Autumn 2010: Dynamic Forces
A Smoking Gun
Helping China strategize to reduce tobacco harm
By Mary Loftus and Robin Tricoles
China’s Ministry of Health has announced that it will ban smoking at medical institutions nationwide by 2011—a huge step for a country where it is estimated that nearly half of doctors smoke.
Smoking has become part of the social fabric in China, in much the same way that the nicotine habit was embraced by Americans in the 1950s and 1960s. About 53 percent of Chinese men smoke. While few women smoke, there are signs that the habit is catching on among younger, urban women.
“China is a particularly important place to prevent and control smoking because it has more than three hundred million smokers and the world’s largest tobacco industry,” says Emory’s Global Health Institute Director Jeffrey Koplan. “Few smokers quit or attempt to quit, few people realize the hazards of smoking, over 40 percent of health workers smoke, and many misconceptions persist about smoking.”
Antismoking efforts face an uphill battle in China, where two-thirds of people say they believe smoking does “little to no harm.” They praise its ability to do everything from reduce stress to keep away mosquitoes.
Emory’s Global Health Institute and the Tobacco Technical Assistance Consortium (TTAC), a national tobacco-control leader based in the Rollins School of Public Health, are collaborating with Chinese public health leaders on successful strategies to reduce smoking and protect the public from second-hand smoke. The Emory Global Health Institute–China Tobacco Partnership is funded by a five-year, fourteen-million dollar grant from the Bill and Melinda Gates Foundation.
“We’re involving people in the communities where they live, work, and play—in schools, hospitals, and work places, for example—in changing the social norm of tobacco use so that tobacco is less desirable, less acceptable, and less accessible,” says Pam Redmon 03MPH, the partnership’s executive director.
Since the partnership was funded in 2008, Koplan, Redmon, and Michael Erikson, a noted expert in national and global tobacco control efforts and director of the Institute of Public Health at Georgia State University, have met with public health officials in China regularly and maintain daily communication. Discussions involve considering likely sites for control programs, the strategies that will work best, and methods for collecting data and evaluating outcomes.
The Global Health Institute–China Tobacco Control Partnership is funding programs in a dozen cities and five universities in China to develop tobacco control initiatives, which range from public health marketing campaigns to local ordinances.
One proven method that seems to work across cultures, says Koplan, is encouraging parents to protect their children by not smoking at home or when their youngsters are in the car. The next step would be to alter the social norm: discourage or ban smoking in schools, parks, restaurants, or other public places.
Equally important are formal interventions and policies. Hong Kong’s successful twenty-year program of tobacco control can serve as a best-practices example for China and other nations, says Koplan.
Hong Kong began its efforts in 1982 with a health ordinance that included legislative amendments (regulation of indoor smoking, warnings on cigarette packs, bans on tobacco advertising). Hong Kong also increased its tobacco tax, smoking education in schools, mass-media campaigns, community events, and leadership from the medical community. Smoking prevalence fell from 23 percent to 12 percent in 2008.
China’s National Tobacco Corporation is the largest tobacco producer and finished cigarette maker in the world, earning billions in tobacco profits and tax revenues. Only about 10 percent of China’s cigarettes are imported.
Nearly two-thirds of the world’s smokers live in ten countries, with China having the highest tobacco use by far, according to the World Health Organization.
“Tobacco is the largest cause of preventable deaths globally, and China has the most smokers in the world,” Koplan says. “There is a huge opportunity in this project to have a major impact on global health.”