Salud Pública de México ISSN: 0036-3634 [email protected] Instituto Nacional de Salud Pública México Wang, Hong Tobacco control in China: the dilemma between economic development and health improvement Salud Pública de México, vol. 48, núm. Su3, 2006, pp. S140-S147 Instituto Nacional de Salud Pública Cuernavaca, México Available in: http://www.redalyc.org/articulo.oa?id=10600316 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative ARTÍCULO DE REVISIÓN Wang H Tobacco control in China: the dilemma between economic development and health improvement Hong Wang, MD, PhD.(1) Wang H. Wang H. Tobacco Control in China: the dilemma Control del tabaco en China: el dilema between economic development and health improvement. entre desarrollo económico y salud. Salud Publica Mex 2006;48 suppl 1:S140-S147. Salud Publica Mex 2006;48 supl 1:S140-S147. Abstract Resumen Although China´s National People's Congress announced A pesar de que el Congreso Nacional de la Población de its decision to ratify the WHO's Framework Convention China anunció su decisión de ratificar el Convenio Marco on Tobacco Control (FCTC) on Sunday, August 28, 2005, sobre Control de Tabaco (CMCT) el domingo 28 de agosto fundamental challenges to tobacco control still exist. A sur- del 2005, los desafíos fundamentales a dicho control todavía vey at the “No Smoking Day” on May 31, 2004 in China existen. El análisis de “Un día sin tabaco”, llevado a cabo el 31 showed that over 73% of respondents do not think that de mayo del 2004 en China, demostró que alrededor de 73% human society will be able to get rid of the consumption of de los encuestados no piensan que la sociedad esté dispues- tobacco products. Although the prevalence of smoking de- ta a liberarse del consumo de los productos de tabaco. Aun- clined 1.2% from 1996 to 2002, the absolute number of que el predominio de fumadores disminuyó en 1.2% de 1996 smokers increased by 30 million during this period. It is al 2002, su número total se incrementó a 30 millones duran- estimated that smoking prevalence will decline 10% in the te este periodo. Se estima que la prevalencia de fumadores next 25 years. However, due to the population increase, the disminuirá en un 10% en los próximos 25 años. Sin embargo, total number of tobacco consumers will be about the same debido al aumento de la población, el total de consumidores as today, which is 320 million. As long as the tobacco indus- de tabaco será próximo al actual, esto es, cerca de 320 millo- try continues to be significant in overall economic develop- nes. Mientras que la industria tabacalera siga siendo signi- ment, and as long as the government continues to play a ficativa en el desarrollo económico y los gobiernos aún significant role in tobacco production, the debate between jueguen un papel específico en la producción del tabaco, el tobacco production and tobacco control will continue. Al- debate entre la producción y el control de éste continuará. though China has already made significant efforts with re- Aunque China ha hecho ya esfuerzos importantes en esta gard to tobacco control, it is still in the beginning of its política de control todavía está al principio de su "largo cami- “long march” towards improving the population´s health no" para mejorar el estado de la salud poblacional a partir de status by reducing tobacco consumption in China. la reducción del consumo del tabaco en el país. Key words: tobacco; control; consumer; smoking; China Palabras clave: tabaco; control; consumidor; tabaquismo; China obacco production and tobacco control policies a health professional’s perspective, tobacco consump- T have been debated intensively worldwide from tion is seen as the major modifiable behavioral risk fac- various aspects. The centerpiece of these debates is eco- tor for many health problems including cancer, heart nomic development versus health improvement. From and respiratory diseases, and results in an enormous (1) Yale School of Public Health. New Haven, Connecticut, USA. Accepted on: March 20, 2006 Address reprint request to: Hong Wang. Yale School of Public Health. 