1 Exposure to Secondhand Smoke in China Qiang Li University of Waterloo and Tobacco Control Office Chinese Center for Disease Control and Prevention 15 th World Conference on Tobacco or Health, Singapore, March 19 th, 2012

China Is the Largest Tobacco Producer, Consumer, and Victim In 2010, 301 million Chinese smoked (~1/3 of the world’s smokers). Each year in China, about 1 million people die from smoking-attributable diseases, and an additional 100,000 people die from diseases associated with secondhand smoke exposure.

Most Chinese People Are Not Protected by a Comprehensive Smoke- free Law At the national level - On March 22, 2011, the Ministry of Health released the Detailed Implementation Rules for Public Place Sanitary Administration Regulation”, which bans smoking comprehensively in 28 public places. – Although these new Implementation Rules are detailed and specific, there is no information about enforcement or fines and other penalties for violation of the smoke-free regulations. At the local level, city SF laws are just mirroring the national level laws.

The proportion of indoor workplaces with comprehensive smoking ban was very low According to the Global Adult Tobacco Survey (GATS) 2010 data, among those who worked indoors, 37.7% reported there was no policy on smoking indoors at the workplace, 31.3% reported smoking was allowed in some indoor areas, and 31.0% reported that smoking is banned completed in all indoor areas at the workplace. During the previous 30 days, – 89.2% of people noticed smoking in workplaces with no smoking ban; – 69.3% of people noticed smoking in workplaces with partial ban on smoking; – 25.5% of people noticed smoking in workplaces with comprehensive smoking ban. The percentage of people working in indoor location noticing someone smoked in their workplaces during the previous 30 days was 63.3%. 4

Tobacco Smoke Pollution Level in Places without Comprehensive SF Law Is High

Chinese People were Unaware of the Harmful Effects of SHS  According to GATS 2010 data, more than 75% of people were not aware that SHS could cause heart diseases in adults, lung diseases in children, and lung cancer in adults.

7 Therefore, Exposure to Secondhand Smoke in China Is High… According to the GATS 2010 data, prevalence of exposure to secondhand smoke was high; 72.4% of nonsmokers were exposed to secondhand smoke in at least one day during a typical week. 72.7% of people reported noticing smoking in indoor public places during the past 30 days, among whom 88.5% for restaurants 58.4% for government buildings Around 35% for health care facilities, schools, and public transport vehicles. 63.3% of people who work indoors reported noticing smoking in indoor workplaces Smoking was reported to occur in 67.3% of homes.

8 The ITC Evaluation of the Long-term Effects of the Smoke-free Olympic Initiatives in Beijing, Shenyang, and Shanghai

9 The Smoke-free Olympic Initiatives in 2008 The 2008 Olympic Games was held in Beijing, Shanghai, Tianjin, Shenyang, Qingdao, Qinhuangdao, and Hong Kong in China. Smoke-free initiatives were adopted in these cities during the Games. Beijing and Shenyang also revised their smoke-free policies prior to the Games.

10 Workplaces: Smoking and Support for Complete Bans

11 Restaurants: Smoking and Support for Complete Bans

12 Bars: Smoking and Support for Complete Bans

13 Smoking prevalence in restaurants in six cities in China compared to Ireland (04), Scotland (06), France (08), Germany (07-08), Netherlands (08), Mexico City(08), and Mauritius (09) 84 IE Mar SC Mar FR Jan NL Jul DE MXC Apr MU Mar 09 China 87-96% % of Restaurants in which there was ANY smoking

14 Conclusions Chinese people are not protected by comprehensive smoke- free law. Exposure to SHS is high in China. In the three Olympic cities, the long-term effects of the smoke-free Olympic Games initiatives were very limited and much smaller than that in some Western countries where comprehensive smoke-free policies were effectively enforced. A comprehensive smoke-free laws with effective enforcement of the smoke-free laws can protect the Chinese people from the hazards of secondhand smoke, as provided by the guidelines of the World Health Organization’s Framework Convention on Tobacco Control.

15 Future Progress has been made: In March 2011, the twelfth five-year-plan outline for national economic and social development of the People’s Republic of China approved by the People’s Congress proposed that China should comprehensively promote a smoking ban in public places. MOH required all health care facilities to be 100% smoke- free by the end of Haerbin made a legislation that is close to 100% smoke- free. The new legislation will be enacted on WNTD We expect that in the next a few years, China will make more progress in protecting people from SHS.