Better Tobacco Control Could Prevent 13 Million Deaths in China

A new study of smoking in China suggests that toughening the country’s tobacco control policies could have a substantial impact on public health and save close to 13 million lives by the year 2050.

Though smoking rates are slowly declining in China, about 50 percent of Chinese men currently smoke, and China accounts for about one-third of the world’s smokers. The country is also the world’s largest tobacco producer, primarily through government-owned companies.

In 2003, China joined the WHO Framework Convention on Tobacco Control that mandates taxes, marketing bans, and other policies, but China has not fully implemented the WHO’s policies.

In the new study, researchers led by Andrew Moran, MD, Herbert Irving Assistant Professor of Medicine at P&S, and David Levy of Georgetown University used a computer model called SimSmoke that predicts future smoking rates based on current and past rates, the number of people who start or quit smoking, and tobacco control policies.

Writing in BMJ (formerly, British Medical Journal), the authors say that without any policy changes, the model predicts 50 million people will die from smoking between 2012 and 2050.

With the implementation of multiple policy tools, the model projected that 13 million deaths would be prevented and smoking prevalence would be reduced by 40 percent. The two most effective policies predicted by the model are increasing tobacco prices through taxation and the enforcement of smoking bans in public places.

“What the SimSmoke analysis does is put numbers and a sense of scale on the potential benefits of tried and true tobacco control policies,” Dr. Moran said. Tobacco smoking is one of the top three factors responsible for death and disability in China, accounting for 16 percent of deaths in 2010.

“Reducing the prevalence of smoking by 40 percent would have an enormous impact on public health in China,” he said. “There are very few things you can do to reduce preventable deaths by so much.”

Preventing smoking deaths also should benefit China’s economy. “China is in a crucial transition time,” Dr. Moran said. “As the population ages, tobacco-related deaths and chronic illnesses will have a bigger impact on the economy. They don’t have a limitless supply of younger people to replace workers who leave the workplace because of illness.”

SimSmoke’s predictions are likely underestimates of the number of smoking-related deaths, Dr. Moran added, because the model did not take second-hand smoking into account. Second-hand smoke disproportionately affects women in China, because only 2 percent of Chinese women actively smoke tobacco, but many non-smoking women are living with or working with smokers.

For more information, see a press release from BMJ.

The study was supported by the NIH (TW009295, CA97450), Bloomberg Philanthropies, Fogarty International Center, and the European Commission Erasmus Mundus fellowship program.  Dr. Moran was supported by a U.S. National Heart, Lung, and Blood Institute Career Development Award (K08 HL089675-01A1).