The Political Mapping of China’s Tobacco Industry and Anti-Smoking Campaign Cheng Li The Political Mapping of China’s Tobacco Industry and Anti-Smoking Campaign Cheng Li John L. Thornton China Center Monograph Series • Number 5 • October 2012 The John L. Thornton China Center at Brookings About Brookings The Brookings Institution is a private non-profit organization. Its mission is to conduct high-quality, independent research and, based on that research, to provide innovative, practical recommendations for policymakers and the public. The conclusions and recommendations of any Brookings publication are solely those of its author, and do not reflect the views of the Institution, its management, or its other scholars. Brookings recognizes that the value it provides to any supporter is in its absolute commitment to quality, independence and impact. Activities supported by its donors reflect this commitment and the analysis and recommendations are not determined by any donation. Copyright © 2012 1775 Massachusetts Avenue, N.W., Washington, D.C. 20036 www.brookings.edu In Memory of my brother, Li Huifu: one of the many who have died prematurely from smoking-related causes. Table of conTenTs Acknowledgments ................................. v Executive Summary.................................ix List of Charts.....................................xix List of Tables ..................................... xx Abbreviations ....................................xxii Chapter 1 – China’s Battle for Tobacco Control: Promising Progression amid Persistent Problems .............. 1 Chapter 2 – Emerging Health, Economic, and Political Crises: Why Chinese Leaders Should Take the Tobacco Epidemic Seriously ............................ 26 Chapter 3 – Leadership Politics and Tobacco Control: Unprecedented Opportunities.............................. 43 Chapter 4 – China’s Tobacco Bureaucracy: Identifying and Breaking Down Institutional Barriers ......... 80 Chapter 5 – Subnational Stakeholders and Tobacco Governance: Yunnan Province and the Hongta Group ........110 Conclusion – Strategic Recommendations for the Anti-Smoking Campaign in China .................. 144 Chronology of China’s Tobacco Industry and Smoking Control (1980-2012) .................152 Bibliography.....................................159 Endnotes.........................................167 About the Author ...............................187 The PoliTical Mapping of china’s Tobacco indusTry and anTi-sMoking campaign John l. ThornTon china cenTer aT BROOKINGS iv acknowledgMenTs his multi-dimensional and interdisciplinary work would not be possible without the support of countless indi- Tviduals and institutions. First and foremost, thanks go to the China Medical Board (CMB), an independent Amer- ican foundation that aims to advance health in China and neighboring Asian countries. For nearly a century, the CMB has greatly contributed to medical and public health research and education. Special thanks to its president, Lincoln C. Chen, members of the board Mary Brown Bullock and An- thony J. Saich, and senior advisor Peter Geithner, for their initial ideas for this project and their intellectual guidance. Thanks are also owed to the Bill & Melinda Gates Founda- tion, which through the CMB, provided the financial sup- port that made this project possible. I am profoundly indebted to two of my very capable research assistants on this project. Eve Cary conducted English-lan- guage research, produced many invaluable charts, checked the accuracy of data and statistics, and offered excellent ed- iting of the manuscripts. Her contribution to the project has been enormous. Yinsheng Li was instrumental to the project through his research assistance on various fronts—conducting Chinese-language data gathering, traveling with me to Yun- nan and other destinations in China, coordinating and con- ducting interviews, and much more. Many improvements of this manuscript presented here should be attributed to their contribution. The PoliTical Mapping of china’s Tobacco indusTry and anTi-sMoking campaign John l. ThornTon china cenTer aT BROOKINGS v In Beijing, thanks are owed to many distinguished public in- tellectuals and public health experts who provided tremen- dous assistance by sharing their expertise and insights and pointing me in the right direction. Yang Gonghuan, former deputy director of the Centers for Disease Control and Pre- vention (China CDC), was extremely generous in offering her precious time through many meetings. Dr. Wang Ruotao, an expert in preventive medicine and a former advisor to China CDC, taught me a great deal about the political culture in- volved in the anti-smoking campaign in China. Hu Angang, a professor at the School of Public Policy and Management at