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What’s keeping Indonesia, China addicted to smoking?

A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”

Smoking costs China $57 billion in 2014: WHO calls for national ban

The economic dividends from China’s tobacco industry are a false economy, which is at odds with government’s vision for China’s future, the World Health Organization (WHO) claimed on Friday.

http://www.ecns.cn/2017/04-16/253586.shtml

“The total economic cost of tobacco use in China in 2014 amounted to a staggering 350 billion yuan ($57 billion), a tenfold increase since 2000,” Bernhard Schwartlander, the WHO representative in China, told a press conference in Beijing.

The increase is a result of more people diagnosed with tobacco-related illness and increasing healthcare expenditure, according to a report jointly released by the WHO and the United Nations Development Program (UNDP) at the conference.

“The direct cost of treating tobacco-related diseases in China was about 53 billion yuan and the indirect cost was expected to be 297 billion yuan,” in which the productivity loss from premature deaths was a major concern, according to the report.

Meanwhile, the report said that tobacco represents an economy of the past as China’s tobacco companies do not fit the vision of an innovative, value-added future economy.

“Projected increases in these costs will lead to negative spillovers effects across many sectors, placing increasing challenges to Chinese economy and businesses, in addition to the social welfare and health system,” it said.

Wu Yiqun, deputy director of the Beijing-based Research Center for Health Development, a think tank, told the Global Times earlier that China has huge public support for a nationwide smoking ban, but the timetable to adopt a law has been on the back burner.

“The proposed law has been mainly stymied by tobacco industry officials due to the huge economic interests involved,” Wu said.

The sector handed over 1.1 trillion yuan ($170 billion) to the State in 2015, up 20.2 percent from the previous year, the State Tobacco Monopoly Administration said in 2016.

The revenue from the tobacco industry derives from corporations whose business model is to create dependence on a lethal substance.

China in 2016 adopted the “Healthy China 2030″ blueprint, which says China aims to reduce smoking rates among adults from 28 percent to 20 percent by 2030.

More than 1 million people die of tobacco-related diseases every year in China, and the number is expected to reach 3 million by 2050 if no action to reduce smoking rates is taken. About 44 percent of the world’s cigarettes were consumed in China in 2014, nearly 26 percent higher than that in India, the report said.

China’s Ministry of Finance announced in May 2015 to raise cigarette taxation from the previous 5 percent to 11 percent, which “led to a reduction in cigarette sales for the first time in 20 years,” according to the report.

However, “cigarettes are increasingly affordable as the increase in cigarette prices has been much lower than the average increase in salaries.”

Smoking Will Kill 200 Million In China This Century, Report Says

The country is the world’s largest producer and consumer of tobacco.

http://www.huffingtonpost.com/entry/smoking-will-kill-200-million-in-china-this-century-report-says_us_58f26221e4b0da2ff8612b55

Habitual smoking in China is set to kill more than 200 million people this century, a new report from the World Health Organization and United Nations Development Program said.

The deaths will come from primarily poor areas of the country, “unless critical steps are taken to reduce China’s dependency on tobacco,” the report, released Friday, said.

Those steps could be difficult in a country that is also the world’s largest producer and consumer of tobacco, according to WHO. Forty-four percent of the world’s cigarettes are smoked in China, and the profits show. In 2015, the smoking industry in China recorded $160 billion in revenue, according to Agence France-Presse.

Dr. Bernhard Schwartländer, China’s WHO representative, said there needs to be more smoke-free policies across the country.

“If nothing is done to reduce these numbers and introduce more progressive policies, the consequences could be devastating not just for the health of people across the country, but also for China’s economy as a whole,” Schwartländer said.

Cigarettes have become increasingly more affordable, according to the report. A 50 percent tax increase on cigarettes could see 47 million fewer male smokers and 20 million fewer premature deaths over 50 years.

“Raising tobacco taxes is one of the most cost-effective measures to reduce tobacco consumption, while also generating substantial revenue for health and other essential programs – investments that ultimately benefit the entire population,” said Bert Hofman, World Bank Country Director for China, Mongolia and Korea, in the WHO press release.

