The Heart of China’s Smoking Epidemic - Verity Aylward
China’s hospitals are at the frontline of the war on smoking. Why will it take a lot more than the recent smoking ban for lives to be saved?
A lone smoker puffs on his cigarette inside the entrance to Beijing Cancer Hospital. The ashtrays on each corner are jam-packed with stubs. For the city’s foremost treatment centre for cancer, it may seem a worrisome contradiction. For the Vice-President of the hospital, Jin Gu, this is progress.
“There are six designated smoke-free areas. Nobody smokes inside the hospital,” Jin says.
In March 2008, the Ministry of Health and Office of the National Patriotic Health Campaign Committee announced a pledge for all medical institutions in China to ban smoking in 2011. This goal has nearly been achieved in some cities, but not for the rest of the county.
Beijing Cancer Hospital became a National Smoke Free Hospital in 2002, making it a leader in the capital’s war on smoking. Tobacco consumption’s reached such an alarming rate; you might understand the Vice President’s pride. Over 300 million people smoke in China and the habit claims nearly 1.2 million deaths per annum.
Despite the hospital’s initiative, the death toll from smoking-related diseases is on the rise. The ban moved the smokers outside, but did it get to the heart of the problem?
“Smoking causes 90 percent of lung cancers worldwide. This is very important for us to talk about, ” says Doctor Chen Keneng, pointing to x-rays of lungs under treatment.
Chen, the Chief of Thoracic Surgery at Beijing Cancer Hospital contends with a habit that’s deeply ingrained.
“Lung cancer patients dramatically increase their recovery rates if they quit smoking, but many continue to smoke during and after treatment,” Chen says.
In China, smoking is a social norm where cigarettes are offered as gifts, seal business deals and even marriages in some cases. Tobacco shops are ubiquitous and the price of cigarettes is considerably cheaper than many developed countries.
The obstacles for hospitals like Beijing Cancer Hospital seem insurmountable. Confronting the tobacco industry could jeopardize the nation’s economic goals.
“China is a leading country in tobacco production and consumption…. It will take some time to provide other opportunities for those people engaged in tobacco planting and sales,” says Xu Guihua, Vice President of Chinese Association of Tobacco Control.
When Beijing Cancer hospital initiated its ban, smoking was rife among its health workers. Over 50% of doctors smoke in China. These doctors promote the habit according to the Vice-President of the hospital, Jin Gu.
“A smoking doctor is advertising tobacco…. but by educating patients about the risks to their health, a doctor can save far more patients than all those lung cancer patients he/she saves in a life,” Gu says.
Beijing Cancer Hospital is going through a process of re-education. The Vice-President says that of the nine doctors in his Department for Colorectal Surgery, two continue to smoke.
“The President of our hospital used to smoke, but since the ban he quit. This had quite an impact,” he says.
Doctors provide information sessions for staff using graphic images to show the dangers of smoking. This has spurred some to conquer their addiction.
“At the height of my smoking habit, when I was almost 30, I suffered from many medical conditions such as insomnia and chest discomfort…. After quitting smoking my overall health has greatly improved,” says Zhang Yi, a Technician in the Information Department.
You might expect health workers not to smoke in the first place.
“Very few people, as few as a quarter of smokers, completely understand the effects of smoking on their health,” says Yang Gonghuan, Deputy Director of the Chinese Center for Disease Control and Prevention.
Many are not aware of the types of cancer caused by smoking. Beijing Cancer Hospital is a pioneer in medical research and treatment and co-operates with medical institutions worldwide.
Dr Zhang Xin, Professor of Urology at Beijing Cancer Hospital trained in England and America to develop his specialist knowledge, “There is definitely a link between smoking and cancer in the urinary tract,” says Zhang.
Figures show that smokers are three times more likely to develop bladder cancer than non-smokers. Recent research also confirms the link between smoking and a rise in colon cancer cases.
Yet people who don’t smoke are also victim to smoking-related diseases. In China, 72% of non-smokers are exposed to second hand smoke, according to a recent survey by the Chinese Center for Disease Control and Prevention. For Beijing Cancer Hospital, the ban on smoking inside is not just to protect non-smokers, but also wean patients off the habit.
“Many patients will quit smoking but families need support when a family member with cancer continues to smoke,” says Gu, the Vice-President of the hospital.
In countries where smoking bans exist, tobacco consumption has been reduced by as much as 20%. Hospitals on the frontline are seeing fewer people die from smoking-related diseases, so why is the reverse happening in China?
“Smoking bans need to be made into law here. The ban at our hospital was a directive, as with the May 1st ban on smoking in public places. You cannot enforce a ban unless it is law,” says the Vice-President, Jin Gu.
Gu has also recommended a clampdown on tobacco advertising in his role as Deputy to the National People’s Congress.
If China’s ban on smoking in public places becomes law, then China’s hospitals may have a chance to halt the cause as well as treat the symptoms of this deadly habit.
After 5 years of staying smoke-free:
The average smoker of one pack of cigarettes a day will decrease their lung cancer death rate by almost 50%. The risk of developing cancer of the mouth, throat or oesophagus becomes half that of a smoker.
After 10 years of staying smoke-free:
The lung cancer death rate is equal to that of a non-smoker. The risk of developing other cancers, such as cancer of the kidneys, pancreas or bladder, is decreased.
