China is home to about one third of the world's smokers and reducing smoking in China could have an enormous public health impact, even on a global scale.
Even though China raised the tax on tobacco products in 2009, this did not translate to higher retail prices for consumers and the only ban that has been enforced is on public transport. WHO went on to publish a report in 2011 which stated that there were multiple opportunities to improve tobacco control.
Using a version of the SimSmoke Tobacco Control Policy model (a model of tobacco smoking prevalence and smoking-related deaths), populated with data from China, researchers from Spain, France and the US estimated the potential health impact of this programme in China from 2015 - 2050.
Under current policies, a total of over 50 million deaths due to smoking were estimated from 2012 to 2050.
Projecting the status quo scenario forward, the researchers estimate that active smoking in males would fall from 51.3% in 2015 to 46.5% by 2050 - and in females from 2.1% in 2015 to 1.3% in 2050
In 2015, the estimated number of deaths from smoking was about one million (932,000 for males and 79,000 for females). In males, annual deaths were expected to peak at 1.5 million in 2040, but then drop to 1.4 million by 2050. In females, annual deaths from smoking were estimated to be 49,000 in 2040 and 42,000 by 2050.
Relative to the status quo scenario, increasing cigarette taxes to 75% of the package price was estimated to reduce smoking prevalence by almost 10% for both males and females by 2015. By 2050, smoking prevalence showed a reduction of 13% for males and 12% for females. The researchers estimate that between 2015 and 2050, this tax would save approximately 3.5 million lives.
Smoke-free air laws and a well enforced marketing ban also showed "potent and immediate" effects. Comprehensive smoke-free air laws were estimated to show a 9% reduction in smoking rates by 2015, increasing to about a 10% reduction in 2050, potentially averting around 3.4 million deaths. A comprehensive marketing ban would reduce smoking prevalence by about 4% and avert just over two million deaths by 2050.
A high intensity tobacco control campaign would lead to a 2.5% relative decline in smoking rates by 2015 and prevent 1.1 million deaths due to smoking by 2050, while stronger health warnings were projected to yield a relative 2.3% reduction in smoking rates by 2050.
The researchers estimate that complete implementation of the WHO framework "would lead to as much as a 34% relative reduction in male smoking prevalence by 2020, and a 41% reduction by 2050." They say, despite the lag time expected between reductions in current smoking and declines in smoking attributable deaths, nearly half a million annual tobacco related deaths could be averted yearly by 2050.
These estimates suggest that substantial health gains could be made, say the authors - a 40% relative reduction in smoking prevalence and almost 13 million smoking attributable deaths averted and more than 154 million life years gained by 2050 - by extending effective public health and clinical interventions to reduce active smoking. They add that these policies would be cost effective and say that "without the implementation of the complete set of stronger policies, the death and disability legacy of current smoking will endure for decades in China."