Shanghai expands public smoking ban

Shanghai widened its ban on public smoking Wednesday as China’s biggest city steps up efforts to stub out the massive health threat despite conflicts of interest with the state-owned tobacco industry.

http://www.digitaljournal.com/news/world/shanghai-expands-public-smoking-ban/article/486881

Nearly a quarter of adults in the commercial hub of 24 million people are smokers, according to the state-run People’s Daily newspaper, citing data from the Chinese Association of Tobacco Control.

Shanghai has had a limited ban on public smoking since 2010, but the regulation covered only certain spaces such as schools and libraries.

The new rule expands the restrictions to all public indoor areas and some outdoor ones.

In June 2015 Beijing municipality adopted the toughest anti-smoking legislation in the country, banning smoking in offices, restaurants, hotels and hospitals.

The southern city of Shenzhen introduced similar rules in 2014.

China has long said it plans to ban smoking nationwide. In November, government health spokesman Mao Qunan indicated measures would be rolled out across the country by the end of last year.

But the measures, which have been available for public comment since 2014, still have not been put into effect.

Anti-smoking measures pose a dilemma for China.

On one hand, smoking has created an enormous burden on the public health system — leading to as many as one million deaths in 2010, according to a 2015 study in medical journal The Lancet.

On the other, the state-run tobacco industry provides the government with an enormous source of income: 1.1 trillion yuan ($160 billion) in taxes and profits in 2015, according to the most recent figures, up 20 percent year-on-year.

China’s tobacco regulator shares offices and senior officials with the state-owned China National Tobacco Corp — a near-monopoly and by far the world’s biggest cigarette producer.

The China representative of the World Heath Organization, Bernhard Schwartlander, said Tuesday in a statement that “the tobacco economy has all but stopped progress on a national smoke-free law”.

“Largely because the tobacco industry in China, which has a vested interest in maintaining an economy based on the production and use of tobacco, dominates the official government body meant to curb tobacco use,” he said.

 

Tobacco lobby holding back smoking ban

On Wednesday, Shanghai becomes the latest municipality in China, following Beijing and Shenzhen, to launch a 100 percent smoke-free policy in public places and work spaces. Some 60 million people-more than the population of many countries-living in these cities can now enjoy smoke-free public places.

http://www.ecns.cn/2017/03-01/247303.shtml

While we congratulate Shanghai on joining Beijing and Shenzhen as global leaders in tobacco control, we must also ask: How is it that only three cities in China have adopted comprehensive smoke-free policies? What is standing in the way of the rest of the 1.3 billion citizens having the right to smoke-free indoor air in their workplaces and factories, and in restaurants and shopping areas?

President Xi Jinping has announced his vision for China’s future. First, he announced the Chinese Dream; then he called for the Chinese economy to reinvent itself, led by industrial innovation; and last summer, he announced his Health China 2030 initiative, a bold declaration that made public health a precondition for all future economic and social development.

As evidenced in this remarkable series of policy announcements, Xi’s vision for China is one in which economic growth enhances, rather than sacrifices, individual well-being.

Unfortunately, there remains a glaring obstacle to realizing the Chinese Dream and Healthy China 2030 vision-an obstacle which has resisted the considerable efforts of China’s public health authorities, advocates and citizens: the tobacco economy.

Tobacco represents an economy of the past. China’s tobacco companies do not fit the vision of an economy driven by innovative, value-added manufacturing and a strong service sector. Its very reliance on Chinese smokers undermines efforts to build a healthy China by 2030.

We celebrate the smoke-free laws in Beijing, Shanghai and Shenzhen. But they are among the wealthiest cities in China, which raises the question of inequality. Smoke-free indoor air should not be a luxury for the wealthy, rather an entitlement for all Chinese citizens who are working hard to realize the Chinese Dream.

Why is this not happening? The reason is largely because of the short-sighted economic interests that are not aligned with the President’s vision.

