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Slowly, China tries to break tobacco habit

Dec 16th, 2007
by AdminCTA.
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Slowly, China tries to break tobacco habit

That won’t be easy where even many doctors still smoke.

By Tim Johnson

McClatchy Newspapers

BEIJING – Smoking has no place at the Olympic Games. But Beijing Mayor Wang Qishan is a reluctant antismoking crusader. After all, he’s a smoker.

He has company at the Olympic Village, where the chief of the Games’ organizing committee also can sometimes be seen through a haze of cigarette smoke.

An astonishing number of China’s cabinet members and sports officials are among the 350 million Chinese whose cigarette habits support a state industry that is generating more taxes in China than any other industry.

Smoking is common even at the Health Ministry. Deputy Minister Gao Qiang smokes heavily, and surveys show that more than 50 percent of China’s male doctors and health workers smoke.

“They are under high pressure, stress, so they smoke to get relief,” said Zhi Xiuyi, the nonsmoking chief of the lung cancer center at Capital Medical University hospital.

Under growing criticism from the World Health Organization and other international bodies, China is slowly combating tobacco usage.

It has agreed to put warning labels on cigarette packs by 2009 and prohibit tobacco-related advertising and promotion by 2011. Last month, Beijing banned smoking in the city’s 66,000 taxis.

But the state tobacco monopoly keeps increasing production. It’s on course to crank out more than two trillion cigarettes this year. Smokers snap up packs of White Sand, Red Pagoda, Yellow Mountain, and 400 other national brands, adding to state coffers. The tobacco industry contributes $31 billion a year in taxes.

In March, the deputy chief of the state tobacco monopoly warned antismoking campaigners not to press too hard.

“We take very seriously the health dangers of smoking, but not having cigarettes also impacts stability,” Zhang Baozen, deputy chief of the State Tobacco Monopoly Administration, told state television.

Cigarette taxes provide Beijing with steady revenue. According to the World Bank, 8 percent of China’s central revenues come from taxes on cigarettes, compared with 3 percent in Britain, 1.8 percent in India, and 0.4 percent in the United States.

Yet there are signs that the central government is embracing limited antismoking efforts, wary of being out of step with much of the rest of the world.

Last year, Beijing ratified a World Health Organisation antismoking convention that commits it to curb smoking in public places, such as schools and buses, and further limit cigarette advertising.

Global health advocates are urging China to reexamine the economic burden of health issues tied to smoking.

The WHO says that one million Chinese die every year from diseases related to smoking and that the toll will climb to 2.2 million fatalities a year by 2020 if current rates continue. It says China faces $5 billion a year in smoking-related health-care costs, part of what it calls a “massive tobacco burden.”

Perhaps even more surprising, the World Health Organisation says that one-third of all Chinese men below the age of 30 today eventually will die of smoking-related disorders.

Part of the reason is that Chinese are smoking at a younger age and smoking more per day. In 1984, the average age when people began to smoke was 22.4 years. By 2006, it was 19.7.

As incomes rise, Chinese smoke more often. Average daily consumption has risen from four cigarettes in 1972 to 10 cigarettes in 1992 and to about 15 today.

Smoking is deeply ingrained in Chinese culture – male culture, that is.

In China, 63 percent of men smoke, while only 3 percent of women do. At weddings, the bride normally circles the reception hall, offering cigarettes to each man, a rite said to augur well for her eventual childbearing. Cigarettes are also handed out at funerals. Between courses at banquets, male diners frequently pause for a smoke.

China’s soaring economy is precisely why some antismoking activists see light ahead. They say the state-owned cigarette companies are becoming a smaller portion of total tax revenue for the government, making measures to contain smoking more feasible.

In a move that pleased antismoking activists, China last year ratified the WHO’s Framework Convention on Tobacco Control, which requires it to stiffen bans on advertising and promotion. As a result, Beijing told the television industry to cut down on unnecessary smoking scenes and pledged that the 2008 Beijing Summer Games would be smoke-free.

