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Tobacco control in china progress barriers and challenges


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Tobacco control in china progress barriers and challenges

  1. 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 1
  2. 2. Overview• Background• What China has done since FCTC• Barriers to effective tobacco control• Recommendations to confront the challenges• Conclusions 2
  3. 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 3
  4. 4. Background (II) Economic Cost of Smoking (in 2008 Price)Cost Estimates % of 20002000 US $7.2 billion ---2003 US $17.1 billion 137%2010 US $34.3 billion 470%Yang, Sung, Mao, Hu (2011) 4
  5. 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) 5
  6. 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 salesSource: Liu and Xiong (2004) 6
  7. 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) 7
  8. 8. What China has done since FCTC ratification 8
  9. 9. Framework Convention on Tobacco Control in China • Signed in 2003 • Ratified in 2005 9
  10. 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 10
  11. 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 11
  12. 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 12
  13. 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 13
  14. 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) 14
  15. 15. Changes in Smoking Prevalence in China 2002 2010 ChangesMale 57.4% 54.0% 3.4Female 2.6% 2.1% 0.5Source: China CDC, GATS Survey (ages 15 and above) 15
  16. 16. Barriers to Effective Tobacco Control 16
  17. 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 officialsSource: Deputy Director General of CNTC (2008 People’s Congress) 17
  18. 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 18
  19. 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 19
  20. 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 20
  21. 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 21
  22. 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 22
  23. 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 23
  24. 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 24
  25. 25. Happy Asian American Heritage Celebration!! 25