The small but successful tobacco tax adopted in 2015, which reduced smoking and increased government revenues, should be drastically increased so that the tobacco companies pay more tax and farmers start growing alternative crops.

Instead, there is continued resistance to further tobacco taxes and stronger advertising restrictions. Most concerning is that progress has all but stopped on a national smoke-free law.

To those who doubt whether rural governments are capable of implementing a comprehensive smoke-free law, I would point to the hundreds of millions of people China pulled out of poverty in three decades-a much tougher implementation challenge, achieved through strong government leadership and coordinated action at all levels.

Xi’s vision for China’s future is clear. The country’s leadership should pass comprehensive legislation against tobacco to ensure all Chinese citizens, not just those in the wealthiest cities, can breathe smoke-free air indoors.

Local leaders like those in Shanghai are taking bold decisions to ensure the health of citizens. And even in the absence of national legislation, they are breathing new life into the Chinese Dream to make Xi’s Healthy China 2030 vision a reality and relegate the tobacco economy to a place it deserves-in the past

Beijing’s Smoking Ban Cuts Nicotine Fiends, Though 22 Percent Still Toke

https://www.thebeijinger.com/blog/2016/12/30/beijing-butts-out-smoking-ban-results-200000-fewer-smokers

While Beijing residents accustomed to smoky restaurants, bars, and other hazy interiors doubted that the city’s latest ban on lighting up would have any effect, it’s actually been a slow but steady success: Most F&B venues report good compliance with the rules, and state media recently reported that 200,000 fewer Beijingers are lighting up these days.

Based on findings jointly released at the end of 2016 by the Beijing Patriotic Health Campaign Committee and the Beijing Municipal Health Commission, the percentage of local adult smokers has gone down from 23.4 percent in 2014 to 22.3 percent this year.

Stricter smoking restrictions were announced in 2014, and put into effect citywide in 2015, barring anyone from puffing at eateries, workplaces, public transport and other public places. However, skeptics assumed that those rules would be less than successful, seeing as a 2011 ban did little to rid the capital tobacco haze (though, according to the BBC, those rules were more vague).

Such doubts were quickly dispelled in the summer of 2015, however, when the rules began to be earnestly enforced. State media says more than 127,000 restaurants, bars and other businesses were inspected since June of last year, leading to 5,300 people being forced to at least stub out their cigarettes, while of those 2,719 people in violation of puffing had to pay fines, which totaled RMB 142,500 (USD 20,700) between June 1 and November 30 last year.

Longtime F&B blogger and renowned man-about-town Jim Boyce vividly recalls just how different a night out in Beijing was before the ban. “Eating, drinking, and smoking were the trinity of activities for people going out back then,” he recalls. “I remember a night at places like First Floor, The Den, or Fubar would leave your clothes reeking of smoke — but that was also true of many bars and restaurants.”

Many Beijigers would argue that the capital’s livehouses were the smokiest of all local joints. I can recall the popular Wudaoying livehouse School Bar being so ashy on New Years Eve 2012, when indie troop Hedgehog drew such large throngs of cigarette-puffing fans that one member of my party opted to leave mid set, complaining her eyes were stinging so bad she could hardly see the band.

School Bar owner Felix Liu says such smoke-adverse patrons breathe easier at the livehouse now. “Most people follow the rule and smoke outside and in our yard, because no one actually wants to stay in a hazy room. But we still have some guests that smoke indoors, and we have to get our staff to stop them.”

Other venue owners say the new clear-air era of Beijing’s public spaces went easier than expected. Pink, manager at Temple Bar, says the stricter smoking ban has been successful. “Most customers are happier about the air quality inside our bar now, and smokers are understanding about the rule and go outside to smoke.”

Tristan Macquet, co-owner at Cafe de la Poste, attributes such compliance to the ban’s financial consequences, saying past capaigns “used to be words without actions, but this time [the authorities] really went all out. Fines for smokers and the restaurants were an incentive. Asking for people to report smokers has its pros and cons but it proved effective. We saw it at the time even in Chinese restaurants on Guijie: smokers were asked to go out to have their cigarette.”