Tobacco Kills 100 Million

Dec 8th, 2007
by AdminCTA.
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Public Health and Cancer Prevention: Success and Future Challenges in Cancer Policy

WEBWIRE – Saturday, December 08, 2007

PHILADELPHIA – Medical research has revealed much about cancer prevention, but is the information reaching all Americans, and are they acting on it? Today, at the American Association for Cancer Research’s Sixth Annual International Conference on Frontiers in Cancer Prevention Research, being held from December 5 to 8 in Philadelphia, Pennsylvania, researchers explore the question of how best to translate cancer prevention science into public health policy.

Quitting smoking and inoculation with the human papillomavirus (HPV) vaccine are two ways that major segments of the general population can drastically lower their risk of developing certain cancers, yet researchers have found that these messages are not necessarily translating into action by the public.

Policies to reduce tobacco harm: What works? Abstract no. A29

To discourage cigarette use, the strategies that are working best on a global basis are to

  • use large graphic package warning labels,
  • ban cigarette advertising,
  • institute smoke-free policies,
  • increase cigarette prices and
  • implement methods to prevent smuggling and counterfeiting of tobacco products,

say researchers at Roswell Park Cancer Institute involved in an International Tobacco Control (ITC) Policy Evaluation study. What hasn’t worked as well as hoped is mandating tar and nicotine levels in cigarettes, they add.

The researchers have been investigating progress on controlling tobacco use from the ongoing Framework Convention on Tobacco Control (FCTC), the treaty devoted to improving public health put forth by the World Health Organization.

The FCTC was adopted by WHO’s member states in May, 2003, and became legally binding for those countries that ratified the treaty in 2005. To date, 151 countries have done so, and are thus required to implement the policies within three years.

“For the first time ever, we are beginning to scientifically assess which governmental tobacco control policies are working and which ones are not” said K. Michael Cummings, Ph.D., MPH, chair of the Department of Health Behavior at Roswell Park Cancer Institute. “In the same way that evidence-based medicine has been built from rigorous evaluation of treatment options, our goal is to contribute to the development of a sound science base for tobacco control policies”

The ITC serves to study which policies are working best in countries that have imposed restrictions, says Cummings. Cummings started the study in four countries in 2002 with a $1.5 million grant from the Robert Woods Johnson Foundation, and to date, $35 million has been raised to expand the research into 15 countries, utilizing the aid of 60 investigators from 17 research institutes.

Because randomized clinical trials can’t be used to evaluate government policies, the ITC study uses as controls those countries that have implemented tobacco control policies and compares the effects on tobacco use behaviors in countries that have not, such as the United States. It is tracking tobacco use behaviors of 1,000 to 2,000 participants in each of the countries, Cummings says. “This is a new model for global public health research that can be used to evaluate other public health policies such as HIV, diet, and cancer screening” he said.

“It made sense for WHO to start off with tobacco as a focal point for action since tobacco use is the leading cause of preventable death in the world today and is a growing epidemic in the developing world” he said. Tobacco use was responsible for 100 million deaths in the 20th century, and that number is expected to grow to 1 billion in the 21st century, he says.

ITC researchers have found that boosting tobacco taxes, comprehensive advertising bans, smoke-free laws, and strengthening cigarette package warnings is an effective recipe for reducing tobacco consumption. “Our research on package warnings has revealed that these warnings, especially if they are large and graphic, are more effective than anyone realized, especially in poorer countries that can’t afford expensive counter-marketing campaigns” he said.

An example of a policy that hasn’t worked, Cummings says, is the European Union’s (EU) establishment of maximum emission standards for tar and nicotine. The goal was to make cigarettes less toxic, but the testing method adopted by the EU was flawed and cigarette makers increased filter ventilation to get around the new rules. Actual exposure to toxins didn’t change. “The well intentioned, but flawed EU policy has given smokers the false illusion that their cigarettes deliver less tar and nicotine, when they don’t” he said.

