[Intl-tobacco] Changing the tobacco trend in China (fwd)

[Robert Weissman]

LETTER: Changing the tobacco trend in China
Volume 356, Number 9227  29 July 2000 / Lancet 2000; 356: 425 - 434
Source: The Lancet, Friday, 7/28/00

Sir--To combat the spread of the tobacco epidemic in the 21st century, WHO
has promoted the Tobacco Free Initiative as one of its major activities
and many countries have set targets to combat tobacco smoking. China is
the largest tobacco producing country in the world, and has over 300
million smokers.

1 Despite the current tobacco control activities, including the Tobacco
Monopoly Law (the law on the exclusive sale of Chinese tobacco within
China), and the fact that the government acknowledges that tobacco use is
harmful, prevalence of smoking in China continues to increase. WHO
predicts that China's current 500 000-700 000 tobacco-attributable deaths
per year, the highest in the world, could rise to 2 million by the year
2025.

2 May 31, 2000, was the World No Tobacco Day, since 1988 the day has been
recognised in China. This year the whole world was waiting to see a
comprehensive anti-tobacco policy implemented in this heavily
tobacco-orientated country. Instead, just 2 days before the no tobacco
day, a report, Total Tobacco Policy, was published3 in the Guanyang
district of Chongqing. The slogan of this policy "fully implement the
total tobacco-growing policy" was pasted up on walls and billboards all
over the district. Local cadres were putting pressure on farmers and
punishing those who were reluctant to follow, and coercing them into
attending a course called "Learn the Policy".  This shows how the tobacco
industries have the power to buy cadres to bring them onto their side, to
succeed in the tobacco market, and to persuade farmers to grow more
tobacco. This sort of campaign also illustrates the lax tobacco-control
policy in China. More should be found out about this "Learn the Policy"
course, to clarify whether it is another way to encourage people to
consume tobacco. The slogan of the World No Tobacco Day--"Tobacco kills,
don't be duped"--falls flat in China and public-health advocates and
anti-tobacco lobbyists make no progress. Furthermore, the aggressive
promotion of free western-brand tobacco, offered by beautiful models in
the bars, discos, and restaurants of south China, is also another way of
boosting the tobacco addiction in the country.

Do we really want to stop the trend of tobacco consumption in China? If
so, health-care professionals need to work together and very hard to
oppose policies promoting tobacco smoking and fight against tobacco
promotion activities, while promoting anti-smoking measures including
tobacco control among youths. All this should be done urgently. Moreover,
smoking cessation services are urgently needed in China to help those who
want to stop smoking but need professional help to do so. Anti-tobacco
lobbyists should work with the Chinese Government to influence policy and
to encourage establishment of smoking cessation services in the country,
with appropriate training provided to health-care professionals to reduce
the burden of tobacco-related disease in the country. Any anti-tobacco
policy should also include prohibition of tobacco sales to youths, ban on
aggressive advertisement campaigns, and reinforcement of existing laws
such as prohibition of smoking in public places. Furthermore, there may
also be a need to make an amendment in the tobacco monopoly law, to give
farmers a choice in what crops they grow.

Abu S M Abdullah

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Department of Community Medicine, The University of Hong Kong, Pokfulam,
Hong Kong (e-mail: asma@hkucc.hku.hk)

1 Lam TH, He Y, Li LS, He SF, Liang BQ. Mortality attributable to
cigarette smoking in China. JAMA 1997; 278: 1505-08 [PubMed].

2 The World Health Report 1999--combating the tobacco epidemic. World
Health Organisation: Geneva, 1999.

3 Staff reporter. Total tobacco policy crushes farmers. The South China
Morning Post May 28, 2000; 7.