The facts

“It is well and truly time for China to kick its tobacco habit: indeed, the country’s future economic and social prosperity depends on it.”
- Dr Bernhard Schwartländer, WHO Representative in China

Noncommunicable Diseases (including those caused by smoking)

  • Noncommunicable diseases cause 63% of deaths worldwide, but they cause 80% of deaths in China

Smoking in China

  • 28% of China’s 1 billion adults are smokers
  • More than half of China’s 570 million adult men are smokers
  • More than 3,000 people die every day, or more than 1 million each year, from smoking related illnesses

WHO Framework Convention on Tobacco Control (WHO FCTC)

  • China signed in 2003, ratified in 2005, and the treaty came into legal force in China in 2006
  • Article 11 of the WHO FCTC requires the implementation of large, visible, rotating warnings covering 50% or more of the principal display areas of tobacco packs
  • China’s health warnings fall short of meeting the WHO FCTC requirements for health warnings

ITC Project and Methodology

  • The ITC Project conducts surveys of smokers and non-smokers in China and 21 other countries
  • Three waves of ITC China Survey data were collected between 2006 and 2009 from 5600 adult smokers and 1400 non-smokers in seven cities in China. A fourth wave of ITC China Survey data was collected from September 2011 to November 2012, and is currently being analysed (and thus is not included in this report)
  • Findings from the ITC China Survey and other ITC countries, and from other international warning label studies, are presented here to provide policy-makers with a clear set of evidence-based recommendations to address the urgent need for large pictorial health warnings on tobacco products in China

Summary of Findings

  • While China has taken steps to improve health warning labels, evidence from the ITC China Project has shown that the text-only health warnings introduced in China in 2008 were not significantly more effective than previous warnings. The ITC Project is currently evaluating the impact of the new warnings (still text-only) that were introduced in 2012
  • ITC experimental studies have shown that Chinese smokers rate pictorial warnings as much more effective than the same warnings without graphic images
  • Evidence from the ITC Project in numerous countries has demonstrated that pictorial warnings increase knowledge of the harms of smoking among smokers and non-smokers, increase behaviors associated with quitting and help smokers refrain from restarting once they quit

Recommendations for Action

  • Implement pictorial warnings on at least 50% of the top of the front and the back of cigarette packages in line with WHO FCTC Article 11 and Guidelines. This would not only significantly increase the impact of health warnings in China, but also help contribute to the achievement of the goals for reducing smoking articulated in the China National Tobacco Control Plan
  • Pictorial health warnings should provide messages to motivate quit attempts, including display of a quitline number
  • Over 60 countries that are Parties to the WHO FCTC, including three of the four other BRICS countries (Brazil, the Russian Federation and India), have already implemented pictorial warnings. Therefore, there are many examples of warnings that could be used to guide the design of more effective health warnings in China.

Tobacco Control in China

WHO Framework Convention on Tobacco Control (WHO FCTC)

The WHO FCTC, the world’s first global health treaty, provides a roadmap for the implementation of tobacco control policies to reduce tobacco use.

International Tobacco Control Policy Evaluation Project

The International Tobacco Control Policy Evaluation Project (the ITC Project) is the first international research program for the systematic evaluation of the WHO FCTC at the population level. The ITC Project is conducting longitudinal cohort surveys in more than 20 countries, including China, and includes over 100 tobacco control research collaborators from over 10 scientific fields.

ThinkTank Research Center for Health Development, Beijing China

The ThinkTank Research Center for Health Development has been advocating for the implementation of pictorial warning labels through its own campaign: “I want to tell you because I love you”. More than 2 million people have visited its exhibitions. 85% of 11,002 people surveyed following the exhibitions were supportive of pictorial warning labels on cigarette packages.

China National Tobacco Control Plan

The China National Tobacco Control Plan, released in December 2012, has established aggressive targets for reducing smoking rates in China – including a relative reduction in smoking prevalence of over 10% among adults, and over 25% among youth in just three years.

About the World Health Organization

WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.

For more information please contact:

Ms WU Linlin
WHO China Office
Office Tel: +86 10 6532 7191