Pipe Dreams: Why the Chinese are Still Smoking

Smoking has been a popular pastime in China since tobacco was introduced in the mid-16th century. Although consumption patterns have changed over time, smoking remains pervasive throughout the country. In fact, an estimated one-third of all cigarettes produced worldwide are consumed in China.

Wilson Center Fellow Carol Ann Benedict is spending her time at the Center writing a social and cultural history of tobacco consumption in China, inspired by her interest in Chinese history and medicine. Her father's work as a thoracic surgeon piqued her interest in health and disease, and she later spent time living in Taiwan and Beijing. Her first book, published in 1996, examined the bubonic plague in 19th-century China.

Prior to the 20th century, infectious diseases caused the majority of deaths in China. But in recent years, smoke-related illnesses such as lung cancer and emphysema have become leading causes of death. Each year, 750,000 people die in China from such diseases.

The World Bank predicts that number could rise to more than a million people per year by 2010. This epidemic sparked Benedict's curiosity about the history behind China's fascination with and addiction to tobacco.

Smoking tobacco has long been embedded in Chinese culture. "One of tobacco's enduring aspects is that it's always associated with sociability and hospitality," she said. "From the beginning, tobacco has always been a gift item." The Chinese typically give out cartons of cigarettes at banquets and as wedding gifts. "In China, if we were men and you walked into my office, I'd have given you a cigarette as an expression of sociability."

Men and women traditionally smoked pipes but, by the end of the 19th century, cigarettes became the trend. Over the past century, cigarette smoking has dramatically risen, particularly among men. "Cigarettes have created a new urban sub-culture," said Benedict. "They're modern and considered masculine."

In the 19th century, women typically preferred hookahs (water pipes) because traditional literature regarded dry tobacco as yin-harmful, drying, and possibly impairing fertility, while water tobacco was considered more yang-replenishing. In recent decades, smoking tobacco in general has declined among women.

Problems with tobacco consumption are not limited to the modern era. Throughout history, Chinese leaders who have tried to restrict or ban smoking have failed. For a brief time in the 17th century, the Qing Dynasty promoted a strict anti-tobacco policy, with the ultimate punishment being death. From 1638-1644, Qing rulers threatened to behead anyone who smoked or even cultivated tobacco. But the threat did not deter people from smoking.

"They tried to control tobacco so they could use it exclusively as a diplomatic gift," Benedict said, "but they were unsuccessful at monopolizing it." After their efforts to ban tobacco failed, Qing rulers began to permit smoking and began taxing tobacco, which generated huge revenues for the imperial court.

In the 19th century, Protestant missionaries came to China preaching an anti-tobacco message. Despite their efforts, smoking remained customary, even after it was identified as a health risk in the mid-20th century.
Benedict said, "Tobacco control efforts in contemporary China can benefit from an understanding of this long history as well as the complex cultural meanings smoking has acquired in China over time."