April 14, 2016
By Marianne Sibaud
As the world’s largest manufacturer and consumer of tobacco, the prevalence of smoking—as well as its associated mortality and morbidity—is high in China. With more than 300 million smokers (the largest population of smokers in the world) the chronic smoking problem is particularly acute. The fact that China is the world’s largest cigarette market (tobacco taxes make up an important portion of government revenue), combined with a general lack of awareness regarding harmful health effects of smoking, have meant that the tobacco epidemic is forecasted to worsen in the coming decades.
A number of economic and political challenges have hindered the Chinese government’s ability to implement a comprehensive public health policy. With tobacco control low on the domestic-policy agenda, there is a conflict between raising awareness about smoking-related health risks and China’s strong economic image that is largely based on the importance of its tobacco industry. Indeed, as the world’s largest grower, manufacturer, and consumer of tobacco, the Chinese government collects over $67 billion in tobacco taxes per year. While these have been funneled to educational and fiscal support to curb smoking attitudes in western nations, China’s social agenda has yet to support the reduction of tobacco use.
The World Health Organization (WHO) has proposed a number of recommendations to curb China’s smoking epidemic, including health education and heavy taxation. While research has shown that tobacco taxes can be effective in reducing smoking rates, the tobacco industry is so interrelated with the government that an effective tobacco control policy will not be quick to emerge. Smoke-free policies rarely align with those of government agencies and other players (for instance, tobacco policy is led by an economic development agency that consults regularly with the tobacco industry). According to The Economist (2014), the government could further increase the cost of smoking (raised to 11% last year) without losing income - since it controls the monopoly, any lost profits can be made up as tax revenues. However, it is unlikely that a rise in the price of cigarettes would be received well by the smoker population, who are accustomed to low taxed cigarettes (as low as two yuan, or 35 cents, a pack). The influence of the tobacco lobby is also significant. China National Tobacco Corporation has a near-monopoly on tobacco sales in China and between 2000 and 2010, 185 cigarette firms and 1,800 brands were reduced to 30 firms and 133 brands, many of which are now aiming to compete on global markets.
Considering the sluggish progress of the government in implementing a comprehensive tobacco-control policy, smoking will likely continue to pose a formidable challenge to Chinese public health. A recent report concludes that, based on the current rates of smoking, there will be over three million smoking-related deaths by the year 2050. Given that smoking is a major contributor to chronic obstructive pulmonary disease and lung cancer, both of which are leading causes of death in China, the health burden from tobacco use is daunting.
With current smoking trends set to persist, it can only be hoped that China will consider the economic gains from its colossal tobacco industry to be relatively less important, as the negative health impacts of smoking on the population garner more awareness. It is likely that the economic burden of tobacco-related illness and death, approximated to the tens of billions of dollars, will rise as the economy and the cost of health care grow.
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