In February, the framework convention on tobacco control came into force, marking another milestone in the international antismoking movement. Japan has ratified the convention but is making only halfhearted efforts at tobacco control, frustrating antismoking activists ahead of No Tobacco Day on May 31.
The slogan adopted by the World Health Organization for this year’s No Tobacco Day is “Health Professionals Against Tobacco — Action and Answers.” The campaign seeks to enlist the support of health professionals, such as medical doctors and nurses, who are well aware of the evils of smoking.
The slogan is fitting for Japan, as a medical association survey shows that 21.5 percent of male doctors in Japan smoke, compared with 3 to 5 percent in the United States and Britain.
In 1992, a group of antismoking doctors and dentists started a campaign to ban smoking at medical and public health facilities and to promote antismoking education for students and the public at large. However, I have yet to see antismoking posters at dental clinics and hospitals. Health professionals should play a more active role in tobacco control.
According to the Japan Nursing Association, 24.5 percent of the nation’s female nurses smoke, double the rate for women in general. This rate perhaps reflects a strong sense of gender equality among female professionals, but it is nevertheless disturbing. The association is pushing a campaign to reduce the level of workplace smoking among nurses to zero immediately, and to halve the percentage of nurses who smoke anywhere by 2006. The campaign is welcome.
The government, regrettably, is indifferent to measures to protect minors from the ills of smoking. More than 20 percent of first-year junior high male students have smoking experience. For second-year male high school students, the rate rises to more than 50 percent.
Most underage smokers (more than 70 percent of third-year student-smokers) obtain cigarettes from vending machines. The 1900 Japanese law prohibiting underage smoking is rarely enforced. This is a serious problem, since smoking is often linked to juvenile delinquency.
Many juveniles openly buy cigarettes at tobacco shops and convenience stores. Under the law banning underage smoking, whoever sells tobacco to minors is subject to a fine of up to 500,000 yen, but only about a dozen people a year are prosecuted for the offense. Police should step up efforts to catch violators.
The tobacco retail industry is considering introducing special ID cards for adult smokers as a means of preventing minors from buying cigarettes from vending machines, but the National Police Agency is skeptical of the proposal, since minors could easily obtain cards from adults.
The nation’s future depends on healthy children. For starters, the Finance Ministry and the tobacco industry should abolish tobacco vending machines. School physicians should make more efforts to prevent underage smoking. Dentists should be able to identify smoking children from their teeth and breath.
The health ministry, under the “Healthy Japan for the 21st Century” campaign, has set out to eradicate underage smoking by 2010, but it is unlikely to achieve that goal under the existing lukewarm measures.
In addition, tobacco control for the general public is not strong enough. The health promotion law, enacted in May 2003, requires managers of public facilities to take measures to prevent exposure to passive smoking, but it has no teeth. Most eating and drinking establishments do not observe the law.
Some municipalities have introduced ordinances to ban smoking in the street, but I believe that Western-style bans on smoking in eating and drinking establishments should be introduced. Controls on passive smoking at such places are important for protecting the health of not only guests but also service staff.
Taxi drivers are also victims of passive smoking. Of some 260,000 taxis operating nationwide, only 3,800, or about 1.5 percent of the total, are nonsmoking cabs.
In 2003, the health ministry issued a directive that taxis be included among public systems to which the health promotion law is applicable, but most taxi companies have ignored the order. Frustrated nonsmoking drivers and passengers last year filed a suit against the government and taxi operators to demand damages.
The Ministry of Land, Infrastructure and Transport, which is promoting a campaign to increase the number of foreign travelers to Japan to 10 million by 2010, should ban smoking in taxis to lure more U.S. and European visitors to Japan, most of whom do not smoke.
An important court decision is expected in late June in Tokyo High Court on a suit demanding compensation for smoking-related health trouble. A group of lung-cancer patients and other people with health problems had sued the government and Japan Tobacco Inc. on allegations that both failed to take effective tobacco-control measures, but the Tokyo District Court rejected the suit, saying nicotine is less addictive than alcohol.
If similar court decisions are repeated in Japan, even after the framework convention on tobacco control has taken effect, doubts could arise about the quality of Japan’s justice system. It is hoped that the court will come up with a decision that will satisfy the victims following a series of court judgments favorable to victims in industrial pollution cases.
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