Ts- inghua University and director of the Center for China Studies at the Chinese Academy of Sciences and Tsinghua University in Beijing, provided his critical insights on the economic costs of tobacco use. Dr. Wei Xing at Tsinghua University helped me to meet a number of scholars in Beijing. I would also like to thank several other PRC scholars and reporters who helped me immensely on various topics related to this project, but have asked to remain anonymous. In Yunnan, I am grateful for the marvelous help of Lin Chao- min, professor emeritus of Yunnan University who is current- ly chairman of the Yunnan Province Sinology Association and vice chairman of the Chinese Association of Minority Ethnici- ties, as well as Shen Haimei, former visiting fellow at the Cen- ter for Northeast Asian Policy Studies at the Brookings Insti- tution and professor of anthropology at Yunnan University’s Anthropological Research Institute. Thank you to Li Ping, vice manager of the Center of Marketing and Sales of the Hongta Group, who candidly provided very useful information about the Hongta Group’s historical evolution and future plans. In the United States, Susan V. Lawrence, Kathy Chen, and Xi Yin, who all previously served or currently serve as the direc- tor of the China program at the Campaign for Tobacco-Free Kids, a partner in the Bloomberg Initiative to Reduce Tobacco Use, deserve special recognition for their generosity in shar- ing their expertise, insights, and information. They are a great The PoliTical Mapping of china’s Tobacco indusTry and anTi-sMoking campaign John l. ThornTon china cenTer aT BROOKINGS vi example of professional and intellectual collaboration in the pursuit of a shared goal. I would also like to thank Professor Matthew Kohrman at Stanford University’s Department of Anthropology, who kindly invited me to attend an innova- tive history conference on the Chinese cigarette industry from the mid-20th century to the present at Peking University in the spring of 2012. Elaine Ooi at the Independent Evaluation Group of the World Bank was tremendously helpful in sug- gesting essential readings on public health and tobacco con- trol from the global perspective. Several distinguished scholars in various professional fields— Lincoln C. Chen, Susan V. Lawrence, Kenneth Lieberthal, An- drew C. Mertha and Ted Piccone—have reviewed the entire manuscript. They have offered many invaluable and compre- hensive suggestions for revision. A great number of improve- ments in this final version should be attributed to their expert insights and constructive criticism. I would be remiss not to thank the Brookings Institution, and especially John L. Thornton, whose vision and foresight about the importance of public health in China guided the project. I am grateful to Martin S. Indyk, Vice President and Director of Foreign Policy, and Kenneth Lieberthal, Director of the John L. Thornton China Center, for their support and guidance of my research. Thanks also to Kevin Foley for his offer to edit the final version of this manuscript for publication, Teresa Hsu for coordinating outreach work, Iris An for her logistical help, Meara Androphy for editing the volume, and Kevin Wu, a se- nior at Yale University and intern at Brookings in the summer of 2011, for his very helpful online research assistance. A special note of appreciation goes to Jordan Lee, a doctoral student of politics at Princeton University and my longtime friend, Sally Carman, for their excellent editorial help. I would also like to thank Wendie Yang and Andrea Pasinetti, two bril- liant young NGO workers in Yunnan who taught me a great deal about grassroots change in China. I am also grateful to The PoliTical Mapping of china’s Tobacco indusTry and anTi-sMoking campaign John l. ThornTon china cenTer aT BROOKINGS vii several Chinese researchers in Shanghai, Tianjin and Henan for their good suggestions and advice at various stages of my research on tobacco control in China. Let it be noted that all errors are the author’s alone and that all opinions and argu- ments in this report are the author’s own, and do not neces- sarily reflect the views of Brookings, the CMB, or any other institution. Finally, I would like to dedicate this book to my late el- der brother, Li Huifu. A casualty of smoking, he was in my thoughts as I wrote this monograph. I can only hope that the continued efforts of the anti-smoking campaign, including this report, will help to win the arduous battle over the tobacco epidemic in the most populous country of the world. The PoliTical Mapping of china’s Tobacco indusTry and anTi-sMoking campaign John l. ThornTon china cenTer aT BROOKINGS viii execuTive summary he high prevalence of tobacco use in China is not only the country’s single most serious