Nearly one in three smokers worldwide lights up in China, where cigarettes — commonly given as gifts — are so tightly woven into the culture, some believe it's an impossible habit to kick. But a new report suggests the keys to quitting lie in the country's own backyard.
Hong Kong has successfully fought tobacco for two decades and seen its smoking rate drop from 23 percent in 1982 when the campaign began to 12 percent in 2008 — the lowest in the world. The former British colony, now under Chinese rule, hit cigarettes hard with taxes up to 300 percent, banned indoor smoking and promoted education through schools and public service announcements — proving that smoking and Chinese culture aren't necessarily married for life.
"We all learn from shared experiences. The U.S. tobacco program has learned from Australia, Canada and others," said Jeffrey Koplan, from Emory Global Health Institute in Atlanta, who wrote a commentary published online Friday in The Lancet medical journal. "Hong Kong is very relevant to Chinese conditions, and the big lesson for all of us to learn is that effective health promotion programs are multidimensional."
About 30 percent of the world's smokers live in China, a number roughly equal to the entire U.S. population. Within the next 15 years it will kill an estimated 2 million Chinese annually, the report said. The country is home to both the world's largest tobacco grower and cigarette producer.
The mainland has taken some steps to reduce smoking, such as banning TV and radio ads and adding health warnings to cigarette packaging, and it was successful in banning smoking at both indoor and outdoor venues at the 2008 Olympics.
But the government now needs to step up and confront its state-owned tobacco monopoly by slapping cigarettes with steep taxes, said Dr. Judith Mackay, a World Health Organization senior policy adviser who's been a long-standing vocal leader of anti-smoking campaigns across Asia, working with China since the 1980s.
"You have to price them out of the hands and the pockets and the mouths of children," she said, adding that China did levy a tax, but it was absorbed by the companies and smokers were never hit with a price increase. "If you can get kids by the age of 19, they don't start smoking hardly after that."
The price of locally made cigarettes varies widely in China, but a pack can be bought for as little as $1.50 in Beijing. By comparison, in Hong Kong, an imported pack costs just over $5.
In Hong Kong, cigarettes have been taxed a number of times at high rates starting at 300 percent in 1983. When the territory left the tax rate unchanged from 2001 to 2008, it saw a rise in tobacco use, including an increase in the average number of cigarettes being smoked by young people from nine a day in 2005 to 11 three years later. Last year, the government levied a 50 percent tax increase to counter the resurgence.
Mackay, who has lived in Hong Kong for 40 years and was not part of the Lancet commentary, said the WHO recently challenged the territory of 7 million to become the first place to push its smoking rate below 10 percent.
She said it's a target that can hopefully be met, showing China what's possible with enough direction. Hong Kong's leaders, along with WHO chief Dr. Margaret Chan, the financial hub's former health director, are also key to helping China realize just how much smoking will cost the country in the long run.
"Some people in China always think that Chinese are a special case, and actually I don't buy it at all," she said. "I've worked with kings and communists in this region and the product is the same, the health effects are the same, the obstacles are the same, what has to be done is the same."
Earlier this week, a national study revealed that China is now home to the most people living with diabetes. Smoking is a major risk factor for that chronic ailment along with heart disease, the country's top killer. Tobacco-related diseases are already linked to about 1 million deaths a year.
"The huge tobacco and cigarette industry and its economic impact are serious challenges to tobacco control," said Koplan. "But not much different from the tobacco industry in the U.S. Good health eventually trumps commercial profits."