Hooked on tobacco: Why China can’t quit despite decades of control

“When I see people smoking in lifts or tourist attractions, I’ll try to get them to stop, but they just don’t care.”

Ms Yan (40), whose friends call her a “modern-day Lin Zexu”, told Lianhe Zaobao (LHZB) that she is especially sensitive to cigarette smoke and has tried persuading nearly every smoker around her to quit.

In Chinese internet parlance, a “modern-day Lin Zexu” — a reference to the Qing dynasty politician who opposed the opium trade in the 19th century — means anti-smoking volunteers or ordinary people who always report second-hand smoke violations.

However, Ms Yan said she would think twice before approaching strangers. “I still get scared if I’m on my own. That woman in Shenzhen did something I wouldn’t dare.”

Public conflicts over smoking

On 24 April, after unsuccessfully asking a man to stop smoking at a non-smoking bus stop in Shenzhen, a woman poured a drink over the cigarette in the man’s hand to put it out. The man in turn grabbed the drink and splashed it back at her. Both parties eventually reported each other to the police.

A few days later, two visitors at Shanghai Disneyland also got into a fight over smoking.

The fact that physical altercations broke out over smoking in two first-tier mainland Chinese cities reignited public debate, placing discussions on smoking bans and tobacco control back in the spotlight.

Shenzhen and Shanghai are generally ahead of the rest of mainland China in smoking control, with lower smoking rates. Yet these clashes show that even in cities with relatively strict tobacco control measures, significant challenges remain.

In recent years, multiple Chinese cities have successively introduced tobacco control regulations, and at least 24 provinces have now enacted tobacco control laws. Shenzhen introduced smoking control regulations as far back as 1998, and tightened them in March 2014, becoming a benchmark for local tobacco control legislation.

Sichuan province and the Xinjiang Uighur Autonomous Region also began enforcing stricter smoking bans on 1 May this year. However, the incidents in Shenzhen and Shanghai led netizens to question the enforcement and practicality of these new regulations.

Some bloggers even posted satirical videos of local residents getting around smoking bans, mocking the disconnect between local tobacco control policies and actual public behaviour.

China is the world’s largest producer and consumer of tobacco. It currently has around 300 million smokers, accounting for about one-third of the world’s smoking population, along with approximately 740 million people exposed to secondhand smoke.

Although China’s adult smoking rate has declined over the past decade, the reduction has been significantly lower than the global average, and progress in tobacco control has been slow.

A report released in April this year by ThinkTank Research Center for Health Development said that the global adult smoking rate had fallen by 26% over the past 16 years, whereas China’s had declined by only 17.4%, below the global average. Meanwhile, cigarette consumption in China continues to rise.

Tobacco control and industrial development tug-of-war

Judith Mackay, senior policy adviser to the World Health Organization (WHO) and director of the Asian Consultancy on Tobacco Control, told LHZB that the national monopoly is the greatest obstacle to tobacco control in China.

China’s tobacco industry operates under a state monopoly system, in which the State Tobacco Monopoly Administration and China National Tobacco Corporation (China Tobacco) function as “one organisation with two names”, serving as both regulator and business operator. This dual role has resulted in a long-term tug-of-war between tobacco control and industrial development.

A joint evaluation report released by China in 2011, Tobacco Control and China’s Future (《控烟与中国未来》), declared that interference by the tobacco industry was the fundamental reason for tobacco control efforts falling short.

In March 2015, Yang Gonghuan, former deputy director of the Chinese Centre for Disease Control and Prevention and one of the report’s authors, published a paper in general medical journal The Lancet noting that tobacco industry interference continued to make tobacco control in China extremely difficult.

China joined the WHO Framework Convention on Tobacco Control 20 years ago, but it has still not made pictorial health warnings on cigarette packaging mandatory, despite more than half the countries in the world already meeting this requirement.

At the legislative level, China has also gone against the global tide and still has not enacted a nationwide tobacco control law.

A Chinese public policy academic, who declined to be named, told LHZB that tobacco control efforts are fundamentally stymied by deep conflicts of interest between government departments, tobacco companies and industry workers.

He said that it is well known that the tax revenue, employment and economic contributions generated by tobacco cannot offset the associated healthcare burdens and productivity losses. However, the latter are hidden long-term costs that are difficult to attribute, whereas the former generate immediate short-term effects.

