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Can China really stop 350 million people from smoking?

BEIJING – There are some 350 million smokers across China, but walking through the country’s many restaurants, bars and other public spaces, you’d be forgiven if you thought there were even more.

It was hardly a surprise when the National Health and Family Planning Commission announced last week that China – the world’s largest producer and consumer of tobacco and home to nearly a third of the world’s smokers – was planning to ban smoking in public places nationwide by year’s end.

The need for a nationwide smoking ban has been recognized by China’s ruling Communist Party in recent years as an unavoidable next step toward maintaining social stability. Having long tied its legitimacy to raising economic prosperity and life expectancy in China, Beijing has seemingly begun to weave quality of life into that opaque rubric by which the government weighs its policy decisions.

In the case of smoking, startling statistics released by the World Health Organization estimate that one million deaths can be attributed to smoking each year in China, with that number expected to rise to three million per year by 2050 if current smoking rates aren’t curbed.

Little is known about the timeline for the proposed ban and how it would be implemented. The government declined to provide NBC News with any additional details about the plan, and anti-smoking advocates had no answers about enforcement either.

Previous attempts at citywide smoking bans in public spaces in China don't provide much hope that a nationwide ban could be quickly instituted.

In 2008 and again in 2011, Beijing instituted bans on smoking in public spaces that took many residents by surprise. The move was hailed by anti-smoking advocates, as “No Smoking” signs were plastered to the doors and walls of many of the capital’s restaurants and other public establishments.

Smoking is deeply embedded in Chinese culture. China's leader Deng Xiaoping smokes one of his favorite Panda brand cigarettes in this 1986 file photo taken in Beijing.
Smoking is deeply embedded in Chinese culture. China's leader Deng Xiaoping smokes one of his favorite Panda brand cigarettes in this 1986 file photo taken in Beijing.Stringer/China / Reuters

But the warnings seemed mere suggestions rather than law, as millions of indifferent smokers kept lighting up.

Studies of the failed bans often cite the need to change the culture of smoking. In China, cigarettes are often given as gifts, and large groups of men often smoke socially and in business situations – contributing to an almost 63 percent smoking rate among adult Chinese men compared to 4 percent for women.

According to the WHO representative for China, Dr. Bernhard Schwartländer, the success of any smoking ban will hinge on education.

“Awareness about the health hazards of smoking is low [in China],” Schwartländer wrote in an email to NBC News. “Only 25 percent of Chinese adults have a comprehensive understanding of the specific health hazards of smoking [and] less than one-third of adults are aware of the dangers of second-hand smoke.”

“Increasing awareness and health education will be important to ensuring successful implementation and enforcement of the national smoke-free law,” Schwartländer concluded.

As medical costs for treating its millions of smokers rise, many in China see the political and social value of reining in public smoking. But many questions linger regarding just how such a radical ban can be enforced after the dramatic failure of similar smaller-scale bans across the country.

“China is a big country and its population is enormous, so it’s a really hard task for the government to push and enforce this smoking ban,” said Dr. Liu Mingqiao of Chaoyang Hospital in Beijing. “The severity of the punishment will also be important because many people will think it’s a little bit ridiculous if someone is slapped with a heavy fine for their smoking.”

“People will also be asking whether government officials will also be punished – like normal people – if they are caught smoking,” Liu said.

Perhaps even more daunting than societal concerns about the ban are the deeply rooted financial interests that tie China’s government to Big Tobacco.

The term Big Tobacco doesn't do justice to the scale of China’s operation. The state-owned tobacco monopoly, China National Tobacco Corporation, reportedly earned revenue upwards of $19 billion, according to its last release of financial data for 2010.

That makes its earnings larger than Philip Morris International Inc., British American Tobacco and Altria Group, Inc. – the world’s three biggest listed tobacco companies – combined.

It also represents significant revenue for heavily dependent – and in debt – provincial and municipal governments that lean on the tobacco monopoly for an estimated 7-10 percent of their annual revenue.

Faced then with the decision between providing relief to the nearly 700 million Chinese routinely exposed to second-hand smoke and lining government coffers, the Communist Party has, up to this point, sided with the health of its pocketbook.

No small wonder, then, that even Chinese state media have complained that tobacco controls have completely failed to curb the industry’s explosive growth.

Despite the deep rooted ties and reliance on tobacco for fiscal support, China has been pushing ahead with its anti-smoking campaign. Some local Chinese media have reported that cigarette suppliers have been having difficulties securing stock of mid- and low-cost cigarettes since the ban was announced.

The government also mandated earlier this month that party officials set an example by not smoking in public places, including government offices, schools, hospitals and public transportation -- a move derided by many as just a lot of hot smoke.

“Government officials are some of the biggest smokers I know,” said Martin, an American in Beijing who co-owns a popular bar called The Local in the capital’s Sanlitun district. “Smoking is ingrained in their culture of eating and drinking, so I think this smoking ban will be virtually impossible to enforce.”

NBC News’ Zoe Zhang contributed to this report.