Current Status and Challenges of National Tobacco Free Health

System Construction

LI XinhuaLI Xinhua DirectorDirector ， ， Division of Health Promotion and Division of Health Promotion and

EducationEducation ，， Department of Maternal and Child Health Care and Department of Maternal and Child Health Care and Community Health, Ministry of HealthCommunity Health, Ministry of Health

October, 2011October, 2011

Overall Working Plan in 2011 Overall Working Plan in 2011

ContentContent

Main Condition and ResultsMain Condition and Results of the 1of the 1stst Secret Investigation Secret Investigation

BackgroundBackground

WHO WHO 《《 Framework Convention on Tobacco Control -- FCTCFramework Convention on Tobacco Control -- FCTC 》》

According to the 8According to the 8thth item and its implementation bylaws item and its implementation bylaws of FCTC, our country should forbid smoking in all indoor of FCTC, our country should forbid smoking in all indoor public places, indoor working places, public public places, indoor working places, public transportation vehicles, and other possible (outdoor or transportation vehicles, and other possible (outdoor or quasi-outdoor ) public places before Jan.9, 2011.quasi-outdoor ) public places before Jan.9, 2011.

I. BackgroundI. Background

Announcement of Overall Forbidding Announcement of Overall Forbidding Smoking in National Health System in 2011Smoking in National Health System in 2011

Multi-measures to Build Up a Tobacco Free Multi-measures to Build Up a Tobacco Free Health SystemHealth System

1. Integrating subsidy allocated by central government, 1. Integrating subsidy allocated by central government, support every region to build up the systemsupport every region to build up the system

2. Organizing experts to visit and inspect tobacco free 2. Organizing experts to visit and inspect tobacco free health system construction at each province (Region, health system construction at each province (Region, Municipality)Municipality)

3. Continue to develop mass media propaganda campaign of 3. Continue to develop mass media propaganda campaign of tobacco control in China tobacco control in China

3. Continue to develop mass media propaganda campaign of 3. Continue to develop mass media propaganda campaign of tobacco control in China tobacco control in China

4. Employ the 34. Employ the 3rdrd party professional investigation party professional investigation company to carry out secret investigation of company to carry out secret investigation of national tobacco free city constructionnational tobacco free city construction5. Take the lead in building up tobacco free 5. Take the lead in building up tobacco free Ministry of HealthMinistry of Health

II. Main Condition and Results the 1II. Main Condition and Results the 1stst Secret InvestigationSecret Investigation

986 health institutions are covered by subsidy of regional 986 health institutions are covered by subsidy of regional tobacco control projects allocated from central government tobacco control projects allocated from central government in 2009 and 2010in 2009 and 2010

randomly select 880 health institutions which achieved the randomly select 880 health institutions which achieved the goal of tobacco free by the end of 2010 goal of tobacco free by the end of 2010

53 institutions and affiliated organizations of Ministry of 53 institutions and affiliated organizations of Ministry of Health (including subunits)Health (including subunits)

1. Investigation Scope1. Investigation Scope

2. Investigation Methods2. Investigation Methods According to relevant contents of secret investigation regulated by According to relevant contents of secret investigation regulated by

Evaluation Criteria of Tobacco Free Health Institutions issued by Evaluation Criteria of Tobacco Free Health Institutions issued by Department of Maternal and Child Health Care and Community Health Department of Maternal and Child Health Care and Community Health (No.223) in 2009, includes tobacco free environment arrangement, (No.223) in 2009, includes tobacco free environment arrangement, smoking ban of indoor public places. smoking ban of indoor public places.

Entrust the 3Entrust the 3rdrd party investigation company, using secret shooting and party investigation company, using secret shooting and questionnaire. All data have their source of investigation videos. questionnaire. All data have their source of investigation videos.

Tobacco control office of China Center for Disease Control and Prevention provide technical support, experts from China Association for Tobacco Control and Think Tank Research Center for Health Development participated in report composition.