Macquet says Beijing’s bar scene has boded well after the ban, adding: “for Café de la Poste, I definitely believe it was the right thing to do. Of course smokers groaned a little at first, but not for long. And the whole atmosphere of the restaurant got better afterwards. Soon it was as if it had always been like this. I think that air quality is such an issue now, especially in term of awareness, that customers really prefer it this way.”

One of the proprietors at Bungalow Tiki Bar says venue owners had just as much, if not more, to gain from the ban. “You reduce table surfaces getting burned, ash on the floor, and, when you have a small place like ours, you avoid the smell. Our bar would be a smoke pit if we’d been open before the smoking ban. It’s changed the whole Beijing nightlife scene. I know a few bars where you can still smoke inside, and now when I go in it’s quite horrible.”

And while the general acceptance, along with assertive enforcement, both seem promising for those opposed to tobacco, not all of the findings in the Patriotic Health Campaign Committee and Municipal Health Commission study were positive. CCTV, for instance, notes that a mere 30 percent of the capital’s adults said they understood the ill effects caused by lighting up. But at least 16.8 percent of them put in the effort to give up the cigs in 2016, a 1.9 percent uptick compared to 2014. We would have been equally interested, however, to learn just how those strong willed Beijingers gave up smoking. Vapes? Tobacco patches? Nicorette gum? Or did they go cold turkey?

Hopefully the next report will clear the air in that regard.

RMB30,000 Fines Under Shenzhen Smoking Ban

Shenzhen smokers: take it outside.

http://www.thatsmags.com/shenzhen/post/17078/rmb30-000-fines-under-shenzhen-smoking-ban

That’s the message from the government today after the city’s already far-reaching smoking ban was extended into the indoor areas smokers favor the most, namely private KTV rooms, bars and massage parlors.

Individual smokers face fines between RMB50-500, while establishments that allow smoking indoors may be slapped with fines up to RMB30,000, according to a report carried by the Shenzhen Daily. Ouch.

The smoking ban was originally introduced in 2014, but a grace period was extended to areas that smokers traditionally favored to give the establishments a chance to begin enforcement.

Internet cafes, in particular, have failed to do so, with the rate of smoking increasing since 2014. Shenzhen’s Center for Chronic Disease Control and Prevention found smoking in 75 percent of Internet cafes recently, according to the same Shenzhen Daily report, a jump from 51 percent in 2014.

Queries submitted to the official anti-smoking WeChat account (szkyws) on Friday revealed establishments that continue to allow smoking will first be warned and later may face fines, with the onus on the businesses to stop smokers from lighting up indoors.

WHO commends Shenzhen’s move to create 100% smoke-free environment

http://www.wpro.who.int/china/mediacentre/releases/2016/20161230-sz-smoke-free/en/

The World Health Organization (WHO) congratulates the government and the people of Shenzhen for their commitment to strengthen the city’s tobacco control laws. Starting on 1 January 2017, Shenzhen will offer all of its citizens and visitors a 100% smoke-free environment in all indoor public places.

“Shenzhen will join a growing list of cities around the world where smoking in indoor public venues is completely prohibited, without exception. A 100% smoke-free law is the only way to protect the people and visitors to this city from the toxic harms of second-hand smoke. There is no other way: there is simply no safe level of exposure to second-hand smoke,” said Dr Bernhard Schwartländer, WHO Representative in China.

The Shenzhen smoke-free law is a model law, fully compliant with the WHO Framework Convention on Tobacco Control. The law was adopted in October 2013 as the first comprehensive smoke-free law to be passed in China However, a grace period was given to certain entertainment and leisure venues to fully comply with the law. That grace period will now end on 31 December 2016.

The smoking ban will also cover outdoor areas of schools, educational and healthcare facilities, parks, stadiums and fitness clubs. In addition, tobacco advertising, promotion, and sponsorship are also completely banned.

The law includes strong penalties and enforcement is closely coordinated between eight government departments and agencies. The challenge now will be to ensure that inspectors have the resources they need and are granted complete access to obtain evidence of violations, and that penalties are consistently imposed.

