IS TOBACCO THE OPIUM WAR OF THE 21ST CENTURY?
New York Dr. Cesar Chelala
To know if tobacco is the equivalent of the opium wars in China it is useful to briefly review its history. When Christopher Columbus explored the New World in 1492, he found the natives smoking a native plant, tobacco, which they did both for medicinal and ceremonial purposes, and was the first to introduce it in Europe.
From 1617 to 1793, tobacco was the most widely used and valuable staple export from the English American mainland colonies and the United States. Columbus would have never imagined that shortly after its introduction in Europe tobacco would become one of the main threats to health in several Latin American and Asian countries, as opium did in the XIX century, particularly in China.
Tobacco, one of the most addictive substances in the world, was introduced to China via Japan or the Philippines in the 1600s. In 1643, Fang Yizhi, a Chinese scholar, was one of the first to alert on the dangers of tobacco when he wrote that smoking tobacco for too long would “blacken the lungs” and lead to death. Chongzhen, the emperor at the time, outlawed growing tobacco and smoking its leaves.
In 1858, the Treaty of Tianjin (Tientsin) which ended the first part of the Second Opium War (1856-1860) not only legalized the import of opium but allowed cigarettes to be imported to China duty-free. By 1900, China was almost entirely permeated by foreign companies.
In 1929, Fritz Lickint, a German scientist from Dresden, published the first statistical evidence linking tobacco use and lung cancer, a finding that was confirmed in 1950 in an article in the Journal of the American Medical Association (JAMA). Only in 1999 the Philipp Morris tobacco company acknowledged that, “There is an overwhelming medical and scientific consensus that cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers.”
Today, while its use has diminished considerably in industrialized countries, it is having a devastating effect on the health of the Chinese population. As Dr. Bernard Lown, a famous cardiologist, already indicated in 2007, “The struggle against tobacco is not being won, it is being relocated.” He also denounced that cigarettes are becoming more addictive and more lethal because of the higher tar and nicotine content.
The state-owned China National Tobacco Corporation (CNTC), trading as China Tobacco, founded in 1982, accounts for roughly 30 percent of the world’s total production of cigarettes, and it is the largest manufacturer of tobacco products. China National Tobacco Corporation falls under the jurisdiction of the State Tobacco Monopoly Administration, or STMA.
The STMA has been under constant pressure from the World Trade Organization (WTO) to loosen its monopoly. Since 2001, increased access has been granted to foreign companies. Today, although CNTC dominates China’s market, foreign brands can still be found in large cities in China. In 2007, it was estimated that CNTC had 32 percent of the world tobacco market.
Tobacco smoking still continues to place a heavy toll on the Chinese people’s health. It is estimated that every day roughly two thousand Chinese die due to smoking. China has now approximately 360 million smokers – a number greater than the U.S. population- who consume 37 percent of the world’s cigarettes. In addition, almost 800 million people suffer the consequences of second-hand smoke. According to the Chinese Academy of Preventive Medicine, smoking will be responsible for approximately 3.2 million deaths annually by 2030.
Tobacco is also costly to the country’s economy. Although tobacco firms paid 864.9 billion yuan in taxes in 2012, when the combined health care costs of those made sick by tobacco plus the loss of productivity they represent the cost is probably much higher. The increased health costs as a result of smoking are part of the tragic legacy of tobacco.
Paradoxically, while the US government has been extremely successful in discouraging smoking at home, it has successfully put pressure on Japan, Taiwan, South Korea and Thailand to break their domestic tobacco monopolies, at the same time flooding them with American cigarettes. This led former U.S. Surgeon General Dr. C. Everett Koop to state, “People will look on this era of the health of the world, as imperialistic as anything since the British Empire – but worse.”
Through its issuing of the China Tobacco Control Plan (2012-2015) the Chinese government has indicated its intention to lower the negative impact of smoking on the Chinese people. The plan, however, has been widely criticized by its lack of concrete proposals.
To effectively combat smoking it is necessary to mobilize communities, educate the people about the health risks and high costs of smoking, impose punitive fines in class action suits and increase tax on cigarettes. Unless these measures are implemented, tobacco will end up causing more damage to the Chinese people than the Opium Wars did in the XIX century.
Cesar Chelala, MD, PhD, is an international public health consultant and the author of “Tobacco or Health,” a publication of the Pan American Health Organization. He is the foreign correspondent for The Middle East Times International (Australia).