Tobacco use is one of the most significant public health issues in China. The health consequences of smoking are many and varied. It is widely recognized that smoking is one of the major causes of lung cancer, stroke, and heart disease. The number of deaths caused by tobacco use in China is currently 1.2 million per year. There are 350 million smokers in China, among which 52.9 percent of males and 2.4 percent of females over 15 years old are regular smokers (Qian, 2016). The economic burden caused by tobacco use in 2012 was estimated to be US$8 billion in health care costs, reduced productivity, premature death, etc. (Yang et al., 2015).
The Rise of the Regulatory State and Tobacco Control
To borrow a term from economics, tobacco users have very large negative “externalities.” The social costs of their behavior are much larger than the private costs imposed on themselves, as many people suffer from second hand smoke. In this case, government intervention is believed to be most effective in the arena of tobacco control.
The Chinese government has been regulating tobacco use for a long time now. Firstly, the government influences the price of tobacco by imposing taxes on tobacco leaf, cigarette production, consumption and distribution. Secondly, at the national level, regulations and laws have been enacted to control tobacco use. A landmark tobacco control legislation was passed in 1991, that is, the Law of the People’s Republic of China on Tobacco Monopoly. Under this law, cigarette advertisements in China are banned in national and international TV and radio programs, as well as in newspapers and magazines. Smoking is also banned in selected public transport and public places. In 2005, China ratified the World Health Organization’s Framework Convention on Tobacco Control (FCTC).
Thirdly, local tobacco control regulations have recently been implemented in some big cities. In Hangzhou, smoking has been banned in most public spaces since March 2010. The Shanghai government has similarly banned smoking in almost all public spaces such as schools and hospitals since March 2010 in anticipation of the Shanghai Expo. Smoking is also banned in public spaces in Guangzhou since September 2010 before the 2010 Asian Games. Since 2008, at least 12 cities have enacted or amended subnational smoke-free public places legislations or regulations. In June 2015, Beijing's smoke-free regulations, the country’s strictest tobacco control law, took effect, leaving all indoor and many outdoor public spaces in Beijing 100% smoke-free (WHO, 2015).
The Effectiveness of Regulation Enforcement
However, the enforcement of laws and regulations for tobacco control has not been very effective. At the national level, China has been relatively slow in implementing its obligations under the FCTC to amend existing laws and regulations to limit the extent of exposure of smoking in at least two areas: banning of all smoking activities in all public spaces; and specifying the punishments for violating tobacco control regulations or laws. In addition to controlling exposure, current laws have to be amended to implement the relevant standards for the inclusion of warning labels on cigarette packages and to ban all advertising, promotion, and sponsorship of the tobacco industry in all media.
As of February 2016, a national smoke-free law that satisfies FCTC requirements has not yet been approved. Also, as reported by the Chinese Center for Disease Control and Prevention (CDC), the effectiveness of current tobacco control policies is unsatisfactory, with a score of only 37 out of 100 points for the implementation of the six major policies in the WHO MPOWER package (Yang and Hu, 2011). (MPOWER is an abbreviation of six policy guidelines: monitoring tobacco use and prevention policies; protecting people from tobacco smoke; offering help to quit tobacco use; warning about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; raise taxes on tobacco.)
According to the Global Adult Tobacco Survey conducted by the WHO in conjunction with the Chinese CDC and US Center for Diseases Control and Prevention in China, the adult smoking rate and exposure rate to second hand smoke in 2010 almost equaled the rate in 2002, suggesting that the enforcement of the newly initiated tobacco control regulations in this period was not very effective. In addition, according to this survey, over 60 percent of smokers continued to smoke despite the warning labels on cigarette packs (CDC, 2011). Also, only one fourth of adults in China were aware of the health hazards of tobacco use and only 16 percent of current smokers planned to or were thinking about quitting in the next twelve months (CDC, 2011).
The progress of tobacco control legislation at the local level to comply with FCTC requirements has also been very limited. One outstanding example is the failure of the Nanchang People’s Congress to pass tobacco control legislation twice in 2010. As of January 2016, a third draft of the legislation is still to be reviewed (JiangNan Dushi Bao, 2016). Furthermore, except for Beijing’s 2015 regulation, most local regulations fail to meet FCTC requirements. For example, FCTC Article 8 requires “universal protection from tobacco smoking in all indoor public places, indoor workplaces, and public transport.” However, in Shanghai’s tobacco control regulations, for example, selective public places are set to be smoke-free, and smoking is allowed to some degree in the remaining public places, including restaurants, bars and offices (Yang and Hu, 2011).
