Over the past half a year since I moved to Beijing to be the World Health Organization Representative in China, I have had the opportunity to visit several provinces and cities. I have seen for myself the progress that is being made in efforts to make public spaces smoke-free.
Most recently, I was in Xi’an to celebrate the city's new regulation banning smoking in indoor public places, which took effect on November 1, 2018. And I am encouraged to see that a growing number of places are showing an interest in and commitment to banning smoking in indoor public places.
During my time here, I have realized how important such bans are and how much people appreciate them, even many smokers, who realize that such bans also protect their family members, particularly their kids, from the harmful effects of secondhand smoke.
Becoming 100 percent smoke-free starts with the political will to make it happen. The Chinese government demonstrated its commitment in 2003 when it became a party to the WHO Framework Convention on Tobacco Control. It reiterated that commitment five years ago this December, when the Communist Party of China Central Committee and the State Council released a notice calling for government officials to ‘walk the talk’ by not smoking in public venues or at public government events. More recently, the President’s Healthy China 2030 vision contains specific targets to reduce adult smoking – from its current 28% of adult population to 20% by 2030. These are all positive indications of high level political commitment to address the tobacco epidemic in this country.
However, while there has undoubtedly been progress, it has been slower than public health officials and national tobacco control advocates had hoped. The momentum is now at the subnational level, where governments are being responsive to local residents who favour smoke-free policies, as repeatedly shown in surveys.
Cities such as Beijing, Shanghai, Shenzhen and Xi'an are at the forefront of the diffusion of the smoke-free movement in China. This public health innovation is leading the country's tobacco control charge from the “bottom up,” successfully enforcing smoke-free regulations and changing social norms through targeted public health campaigns.
Now other places are following their lead. Hangzhou introduced a smoking control regulation that bans smoking in indoor public places, workplaces and public transportation, which comes into effect on January 1st 2019. Zhangjiakou, one of the host cities for the 2022 Winter Olympics, has released for comment a draft smoking control regulation. The draft from Zhangjiakou also forbids the use of electronic cigarettes in public places where smoking is banned, thus reflecting the changing landscape of smoking and the need to protect the public from all forms of tobacco, not just cigarettes.
Guangdong has stepped forward as the first province to draft a regulation that would require indoor public places and workplaces to be 100 percent smoke-free. At present, the proposed regulation in Guangdong would only apply to urban areas, cities and counties; rural areas would be exempt. Likewise, Hangzhou's regulation offers entertainment places, hotels and restaurants an unlimited grace period for compliance. Such gaps and loopholes make enforcement more costly and difficult, and more difficult to assess the positive health benefits.
What is needed and has been long advocated by China’s tobacco control champions is a nationwide ban on smoking in public places. The second draft of the Essential Health and Health Promotion Law provides another opportunity for further progress. While the current draft misses an opportunity to call for a national ban on smoking in public places, it is encouraging to see that it highlights enhanced supervision and enforcement of smoking bans, and includes strong language on pricing measures and tax. In subsequent revisions, the draft law must ensure that cities and counties that wish to adopt their own smoke-free regulations should be allowed to do so even before provincial or national level regulations are adopted.
The incidence of smoking among low-income groups in China is higher than among high-income, and rural residents smoke more than those living in urban areas. The current tobacco epidemic compounds the challenges of escaping poverty, because of the catastrophic costs of tobacco-related health care costs.
Only a smoke-free law that bans smoking in all indoor public places, without exemptions, will ensure that those living in poorer and less well-resourced communities enjoy the same protection from exposure to secondhand smoke — which is toxic even in limited quantities — as their wealthier, urban counterparts. A nationwide smoke-free law would help China accelerate and achieve its goal of eliminating poverty.
Beijing, Shanghai, Shenzhen and now Xi’an have shown that it can be done: That a robust smoke-free law, well enforced, can work in China nationwide.
From the leadership commitment at all levels, to the Chinese people that are striving for a better life, I have full confidence that China can make even greater progress toward making all its public places smoke-free.