Will China's Smoking Ban Succeed?

Tobacco use is one of the top risk factors for the non-communicable diseases the World Health Organization is targeting, and WHO has already done a lot of anti-smoking work over the past few years. The WHO Framework Convention on Tobacco Control entered into force in 2005, and its core demands include both price and non-price measures to be taken by signatory countries. Price measures include taxes to increase the per-pack cost of tobacco products, and non-price measures include protection from exposure to tobacco smoke and regulation of tobacco product content, labeling, and advertising.

China is one of the Convention's 168 signatories, and on Sunday its ban on smoking in bars, restaurants, hospitals, and other public places took effect. The question, though, is whether the ban will be observed. Benjamin Haas reports in the Los Angeles Times:

A few days before the ban was set to go into effect, many places in Beijing had only heard of the restrictions from news reports, and no one had received an official notice. [Cafe manager Xu Dongguang] didn't have plans to comply.

"Our whole restaurant is the smoking section," he said. "Maybe we'll try to ask people to go outside, but in the end, the customer is God."

Efforts to ban smoking in public places here have been plagued by false starts and failed campaigns. China, with the world's largest population, also has the most smokers -- more than 300 million -- a deeply entrenched smoking culture and little awareness among the general public about the health risks.

The current ban was mandated by the State Council, China's top administrative body, in response to a World Health Organization treaty Beijing signed in 2006 pledging to enact nationwide tobacco-control legislation within five years. China already has missed the deadline by almost five months.

The law mandates a penalty of 30,000 yuan, or about $4,600, for owners of establishments that do not comply, but it is still unclear who will enforce the ban and what actions will trigger such a steep fine.

Haas notes that cigarettes are common in business dealings, and that reminded me of Peter Hessler's 2008 New Yorker article "The Wonder Years," (subscription only) which profiles Wei Ziqi, an entrepreneur in the village of Sancha. Hessler explains that Wei learned to smoke because he knew it was "a critical skill for any Chinese man engaged in the world of business guanxi, or relationships ... For male Chinese entrepreneurs, the give-and-take of cigarettes represents a kind of semaphore." Hessler writes:

Wei Ziqi knew that smoking was unhealthy, and periodically he tried to quit. But status was far more addictive than nictine. Once, he told me about a dinner he'd attended in Huairou. "I had a pack of Chunghwa that had been given to me by a customer," he said. "One man at the table had Red Pagoda Mountain, and another had State Express 555. But I was the one with the most expensive brand. They were all important people; each one had some possible use to me. I'm thinking about installing a solar water heater for the guesthouse, and there's a government program that pays for that in the countryside. One of the men deals with that program. So it might be possible for me to install it for free."

I don't know whether smoking was ever so integral to US business dealings, but cigarettes certainly used to play a larger role in our national culture. In 1963, annual per-capita cigarette consumption was 4,345 cigarettes, and tobacco was responsible for a growing number of deaths. In 1964, the Surgeon General's Smoking and Health report came out and the public started to see smoking as a health hazard. In the ensuing decades, both state and federal governments adopted a range of policies designed to reduce exposure to tobacco smoke: requiring warning labels on cigarette packaging, limiting tobacco advertising, taxing tobacco products, prohibiting the sale of tobacco products to children, restricting smoking in public places. Governmental and non-profit groups have also conducted educational campaigns on smoking's impacts. By 1998, per-capita cigarette consumption had fallen to 2,261, nearly half of what it was 35 years earlier. CDC deemed this reduction in tobacco use one of the Ten Great Public Health Achievements of the 20th Century.

China may well achieve a similar reduction in tobacco use over the next four decades, but it will require the government getting serious about enforcing its anti-smoking laws. The fact that 3,000 people die from smoking-related illnesses every day in China should provide some motivation. Changing a culture is never quick or easy, but it's often the healthiest thing to do.