The enforcement of tobacco control regulations at the local level has also been ineffective. For example, between 1998 and 2013 in Shenzhen, no single person was fined for violating tobacco control regulations (Yangcheng Evening News, 2013). Similarly, no one was fined for a period of 10 months in Guangzhou for violating tobacco control law after it was enacted in 2010 (Yangcheng Evening News, 2011).
Local officials, who have incentives to maximize fiscal revenue, may not be willing to fully enforce tobacco control policies.
Coordination in the enforcement of tobacco regulations is another important issue that needs to be resolved. At the central level, a group consisting of eight government departments, “the leading small group for the Implementation Coordination Mechanism of FCTC”, was initiated by the State Council in April 2007 to coordinate the implementation of FCTC policies (Qian, 2016). This small leading group announced a plan for tobacco control between 2012 and 2015. However, the plan has failed to achieve some of its key targets, such as reducing the number of smokers and the volume of cigarette consumption (People’s Daily, 2016).
At the local level, there are usually more than a dozen government departments involved in the enforcement of tobacco control regulations and it is not easy to coordinate them. For example, in Shenzhen and Guangzhou, there are 12 and 15 government departments, respectively, involved in regulations enforcement. They include the bureaus in charge of health, education, transportation, public security, city urban administration, market supervision, industry and commerce, etc. There were no full time invigilators in Guangzhou for the enforcement of tobacco control regulations (Nanfang Daily, 2013).
Why Tobacco Control Regulations are not Effective in China
The ineffectiveness of tobacco control regulations can be explained by the incentives of bureaucrats, as bureaucrats do not just set the regulations, they are also responsible for their implementation. Compared to bureaucrats in Mao’s era, bureaucrats have become even more influential and have incentives to pursue their goals strategically in the process of policy implementation. The incentives of bureaucrats are configured by two institutions: the performance evaluation system for government officials and the government monopoly over the tobacco industry (Qian, 2016).
First, the performance evaluation system for local government officials is the main institutional reason to explain local government bureaucrats’ weak incentives to enforce regulations. The tobacco industry plays an important role in the local economy. Local officials, who have incentives to maximize fiscal revenue, may not be willing to fully enforce tobacco control policies. In 2015, the tobacco industry contributed RMB 1.09 trillion to the Chinese government, accounting for about 7.16 percent of total fiscal revenue (Economic Daily, 2016). For many local governments, the fiscal revenue from the tobacco industry is extremely important and the enforcement of tobacco control regulations may affect the local fiscal revenue.
Second, bureaucrats’ incentives are also shaped by the organizational arrangement for the enforcement of regulations and laws concerning tobacco: the government monopoly of the tobacco industry. The State Tobacco Monopoly Administration (STMA) is both a government department and the monopoly of the tobacco industry. The STMA has secured a place in the leading small group for implementing FCTC obligations, leading to a situation of “regulatory capture,” where the regulators of the tobacco industry actually represent the interests of the regulated.
In the future, to improve the effectiveness of tobacco control regulation enforcement, the performance evaluation system for government officials must be reformed to make them accountable for the outcomes of tobacco control policies. Second, establishing an independent agency responsible for tobacco control may address the regulatory capture issue.
Chinese Center for Disease Control and prevention (CDC) (2011). Global adult tobacco survey, China country report. Beijing: Chinese Center for Disease Control and Prevention.
Economic Daily (2016). “Yancaoye Shangjiao Caizhen Chao Wanyiyuan”, January 18, 2016.
JiangNan Dushi Bao (2016). “Quanguo 14 Cheng, Nanchang Shinei Xiyanlu zuigao”, January 8, 2016.
Nanfang Daily (2013). “15bumen guanyan Quanwu Kongyan Zhifa dui”, September 2, 2013.
People’s Daily (2016). “Woguo Shouge Kongyan Guihua Wei dabiao”, January 27, 2016.
Qian, J. (2016). Tobacco control in China: Institutions, bureaucratic noncompliance and policy ineffectiveness. in Kjeld Erik Brøsdgaard (ed), Chinese Politics as Fragmented Authoritarianism. London: Routledge.
Yangcheng Evening News (2011). “Kongyan tiaoli Shishi 10geyue Guangzou kaichu shouzhang fadan”, July 1, 2011.
Yangcheng Evening News (2013). “Shenzhen kongyan tiaoli chutai shinian weichuju yizhang fadan”, December 27, 2013.
World Health Organization (2015). Smoke-free policies in China: evidence of effectiveness and implications for action.
Yang, G. and Hu, A. (2011) Tobacco Control and China's Future. Beijing: Economic Daily Press (in Chinese).
Yang, G. et al. (2015). The road to effective tobacco control in China. The Lancet, 385(9972), 1019-1028.