China alone has nearly one-third of the world's smokers

One year ago, the 192 Member States of the World Health Organization unanimously adopted the Framework Convention on Tobacco Control, the first public health treaty ever negotiated under the auspices of WHO. Since then, 118 Member States have signed the FCTC, including China in November 2003. With its signature, China has indicated that it will strive in good faith to formally ratify the Convention and display a political commitment to reach its ambitious objectives.

Currently, there are an estimated 1.3 billion smokers worldwide. An estimated 350 million of them are in China alone, nearly one-third of the world's smokers. A significant number of China's smokers live in rural areas. More than 60 percent of all Chinese men smoke. One in four of all tobacco- related deaths in the world occur in China -- that's 1.2 million such deaths in China each year. ''But numbers alone do not tell the whole story,'' says Dr Henk Bekedam, WHO Representative in China. ''The toll of any public health crisis is illustrated by the lives of those it affects.''

The contribution of tobacco to disease and premature death is well documented. But this year, on World No Tobacco Day, WHO is also drawing attention to the ways in which tobacco use poses an enormous, crippling financial burden on individuals and nations -- the vicious circle between tobacco and poverty. 84 percent of the world's smokers live in developing and transitional economies.

In China, as elsewhere, it is the poor and the poorest who tend to smoke the most. For the poor, the money spent on tobacco is money not spent on basic necessities, such as food, shelter, education and health care. For example, poor, rural households in southwest China spend over 11 percent of their total budget on cigarettes, often at the expense of vital, basic needs. Money plays a big role in China's debate over tobacco control.

China is the world's largest producer of tobacco. China's estimated 350 million smokers represent a huge market. Tobacco revenues are substantial. In Yunan Province, for example, tobacco revenues are about 70 percent of overall provincial revenues. This is why there is such fear over the idea of further strengthening tobacco control and reducing demand. ''Tobacco taxation, however, is one of the most effective measures for reducing tobacco use without loss of revenues,'' says Dr Bekedam. The government's revenues rise with higher taxes, despite the drop in sales. ''All this helps to create a win-win situation," says Dr Bekedam, "And supports the argument for raising taxes on tobacco products.''

In general, the discussion in China has focused on tobacco revenues. Often forgotten are the actual costs of tobacco use and addiction, to individuals, families -- particularly the poor -- and the nation as a whole.

Tobacco users are at much higher risk of falling ill and dying prematurely of tobacco-related diseases, depriving families of much-needed income and adding to health-care costs. If the main breadwinner becomes ill or dies prematurely from tobacco use, the family's ability to make ends meet is threatened, often triggering a slide into poverty. For the poor, medical care is not always available. When it is, such care is often a luxury that many simply cannot afford or puts many families into huge debt. At a national level, the financial burden includes increased health-care costs, and lost productivity due to illness and early death.

In China, a study from the mid-1990s estimated the direct and indirect health costs of smoking at about US$6.5 billion a year. With tobacco use poised to kill three million people a year in China by the middle of this century, such costs are bound to skyrocket. There are other urgent areas of focus in the debate over tobacco control. One of these is the issue of ''passive smoking.'' It is well known that smoking can seriously affect the health of non-smokers, including infants and children whose parents and relatives smoke around them. ''A child is the symbol of its parents' hopes and dreams -- the pride of the family,'' says Dr Bekedam. ''Parents lavish love and attention on their child in a culture that places great importance on the need to nurture future generations. Why endanger this vulnerable treasure through the hazards of second-hand smoke?" ''Passive smoking'' is also a serious health hazard at work and in public places.

A major study not too long ago found that over one-half of all non- smokers in China were exposed to ''passive smoke.'' WHO is encouraged by China's steps towards curtailing and banning smoking in public places -- and hopes this campaign will be stepped up further.

There are many items on the FCTC agenda that China has been implementing for quite a while, and others that are gathering steam. WHO applauds China for such efforts, as the country continues along the path to ratification of the FCTC. The challenges are enormous, the task immense.

The global tobacco epidemic, including the scenario in China, did not occur overnight. But step- by-step, the situation can be addressed. WHO hopes that China will go through the process to ratify the FCTC, and thus provide strong leadership in this crucial campaign. The World Health Organization looks forward to partnering with China in this effort, in the months and years ahead. For further information on World No Tobacco Day visit http://www.who.int .