Similar to Beijing and Shanghai, results from a survey done in Shenzhen show there is strong support for a comprehensive smoke free law among the general public. In addition, the Shenzhen survey also revealed high levels of support from owners and managers of public venues.

“Three of China’s four first tier cities will now have comprehensive smoke-free laws, fully in line with the WHO Tobacco Framework Convention.. These cities, covering a population of more than 60 million, are exemplifying leadership and setting the scene for what is our ultimate goal – a national 100% smoke-free law which gives the same protection to all citizens in China, wherever they live,” said Dr Schwartländer.

A draft national smoke-free law is currently being debated at the State Council. With more than 300 million smokers, China has by far the largest number of smokers worldwide. Every year, 1 million smokers die of tobacco related diseases, and 100,000 Chinese non-smokers are dying of the consequences of being exposed to second hand smoke.

“Beijing, Shenzhen and Shanghai are showing the way by going completely smoke free, covering all indoor and many outdoor public places. We know that it works and how it can be done. It is now time to move an equally strong national smoke free law to make sure that all Chinese can benefit from the same level of protection against the deadly exposure of second hand smoke”, said Dr Schwartländer. “A Healthy China is a smoke free China”.

“Shenzhen has given the people of the city the most precious year-end gift it could possibly give – the gift of clean indoor air, of health, and of life. I cannot think of a better way to start the new year of 2017,” said Dr Schwartländer.

About the World Health Organization

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

For more information please contact:

Ms WU Linlin
Email:wul@who.int
Office Tel: +86 10 6532 7191

Beijing public smoking ban sees significant effect

A newly released report shows Beijing has seen a significant drop in the number of smokers by 200 thousand since the city brought in a strict smoking ban less than two years ago, The Paper reports.

http://english.cctv.com/2016/12/30/ARTIdBzgQ8OF7DnrmDC0Z11L161230.shtml

According to a report on tobacco use among adults, the smoking rate this year went down to 22.3 percent, compared with 23.4 percent in 2014, even though only about 30 percent of adults were said to understand the serious risks to disease caused by smoking.

The report also indicates that 16.8 percent of adults attempted to quit smoking this year, an increase of 1.9 percent compared with 2014.

Meanwhile, the report also shows that smoking in public spaces and second-hand smoking indoors has also been declining.

An earlier report shows that Beijing has established the most transparent law-enforcement system for smoking control in the country, with over 1,400 people among every 10,000 receiving smoking-quit services.

China to Ban Smoking in Public By the End of the Year

http://nextshark.com/china-smoking-ban-2017/

Smokers in China should find a new habit in 2017 as the country is set to implement a stricter nationwide cigarette smoking ban by the year’s end. The country’s National Health and Family Planning Commission and a senior government official introduced the regulation to control smoking in public areas at the Global Conference on Health Promotion in Shanghai on Tuesday, Shanghaiist reported. In a statement, the commission’s publicity head Mao Qun’an announced that “smoking harms health has become a global consensus.” The legislation drafted will make it illegal to smoke in all indoor public venues, public transport, and even workplaces. Outdoor spaces, like hospitals, primary schools, kindergartens, tourist sites, and stadiums will also be off limits to smoking. A fine of up to 500 yuan (US$72) will be imposed for every person who violates the new rule, while businesses which fail to comply will risk having their operating license revoked plus a fine of up to 30,000 yuan (US$4,320).

According to the Chinese Association on Tobacco Control, China is home to around 316 million smokers in the country. The country, which produces the world’s largest supply of cigarettes, has yet to enforce the WHO-endorsed graphic packaging to local tobacco companies. Other factors seen as the cause for such rampant cigarette use is the lack of information drive tackling the harm it causes. The price of cigarettes in the country also remains cheap with some brands priced for just 10 RMB ($1.60) per pack. In 2011, the Chinese government attempted a similar legislation but failed to effectively enforce it. The commission is hoping to improve its implementation this time around.