On Sunday, China banned smoking in public places such as restaurants, bars and other indoor spaces.
But a lack of public understanding about the dangers of smoking in the nation of 300 million smokers – where the state owns the tobacco syndicate – suggests it may not have the desired impact.
Lifestyle diseases are the biggest killer in the developed world and now people in developing countries are not only catching up but may in fact be leaping ahead.
The World Health Organization (WHO) recently launched the Global Status Report on NCDs showing we are in the midst of a rapidly evolving, powerful but often silent epidemic of non-communicable diseases (NCDs) – cancers, diabetes, lung diseases and heart and vascular diseases.
They kill more people every year than infectious diseases and 80% of their victims live in poor countries.
They strike earlier in the developing world than in rich countries, and they condemn their sufferers to continuing poverty as medical bills swallow families’ incomes and kill or maim breadwinners.
Poor countries with the weakest health systems are suffering from a double burden of disease – diseases of poverty and diseases of excess – excess alcohol, tobacco, food leading to obesity, and salt.
People in the developing world are more likely to have a non-communicable disease as well as an infectious disease.
For example, they are much more likely to smoke and to have tuberculosis (TB). Because of smoking, they are much more likely to die from TB. And if TB doesn’t kill them, they die from lung cancer.
But these premature deaths and illnesses are largely avoidable and preventable. Better still, preventing them is not expensive – and is far cheaper and more cost effective than treating them.
So it doesn’t make sense for us to say that low-income countries should only focus on infectious diseases such as HIV or malaria, any more than it makes sense for our aid to neglect NCDs.
The world has quietly and rapidly been overtaken with the NCD phenomenon. Between now and 2030 we will see the proportion of deaths due to NCDs continue to rise from less than 60% to more than three quarters.
And just as they threaten the lives of individuals and the viability of families, they threaten the productivity of nations and whole global regions.
In South Asia, for example the World Bank estimates that if NCDs could be prevented, Gross National Productivity will increase by 4% to 10%.
Despite the myths and the stealth of this epidemic, the world is slowly waking up and as this happens, opportunities arise.
The First Global Ministerial meeting on NCDs is taking place in Moscow, preparing for September when the United Nations will hold a meeting on NCDs for presidents and prime ministers in New York.
There is often some scepticism about the effectiveness of such gatherings, but past meetings on the Millennium Development Goals last year and on AIDS in 2001 have shown that they can mobilise new funds, catalyse political commitment and develop coherent international action if done well.
Effective, feasible and affordable interventions exist to prevent and treat NCDs.
According to the journal Lancet reducing smoking rates and lowering the amount of salt we consume (which in turn decreases blood pressure), together with drug treatment to lower blood pressure and cholesterol for people at high risk of cardiovascular disease could avert up to 32 million deaths over 10 years at a cost of less than US$1.50 per person annually.
These are blue chip investments in anyone’s terms, with annual costs of these interventions across the world estimated at approximately $6 billion.
To put that figure in context, remember that Australians alone spend over $2 billion a year on pet food.
Other low cost interventions are also important. These include encouraging more exercise and eating healthier diets that are lower in fats and higher in vegetables and fruit.
Similarly enforcing smoke-free workplaces, combining public-awareness campaigns with regulation of tobacco packaging and labelling, complemented by comprehensive bans on tobacco advertising, promotion and sponsorship are cheap and effective.
Increasing taxes on cigarettes and alcohol raises money – money that can be invested in promoting health, as leaders including states like Victoria and countries like Thailand have shown.
Obviously, success against the NCDs is too important and too complicated to be left solely in the hands of doctors.
Not only do we need our politicians in New York, but we need the continuing contributions of a whole range of groups across the public and private sectors – non-government organisations, academia in education, trade, finance, agriculture, urban planning, advertising and communications, and business and industry.
It will be a complex business but is by no means impossible.
What is there to gain? Get this right and there is an untold number of premature deaths that could be avoided, and suffering that could be prevented or treated.
Spiralling healthcare costs could be avoided and turned to better use and productivity enhanced.
Get it wrong and already stretched health services will simply buckle and the global health bill will continue to skyrocket.
We all need to be working towards prescription for ourselves personally, for Australia, and for the world.