International Herald Tribune, Friday, March 22, 1996, Page 2
China, Tobacco and Health / 3 on a Match
By Patrick E. Tyler
New York Times Service
BEIJING - Rushing down a Beijing alleyway where a north wind was kicking up dust among the vegetable stands and cigarette vendors, Huang Jinhui, 25, paused to explain to a stranger why he smokes.
"Man must smoke," said Mr. Huang, a young barber from Sichuan Province in central China. "I know that smoking is not a good habit, that it's harmful to your health. But I have no choice. To carry on social relationships and to do business, I have to smoke."
In a nearby alleyway restaurant, where the tables were littered with empty beer bottles and oily plates and the air was a gauze of tobacco smoke, Fu Li, a young woman from Henan Province, fiddled self-consciously with her cigarette.
"In the very beginning, it was just for fun," she said of her habit. "When you play mahjongg with friends, if someone offers you one, you cannot refuse. I never really think about the consequences."
Few Chinese do, but that may be changing.
China today has the biggest smoking habit in the world, with an estimated 300 million smokers out of 900 million adults, accounting for 30 percent of the world's consumption of tobacco.
The per capita consumption of Chinese smokers still lags behind some industrial countries, where as many as 22 cigarettes a day is the norm among smokers, but China is rapidly catching up. The average Chinese smoker went from 12 cigarettes a day a decade ago to 16 today.
The governing Communist Party, which has built its legitimacy on doing a better job for the social welfare of the 1.2 billion Chinese than all the emperors and dictators of old, will soon be confronted with an epidemic of lung cancer and respiratory and heart diseases that threatens to overwhelm its health establishment.
The government has recently begun to mobilize a national campaign against smoking. But this effort runs against a powerful tide of interests vested in the vast state-owned tobacco monopoly, which has become the world's largest cigarette producer and whose tax revenues are the government's single greatest income source $8.6 billion in 1995.
"The tobacco industry is the No. I pillar of China's economic development, and so it is going to be a little difficult for us to get the smoking levels down in the near future," said Zhou Wei, a Public Health Ministry official assigned to combat smoking.
The government has banned tobacco advertisements from television, magazines and newspapers, but sports events are festooned with the trappings of tobacco products, as are billboards throughout the country. Beijing, Shanghai and other major cities will try to enforce a ban on all smoking in public places, but health advocates, not to mention ordinary Chinese, are skeptical.
The consequences of China's fondness for tobacco appear to be staggering. The Centers for Disease Control and Prevention in Atlanta, which track global health effects of smoking, say lung cancer rates are increasing 4.5 percent a year in China and estimate that by 2025 some 2 million Chinese will die of smoking-related illnesses each year - four times the number of deaths today.
China's smoking explosion has come much later than the West's, and so too will the medical consequences follow.
"In the West, we didn't see the full male lung cancer epidemic until the 1980s," said Dr. Richard Peto, an epidemiologist at Oxford University.
Those cancers, he said, were spawned by the postwar increase in smoking, between 1945 and 1965, and by the time the crisis hit, smoking rates already were in decline.
In China, per capita tobacco consumption continues to rise.
Dr. Peto said, "In the mid-1980s, I predicted that the risks from smoking in China were rather less than among British or American smokers," largely because daily consumption levels were only half what they were in Western countries.
"But with more detailed evidence now available," he continued, "we are saying that the risk is not less than for British or American smokers and, therefore, at least 50 million of the children now living in China will be killed by tobacco."
When the Communists swept into power in Beijing in October 1949, China's male population represented about 10 percent of the adult population in the world and smoked about 10 percent of the cigarettes consumed. Today, Chinese men are still roughly 10 percent of the world population, but they consume nearly a third of the world's cigarettes. Some 61 percent of adult males smoke in China, but only 7 percent of the women ' according to the World Health Organization. (By comparison, 28 percent of American men smoke, and 24 percent of women.) But that big disparity between the sexes, too, is changing. More and more young women are adopting Western notions of women's independence, and cigarettes, along with bright makeup and tight jeans, have become symbols of the modem Chinese woman.
"China is about at the stage where the United States was in the 1940s and 1950s, where you have got very high male smoking rates and very few women smokers," said Judith Mackay, a Hong Kong-based doctor.
As young women take up the habit, it will only get worse. "If the Chinese smoke like Americans, then they will die like Americans," Dr. Peto said.
Xiping Xu, an expert on China at Harvard University's School of Public Health, said: "My biggest concern is that more and more high school and college students are smoking. Thire is a lot of social pressure, and even the girl students are smoking."
It has not helped that many Chinese icons, including Deng Xiaoping, the country's 91 -year old paramount leader, are lifelong smokers.
Mr. Deng, whose health has seriously declined since 1993, is believed to have finally given up the habit, but his public image as a hardgrit revolutionary who rolled his cigarettes in newspaper engenders more admiration in China than opprobrium.
Prime Minister Li Peng, however, has adopted a high anti-smoking profile. As 3,000 delegates to China's National People's Congress, or Parliament, gathered in the Great Hall of the People last week, Mr. Li chastised 100 deputies from Shandong Province when he found cigarettes for sale in their meeting room.
'' Selling cigarettes here?" he asked, noting that Beijing was preparing to enforce a ban on smoking in all public places and that this year's session of the Parliament was supposed to be smoke free.
Wang Jinquan, who works for Beijing's housing department, said: "I started to smoke when I was in high school. My father died at that time, and I felt so bad, people told me to smoke and relax." Looking more harried than relaxed, Mr. Wang added: "In our hometown almost every person smokes. You know, it is easier to make business, or to make friends, when you draw out a cigarette and offer it to others. Without cigarettes and drinks, you can't get anything done in our town."
Even among doctors, smoking is on the increase in China.
Li Chunjiu, 58, a surgeon at Beijing Hospital, says he got his smoking habit from a fear of snakes.
When a huge flood struck central China five years ago, Dr. Lijoinedateam of 10doctors and nurses who rushed there to help. But news that the flood zone was crawling with snakes set him shivering.
"I heard that snakes are scared of cigarette smoke and the local farmers even lay tobacco leaves on the paths to keep the snakes away, so that is why I started smoking at the time," he said. "But I haven't been able to quit."
A pack of Chinese cigarettes costs as little as the equivalent of 5 cents in the Chinese countryside and in the cities the best brands are less than 50 cents.
For all their attraction, foreign brand cigarettes have only a tiny share of the legal Chinese market, 2 percent or less, said Robirt Fletcher, chairman of the Tobacco Institute in Hong Kong. Should China drop its barriers to foreign tobacco to enter the World Trade Organization, U.S. and British tobacco companies are prepared.
"It wouldn't matter if every single smoker in America quit tomorrow," Dr. Mackay said, "because the tobacco companies would have found a much bigger market."
Smoked to Death
Reuters
BEIJING - A teenager from north China who smoked 100 cigarettes on a bet won his wager but lost his life when his heart gave out, a newspaper reported.
As a crowd of passers-by watched, the 19-year-old, identified only by his surname Wu, suddenly lost his color and collapsed after finishing a fifth pack of Peony brand cigarettes, according to the report.
Mr. Wu, a construction worker in Tianjin, was declared dead at the hospital, the newspaper said.
"The attending doctor determined that Mr. Wu,died of a heart attack brought on by excessive intake of cigarette smoke and acute nicotine poisoning," it said.