Two decades after the Chinese public health community celebrated the adoption of a landmark anti-smoking treaty, smoking rates have barely budged, even as they have dropped significantly in some of the other countries that signed onto the World Health Organization (WHO) agreement, known as the Framework Convention on Tobacco Control.

So what went wrong? 

In short, a spectacularly successful campaign by China National Tobacco Corp., the state-owned cigarette monopoly, to stall, derail and influence key aspects of how the treaty has been implemented, an investigation by The Examination and its media partners has found. 

Under the accord, the first international treaty organized by the WHO, China promised to take a range of measures to curb smoking, joining other countries in attempting to address the world’s No. 1 risk factor for preventable death. Though less well known in the United States, which never ratified the treaty, the tobacco control convention provides the legal underpinnings that have led to lower smoking rates in much of the world over the past 18 years.  

The accord binds 182 countries to undertake a range of measures to reduce tobacco use and protect the public from the dangers of secondhand smoke – measures that include promoting tobacco taxes, banning smoking in public places and outlawing most forms of tobacco advertising.

China is not the only country that is falling short on the tobacco treaty. But two factors make it stand out. First, China is far and away the world’s largest cigarette market, consuming nearly half the global output. Second, the government has failed to reconcile the conflict inherent in both operating the world’s largest cigarette company and tackling the world’s largest lung cancer epidemic.

Indeed the tobacco treaty has stalled before the might of the company, known as China Tobacco, a massive state-run entity that is at once a cigarette maker, the country’s tobacco regulator and one of the government’s largest sources of revenue. China Tobacco and the government agency that is supposed to oversee it, the State Tobacco Monopoly Administration, are effectively one and the same, sharing leadership, staff and offices.

China Tobacco executives were part of the team that represented China in the negotiation of the treaty, and they have played a major role in how it has been implemented. As a result of this interference, China has not lived up to many of the commitments it made, with predictable but ghastly consequences: More than a million people a year die in China from smoking or inhaling secondhand smoke, with deaths expected to accelerate in coming years.

Design and development by Mago Torres