Inside Job

I live in a nation where 27% of the Health Ministry smokes.

Compare this to the entire population of cigarette-loving America, of whom only an estimated 23% smoke. Or to Canada, where 21% of the population smokes. Or to Australia, where the smoking rate dropped to 19.5% in 2002. But according to the American Cancer Society, Japan has the fourth-highest percentage of adult smokers in the world, with 30% of the adult population lighting up as of Japan Tobacco Inc.’s 2003 annual survey. Smoking men account for 48.3% of the population, rising to 59.9% for men in their 30s, and  Japanese smokers even smoke more than their international counterparts: while the average Canadian smoker takes in 16.2 cigarettes a day and American daily smokers take in about 18, the average Japanese smoker sucks back 22.9 cigarettes every day, a level defined as "heavy smoking" by the Office of the U.S. Surgeon General.

But the problem of smoking in Japan isn’t so much its prevalence, but its unconscious commonality. Normally polite and considerate people lose all thought of others when it comes to their cigarettes. Last winter, I spent five hours on a chartered bus including educators, pharmacists and health-care workers who would consistently get off the bus for a washroom break, return, and automatically light up as soon as the bus started moving again. My Japanese friend tried to counter my outrage with the comforting words, “I never believed second-hand smoke was dangerous anyway.” In the second-largest economy on the planet, with world-renowned standards for education, how could such ignorance prevail?

Forty years ago, back in 1964, the Advisory Committee to the Surgeon General made the following discoveries, shocking a nation out of its complacent puffing habits:

Cigarette smokers were 70% more likely to die of coronary artery disease than non-smokers. Smokers were 500% more likely to die of chronic bronchitis and emphysema than non-smokers. The average male smoker (10-19 cigarettes daily) faced a 9- to 10-times increased likelihood of contracting lung cancer, while for heavy smokers (20-39 cigarettes daily) the risk increased at least 20-fold, and the death rate for lung cancer among smokers was found to be 1000% higher than for non-smokers. In fact, compared to non-smokers, the average smoker was 70% more likely to die from all causes, while heavy smokers saw their death rate increase by 90%.

There are significant quantities of over 4000 different chemicals in cigarette smoke. Of the 36 existing compounds confirmed as “known” carcinogens by the International Agency for Research on Cancer (IARC), at least 10 are contained in cigarette smoke, meaning that over one quarter of all the confirmed carcinogens in the universe are contained in cigarette smoke, in addition to about forty more that the IARC classifies as “probable” or “possible” carcinogens.

Even tobacco giant Philip Morris USA Inc., whose Marlboro brand accounts for over a third of American cigarette sales, states that Philip Morris “agrees with the overwhelming medical and scientific consensus that cigarette smoking is addictive,” that “cigarette smoking causes lung cancer, heart disease, emphysema and other serious diseases in smokers,” and notes that “public health officials have concluded that secondhand smoke from cigarettes causes disease, including lung cancer and heart disease, in non-smoking adults, as well as conditions in children.”

Until this year, the Japanese Health Ministry had smoking areas and four cigarette machines on its premises.

There is, in fact, one cigarette vending machine for every 202 people in Japan. Between 1992 and 2002, in an age when many nations endeavored to eliminate the machines to curb youth smoking, Japan augmented its fleet of cigarette machines from 495,900 to 629,000. And yet, while Australia and Canada take into account underage smokers from the ages of 14 and 15, respectively, Japan’s tobacco surveys are not performed by the Health Ministry, but by Japan Tobacco, which takes into account only its legal market of smokers over the age of 20. The rate of smoking among high school students has been independently estimated at around 25%.

Japan Tobacco is the third-largest tobacco manufacturer on the planet, and it is 50% owned by the Japanese Finance Ministry—not the Health Ministry. Health Canada offers stark warnings to smokers, requiring that cigarette packages bear massive full-color images depicting various horrifying diseases associated with smoking, accompanied by warnings reading, “Cigarettes are highly addictive;” “cigarettes cause strokes;” “cigarettes cause lung cancer;” “tobacco use causes crippling, often fatal lung diseases;” “tobacco use can make you impotent.” In Japan, a small, light-blue label on the side of Japan’s top-selling Mild Seven cigarette packs cautions smokers, “Because it may be harmful to your health, let’s take care not to smoke too much.” It adds, “Please mind your smoking manners.”

The Finance Ministry is bound by law to ensure a “stable supply of tax revenue” through the “sound development” of the tobacco industry, while Japan Tobacco maintains that cigarettes represent only one of many risk factors for cancer and disease, and that smokers develop only a minimal psychological and physical addiction to nicotine.

Roughly 1.16 trillion yen (US$10.6 billion), 2.6% of the nation’s tax income, is earned annually through cigarette taxation. Low prices keep sales brisk: even after a 20-yen price hike in 2003, a pack of Mild Seven cigarettes costs only 270 yen (US$2.47) per pack of 20, while the average pack under Canada's lowest taxation still goes for US$3.48, and in Kentucky, with tobacco taxes at fire-sale levels, the average pack will still run up $3.27 at the register.

