2000 Chinese lives go up in smoke each day

I was interested to read last week that the world’s biggest national consumer of cigarettes – China has 350 million smokers - will totally ban the advertising of tobacco products from 2011.

I am pursuing a limited study of the incidence of smoking in China and three other developing countries - India, Pakistan and Bangladesh. On the face of it cigarette consumption is one of the most serious public (and perhaps general) health issues in the world today. In global terms it is primarily a developing country problem.

China signed the Framework Convention on Tobacco Control of the World Health Organization (WHO) in March 2003, ratified the convention in October 2005 with the convention coming into effect on January 9. 2006. China however still lacks a law prohibiting smoking in all public places though smoking is banned in cinemas, libraries, song and dance halls, and conference rooms in the country. Only 28 cities on the Chinese mainland are free of advertising of tobacco.

The Chinese smoking situation is dire. China is the biggest source of smoking-related deaths in the world – around 2000 die per day. Some estimate this will increase to 8,000 per day or 3 million per year by 2050. In the West deaths are often due to heart disease whereas in China the deaths are often associated with tuberculosis, emphysema, stomach and liver cancer. Press reports commonly cite statistics saying that ¾ of Chinese men smoke – this seems an exaggeration - and that smoking is killing half of such men. Chinese women generally do not smoke.

An interesting WHO publication, Tobacco Control Country Profiles 2003 has interesting data on China. The figures provided contrast with some presented in the press and provide a possible glimmer of optimism but an overall picture of despair.

This source suggested that in 1998 about 53.4% of men smoked but only 4% of
women. Thus 29% of the overall adult (aged 15+) population smoke – about twice the prevalence of Australia.

Rates of youth smoking seem 'low' – 11.1% of male youth and 6.4% of female youth. While the women are becoming more represented in the population of smokers, men are becoming less so.These rates of youth smoking are comparable to the ‘ low’ levels now being experienced in Australia.

Putting these two bits of information together the bulge in smoking deaths in China looks like being a once-off. But the low youth rates and high adult rates of male smoking are partly due to the fact that initiation rates in China seem to be concentrated in the 20-25 age group among men.

Nevertheless per capita consumption of cigarettes has declined in China since 1990.
A smoking prevalence study of China was conducted in 1996 and seems to be about the best recently available information. A difficult feature of the Chinese problem is that the population of ex smokers is so small at only 2.3% of the population – in Australia it is larger than the population of current smokers. Nevertheless even in 1996 most Chinese were well aware of the risks of secondary and primary tobacco smoke.

I’ll post again on developing country smoking issues when I feel more confident about dealing with differences in data from different sources.