20170420-WHO-The_Bill_China_Cannot_Afford_56页_2mb

The Bill China Cannot Afford: Summary

Core Content

This report, authored by the World Health Organization (WHO) and the United Nations Development Programme (UNDP), presents a comprehensive analysis of the health, economic and social costs of tobacco use in China. It highlights the urgent need for stronger tobacco control policies to align with China's national goals of health improvement, poverty eradication, and sustainable development.

Main Points

• Tobacco Epidemic in China
  China is the world's largest producer and consumer of tobacco. In 2014, it accounted for 44% of global cigarette consumption, with over 315 million smokers, representing 28% of the adult population. Smoking rates among men are particularly high, with more than half of adult men being smokers, and many young men starting to smoke as adults. Women's smoking rates are low but may rise with economic development.

• Health Impact
  Tobacco use is a major driver of the non-communicable diseases (NCDs) epidemic in China, responsible for 87% of all deaths and 70% of the total disease burden. Over one million people die annually from tobacco-related illnesses, with projections of 2 million by 2030 and 3 million by 2050. These deaths are disproportionately among the poorest and most vulnerable.

• Economic Costs
  In 2014, the total economic cost of tobacco use in China was estimated at ¥350 billion (US$ 57 billion), which is 0.55% of the country’s GDP. This includes direct medical costs (¥53 billion or US$ 9 billion) and indirect costs such as lost productivity (¥297 billion or US$ 48 billion). The economic burden has increased tenfold since 2000, driven by rising healthcare expenditures and more people being diagnosed with tobacco-related illnesses.

• Social Costs
  Tobacco use exacerbates poverty and inequality by diverting family funds from essentials like food and education, and by causing catastrophic medical costs for low-income households. The death of a primary income earner due to tobacco-related illness can plunge families into long-term poverty, with recovery taking up to 10–20 years.

• Tobacco Industry's Role
  The China National Tobacco Corporation (CNTC) is the largest and most profitable tobacco company in China, controlling 98% of the domestic market. It contributes around 7% of the central government’s revenue, yet its economic contribution is overshadowed by the human and societal costs it incurs.

Key Recommendations

• Adopt a Comprehensive National Smoke-Free Law
  A strong national smoke-free law covering all public places is recommended to reduce tobacco use and its negative impacts.

• Increase Tobacco Taxes
  Raising tobacco taxes, particularly by 50%, would significantly increase government revenue (around US$ 66 billion annually) and prevent 20 million premature deaths over 50 years, as well as save 8 million people from poverty.

• Implement Strong Demand Reduction Measures
  A comprehensive package of measures should be adopted within two years, including a ban on tobacco advertising, promotion, and sponsorship; mass media campaigns on the harms of tobacco; and graphic health warnings on 50% of tobacco packages.

• Eliminate Industry Interference
  The tobacco industry should be excluded from tobacco control policymaking to ensure effective and ethical regulation.

• Establish a Dedicated Policy Body
  A new body under the State Council should be created to oversee the implementation of WHO FCTC and tobacco control policies.

Conclusion

Tobacco control is not only a health issue but also a crucial component of economic and social development. The report argues that stronger tobacco control policies will yield significant health, economic and social benefits, particularly for the poor. These policies are essential for achieving China’s vision of a "Healthy China" and for meeting the Sustainable Development Goals (SDGs) and the 2030 Agenda for Sustainable Development. The current economic model that benefits from tobacco use is unsustainable and incompatible with China’s long-term development objectives.

Economic and Social Benefits of Tobacco Control

• A 50% increase in cigarette prices could prevent 20 million premature deaths and save 8 million people from poverty.
• A comprehensive smoke-free law could avert 6 million deaths and prevent 2 million people from becoming impoverished.
• Stronger tobacco control policies would reduce health inequalities, improve productivity, and support the government’s poverty eradication goals.

Alignment with Global Goals

China has ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) and is a key player in the global fight against tobacco. The report emphasizes that accelerating the implementation of WHO FCTC measures is vital for achieving the SDGs and the 2030 Agenda for Sustainable Development, which aim for a healthier, more equitable, and sustainable world. Tobacco control is presented as a strategic investment that aligns with these global priorities.