Lancet on Japan anti-smoking plan

[Robert Weissman <rob@essential.org>]

TOKYO Smoking, sake, and suicide: Japan plans a healthier future
Volume 354, Number 9181  4 September 1999
by Sarah Ramsay 
JAPAN;
Source: The Lancet, Saturday, 9/4/99

With low tobacco prices, few restrictions on smoking, and cigarette
vending machines on almost every corner, Japan has long been known as a
sanctuary for smokers in a world that is increasingly hostile towards
nicotine addicts.

But its reputation as a puffers' paradise may not last much longer if a
recent Health and Welfare Ministry proposal to halve the percentage of
smokers by 2010 is put into practice.

The recommendation, contained in a 10-year plan to improve the health of
the nation, marks the first time that the Ministry has set numerical
targets to control cigarette consumption.

Although the plan is still at the discussion stage, the Ministry's break
from its usually ambiguous stance toward smoking prompted front-page
headlines and angry protests from the powerful tobacco industry when it
was made public on Sept 12.

The report, entitled Healthy Japan 21, noted that more than 55% of adult
Japanese men smoke, the highest rate in the industrialised world. In
addition, it observed that cigarette consumption is on the rise among
women and minors.

Although the sale of 336 billion cigarettes per year contributes to the
economy, the report noted that benefits are outweighed by the 4 trillion
yen (US$33 billion) costs of health care and smoking-related accidents. In
1995, it estimated that smoking was a major factor in 95 000 deaths, 12%
of the nation's total. This is set to increase as lung cancer surpassed
stomach cancer as a cause of death in Japan last year.

The bluntness of the message and the clarity of the goals were in sharp
contrast to the usual laissez-faire attitude to smoking taken by the
Japanese government. Cigarette packets, for example, display the most
gentle of official warnings: "As there is a risk that it might damage your
health, try not to smoke too much. And be sure to observe smokers'
etiquette."

In a throwback to an era when economic growth took precedence over health,
the government has a legal obligation to promote cigarette sales, which
generate huge public revenues. The Finance Ministry holds a majority stake
in Japan Tobacco Inc, which has a virtual monopoly on the industry, and it
expects to receive 896 billion yen (US$7.5 billion) in cigarette taxes for
the year ending March 31.

An intra-ministerial confrontation now looms between finance and health
bureaucrats over the new proposals. In the past, this would have been a
no-contest, but the Finance Ministry has been weakened by scandals and
recession, while the influence of the Health Ministry is set to grow along
with the rapid aging of Japan's population.

The battle is also being waged outside the government. Japan Tobacco has
protested against the numerical targets, saying consumers should be
allowed to gauge the risks of smoking for themselves. Anti-smoking groups,
who have launched a series of recent law suits against tobacco
manufacturers, welcomed the proposals. Health Ministry officials will hear
detailed responses to the recommendations at a series of symposiums and
public meetings before a final plan is drawn up in January.

Smoking was not the only controversial aspect of the Healthy Japan 21
report. It also proposed a 66% reduction in the acceptable level of
alcohol consumption.

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