China’s Smoking Crisis: A Medical Device Opportunity

Nowhere is there more to be gained from the global tobacco epidemic than in China. For example, for every 10 cigarettes smoked globally, four were smoked in china—4 million every minute, 6 billion every day and 2.3 trillion for the calendar year. In 2011, more than 300 million Chinese, a number almost equivalent to the entire U.S. population, smoked cigarettes every day. Tobacco-related diseases now account for 12 percent of total deaths in China, at a rate of 1.2 million per year.

Among the most serious diseases caused by smoking are lung cancer, cardiovascular disease and a host of other illnesses, including chronic obstructive pulmonary disease and cancers of the esophagus, larynx, throat and mouth. Lung cancer is now the most common cancer in China, with the majority of patients diagnosed at an advanced stage. Mortality rates from lung cancer in China have increased significantly.

These health trends have driven a strong increase in demand for pulmonary, cardiac and diagnostic devices for Chinese patients. Pulmonary products in high demand include ventilators, inhalers and oxygen concentrators. Cardiac devices include heart valves, ventricular assist devices, on-pump coronary artery bypass devices and endoscopic vessel harvesting devices. And diagnostic devices include CT scanners, bronchoscopes and mediastinoscopes. International medical companies specializing in these medical devices would be wise to investigate opportunities for sales, distribution and manufacturing in China.

Despite a growing public awareness of the risks associated with tobacco consumption, Chinese anti-smoking campaigns have done little in the past decade to alter the overall prevalence of tobacco use. The Chinese government recently announced a ban on smoking in designated public places after signing on to the World Health Organization (WHO) Framework Convention on Tobacco Control in 2003. However, overall male smoking prevalence has dropped by fewer than four percentage points since. According to the 2009 Global Adult Tobacco Survey conducted by WHO, fully 52.9 percent of adult Chinese males were current smokers. Comparatively, only 2.4 percent of adult Chinese females
reported themselves as current smokers.

While women face strong social stigma if they take up smoking, tobacco use is the cornerstone of male social interaction in China. Men who want to climb the ladder of success must smoke. Most men who want to build and maintain business relationships must smoke. Those who give name brand cigarettes to their superiors or pass around a pack of smokes to their peers are considered “manly men.” They earn respect and face in a culture where face is everything.

Even public health professionals who acknowledge the dangers of tobacco are loathe to advise against smoking. Speaking to a Stanford anthropologist, a Kunming, China-based lung surgeon admitted to passing out cigarettes to other doctors in his department. “How can I dump cigarettes altogether?” he asked. “It’s part of getting along, part of what keeps us all friendly and relaxed.”

But more than social and cultural barriers, Chinese tobacco-control advocates must overcome massive economic obstacles as well. The domestic tobacco industry is one of the largest sources of tax revenue for the central government, rivaling such sectors as real estate and petroleum. During the last 10 years, the tobacco industry consistently has contributed between 7-10 percent of annual central government revenue. Commercial and consumption taxes on tobacco generated more than $119.5 billion in 2011. And in an era of social instability, government officials—especially those in China’s tobacco producing Southwest—are worried that any threat to the industry will drive down revenue and increase local unemployment.

If Chinese leaders fail to stem the steady tide of smokers, they are likely to see many more of their own succumb to smoking-related diseases. At current rates, 50 million of today’s children living in China will die prematurely of tobacco-related diseases. Also, fully one-third of Chinese men alive today will die due to smoking-related illnesses. Even those who do not take up smoking are at risk. According to in-country studies, nearly 738 million Chinese are affected by secondhand smoking. In 2002, an estimated 48,400 women died of lung cancer or heart disease attributed to passive smoking.

Experts agree that China’s smoking crisis is at a crossroads. It is unknown whether public awareness will lead to a Western-style reduction in tobacco use, or whether social and economic barriers will allow the epidemic to continue unabated. But with either outcome, foreign medical device companies should be able to tap into this growing market.

Ames Gross is president and founder of Pacific Bridge Medical, a Bethesda, Md.-based consulting firm that helps medical device companies succeed in Asia. A recognized national and international leader in the Asian medical markets, he founded Pacific Bridge Medical in 1988, which has helped hundreds of medical companies with business development and regulatory issues in Asia. For more information, visit www.pacificbridgemedical.com.