China Bans Smoking in Public—But Does It Matter?

3,000 people in China die every day from smoking-related illnesses. A new smoking ban went into effect on May 1, 2011. (FREDERIC J. BROWN/AFP/Getty Images)

A summary from the Los Angeles Times:

Starting Sunday, all bars, restaurants, hospitals and other public places in China are slated to become smoke-free, inside and out.

China, with the world’s largest population, also has the most smokers—more than 300 million—a deeply entrenched smoking culture and little awareness among the general public about the health risks.

 The current ban was mandated by the State Council, China’s top administrative body, in response to a World Health Organization treaty Beijing signed in 2006 pledging to enact nationwide tobacco-control legislation within five years.

The law mandates a penalty of 30,000 yuan, or about $4,600, for owners of establishments that do not comply, but it is still unclear who will enforce the ban and what actions will trigger such a steep fine.

 …

China accounts for a third of all cigarettes smoked worldwide, and about 3,000 people die every day here from smoking-related illness, according the World Health Organization. Cigarette smoke contributes to four of the five leading causes of death in China, WHO says.

Public health experts doubt that the ban will be immediately effective, citing legal and education obstacles.

Can the ban be enforced?

We spoke with Dr. Yuanli Liu, a senior lecturer at the Harvard School of Public Health, and director of their China Initiative. He told us this over the phone:

 I would think that the issue is not with the capacity. The issue is with commitment.

I think the government will not, at least for the near future, forcefully enforce this new regulation, for several reasons.

 One, for economic reasons. After all, tobacco taxes still constitute quiet sizable government revenue, as 8-10% of the central government revenue comes from tobacco smoking. And here is a classic case of conflict of interest, in terms of putting the short-term economic interest ahead of a long-term public health interest, right?

 And secondly, I think the awareness of the harmful effects from smoking is something that needs to be enhanced, among the policy makers, as well as the general public. I think there is a lack of a comprehensive understanding of the relationship between smoking and diseases… so there is a culture aspect, which I am also worried about, not just enforcement capability.

 My priority concern is not with capacity; I think the capacity is there. My question is whether the government is really committed to mobilizing those capacities.

 What’s happened since the previous smoking ban 5 years ago?

In 2006, the Chinese government signed the Free Tobacco Initiative. Dr. Liu says there has been little progress since then.

Very little progress has been made in tobacco control, even though China ratified the World Health Organization convention on tobacco control.

I think the essence of the problem is that there is a lack of sense of urgency… If you can demonstrate that smoking not only kills but kills very quickly, and happens instantly—like the food security issue, like infectious diseases—[if] they see it happen in real time, I think the reaction would be very different. But if you tell them that smoking kills, but it kills you in 20 years time, I think the sense of urgency is much less.

And meanwhile, if you enforce the regulation vigorously in tobacco control, the government will see their revenue probably reduce, and some smokers will not be happy.

 Let me add one point. That is, when we say “government”, we should be mindful of the different agencies with different agendas.

 There is a Ministry of Health which has been probably the only strong advocate for tobacco control on the part of the Chinese government so far. However within the political power structure in China, the Ministry of Health is not a very strong ministry. It’s a very weak ministry. It doesn’t have many financial, organizational and human resources.

 And meanwhile… the government agency that is supposed to be in charge of implementing WHO Free Tobacco convention is not the Ministry of Health, it’s the Ministry of Industry. And that ministry is also in charge of the tobacco industry. So there is a classic case here of conflict of interest, right?

Before this banning legislation went into effect, the Ministry of Health also set a good example by making the Ministry of Health building smoke-free first, and also by requiring the health facilities [to be] smoke-free by the end of this year. So the Ministry of Health has been working hard on behalf of public health. But it’s the other ministries, including the ministry of industry and information, that are in charge of implementing the tobacco control policy, that are hesitant.

It may make sense in terms of having some revenue from the tobacco industry and keep some people in their jobs—in the tobacco industry-related jobs. But in the long-run, the cost is much, much higher and you need to take action now.

An economic and political issue

Teh-wei Hu, professor of public health at the University of California, Berkeley, told us he believes whether the new smoking ban is enforced is not really a health issue, but an economic and political issue.

The crucial points are control, enforcement and collection of fines. Who will be involved? If these elements are missing, respect [for the ban] becomes optional.

I think that it’s good that the Ministry of Health has made the regulation of no smoking in public and made major news. However, as you know, that there is no really explicit implementation and monitoring as well as penalty.

Although most of the health people think it’s a health issue, the Chinese government is really considering it an economic issue, given the revenue, given the national monopoly. And furthermore, I think, it’s a political issue, because the leaders who often wonder whether [if by] raising the tax, for instance, the low-income smokers may not feel happy, and they often consider this may be a factor of social instability. Although I do not agree with that, I think that’s their argument. What we think is that it’s really good for them to quit smoking.

 But you know, politicians are more in the short-run… but not really in the long-term, so I think that’s the problem we have.

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