The ITC has also established the first international cigarette repository, which currently holds 10,000 cigarette pack varieties from 15 different countries. This research shows that tobacco manufacturers alter their products frequently without revealing that they are doing so, he says. “Foods and drugs are regulated so that consumers are informed when the products are altered. The same should be true for tobacco products” Cummings said.

WHO Framework Convention on Tobacco Control

Oct 11th, 2005
by AdminCTA.
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China and hence Hong Kong ratified the WHO Framework Convention on Tobacco Control and was given formal confirmation on the 11th of October 2005.

On 11 October 2005, the Government of China informed the Secretary-General of the following:

In accordance with the provision of article 153 of the Basic Law of the Hong Kong Special Administrative Region of the People’s Republic of China and article 138 of the Basic Law of the Macao Special Administrative Region of the People’s Republic of China, the Government of the People’s Republic of China decides that the WHO Framework Convention on Tobacco Control and the declaration made by the People’s Republic of China on the prohibition of the introduction of tobacco vending machines shall apply to the Hong Kong Special Administrative Region and the Macao Special Administrative Region of the People’s Republic of China.

In English: WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL
In Chinese: 世界卫生组织烟草控制框架公约

The WHO FCTC: a global health treaty

The WHO Framework Convention on Tobacco Control (WHO FCTC) is the first global health treaty negotiated under the auspices of the World Health Organization. This convention is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. It represents a paradigm shift in developing a regulatory strategy to address addictive substances; in contrast to previous drug control treaties, the WHO FCTC asserts the importance of demand reduction strategies as well as supply reduction issues.

The WHO FCTC was developed in response to the globalization of the tobacco epidemic. The spread of the tobacco epidemic is exacerbated by a variety of complex factors with cross-border effects, including trade liberalization, direct foreign investment, global marketing, transnational tobacco advertising, promotion and sponsorship, and the international movement of contraband and counterfeit cigarettes.

From its first preambular paragraph, which states that the “Parties to this Convention [are] determined to give priority to their right to protect public health”, the WHO FCTC redefines the role of international law in preventing disease and promoting health. The core demand reduction provisions in the Convention are contained in Articles 6-14, which detail the price, tax, and non-price measures necessary to reduce the demand for tobacco. The core supply reduction provisions are contained in Articles 15-17. Another novel feature of the Convention is the inclusion of a provision to address liability issues. Mechanisms for scientific and technical cooperation and exchange of information are set out in Articles 20-22.

This Convention shall enter into force on the ninetieth day following the date of deposit of the fortieth instrument of ratification, acceptance, approval, formal confirmation or accession with the Depositary. At that time, States Party to the WHO FCTC will become legally bound by its provisions. The Convention opened for signature on 16 June 2003 in Geneva, Switzerland. It remained open for signature at the United Nations Headquarters in New York, the Depositary of the treaty, until 29 June 2004. States that have signed the Convention have indicated that they will strive in good faith to ratify it and committed themselves not to undermine the objectives set out in it. Although the Convention is no longer open for signature, states that did not sign the WHO FCTC may nevertheless become a party to the treaty through accession, which is a one-step process equivalent to ratification.

The global network of state and non-state actors developed over the period of the negotiations will be important in preparing for the implementation of the Convention at country level. In the words of WHO’s Director General, Dr LEE Jong-wook:

The WHO FCTC negotiations have already unleashed a process that has resulted in visible differences at country level. The success of the WHO FCTC as a tool for public health will depend on the energy and political commitment that we devote to implementing it in countries in the coming years. A successful result will be global public health gains for all.

For this treaty implementation to materialize, the drive and commitment that was evident during the negotiations will need to spread throughout the national and local levels, so that the WHO FCTC becomes a concrete reality where it counts most: at the country level.