BEIJING – Nearly every day in China, women go to work in smoke-filled offices, exposed to the fumes of cigarettes smoked mainly by male colleagues. After work, many go home to breathe secondhand smoke created by husbands or other family members.
China is known as the Smoking Dragon, but its addiction to tobacco isn't shared between the sexes. According to the most recent national survey, 288 million men smoked regularly in China in 2010, compared with 13 million women.
Lately, the women are striking back. Last fall, China's State Council proposed the nation's toughest restrictions yet on indoor smoking and the marketing of tobacco. The announcement was a victory for China's tobacco-control movement, which includes women who have been on the front lines for decades.
"This is a very important step," said Yang Gonghuan, an epidemiologist who's been documenting tobacco's toll on Chinese public health since the 1980s. "It is very difficult to push for these kinds of changes on a national level. … It has taken many, many years."
Although China is known for its smog and other environment problems, no public health issue poses more of a threat than tobacco. An estimated 1 million Chinese die each year from smoking-related diseases.
China's anti-smoking movement includes many prominent men. Former NBA center Yao Ming and other celebrities have joined the cause.
Leading the charge
Yet in government and among tobacco-control groups, women are leading the charge. China's health commissioner, Li Bin, has been outspoken in seeking a national indoor-smoking ban. Li sits on the State Council, a top-level panel that drafted the restrictions unveiled in November. Two of her key deputies are women.
Among academics, Yang is known for her extensive research into tobacco use and disease trends. Brookings Institution researcher Cheng Li said Yang "has played a crucial role in China's anti-smoking campaign," particularly by co-authoring an influential 2011 report that documented the health effects.
Chinese have smoked tobacco for centuries, and until the early 1900s women regularly could be seen with men puffing on pipes. But with the advent of cigarettes, Chinese intellectuals and foreign missionaries started frowning on women who smoked.
As a result, women quit smoking, even as Chinese leaders such Mao Zedong and Deng Xiaoping smoked openly in public, encouraging the habit among men.
Today, China is the world's biggest consumer of tobacco. It's also the largest manufacturer, producing more than 2.3 trillion cigarettes yearly, nearly half the world's total. The China National Tobacco Corp. — an arm of the State Tobacco Monopoly Administration — controls nearly all the cigarette brands sold.
That puts the Chinese government in an unusual dual role: One arm of the government, the Health Ministry, tries to restrict tobacco use and warn of its dangers, while other government agencies benefit from tobacco's profits and tax revenues, which totaled nearly $120 billion in 2012, about 6 percent of government revenues.
"This is why tobacco control in China happens so slowly," said Yang, a professor of medicine who directs the Burden of Disease Research and Dissemination Center in Beijing. "The tobacco industry is very powerful."
In recent years, attitudes toward smoking have started to shift. Top leaders of China's Communist Party are either nonsmokers or are careful not to be spotted lighting up in public. Late in 2013, the party banned government officials from smoking in public or giving cigarettes as gifts. Individual cities have enacted their own restrictions on tobacco.
The draft regulations unveiled in November, if enacted and enforced, would take China into another realm. The proposed rules would ban indoor smoking and make businesses responsible for enforcing the ban, subject to fines if they don't. It would limit the marketing of tobacco in China and require larger warnings on cigarette packs.
The fate of tobacco control in China might come to a head in the months to come. The Health Ministry has urged the State Council to make the proposed tobacco restrictions a "tier one" priority, which would facilitate their enactment in 2015. If it remains a lower tier priority, enactment of new rules might be delayed, giving the tobacco industry more time to derail them.
Yang said concerns over rising health care costs are getting the government's attention. One study has estimated that, as of 2010, China's medical and lost-labor costs of tobacco-related diseases totaled $253 million yearly, far more than revenues and taxes generated by tobacco.
"Twenty years ago, I think, the Chinese government cared mainly about economic development," Yang said. "Now there is more and more awareness about chronic diseases. The government is being forced to consider the [economic] burden."