This is not merely a legacy of the past: in October 2003, judge Kikuo Asaka flatly rejected a liability suit against Japan Tobacco, dismissing arguments that existing warnings on cigarettes were insufficient, and downplaying the addictive nature of nicotine while echoing the industry position that smokers are free to quit if they choose. Asaka, a smoker, replaced the original non-smoking judge midway through the proceedings.

The Japanese government has at last begun to move on the issue, but largely for appearances. In May 2003, the government introduced the Health Promotion Law to restrict smoking in public places, but the law fails to stipulate any punishment for violations. In accordance with the World Health Organization's Framework Convention on Tobacco Control, the Finance Ministry has declared that all cigarette packages will require new warnings covering one full third of the pack, visible on both sides, that address the dangers of lung cancer, stroke, and heart disease, as well as the risks posed to pregnant women and children and the addictive properties of nicotine. However, these warnings will not take effect until June 2005. But the Health Ministry has indeed pledged to eliminate smoking in its offices and remove its smoking areas, although the reception area and some restaurants on the premises will remain smoker-friendly.

Starting this spring, teachers will no longer be allowed to smoke in Tokyo public high schools, and other school boards around the country are expected to follow by next year. In the elementary school where I work, I recently helped the school nurse run her first-ever tobacco awareness lesson with a class of 36 grade six students. Reassuringly, many of the kids already knew that cigarettes were harmful to the lungs and that nicotine was addictive. But when the nurse asked how many of them had people in their lives who regularly smoked around them, nearly every child raised a hand. Maybe next time their parents should sit in on the class.

Written March 2004.

• “Report of the Advisory Committee to the Surgeon General of the Public Health Service” available through Philip Morris USA (www.philipmorrisusa.com/health_issues)
• Chemical constituents of tobacco smoke from Jefferson Fowles, Michael Bates and Dominique Noiton, “The Chemical Constituents in Cigarettes and Cigarette Smoke: Priorities for Harm Reduction, A Report to the New Zealand Ministry of Health,” March 2000 (www.ndp.govt.nz)
• Canadian cigarette warnings from Health Canada (www.hc-sc.gc.ca/hecs-sesc/tobacco)
• US and Canadian cigarette prices from the Non-Smoker’s Rights Association www.nsra-adnf.ca
• Philip Morris cigarette sales from Hoover’s Online (http://www.hoovers.com/philip-morris-usa/--ID__55933--/free-co-factsheet) 
• California’s smoking and cancer rates from “Decline in lung cancer rates – California, 1988 to 1997,” Center for Disease Control and Prevention (www.cdc.gov/tobacco/research_data/)
• Australian smoking rates from Tom Noble, "Smoking rate falls below 20%", The Age, May 23, 2002 (www.theage.com.au) 
• US smoking rate and Japanese cigarette prices reported in “Percent of Japanese who smoke at record low,” Reuters, November 10, 2003 (www.globalink.org/34890) 
• Japanese smoking rates reported in “30 percent of Japanese smoke,” Mainichi Daily News, November 10, 2003 (www.globalink.org/34890)
• Government ownership of Japan Tobacco and judge Asaka's comments reported by Kiroku Hanai, "Stub out the smoking habit," The Japan Times, November 24, 2003 (www.japantimes.com)  
• The Ministry of Health’s acceptance of smoking on its premises reported in “Tokyo court rejects suit linking smoking and cancer,” Japan Today, October 22, 2003 (www.japantoday.com/gidx/news276404)  
• Cigarette vending machine numbers and Japan’s global smoker standing come from Hiroshi Matsubara, “Japan slowly pulls head out of sand on smoking ills,” The Japan Times, October 22, 2003 (www.japantimes.com)
• Information regarding Japanese children from Alice Gordenker, "Finally, anti-tobacco lessons come to schools," The Japan Times, February 11, 2003 (www.japantimes.com)
• Announced cigarette initiatives and annual tax revenues from "Cigarette labels to carry stronger health warnings," The Japan Times, July 3, 2003 (www.japantimes.com)
• Ministry of Health anti-smoking policy reported in "Health ministry to ban smoking in its offices," The Japan Times, August 28, 2003 (www.japantimes.com)
• High school smoking ban reported in "Smoking to be banned at Tokyo public high schools," Japan Today, July 3, 2003 (www.japantoday.com)
• The rejection of Brown & Williamson Tobacco Corp.’s appeal was reported in “U.S. Supreme Court rejects tobacco appeal,” CNN, June 29, 2001 (www.cnn.com/2001/LAW/06/29/sc.floridasmokers) 
• Japanese population from the CIA World Factbook (http://www.cia.gov/cia/publications/factbook/)