WHO expert: indoor public places should be 100% smoke-free; stronger e-cigarette regulation recommen

National-level tobacco control legislation has entered its final stages, but the outcome of the related disputes remains unclear.

As early as January 2016, Mao Qun'an, spokesperson for the National Health and Family Planning Commission, revealed that national-level tobacco control regulations were expected to be released within the year.

However, there has been much controversy regarding the current draft of the "Regulations on Controlling Smoking in Public Places." On June 16, 2016, due to dissatisfaction with the draft's provisions for smoking areas in public places, Xu Guihua, former executive vice president of the China Tobacco Control Association and a renowned tobacco control expert, described the draft as "a bucket with a big hole in the bottom."

What kind of tobacco control regulations does China need? On August 26, Angela Pratt, a tobacco control expert from the WHO China Office, gave an exclusive interview to The Paper, emphasizing that establishing exceptions for smoke-free requirements in indoor public places is a serious mistake.

There is an urgent need for strong national smoke-free regulations.

Two years ago, the draft "Regulations on Controlling Smoking in Public Places (Submission Draft)" proposed a complete ban on smoking in all indoor public places, but the later draft of the "Regulations on Controlling Smoking in Public Places" saw significant changes. According to Xu Guihua, the draft's seventh article proposes that "the following public places may set up smoking areas," including restaurants, bars, cafes, tea houses, dance halls, game rooms, hotels, and airport terminals.

Some experts believe that compared to the initial requirement for a "completely smoke-free" environment, the current draft represents a significant regression.

The Paper: How does the WHO view China's tobacco control efforts over the years? What progress has been made, and what gaps remain?

Angela Pratt: In recent years, China has made significant progress in tobacco control—Beijing's strong tobacco control regulations are a major highlight. However, further work is needed: the primary focus should be on establishing a strong national smoke-free law that fully complies with the WHO Framework Convention on Tobacco Control. This is crucial because many people are still forced to be exposed to deadly secondhand smoke, which is unacceptable.

The Paper: What is the most urgent need and the most pressing issue for tobacco control in China?

Angela Pratt: The most urgent task for tobacco control in China is to enact a strong national smoke-free law that ensures 100% smoke-free environments in all indoor public places and workplaces. In 2014, relevant departments submitted a very strong regulatory draft to the State Council—this version of the regulation should be fully approved without further delay. This way, more people can be protected from exposure to toxic secondhand smoke.

The Paper: Are there any specific challenges in tobacco control in China?

Angela Pratt: China faces particularly severe challenges in tobacco control. The number of smokers is around 315 million, with over a million deaths each year due to tobacco. Another significant challenge is that the China National Tobacco Corporation is a state-owned enterprise and has significant influence over tobacco control policies. This creates a fundamental conflict of interest.

The Paper: How can these issues be addressed?

Angela Pratt: Taking Russia as an example, despite having a large smoking population, Russia has passed very strong tobacco control laws in recent years. Many other countries have also taken action to eliminate the tobacco industry's influence on tobacco control policies.

There should be no exceptions for smoke-free requirements in indoor public places.

At the local level, Beijing took the lead in implementing what is known as the "strictest" tobacco control regulations in June 2015. On July 28, 2016, the draft amendment to the "Regulations on Controlling Smoking in Public Places" was reviewed for the first time at the 31st meeting of the 14th Shanghai Municipal People's Congress, proposing a complete ban on smoking in indoor public places. The WHO has also praised Shanghai's determination to achieve 100% smoke-free status.

The Paper: What should be noted in the subsequent process of the draft amendment to the "Regulations on Controlling Smoking in Public Places"?

Angela Pratt: Strong smoke-free legislation proposals sometimes encounter opposition from forces attempting to weaken the legislative strength—such as attempts to establish exceptions or loopholes for smoke-free requirements. This has been a common issue both in China and globally. However, establishing exceptions for smoke-free requirements in indoor public places is a serious mistake! Because any level of exposure to secondhand smoke is unsafe; the only protection is a 100% smoke-free indoor environment.

The Paper: How does the WHO evaluate Beijing's "strictest" tobacco control regulations implemented in June 2015?

Angela Pratt: Beijing's tobacco control regulations are very strong—indeed, they are the "strictest" in China to date and fully align with the WHO Framework Convention on Tobacco Control.

There is a need for rapid regulation of electronic cigarettes.

In May 2016, Germany's new Tobacco Products Act came into effect, along with several new tobacco control regulations, including a ban on tobacco companies using the internet, radio, television, and print media for advertising, as well as prohibiting outdoor advertising for tobacco products and electronic cigarettes; regulatory authorities will treat nicotine-containing cigarettes and non-nicotine electronic cigarettes equally; starting April 1 of this year, it is prohibited to sell electronic cigarettes and electronic water pipes to minors.

The Paper: Electronic cigarettes have been marketed as alternatives to tobacco, and in recent years they have become a trend among youth. Will electronic cigarettes and electronic water pipes become a new direction for tobacco control?

Angela Pratt: Currently, there is no evidence proving the safety of electronic cigarettes, nor is there conclusive scientific evidence that electronic cigarettes can aid in quitting smoking. Although electronic cigarettes do not contain combustible tobacco (i.e., smoke), the vapor from certain electronic cigarettes contains various toxic chemicals at levels that can be equal to or even higher than those found in traditional cigarettes. Therefore, the WHO recommends that all countries take swift action to regulate electronic cigarettes. It is particularly important to note that the sale and marketing of electronic cigarettes to minors should not be allowed.

The Paper: Does the WHO have statistics on the number of youth smokers in China, their ages, and what targeted measures can be taken in China to prevent youth smoking?

Angela Pratt: The most recent survey of youth aged 13 to 15 shows that 11% of boys, 2% of girls, and overall 7% of adolescents are currently smokers.

All tobacco control policies—including smoke-free public places, bans on tobacco advertising, promotion, and sponsorship, and increasing taxes to raise the cost of tobacco consumption—are crucial for protecting youth from the harms of tobacco use.

Most lifelong smokers start during their youth. Therefore, protecting youth from starting to smoke is helping to provide them with lifelong protection.

(Original title: WHO expert: indoor public places should be 100% smoke-free; stronger e-cigarette regulation recommended)