This article was also published on MPO
Imagine a working-class family in a small city in central China. The respected patriarch is fighting lung cancer. His prognosis is not good. The free medical care of the Mao era has long since disappeared, and his son now faces a hard choice: Should he and his wife bankrupt the entire family by providing his father with needed care, or should they turn their backs on traditional obligations and so hasten his death? The son– himself a smoker– is only vaguely aware that his habits subject himself to the same risks as his father. And his wife, who never took up the habit, is wholly unaware of the risks she and her daughter assume from living in this home.
As Western countries have witnessed precipitous drops in smoking rates, China has become the new heart of the global tobacco epidemic. Of every cigarette consumed during the past decade, one in three were smoked in China: more than 4.3 million a minute, 6.2 billion a day and just over 2 trillion a year. In 2012, more than 310 million Chinese– nearly as many as the entire U.S. population– smoked cigarettes every day. Smoking-related diseases account for just over 11 percent of all deaths in China, more than a million every year.
The most serious of these diseases are lung cancer and respiratory illnesses like COPD. Cardiovascular disease and a host of other cancers have seen dramatic increases, as well. Among all cancers, lung cancer is now the most common in China, with mortality rates rising 465 percent in the last 30 years.
Trends like these have influenced a growth in demand for pulmonary, cardiovascular and diagnostic devices among consumers in China. Pulmonary products on that list include inhalers, ventilators and oxygen concentrators. Heart valves, on-pump coronary artery bypass (ONCAB) devices, ventricular assist devices (VADs) and endoscopic vessel harvesting (EVH) devices are all cardiovascular devices in high demand. Diagnostic devices for diseases like lung cancer include bronchoscopes, mediastinoscopes and CT scanners. Companies specializing in these devices would do well to explore their options for sales, distribution and manufacturing in China. There are many opportunities in the China medical device market.
Even with greater public awareness of the risks associated with tobacco consumption, Chinese anti-smoking campaigns have achieved little success in cutting the overall prevalence of tobacco use. Last year, the central government instated a public smoking ban, as party to the World Health Organization’s international Framework Convention on Tobacco Control. Male smoking prevalence has fallen by 3.9 percentage points since China signed the treaty in 2003. As of 2010, almost 53 percent of Chinese adult males said they were current smokers. In the same survey, slightly more than 2 percent of Chinese adult females reported themselves as current smokers.
Women encounter strong social stigma if they take up smoking, but tobacco use is the cornerstone of male interaction in China. Men who climb the ladder of success must smoke. Men who maintain strong social and business relationships must smoke. Those who give brand name cigarettes to their bosses or dole out smokes among their friends are seen as “manly men.” They earn face and respect in a culture where these mean everything.
Yet even doctors and public health workers who acknowledge the dangers of smoking hesitate to advise their patients against it. During an interview with a Stanford anthropologist, a Chinese lung surgeon said that doctors in his department regularly passed out cigarettes to one another. According to the surgeon, it was a way to keep everyone in the ward “friendly and relaxed.”
But stronger than cultural and social barriers are the economic barriers that Chinese anti-smoking advocates must overcome. The tobacco industry is among the largest sources of tax revenue for the Chinese government, rivaling sectors like petroleum and real estate. Over the last decade, the tobacco industry has generated nearly 10 percent of central government revenue annually. Commercial and consumption taxes contributed more than 600 billion yuan last year alone. And in an era of instability, both central and local government officials– specifically those in China’s Southwest– are concerned that challenges to the industry will threaten tax revenue and local employment.
Should Chinese leaders find themselves unable to stem the country’s steady tide of smokers, they will see more of their own fall victim to tobacco-related diseases in the near future. At prevailing rates, one quarter of Chinese children alive today will die prematurely of smoking-related diseases. Additionally, one in three Chinese men currently alive will also die of similar causes.
And those who do not start smoking are also at risk: nearly 50,000 Chinese women died of heart disease or lung cancer attributed to secondhand smoking in just one year. Today, more than 700 million Chinese are similarly exposed to passive smoking.
Researchers agree that China’s tobacco epidemic is at a critical point. No one knows whether public awareness will lead to Western-style reductions in smoking, or whether economic and social barriers will have the opposite effect. No matter what happens, international medical device companies should position themselves to tap this growing market.