3. Investigation Time3. Investigation Time

The 1The 1stst stage was scheduled at Oct.11~Nov.10, 2010, which stage was scheduled at Oct.11~Nov.10, 2010, which successfully investigated 1781 institutions. successfully investigated 1781 institutions.

The 2The 2ndnd stage was scheduled at Nov.11~12, 2010, which stage was scheduled at Nov.11~12, 2010, which successfully investigated 112 institutions that had strict successfully investigated 112 institutions that had strict entrance administration and could not enter directly without entrance administration and could not enter directly without letter of introduction. letter of introduction.

4. Evaluation Indexes4. Evaluation Indexes

10

7

5

5

2

13

5

Environmental Index

Environmental Index

Smoking Status

Smoking Status

29 或 27

18

47 or 45

Comprehensive Score

Comprehensive Score

Smoking Ban SymbolSmoking Ban Symbol

Propaganda MaterialPropaganda Material

Sale of cigarettes is forbidden of supervised

area

Sale of cigarettes is forbidden of supervised

areaOutdoor Smoking AreaOutdoor Smoking Area

Cessation Outpatient Service

Cessation Outpatient Service

Indoor places forbidden smoking

Indoor places forbidden smoking

working staff is not allowed to smoke wearing overalls.

working staff is not allowed to smoke wearing overalls.

Fixed Bulletin BoardFixed Bulletin Board

Tobacco Control Propaganda Material

Tobacco Control Propaganda Material

3

4

Outdoor smoking area

Outdoor smoking area

Distinct InstructionDistinct Instruction

3

2

Discover cigarette ends

Discover cigarette ends

Found smoker, no one dissuade

Found smoker, no one dissuade

Found working staff was smoking

Found working staff was smoking

-1

-1

-2

Tertiary Indes

Tertiary Indes2

2

2

2

2

EntranceEntrance

Waiting HallWaiting Hall

Gentlemen’sGentlemen’s

ElevatorElevator

StaircaseStaircase

Overall Index

Overall Index

Primary Index

Primary Index

Secondary Index

Secondary Index

In order to compare secret investigation results of different institutions easily, calculate score of different indexes and deduct with full mark of that index, so that to get index score percentile.

Score and Ranking of Provinces (regions, cities)Score and Ranking of Provinces (regions, cities)

72. 471. 8

69. 568. 768. 368. 267. 867. 767. 2 6765. 6

64. 664. 463. 863. 5 63 62. 662. 562. 462. 362. 361. 461. 360. 559. 959. 758. 958. 658. 257. 556. 9

55. 8

50

55

60

65

70

75

上海

浙江

天津

广东

江苏

青海

北京

宁夏

内蒙古

湖北

云南

重庆

山西

贵州

湖南

福建

河北

黑龙江

广西

辽宁

吉林

新疆兵团

安徽

海南

甘肃

西藏

新疆

四川

陕西

江西

河南

山东

5. Main Results and Existing Problems5. Main Results and Existing Problems

Problem 1Problem 1 ：： Smoking Ban IdentificationSmoking Ban Identification

Figure 4Figure 4 ：： Smoking Ban Symbol Proportion sat Smoking Ban Symbol Proportion sat different places set by various institutionsdifferent places set by various institutions

（（ %% ））

Reception Office Entrance Staircase

Toilet Meeting Room Restaurant

Problem 2Problem 2 ：： Outdoor Smoking AreaOutdoor Smoking Area

Figure 5Figure 5 ：： Outdoor Smoking Area Proportion Outdoor Smoking Area Proportion set by various of institutionsset by various of institutions （（ %% ））

Problem 3Problem 3 ：： Complete Indoor Smoking BanComplete Indoor Smoking Ban

Figure 6Figure 6 ：： Indoor Smoking Phenomenon Indoor Smoking Phenomenon ProportionProportion （（ %% ））

Problem 4Problem 4 ：： Tobacco Control PublicityTobacco Control Publicity

Table 1Table 1 ：： Tobacco Control Propaganda Material Tobacco Control Propaganda Material Posted at Various InstitutionsPosted at Various Institutions （（ %% ））

