I find it fascinating that over 50% of men in China are smokers, while only about 5% of women are. Why such a huge discrepancy? These are massive questions for China’s public health teams: why do so many Chinese men smoke? Or you could ask the reverse questions; why do so few Chinese women smoke, and can we adapt their differing value systems to help men stop smoking?

One important thing to note first is that this 50% rate is by no means abnormal, in terms of world history. America is furthest along the anti-smoking bandwagon but smoking rates among men in the 1950’s were likely similar to that of China now. And many countries in Asia have similar or higher rates, including Japan. There seem to be common stages of the tobacco epidemic that are highlighted in the fascinating graph below (source: Lopez et al., 1994). As you can see, China is only in stage 2, where a massive percentage of men become addicted, and a couple decades down the line the rate of disease and death will skyrocket. Note how in the first stages, women smoke far less than men in all societies. Much of the west and Europe is already in Stage 4, where smoking levels taper off but the death rates peak.

So, back to the main question; what is the cultural difference? I’m honestly not sure, but I would love to hear other opinions about it. Certainly there is a culture of men trying to act cool as teens, and they get hooked and can’t stop. This is a universal issue for men; but perhaps as adults there is a uniquely Chinese strong culture for businessmen to drink and smoke, especially during meetings, where it may be considered rude to refuse either a toast or a cigarette. And historically, China’s leaders Mao Zedong and Deng Xiaoping were very heavy smokers and always photographed with a cigarette.

Clearly these cultural issues will take decades of public education to change. Much quicker changes, proven in many countries, would be higher tobacco taxes, warning labels on packs with graphic pictures, and the crucial banning of smoking in all public areas. There’s no reason to think China is any different than other countries, and eventually the cultural attitudes will change here as well. Unfortunately, between now and then, millions of people are going to continue to die from this awful addiction.