Since China Tobacco contributes about 7% of the country’s annual tax revenue, a proportion similar to defence spending, there has long been a popular saying that “cigarettes pay the taxes to build aircraft carriers”. While logically flawed, the saying reflects the importance of the tobacco industry to fiscal revenue.

The contribution of China’s tobacco industry goes beyond taxation. Through tobacco leaf cultivation, cigarette manufacturing and the profit revenues generated under the monopoly system, the industry is deeply embedded within the country’s fiscal structure. This also creates greater structural contradictions for China in tackling tobacco control.

Judith Mackay said that public health circles widely regard tobacco tax increases as the most effective way to reduce smoking rates, but progress on this measure has also been slow in China due to the influence of the monopoly system.

Raising tobacco taxes may increase fiscal revenue, but higher cigarette prices suppress consumption, ultimately affecting cigarette sales and industry revenues — outcomes the tobacco industry wants to avoid.

In 2015, China raised wholesale tobacco tax rates from 5% to 11%. Industry observers believed the move significantly curbed consumption, with cigarette sales falling by around 2.3% and 5.6% respectively that year and the following year. However, China has not implemented any major nationwide tobacco tax reforms since then.

Local tobacco control weakened by tobacco economy?

While tobacco control progress in China overall has been slow, there are also major regional disparities. Some provinces that rank near the bottom in tobacco control are also regions where the tobacco industry occupies a relatively large share of local fiscal revenue and economic structure.

According to official data, Yunnan, Guizhou, Hunan, Henan and Sichuan consistently rank among the top five provinces in tobacco planting area and cigarette production volume, and smoking rates in these provinces also tend to be relatively high.

Yunnan is especially dependent on the tobacco industry. Publicly available information shows that tobacco tax revenue once accounted for more than half of the province’s fiscal income, and in recent years has still remained at around 45%. A 2022 survey by the Chinese Centre for Disease Control and Prevention also showed that Yunnan had the country’s highest smoking rate, at approximately 35%.

Zhan Shaohua, associate professor of sociology at Nanyang Technological University in Singapore, said that the tobacco industry is an important source of tax revenue for some local governments and is deeply tied to local economies. As a result, local governments often lack motivation to strengthen tobacco control. In particular, local fiscal pressures have been extremely heavy in recent years, which has probably made tobacco control and restrictions on tobacco production even more difficult.

However, Chen Bo, senior research fellow at the East Asian Institute of the National University of Singapore, disagreed.

He said that the size of the smoking population and consumer purchasing power are what ultimately drive tax revenue for major tobacco-producing provinces, as these places do not actually consume much of their own product internally.

He said, “A problem gets resolved quickly usually because of external pressure or very strong domestic calls for action. In the absence of external or internal pressures, the issue rarely becomes a national priority for immediate resolution — but that does not mean it is being deliberately delayed.”

Social culture promoting cigarettes

The academics interviewed also believe that China’s tobacco control challenges stem not only from policy issues, but also from the cultural and social significance of cigarettes in Chinese society.

Tan Gangqiang, head of Xiehe Psychological Consultation Office in Chongqing, said when interviewed that China’s deeply rooted “smoking culture” goes beyond the commodity itself. Offering and gifting cigarettes are part and parcel of Chinese social customs and interpersonal etiquette, making this a deeper underlying factor in tobacco control.

A common saying goes, “Without cigarettes there is no courtesy; without alcohol there is no banquet,” reflecting the importance of tobacco and alcohol in traditional social and ceremonial culture.

Tan said that cigarettes, like alcohol, are also a “status symbol”. If a particular social circle favours a certain cigarette brand, it becomes easier for members to form their own group identity. Under such peer pressure, refusing cigarettes may carry the risk of social exclusion.

However, Shen Hsiu-hua, associate professor at the Institute of Sociology at National Tsing Hua University in Taiwan, pointed out that while cigarettes are an important social medium in mainland China, second-hand smoke is, in essence, similar to queue-jumping and spitting — it concerns public interest and civic morality.

She said that social protection systems in mainland China have not fully kept up with the rapid pace of social transformation and urbanisation. As a result, individuals tend to prioritise their own interests, making it difficult to establish public order.

However, Tan believes that as younger generations adopt new forms of social interaction and symbols, such as coffee and bubble tea, the social function of cigarettes will gradually weaken, and tobacco control efforts will become more effective.

“This will be quite a long process of reshaping society, but it’s better than nothing,” he said.

This article was first published in Lianhe Zaobao as “烟草经济与公共卫生拉锯 中国控烟路漫漫”.

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