China's soundtrack: the clearing of smokers' lungs

Letter from Beijing:  One of the things most guide books to China will tell you is that it is customary for a guest to be greeted…

Letter from Beijing: One of the things most guide books to China will tell you is that it is customary for a guest to be greeted with a cup of green tea.

This is not untrue but it is misleading. The tea, usually in a paper cup inserted into a plastic holder, is indeed proffered as soon as you sit down. But before you sit down, you are offered - at least if you are male - another customary token of welcome and respect. Your host reaches into his pocket, pulls out his packet of cigarettes and offers you one.

Almost everywhere I've been in China, from a peasant's hut in Inner Mongolia to a government office in Beijing, and from an unemployed worker's flat in Shanghai to a cave dwelling in Shaanxi, the ritual is the same. Smoking together is the medium of male bonding and the refusal of a cigarette borders on rudeness. It is not an ancient custom - smoking only really took off in the late 1970s - but the rapidity with which tobacco has replaced tea as the primary token of friendship is a mark of how deep the habit has gone in a relatively short time.

Chinese women, as a rule, don't smoke, but Chinese men do. Sixty per cent of the adult male population has the nicotine habit, and you don't have to be a statistician to know this. Men smoke in taxis, between courses in restaurants, in the fields, in offices and, to judge from the ubiquity of hotel signs imploring them not to do it, in bed. Even if you couldn't see the cigarettes or smell the smoke, you could hear that this is a tobacco culture. One of the characteristic, though not quite charming, sounds of Chinese cities is the deep, harsh, rattle of a phlegm-laden chest being cleared preparatory to a great, big, hawking spit. This habit presumably predates the mass consumption of tobacco, but its frequency and volume have undoubtedly been greatly amplified by it.

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Given the often-foul quality of the air in China's polluted cities, one might have thought the simple act of breathing delivers enough toxins to the lungs to satisfy the most adamant death-wish. Evidently not: the Chinese light up five billion times a day, consuming almost one in three of the world's cigarettes. There are more smokers - around 350 million - in China than there are people in the United States. The human cost is phenomenal: about 3,000 deaths from smoking-related illnesses every day. It is estimated one in every three of today's young Chinese men will have died from smoking by 2040.

Before I came to China, I assumed that this was all the fault of the American and British tobacco giants who have been using China to compensate for their declining markets in the West. It is certainly true that these companies are doing all they can - including, in some cases, smuggling - to get into the Chinese market. But the fact is that I've yet to see a single Chinese person smoking a western brand. To an overwhelming extent, the damage is being done by a single cigarette-pusher: the Chinese government. The tobacco market is dominated by the China National Tobacco Corporation (CNTC), which is a state monopoly. CNTC's sales, almost all of them domestic, account for one-third of the global market, or about the same share as the three largest multinational tobacco companies put together.

As is the case in every country, government revenue from these sales is dwarfed by the costs of providing healthcare to sick smokers. But the direct involvement of the state as a tobacco producer surely contributes to the weak official response to what amounts to a slow-burning national disaster. China signed up to the World Health Organisation's Framework Convention on Tobacco Control last year, committing the government to control tobacco advertising and sponsorship and to combat smuggling.

Cigarette vending machines are being banned and public transport companies in most cities ban smoking. But cheap, tar-heavy, government-produced cigarettes are on sale everywhere (hotels, for example, often provide them alongside the minibar) and it is virtually impossible to stop children from getting their hands on them.

Most importantly, there has been little in the way of serious public education on the dangers of smoking. Most Chinese doctors smoke and, in Shanghai, 40 per cent of all medical workers (including nurses) do so. Chinese smokers I've talked to, including highly educated people, tend to be at best only vaguely aware of the health consequences, and I've heard the view expressed that, because of a genetic quirk, tobacco is bad for westerners but not for Chinese people. One survey found 60 per cent of Chinese adults did not know smoking can cause lung cancer while 96 per cent were unaware it causes heart disease.

Ignorance may be one reason why Chinese men continue to smoke in such huge numbers. Stress may be another, though the fact most Chinese women, who hardly have an easy life, don't smoke suggests the link is tenuous. One factor is certainly that smoking seems cool, modern and western. It is not easy to see, through the acrid haze, that westerners are finally deciding otherwise.

Fintan O'Toole

Fintan O'Toole

Fintan O'Toole, a contributor to The Irish Times, writes a weekly opinion column