Chinese anti-smoking advocates are making new efforts to replace the aesthetically appealing designs of cigarette packs with images of diseased human organs in a bid to convince the country's estimated 300 million smokers to drop the habit.
Anti-smoking lawmakers and political advisors in China are renewing their fight this week to put graphic health warnings on cigarette packs, similar to those found in other countries.
The graphic warning labels typically picture gangrenous toes, diseased lungs and damaged hearts, an abrupt contrast to the beautiful mountains, rivers and historical sites often pictured on Chinese cigarette packs.
"People have the right to accurate information about the harm of smoking through health warning labels on tobacco products," Ma Li, a deputy to the National People's Congress (NPC), said on the sidelines of the ongoing sessions of China's top legislature and political advisory body.
In China, only 23.2 percent of adults believe that tobacco can cause strokes, heart attack and lung cancer, Ma said.
A July 2011 report from the World Health Organization (WHO) stated that graphic health warning labels featured in tobacco packaging and mass media campaigns have both been shown to reduce tobacco use.
"Packaging labels are the easiest, most effective and most direct way to warn about smoking. Large graphic images are very effective at keeping would-be smokers at bay, especially young people," said Ma, who is also director of the NPC's Education, Science, Culture and Health Committee.
About 110 billion packs of cigarettes were sold in China in 2011, a 29-percent increase from 2004.
"If graphic warning labels are printed on cigarette packs, it's as effective as printing 110 billion health pamphlets every year," said Shen Jinjin, director of the Center for Disease Control and Prevention in the city of Yancheng in east China's Jiangsu province.
China signed the WHO Framework Convention on Tobacco Control (FCTC) in 2003 and made it effective as of January 2006. It also pledged to fulfill its FCTC obligations before Jan. 9, 2011.
Article 11 of the FCTC requires health warning labels on tobacco packaging to be approved by a "competent national authority." It also specifies that the labels should cover no less than 30 percent or more of the face of the cigarette packaging and be "large, clear, visible and legible."
However, cigarettes sold on the Chinese mainland still lack pictures and specific warnings.
"The only improvement in China's commitment to the WHO's FCTC on packaging are the ambiguous warnings 'smoking is harmful to your health' and 'quitting smoking reduces health risks' that have been printed on the front of cigarette packs since October 2008," said Wu Yiqun, executive vice director of the Thinktank Research Center for Health Development.
The size of the warning's text is small and does not contrast strongly with the color of the packaging, Wu said.
"The ambiguous warnings cannot convey the message that the use of tobacco brings about considerable health risks," Jin Dapeng, a national political advisor and vice head of the China Health Law Society, said in a proposal submitted to the 11th National Committee of the Chinese People's Political Consultative Conference (CPPCC).
Cigarette packaging has been a frontline in the battle being waged between tobacco companies and health organizations.
Scientific research has shown that large, graphic health warning labels on tobacco packaging can effectively influence people's emotional reactions, increasing their desire to quit smoking and catching the attention of teenagers, children and people who cannot read, said Dr. Sarah England, a former technical officer at the Tobacco Free Initiative of the WHO Representative Office in China.
According to a WHO report, 42 countries now have graphic warning labels for tobacco packaging. Only 18 countries had such warnings in place in 2008.
Tobacco gift culture is a major obstacle for tobacco control in China. In China, cigarettes are a symbol of social status and are often given as gifts. However, anti-tobacco groups believe that printing graphic health warnings on packages will help to change this custom.
China received a "Dirty Ashtray Award" from the NGO Framework Convention Alliance after China's representatives made excuses for not printing warning pictures on cigarette packaging during the third Conference of the Parties of the WHO FCTC, which was held in South Africa's city of Durban in 2008.
China's hygiene and health authorities have no say in the design and implementation of warning labels for tobacco packaging. The Tobacco Monopoly Bureau, led by the Ministry of Industry and Information Technology, has the final say in matters regarding tobacco sales in China.
Health experts claim that the government uses a double standard for tobacco packaging. Some believe that health warnings are deliberately weakened on the Chinese mainland for the sake of the Tobacco Monopoly Bureau's profits. On the other hand, graphic health warning labels have to be printed on packs when the same tobacco products are sold in Hong Kong, Macao and Taiwan.
"If cigarettes with graphic warning labels are disrespectful to Chinese culture, then why are they still sold in Hong Kong, Macao and Taiwan?" asked Ma.
UPHILL BATTLE
Depite repeated setbacks, lawmakers and political advisors have continued to press for more anti-smoking legislation and proposals.
Ma's motion to require graphic warning labels on tobacco packaging marks her fifth consecutive year of anti-smoking efforts.
"NPC's Education, Science, Culture and Health Committee talks about anti-smoking issues every year, but smoking control legislation still failed to be included in the 12th Five-Year Plan (2011-2015)," Ma said.
The public appears to be on the legislators' side. More than 90 percent of the 11,000 respondents of an online survey conducted by Chinese web portal Sohu.com said they support the creation of graphic packaging legislation, while 82 percent said they think the current warning labels are ineffective.
Local governments should get more involved in smoking control, said Health Minister Chen Zhu, adding that his ministry and other government departments are mulling a proposal to raise taxes on low- and mid-level tobacco products in China.
According to WHO statistics, tobacco continues to be the leading cause of preventable death worldwide, killing nearly 6 million people every year. Every year, 1.2 million people in China die from smoking-related diseases.