60 College Street, 208034, New Haven, Connecticut, USA E-mail: [email protected] S140 salud pública de méxico / vol.48, suplemento 1 de 2006 Tobacco control in China ARTÍCULO DE REVISIÓN health care burden.1 From an economic development ing of tobacco in 2003, which was about 34% of the perspective, however, tobacco production is viewed as worldwide total of land used for the growing tobacco an important contributor to the economy, which in- in the same year. Tobacco yield was 2.26 million tons, cludes the contributions to employment, incomes of which was about 37.2% of overall worldwide produc- people who work in tobacco production, and tax reve- tion in 2003.4, 5 nues.2 This debate becomes even more intensified in The areas where tobacco is grown include all prov- China due to the size of tobacco production as well as inces/municipal cities except Beijing, Shanghai, Tianjin, the magnitude of consumption and the role of the gov- and Tibet (Table II). Yunnan, Guizhou, and Henan prov- ernment in the health sector and tobacco industry. inces are the first three provinces in terms of both the land used for growing tobacco and tobacco yield. Over 52% of The tobacco industry and its contribution tobacco was produced in these three provinces in 2003.4 to economic development in China Tobacco manufacturing is a state-run enterprise. The total number of cigarettes produced in China is It is reported that China is the largest tobacco produc- about one-third of total production in the world. The er in the world;3 about one-third of tobacco products annual increase in the total number of cigarettes pro- are produced in China. The tobacco industry includes duced was about 10% before 2000 (Table III). Although three systems: tobacco agriculture, tobacco manufac- the annual increase has declined in recent years, the turing, and the tobacco trade. production of cigarettes reached 35.8 million boxes (1 In the tobacco agricultural system, the land used box contains 50 000 cigarettes) in 2003, which is 22 times for the growth of tobacco leaf and the yields of tobac- as much as the production in 1949.5 co leaf was growing with a fluctuation in China dur- The tobacco trade system includes both points of ing 1949 and 1997. In 1997 the amount of land used for distribution and point of sale sub-systems. The point growing tobacco reached 2.35 million hectares, and the of distribution sub-system is a state-run system. Dur- yield of tobacco reached to 4.25 million tons (Table I). ing “The Ninth Five-Year Plan” period (1996 to 2000), Although the land used for the growth of tobacco and about 4.2 billion yuan was invested in the tobacco dis- the yield of tobacco has declined since 1997, about 1.26 tribution system, and 16 530 points of distribution were million hectares of sown land was used for the grow- built across the country. Among these points of distri- bution, 2 640 are located in urban areas and 13 890 are located in rural areas.5 In addition, there are nearly five Table I million points of sale of cigarette across the country, TOTAL SOWN AREAS OF FARM CROPS AND TOBACCO most of which are owned by the private sector.6 YIELD IN CHINA DURING 1978-2003 Currently, the tobacco industry is a very impor- tant economic sector in China. It is reported that to- Total Area for Percentage Yield of sown area tobacco of area tobacco leaf bacco production significantly contributes to China’s Year (1 000 Hectares) (1 000 Hectares) for tobacco (%) (10 000 Tons) economy by providing both tax revenue to the gov- ernment and employment to the population. 1978 150 105.0 784.0 0.52 124.2 The revenue provided by the tobacco industry is 1980 146 381.0 512.0 0.35 84.5 one of the largest sources of government revenue. It is 1985 143 626.0 1 313.0 0.91 242.5 estimated that the contribution by the tobacco indus- 1989 146 554.0 1 798.0 1.23 283.0 try to the government revenue was 900 billion yuan 1990 148 363.0 1 593.0 1.07 262.7 1991 149 586.0 1 804.0 1.21 303.1 between 1949 and 2000. Since the 1980s, tobacco tax 1992 149 008.0 2 093.0 1.40 349.9 revenue has been the number one source of revenue 1993 147 741.0 2 089.0 1.41 345.1 for the government. Tobacco tax revenue made up 1994 148 241.0 1 490.0 1.01 223.8 11.2% of total government revenue in 1996. Although 1995 149 879.0 1 470.0 0.98 231.4 this figure has declined recently due to economic de- 1996 152 381.0 1 853.0 1.22 323.4 velopment in other sectors, tobacco taxes still made up 1997 153 969.0 2 353.0 1.53 425.1 about 7.4% of the government’s total revenue in 2003 1998 155 706.0 1 361.0 0.87 236.4 (Table IV).5 The tobacco industry is also one of the major 1999 156 372.8 1 373.7 0.88 246.9 sources of revenues to local governments in tobacco 2000 156 299.8 1 437.2 0.92 255.2 growing areas.