Public smoking regulation in China: no more hot air

Abstract

As part of ongoing tobacco control efforts in China, the Communist Party and the state council have recently issued a statement banning officials from smoking cigarettes in places such as schools, hospitals, and on public transport. Tobacco will also no longer be sold at government or Communist Party offices. This welcome rule is an encouraging step forward, but in a country where smoking is widespread and socially acceptable, and the tobacco industry provides a huge source of income for the government, how effective is it likely to be? China has the most smokers in any country (about 300 million) and accounts for 40% of global tobacco production and consumption. High tobacco use is linked to an average of 1·2 million deaths annually in China, 100 000 of which are caused by exposure to second-hand smoke. Previous efforts to ban smoking in public areas in China have had little success. In 2011, locally regulated guidelines were issued banning smoking in indoor public places, and signs prohibiting smoking are commonplace in restaurants and bars. However, poor enforcement and few penalties for non-compliance mean that the rule is widely ignored. Consequently, smoking in public remains widespread, and up to 70% of adults are regularly exposed to second-hand smoke. The new rule suggests government commitment to the issue, but it needs to be a step towards a national ban on smoking in public places. Moreover, it might be difficult to implement. According to the Chinese Association on Tobacco Control, 61% of male Chinese civil servants smoke, more than half of who say they have never tried to quit, and up to 60% of doctors in China are smokers. Awareness programmes highlighting the health benefits of smoking cessation are clearly key to the success of an effective tobacco control strategy. Once a strict national law banning smoking in public has been framed as the next stage of a proactive tobacco control strategy, the next bold step for China's Government to consider would be to tackle the tobacco epidemic as done in Hong Kong by raising taxes on cigarettes and gearing up anti-tobacco leadership by the medical community.