cleansing rituals or to allow shamans and priests to alter their minds for purposes of divination or spiritual enlightenment. After the European exploration and conquest of the Americas, the practice of smoking tobacco quickly spread to the rest of the world. In regions like India and Sub-Saharan Africa, it merged with existing practices of smoking (mostly of cannabis). In Europe, it introduced a new type of social activity and a form of drug intake which previously had been unknown.

Perception surrounding smoking has varied over time and from one place to another: holy and sinful, sophisticated and vulgar, a panacea and deadly health hazard. In the 20th century, smoking came to be viewed in a decidedly negative light, especially in Western countries. This is due to smoking tobacco being among the leading causes of many diseases such as lung cancer, heart attack, COPD, erectile dysfunction, and birth defects. The health hazards of smoking have caused many countries to institute high taxes on tobacco products, run ads to discourage use, limit ads that promote use, and provide help with quitting for those who do smoke.

Smoking in Macau

Smoking in Macau is regulated more strictly than in mainland China, but not to the extent of the regulation of smoking in Hong Kong.

In May 2009 the government of Macau Special Administrative Region (SAR) announced a planned indoor smoking ban for all public places, "to create a fair environment where smokers have the freedom to smoke and non-smokers also have the freedom not to inhale second-hand smoke," Health Bureau director Lei Chin Ion said. In April 2009 the government of Macau SAR announced proposed legislation that sought to raise the tobacco sales tax by 300%. Casinos and gambling are a major aspect of tourism in Macau. Smoking is banned on the main floors of casinos, but is permitted in closed-off ventilated smoking areas, which are located on the casino floors. A majority of Macau residents support a total ban on smoking in public places, but lawmakers in closed session on 20 April 2010 were unable to reach a consensus regarding a total ban inside casinos. The increasing number of smokers is a cause for concern, as 17% of people in Macau smoke.

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