Wang Qinghua (left), a smoker from Liaocheng, Shandong Province, receives treatment at a private smoking cessation clinic on May 31. Photo: CFP

Any smoker will tell you that kicking the habit is tough. Given the fact that medical journal The Lancet estimates China has over 300 million smokers, one would think that facilities designed to help them quit would be popular.

Despite the fact that lung cancer rates in China are soaring and the number of lung cancer patients could reach 1 million by 2025, the prospects of "smoking cessation" clinics around the country are looking dim.

"The clinic opens once a week and it is rarely visited. It would be counted as 'too many' if three smokers showed up. Sometimes I question whether we are wasting medical resources here," an anonymous doctor working with a smoking cessation clinic in Shanghai told the Global Times.

Despite the low traffic, Xiao Dan, a research fellow with the World Health Organization Collaborating Center for Tobacco and Health based in Beijing Chaoyang Hospital, said that utilization rates are increasing. The smoking cessation clinic affiliated with her hospital was first launched in 1996 and now sees roughly 1,000 patients a year, an increase over previous years.

But even if usage is slowly increasing, smoking cessation clinics across the country face the strong likelihood of being shut down. Zhongda Hospital in Nanjing, Jiangsu Province, is close to being shut down with only two or three smokers coming in every month over the past three years, according to the Nanjing-based Xinhua Daily. Four out of nine smoking cessation clinics in Kunming, Yunnan Province have already been shut down, the Kunming Daily reported.

Kicking the wrong habit

Zhi Xiuyi, head of the Lung Cancer Treatment Center of Xuanwu Hospital in Beijing, said that a key problem facing these clinics is that few smokers willingly seek professional help. Many smokers reached by the Global Times said they were unaware of the clinics. They said that because smoking itself is not a disease, they would not visit a clinic for it and would rather deal with the habit on their own.

Doctors reached by the Global Times pointed out that most patients only agree to go to the clinics after they develop smoking-related health problems. "There is not enough publicity about us and many smokers are not aware that they are addicted to cigarettes. Some are ignorant of the hazards of smoking. Our patients usually come to us for a consult after noticing our logo at hospitals," said Xiao, adding that the government only offers limited support, which means that additional costs are a deterrent to patients, and that clinics do not have the necessary equipment.

"It can cost up to 3,000 yuan ($492) for a three-month course of treatment at a clinic. Since some medicines are not included in the health care system, these fees may have further hindered the clinics' development," Zhi said. He also argued that the system should at least cover the medical expenses of smoking cessation treatment for those suffering from cardiovascular or respiratory diseases, as smoking would worsen their health.

Yang Gonghuan, former deputy director of the Chinese Center for Disease Control and Prevention, said that 91.4 percent of Chinese smokers have not received any services on smoking cessation and the relapse rate is 30 percent, the People's Daily reported.

In 2012, Chen Zhu, former health minister, said that health care reform should promote reductions of tobacco use by including smoking cessation medicines into the system. The Beijing municipal government was mulling this plan in October, the Nandu Daily reported.

Cigarette pushers

After years of campaigning against tobacco use, Zhi said that this health issue was in many ways a fight between a "tobacco army" and a few "anti-tobacco fighters," and that the former spreads its influence via a variety of methods, often using altruistic means to improve their image, such as donations to poverty-stricken regions. Zhi said that these were some ways around rules that stop them from advertising.

The Beijing News reported in May that tobacco companies sponsor around 70 percent of the research programs at universities or scientific institutes.

Tobacco also contributes significantly to government coffers. The China National Tobacco Control Plan 2012-2015 read that taxes paid by the tobacco industry in 2010 totaled 498.8 billion yuan, making up of 6 percent of the national fiscal revenue.

Yang Jie, a research fellow with the Tobacco Control Office of the Chinese Center for Disease Control and Prevention, said that despite the revenue generated, health problems caused by smoking would represent a massive cost. "The government will also have to pay for the health insurance of those patients falling ill because of smoking, this may cost more than the revenue created by tobacco companies," said Yang Jie. "But since it takes a much longer time for chronic diseases to manifest, the authorities may prefer to receive the immediate income."

Smoke in their eyes

Bu Hanmeng, a former physician and former smoker of 20 years, told the Global Times that there were many reasons why people smoke. "Besides stress relief, smoking makes you feel stylish, especially when it is a famous brand. When cigarettes become a symbol of money and power, it is harder to persuade people to stop smoking them. And people rarely fear death if it is far in the future."

He suggested that the current warning labels on cigarette packages were too small. "If authorities required tobacco companies to, for example, cover 50 percent of the package with a skull and a warning, maybe there would be fewer people showing off their cigarette brands."

But even hospitals cannot avoid the invasion of cigarettes. Bu admitted that he used to smoke with colleagues between operations to help ease work pressure.

"More than 50 percent of male doctors and teachers smoke at work when they should serve as examples to stay away from cigarettes. Many young smokers actually first pick up smoking by 'learning' from their teachers," said Zhi.

The National Health and Family Planning Commission announced that smoking would be banned in public enclosed spaces from May 1, 2011. Businesses are required to dissuade smokers from smoking and the regulation also banned cigarette vending machines in public spaces.

"But without punitive measures, the regulation is powerless in terms of enforcement. We cannot force smokers to quit; but we need to work to create a cigarette-free environment and gradually push them to drop it," Yang Jie said.