Helping smokers to quit

Authorities in Harbin, Heilongjiang province, and Tianjin municipality enforced local tobacco control laws respectively on May 31, the 25th World No Tobacco Day. One was to ban smoking in public places and another is designed to protect non-smokers. It was the first time tobacco control measures have been implemented in law on the Chinese mainland. According to experts of legislation on tobacco control from the two cities, the basic principle of the laws is to protect the rights of non-smokers. The question is how about the smokers?

The head of the Ministry of Health declared last month the authority is considering covering anti-smoking consultation services and drugs with basic medical insurance and including anti-smoking measures as part of the essential medicine list.

If implemented, it will be the first time the authority extends its hand to help smokers. They have been demonized as selfish sources of pollution. It is time now to restore their real identity as victims of the whole story who have been isolated by man-made nicotine addiction from the normal world for too long.

However, the minister's words have been greeted with skepticism. Even the Ministry of Human Resources and Social Security, the authority in charge of drafting medical insurance guidelines and the essential medicine list, indicated nicotine addiction is not a disease for neurologists and smoking is still a public health issue, so the anti-smoking drugs are not listed now. The common opponents' logic is much simpler: Non-smokers have no responsibilities to help smokers.

Yet China currently has 350 million smokers and 740 million second-hand smokers. Tobacco is the leading cause of preventable and premature death, killing more than 1.2 million people in China every year — more than the number of deaths caused by AIDS, tuberculosis, traffic accidents and suicide combined together

Both smokers and second-hand smokers are endangered by respiratory, heart and cerebrovascular diseases caused by tobacco use. If these diseases' treatments and relevant drugs are covered by medical insurance — and the causal relation between tobacco use and these diseases has already been established — it will evidently save more money and trouble to provide anti-smoking drugs and treatments to prevent these diseases in advance.

Statistics show 36.4 percent of Chinese smokers, about 127.4 million people, have tried to give up smoking during the past 12 months, 91 percent of whom do it without professional medical assistance and 3.1 percent used anti-smoking drugs. Only 3 to 7 percent of these 127.4 million smokers succeeded in quitting tobacco use.

Clinical test results indicate more people quit smoking with the help of anti-smoking drugs. Even if it costs about 3,300 yuan ($524 dollars) to use the drugs for one treatment course, the price is much lower than that for treating lung cancer or heart disease caused by smoking. The more smokers become nonsmokers, the more money we will save in medical insurance. Data from the Chinese Center for Disease Control and Prevention suggests each non-smoker spends about 20 percent less than smokers in medical care expenses during his or her lifetime.

Reports from both the US and Chinese Centers for Disease Control and Prevention in 2011 suggest that smoking reduces life expectancy by about 13 to 14 years on average. So providing smokers with treatment can save a huge loss in productivity, a fact long concealed by China's fast economic growth.

The productivity loss comes from sick leave, decrease in work efficiency caused by smoking-related diseases as well as premature death. If the first two losses are difficult to evaluate, a quick look at deaths caused by smoking can prove the necessity and urgency of helping smokers.

About 1.2 million Chinese died of smoking in 2005, 33.8 percent of them aged between 40 to 69 years old, resulting in 20 to 25 years in loss of life per head on average, according to the CCDCP. The annual death toll caused by smoking is expected to rise to 2 million in 2020, and 3.5 million in 2030, 21.5 percent and 43.75 percent of the world's total respectively, if China does not improve its tobacco control.

Even for the survivors, many of them are inflicted with chronic diseases. Take cerebrovascular disease caused by smoking as an example. About 75 percent of patients lose an ability to work to various degrees and 40 percent of them become severely disabled. It is even more difficult to evaluate the productivity loss of second-hand smokers given the huge numbers of them. No matter how many jobs it supplies and how much tax and revenue it offers, the very nature of the tobacco industry as a profiteer of the leading cause of preventable death will not be changed.

So when Chinese authorities consider helping smokers to quit smoking with funds from medical insurance, it should also transform the State-owned tobacco industry step by step and strengthen relevant tobacco control measures, especially those that prevent young people from smoking. Studies show more than 80 percent of adult smokers begin smoking by 18 years of age with 99 percent taking it up by 26 years of age.

As for veteran Chinese smokers, they are at the most risky age now. More than half of Chinese smokers consume cigarettes at and below 5 yuan a pack. The smoking ratios in adult workers and peasants are 67 percent and 60 percent respectively. It is urgent to raise their awareness of the harm caused by tobacco use and provide them with financial assistance from medical insurance to help them quit. This is also in line with the spirit of China's basic medical insurance system.

Certainly, they can decide of their free will if they want to receive the treatment. Since it involves a large number of people and an enormous amount of money, it can be piloted in some places first as a preparation for its nationwide implementation.

China has not yet fulfilled its overdue commitments to the World Health Organization's Framework Convention on Tobacco Control, an international tobacco control treaty ratified by China in 2003 that took effect in China in 2006. So the authority has an obligation to provide Chinese smokers with subsidized medical treatment and drugs to help them quit smoking until it succeeds in creating a healthy public environment as required by the framework convention.

By then, anti-smoking medicine and treatment should be removed from the list of medical insurance and the essential medicine list because the authority should be regarded as already playing a responsible part in dissuading people to smoke.

As for new smokers, Taiwan provides the Chinese mainland with a practical solution. There, smokers must pay an additional 2 yuan a pack of cigarettes that is collected by tobacco control authorities to provide anti-smoking medicine and treatment for smokers who want to quit.