China has an estimated 300 million smokers.

China has an estimated 300 million smokers.

Craig Kirkwood/Flickr (CC BY-SA 2.00)

Antismoking campaign pays off in Beijing

In 2009, China's estimated 300 million smokers consumed a staggering 2.3 trillion cigarettes: more than the number smoked in the next four top tobacco-consuming countries—Indonesia, Japan, Russia, and the United States—combined. The health toll is enormous as well: Tobacco causes roughly 1 million deaths in China each year, including 100,000 fatalities blamed on secondhand smoke, according to the World Health Organization (WHO). If tobacco use is not curtailed, WHO warns, China’s death toll could rise to 3 million each year by 2050.

The nation’s capital, Beijing, is taking that chilling message to heart. On 28 November, the Beijing Municipal Government adopted a ban on smoking in all indoor public places—"with no loopholes and no exemptions," crowed Bernhard Schwartländer, the WHO representative in China, in a press release. The new law will take effect on 1 June 2015.

And what Schwartländer called "a quantum leap forward on tobacco control" is in the works. Last week, the Legislative Affairs Office of China’s State Council published a draft national tobacco control law that would make all indoor and some outdoor public places smoke-free; ban tobacco advertising, promotion, and sponsorship; and require graphic health warnings on cigarette packages. Observers expect that the nationwide law will be adopted next year.

The bans will face resistance from inveterate smokers, and enforcement remains an open question. In the runup to the 2008 Beijing Olympics, the city forbade smoking in taxis, sports arenas, museums, government buildings, parks, and restaurants. Shanghai followed suit with antismoking regulations centered on the 2010 World Expo. But enforcement has been half-hearted. The politically powerful China National Tobacco Corporation, a state-owned firm with a virtual monopoly, has resisted controls, and taxes on tobacco sales help fill government coffers. Authorities have been torn between promoting public health and minding the public purse.

This time could be different. Previous laws were weak, "and it is difficult to enforce a weak law," says Angela Pratt, who leads WHO’s Tobacco Free Initiative in China. The new Beijing law has teeth, including stringent fines for business managers who don't comply, she says. Moreover, she says, the Beijing government has “strong determination … to tackle a problem which right now is very negatively impacting the health of its citizens."

Another important factor that could help the ban succeed is "a cultural change" in attitudes toward smoking, says Xiao Shuiyuan, a public health specialist at Central South University in Changsha. "People, including high-ranking officials, are finally recognizing the damage [caused by] tobacco use, not just to the health of people, but also to the image of the country and of their cities," he says. The number of smokers appears to be declining in cosmopolitan cities like Beijing and Shanghai, he says. But that enlightenment hasn’t penetrated rural China, he says.

Nevertheless, “Beijing's smoke-free law is a major victory for public health in China," Michael Bloomberg, the former mayor of New York City, said in a statement. Bloomberg Philanthropies, the Bill & Melinda Gates Foundation, and other groups have financed antismoking research and public education campaigns in China.