Search

The prevalence of tobacco in Chinese men has peaked since the 1980s. The past 30 years, the smokers start to smoking more and more early, and a half of smokers did before 20 years old in 2010 survey; the prevalence of male smoking only fallen about 10% from 1984 to 2015, did not drop and still over 50% from 2002 to 2015. For female, its prevalence of smoking has been kept very low level. By 2015, after 10 years the entry into force of the Convention, the prevalence of SHS exposure at homes and in the public places were dropped to 46.7 and 54.3%, separately. However, there are still about half of the non smokers at home or in public places suffer from SHS exposure. Reviewing eight case-control or prospective cohort studies in different urban and rural of China from 1980s to 2005. The overall mortality of smokers was significantly greater than that of nonsmokers, relative risk (RRs) are from 1.1 in 1990s rural to 1.65 in 2010 urban. The urban male smokers who had started before age 20 years had twice the never-smoker mortality rate (RR 1.98, 1.79–2.19) and who daily smoked more than 25 cigarettes was closed twice (RR 1.93, 1.75–2.12). Based on these estimation, smoking caused about one million (840,000 male, 130,000 female) deaths in China in 2010. The female tobacco attributable mortality fraction may be over-estimated from GBD2010 study and WHO 2008 study, which is different with the results of all epidemiological studies. GBD study estimated that exposure SHS causes around 159,000 deaths in China in 2010. Although it is need to further approach and deepen for the scientific evidence on secondhand smoke, the current global and Chinese evidences were sufficient for public health intervention.

Article 11 has formed the basis for international action to communicate the health risks of tobacco use, and requires each Party to implement within 3 years after ratifying the treaty. The Regulations on Cigarette Packaging and Labeling in the Territories of the People’s Republic of China (the Labeling Regulation) jointly issued and updated by STMA and GAQSIQ in 2008, 2011 and 2016, are the reproduction of STMA’ Research on Counterproposals and Countermeasures against WHO FCTC. This is a typical case of national public power servicing for the interests of tobacco industry. The cigarette package display and assessment study strongly suggested that the Chinese text-only health warnings on cigarette packages are very low effective. By 2016, 105 Parties adopted the graphic warnings on cigarette packaging, covering 58% of the world’s population. China is obviously behind.

Marketing and promotion increase tobacco sales by encouraging current smokers to smoke more and decreasing their motivation to quit. Marketing also encourages potential users, young people specifically to try cigarettes and become long-term customers. The key point of Article 13 of WHO FCTC is to undertake a comprehensive ban all tobacco advertising, promotion and sponsorship (TAPS) within 5 years after ratifying the treaty. The Chinese Advertising Law promulgated in 1994 were obvious deficiencies compared with WHO FCTC. However, tobacco industry has been impeding the revision of national laws to reserve room for TAPS. Eight types of prevalent tobacco advertising in China are summarized: disguised forms of tobacco advertising or promotion in media, outdoor cigarette advertising, the displays at the Point Of Sale, grand scale gathering for brand recommendation and product presentations, tobacco advertising at internet and new media, cigarette packaging as advertising and production and distribution of items that resemble cigarettes such as sweets and toys. The tobacco industry often participates in sponsorship such as education, scientific research, sports, music, cultural, social events and public education campaigns in the name of social responsibility. Over 100 Tobacco Hope primary schools is a typical case. Surveys in 2009–2015 showed extremely high exposure to TAPS among urban population, especially among teenagers. To promote comprehensive ban all forms of TAPS, a lot of public health advocacy campaigns have been carried out over past 10 years. The amended Advertising Law and the other regulations have come into force successively, most form of TAPS have been banned up to 2015.

In this chapter we review how to implement Article14 of WHO FCTC assisting smokers to quit tobacco use in China. In 2015, the currently smokers run up to 315 million, only 18% ever smokers gave up smoking, but proportion of taking action to quit (quitter and relapse maker) was increasing over 50%, which revealed the tremendous and increasing demand for smoking cessation in China. Chinese government has supported the popularization and establishment of cessation clinics and hotlines, introduced simple smoking cessation intervention techniques, updated guidance in cessation clinics and developed guidance cessation hotline although these strategies and measures are need to be further improved. However, why a few people visit the smoking cessation clinic in China with great demand for smoking cessation? The fundamental reasons are related to that Chinese government have not integrated tobacco dependence diagnosis, treatment and counseling into their health-care systems, especially into the primary medical service. Also the costs of quitting services and treatment are totally not covered with the medical insurance plan or by public funding or reimbursement schemes. Chinese government should adjust the current cessation strategy and take effective measures on the WHO recommendations approach of offering quit help, to promote cessation of smokers and adequate treatment for tobacco dependence.

Since 1980s, the tobacco control campaign has been supported by financial assistance of international community. Tobacco control donation from major American foundations has increased considerably after China ratified the WHO FCTC in 2006. The research grants are to support the study of health risk of tobacco use, prevalence pattern of smoking and secondhand smoke exposure (SHS), as well as policy assessment of tobacco control. Next, tobacco control as a significant public health measure was introduced project activities in an early health loan of the World Bank. For the past century, such distinguished philanthropies as the Rockefeller foundation (China Medical Board), Ford Foundations have pioneered many fields in China, especially in medicine. The Bloomberg Initiative (BI) Grants and the Bill & Melinda Gates Foundations provided the biggest support for tobacco control in China. During 2007–2016, BI grant has provided 21.4 million US$ fund to China for tobacco control with 96 projects for national professional organization, local agency of tobacco control, university and non-government organization (NGO). The Grant supported to promote national and local tobacco control legislation, including 100% smoke free environments in project cities, and so on. The Bill and Melinda Gates Foundation continues to provide more than $34 million (US) to support policy interventions, social marketing and building the evidence base in tobacco control in China. Meanwhile, it is important for tobacco control community should consider how to promote domestic charitable donations to tobacco control.

The development and sustainment of a comprehensive tobacco-use surveillance system is critical to support its national plans, priorities, and programs, as well as an obligation for the WHO FCTC’s Parties. We discussed methodology used in China’ tobacco surveillance, including sample design, module and questionnaire, along with the indicators and analysis methodology for policy performance assessment. China updated the surveillance data almost every 5 years with the similar indicators; results from the five national adult surveys and 2014 youth survey provided the trend and distribution of tobacco use at national level. Prevalence of tobacco use in China did not change a lot more than 10 years after WHO FCTC came in force in 2005, decreasing 1% and hovering around 27%. The tobacco control policies implementation was very poor in China during this period: the average score for the implementation of the five key policies of MPOWER assessment was 37.3 points based on 2010 GATS-China. The current system can’t effectively monitor the tobacco industry and has trouble with data sharing and data use, therefore, the surveillance system on tobacco is need to further improvement in China. In addition, the regular funding is shortage and capacity for surveillance is still limited, especially in local level.

This chapter, as the introduction of the book “Tobacco Control in China”, described the response to the tobacco use pandemic from international public health community so as to understand the tobacco control in China by the international perspective. Tobacco use pandemic is a global problem and must be solved at the global level. It cannot be solved by traditional public health strategy, but should be solved based on the international law at the legal level! WHO Framework Convention on Tobacco Control (WHO FCTC) is the important weapon responding the tobacco pandemic under the Globalization. However, the attitudes and actions of the Chinese government during the negotiations on the WHO FCTC have shown that China’s more pursuit of international recognition beyond pursuit of public health and safety, has presaged the setback of the implementation of WHO FCTC in China. Thirdly, the brief review of the tremendous progress made by the most Parties of WHO FCTC over the last 10 years reflects the status of China’s tobacco control described in the following chapters as a mirror.