Chronic Lung Disease May Ravage China

The fact that smoking and pollution will cause millions of deaths in China, a nation of 1.4 billion people, may not come as much of a surprise­­. But a new study by researchers at the Harvard School of Public Health quantifies the staggering human toll.

Between 2003 and 2033, the researchers estimate, 83 million Chinese will die from chronic obstructive pulmonary disease (COPD) and lung cancer, which would constitute nearly a quarter of the nation’s deaths during this period.

The study—which modeled the effects of varying amounts of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis—predicted that 65 million people would die from COPD and 18 million from lung disease in this period. Eighty-two percent of COPD deaths and 75 percent of lung cancer deaths in the model can be attributed to the combined effects of smoking and pollution.

“A large percentage of these death tolls is actually preventable by aggressive policy targeted at reducing smoking and other policy views in China,” said Hsien-Ho Lin, a research fellow at the School of Public Health and an author of the paper.

The study, published in the prestigious British medical journal The Lancet, found that complete gradual cessation of these risk factors by 2033 could save 26 million lives from COPD and over 6 million from lung cancer.

But of the 67 million COPD and lung cancer deaths attributed to smoking and solid-fuel use, over 10 million would be unavoidable even if the risk factors had been eliminated in 2003, due to persisting effects of past exposure.

The study also found that eliminating these risk factors would help combat tuberculosis deaths, according to Megan Murray, a professor at the School of Public Health and an author of the study, though the effect on tuberculosis deaths is hard to model because of the availability of successful tuberculosis treatment methods.

Indoor air pollution poses an exceptionally high risk in China, where more than 70 percent of households use solid fuels such as wood, biomass, and coal for heating and cooking. China, where over half of all men smoke, is also a leading market both for world tobacco production and for cigarette consumption.

William C. Kirby, a Harvard expert on Chinese history and business who travels to China roughly five times a year, described China’s smoking problems as a “central part of the social repertoire,” noting that Chinese leaders such as Mao Zedong and Deng Xiaopeng were “role models of smoking.”

“It is a problem of government financial addiction, physical addiction, and in some sense a social addiction,” said Kirby, who is a former dean of the Faculty of Arts and Sciences. “[This] doesn’t mean, however, that one should not and cannot begin to implement the measures recommended in this study.”

The study mentions tobacco taxation, advertising bans, cleaner fuels, and fuel pricing changes as ways to reduce health risks.

But Lin said there are many difficulties in implementing the policy changes, especially among China’s rural poor.

“China actually has pretty good access to electricity and clean gasses,” Lin said. “The thing is that they are not all that affordable for these people.”

Despite these challenges, Kirby said policy changes are not inconceivable, noting that the Chinese government “certainly pursues many policies it believes are for the public good,” not only popular measures.

“In those areas where it seeks to be effective—building highways, containing dissent, for example—it is one of the most effective governments in the world,” Kirby said.

—Staff writer Peter F. Zhu can be reached at pzhu@fas.harvard.edu.