CategoryCategory Tobacco Control Tobacco Control Bulletin BoardBulletin Board

Tobacco Control Tobacco Control Propaganda MaterialPropaganda Material

Health Administrative Health Administrative DepartmentDepartment 25.925.9 14.314.3

Public Health InstructionsPublic Health Instructions 29.929.9 17.817.8

Medical InstitutionsMedical Institutions 42.242.2 20.920.9

National Medical National Medical InstitutionsInstitutions 35.635.6 18.918.9

1. Oragnize Seminar of National Health Education and Health Promotion

III. Introduction of Overall Promotion and III. Introduction of Overall Promotion and Construction of National Tobacco Fee Construction of National Tobacco Fee

Health System in 2011Health System in 2011

2. Organize Supervision of National Tobacco Free 2. Organize Supervision of National Tobacco Free Health SystemHealth System

TimeTime Task and RequirementsTask and Requirements

Jan. –Dec.Jan. –Dec.AprilApril

MayMay

June-JulyJune-July By the end of JulyBy the end of JulyDec. or Beginning Dec. or Beginning of Next Yearof Next Year

Self-examination and self-monitoring Self-examination and self-monitoring Issue Announcement of Implementation Issue Announcement of Implementation Supervision of National Tobacco Free Health Supervision of National Tobacco Free Health System ConstructionSystem ConstructionIssue National Tobacco Free Health System Issue National Tobacco Free Health System Cross Supervision Evaluation ManualCross Supervision Evaluation ManualRegional cross supervision evaluation Regional cross supervision evaluation Report the result of cross supervision Report the result of cross supervision evaluation to CHINA CDC evaluation to CHINA CDC Construction Work Summarizing MeetingConstruction Work Summarizing Meeting

3. Organize Tobacco Control 3. Organize Tobacco Control Training Course among Training Course among Administrative Officials at Administrative Officials at different levelsdifferent levels

TimeTime Training CoursesTraining Courses

Jan.Jan.JuneJuneJulyJulyJulyJulySep.-Oct.Sep.-Oct. Oct.- Dec.Oct.- Dec.

The 1The 1stst Regional and Municipal Health Bureau Director Regional and Municipal Health Bureau Director Tobacco Control Training CourseTobacco Control Training CourseNational Health Supervision Trainer Training CourseNational Health Supervision Trainer Training CourseShandong Health Administrative Officials Training Shandong Health Administrative Officials Training Course (2 sessions) Course (2 sessions) Henan Health Administrative Officials Training Course Henan Health Administrative Officials Training Course Health Administrative Officials Training Course of Health Administrative Officials Training Course of Xizang and Xinjiang Autonomous RegionXizang and Xinjiang Autonomous RegionRegional and Municipal Health Bureau Director Regional and Municipal Health Bureau Director Tobacco Control Training CourseTobacco Control Training Course

4.Integrated with tobacco control project subsidized by 4.Integrated with tobacco control project subsidized by central government, continue to support construction central government, continue to support construction work in each region. work in each region.

5. Organize experts, and strengthen supervision forces. 5. Organize experts, and strengthen supervision forces.

6. Training and mobilizing media to participate in 6. Training and mobilizing media to participate in propaganda and supervision of tobacco free health propaganda and supervision of tobacco free health systemsystem

7. 7. Issue 2011 China Tobacco Control Report on World No-Issue 2011 China Tobacco Control Report on World No-Tobacco Day.Tobacco Day.

8. Prepare and disseminate propaganda materials.8. Prepare and disseminate propaganda materials.

9. Organize and develop 2011 National Secrete Investigation 9. Organize and develop 2011 National Secrete Investigation work. work.

10. Organize summary and commending meeting at 10. Organize summary and commending meeting at appropriate time. appropriate time.

Begin with yourself, integrating innovative thoughts, explore a CHINA Way to follow Framework Convention on Tobacco Control.Framework Convention on Tobacco Control.