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Tobacco control in china progress barriers and challenges
1. Tobacco Control in China: Progress,
Barriers, and Challenges
Teh-wei Hu
Professor Emeritus of Health Economics
University of California, Berkeley
To be present at
Asian- Pacific American Heritage Celebration, CDC
May 4th, 2012
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2. Overview
• Background
• What China has done since FCTC
• Barriers to effective tobacco control
• Recommendations to confront the challenges
• Conclusions
2
3. Background (I)
Smoking Prevalence
• Out of 1.3 billion population
– 300 million smokers in China
– 740 million secondhand smokers
– 1.2 million mortality attributable to smoking
Source: China CDC, 2010 Survey
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4. Background (II)
Economic Cost of Smoking
(in 2008 Price)
Cost Estimates % of 2000
2000 US $7.2 billion ---
2003 US $17.1 billion 137%
2010 US $34.3 billion 470%
Yang, Sung, Mao, Hu (2011)
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5. Background (III)
China’s Tobacco Industry
• China National Tobacco Company (CNTC) is
the government monopoly
– Produced 2.375 trillion cigarettes (2010)
– One third of the world’s total production
Source: China Tobacco (2010)
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6. Background (IV)
China’s Tobacco Contribution to the
Chinese Economy
• 5 million rural households (20 million
population) engaged in tobacco farming
• 0.5 million employed in tobacco industry
• 3.5 million people engaged in retail cigarette
sales
Source: Liu and Xiong (2004)
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7. Background (V)
China’s Tobacco Tax
• Current tax rate: 38-40% of the retail price
• Contributed 11.4% of total government
revenue (1995)
• Contributed 7.6% total government revenue
(2010)
• Contributed US$100 billion tax revenue (2011)
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10. Tobacco Tax/Price Provision
• May 2009 tobacco tax adjustment was not
passed onto the retail price (CNTC absorbed
from its profits)
• On March 2012, Ministers of MOH and MOIIT
recommended higher retail price on tobacco
products at the People’s Congress
• On April 2012, Premier Wen pledged to ban
public funds to buy higher end cigarettes
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11. Warning Label provisions
• State Tobacco Monopoly Administration is a
key member of the government FCTC
implementations committee and has been
negotiating the content and size of the label
• Warning label should be 50% of the display
area; China only allows for 30%
• As of April 2012, only Chinese will be used on
warning labels
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12. Smoke-Free Environment
• Smoking ban at the 2008 Olympics in Beijing
(exemplified bars and cafes)
• Smoking ban at the 2010 Shanghai World
Expo (with some penalty enforcement)
• Numerous pilot experiments in medical
schools, hospitals, and high schools across
China
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13. Smoke-Free Legislations
• May 2011 MOH legislation
• No officials above ministry level endorsed the
smoke-free legislation
• No top officials publicly championed the
legislation
• Enforcement is up to regional administrations
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14. Effectiveness of MPOWER Tobacco
• WHO tobacco control surveillance (GATS) showed
that China scored of 37.3 out of 100 of ten
indicators of the MPOWER tobacco control
strategies
• In WHO’s ranking of the success of countries in
tobacco control and FCTC compliance, China
ranked in the bottom 20%
Source: Yang, G.H. et al.
Biomedical and Environmental Sciences 23, pp.422-429 (2010)
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15. Changes in Smoking Prevalence in
China
2002 2010 Changes
Male 57.4% 54.0% 3.4
Female 2.6% 2.1% 0.5
Source: China CDC, GATS Survey (ages 15 and above)
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17. Political Barriers
• Top Chinese leaders consider tobacco control
as a politically sensitive topic
• “Raising tobacco tax would cause social
instability in China”
• “I don’t want to be an unpopular leader” – top
government officials
Source: Deputy Director General of CNTC (2008 People’s Congress)
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18. Structural Barriers
• Government established Tobacco Monopoly
Laws (1982)
• Regulatory body (State Tobacco Monopoly
Administration) and the industry (China
National Tobacco Company) are essentially the
same entity
• CNTC members attend meetings of the
governing body of the WHO/FCTC conference
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19. Economic Barriers
• Raising tax would reduce cigarette consumption
and diminish the tobacco industry’s contribution
to the Chinese economy
• Concerned with potential revenue reduction
• Several key regional economies would be severely
affected
• Raising tax could have inflationary impact on
overall consumer price index
• Unfair burden on low income smokers
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20. Social Barriers
• Offering cigarettes to friends is a sign of
friendship and a form of greeting
• Gift giving of cigarettes at festivities,
celebrating occasions (birthdays, weddings,
new years)
• Expensive brands of cigarettes and gifts to
ones superior shows respect and deference
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21. Recommendations (I)
Top-Down Approach
• China’s one-party political system is an effective
top-down administrative system (SARS
epidemic, natural disasters, healthcare reform)
• Convincing top leaders to initiate tobacco
control measures in earnest
• Penalties are more effective when it comes
from the government
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22. Recommendations (II)
Bottom-Up Approach
• Non-smokers still outnumber smokers
• Making non-smokers rights to a smoke-free
environment to effectively influence top
leaders
• Promote more non-government organizations
advocating for non-smoker rights
• Mobilize media channels to dispel myths
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23. Recommendations (III)
Structural Change
• Government ownership of the tobacco company
conflicts with the implementation of the FCTC
• Separating government ownership of the tobacco
industry requires People’s Congress legislation
• The tobacco industry has been contributing less
of a percentage to central government revenue
• Having the CNTC as a private entity would likely
result in less resistance to implementing FCTC
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24. Conclusions
• Political championship at the highest level is needed
• Evidence-based advocacy to convince new
generation of leaders
• Structural changes to the tobacco industry
• Enhanced awareness of health risks of smoking and
passive smoking
• Grassroots movements, changing social norms to
bring about a cultural change
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