In the wake of newly released survey data on smoking in China, most news reports have focused on the fact that China’s smoking rates overall remained about the same — more than a quarter of all adults — despite extensive efforts to curb tobacco use. And the overall number of smokers, more than 316 million, increased with population growth even as the number of cigarettes smoked per person rose from 14.2 to 15.2 per day.
Pam Redmon, who has worked on tobacco control in Chinese cities for years, acknowledges that these dim results show how difficult it is to change ingrained habits in China.
“I would’ve liked to have seen that number start to go down. Everybody would. I think what we’re seeing is that social norms have not started to change,” said Ms. Redmon, administrative director of the Tobacco Center of Regulatory Science at Georgia State University’s School of Public Health.
But she is also inclined to focus on the more positive side of the China Centers for Disease Control and Prevention tobacco survey.
It showed that not only has the awareness of the health risks of cigarettes increased, but secondhand smoke exposure in the workplace, restaurants, hospitals, schools and other public places has declined markedly, she told Global Atlanta.
There’s also the fact that some cities targeted by Atlanta-led public health teams in the past few years show lower prevalence rates than the national average, and more importantly, an increasing appetite for action in the form of new regulations and enforcement schemes.
Among 14 cities measured in the recently released China City Adult Tobacco Survey (including seven where the China Tobacco Control Partnership worked) smoking rates ranged from 17.7 percent to 24.5 percent, compared to 27.2 percent at the national level.
Ms. Redmon can’t draw a causal link between the team’s work and these results, as there are a variety of factors that can affect the data. But she has seen cities position themselves at the vanguard of tobacco-control policy, setting an example for national leaders. The city of Beijing’s blanket ban on smoking in indoor public space earlier this year came on the heels of creative efforts by smaller cities to curb usage, including by promoting smoke-free weddings (Qingdao) and creating smoke-free restaurant districts (Hangzhou).
“I look at these [cities] almost like incubators,” said Ms. Redmon, who works alongside Michael Eriksen, dean of the Georgia State’s School of Public Health and a foremost authority on tobacco control worldwide. Dr. Eriksen and Emory University’s Jeffrey Koplan were co-administrators on the 17-city partnership that was conducted under the banner of the Emory Global Health Institute until last year. They’re continuing the work on a new Georgia State-led project backed by Pfizer Inc. targeting five new cities.
In September and October, the team was together in China again finishing out the Emory work and looking forward to the future.
A highlight of the trip and another point of optimism, Ms. Redmon said, was an awards ceremony honoring businesses from all 17 cities that had instituted smoke-free policies.
Most of the award winners were Chinese companies, giants like Taiping Insurance, Tsingtao Brewery or e-commerce giant Alibaba Group, but some foreign firms like GE Energy were honored through their Chinese subsidiaries. An overall winner of “best smoke-free business” was named in each city, followed by honorees in implementation of policies, enforcement of policies and cessation support. The awards ceremony generated substantial media attention, even among state-owned newspapers — influencing public opinion is a key piece of the work in China.
Ms. Redmon said Chinese city officials from the former project are now taking on the task of training five cities selected under the new project: Diffusion of Tobacco Control Fundamentals to Other Large Chinese Cities.
“It’s exciting to see that, and that’s how it’s really supposed to happen,” Ms. Redmon said. “We can share international best practices, but it has to be tailored to China and Chinese customs, and they are much better prepared to do that, and they’re much more credible than we are.”
Also, this time, the GSU-led team will conduct an initial survey that will serve as a baseline to measure the effectiveness of their tobacco control efforts, something that hasn’t been done before. The cities included in the Pfizer-backed project are Chongqing, Chengdu, Wuhan, Xi’an and Xiamen.
The team is planning another trip to China later this year to continue the work, possibly bringing city officials to Hong Kong to get an up-close look at its progressive policies.
Georgia State got word in November that the Pfizer grant, which was started with an $850,000 grant renewable for three years up to $2.1 million, had been renewed for a second year at $867,000, Ms. Redmon said.
It couldn’t have come at a more important moment: Dr. Eriksen and Dr. Koplan wrote in “The Lancet” in October that the number of tobacco-related deaths in China is set to double to 2 million per year by 2030 without bold action. Another study said that one of three young men in China will eventually die from smoking-related illnesses. More than half of Chinese men smoke, compared with only an estimated 2.7 percent of women.
Read more about this work in ‘China’s Smoking Dilemma’ on Georgia State University’s magazine site, or view the gallery below. All photos by Anna Varela.
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