That progress has been achieved thanks to the unceasing efforts of anti-smoking activists who have played a major role in the campaign since the early stages in the late 1990s. Many of the best-known activists have been women, such as Yang Gonghuan, former vice-director of the Chinese Center for Disease Control and Prevention, and Xu Guihua, vice-director of the Chinese Association on Tobacco Control. Two other powerful women, Li Bin, head of the National Health and Family Planning Commission, and Cui Li, one of the commission's vice-ministers, are also known to be firm supporters of tobacco control.

Wu started planning the ThinkTank Research Center for Health Development in 2001, five years before she retired. She said she started the NGO so she could continue her crusade but employ methods different from those used by the CDC, a government organization. "NGOs can play a more independent role in tobacco control," she said, pointing out that experts at NGOs are not only better able to talk openly with government officials, but are also more likely to offer detached opinions because they have no need to curry favor with the administration.

"For example, it's difficult for officials or experts in a government department to raise objections against the State Tobacco Monopoly Administration, but experts employed by NGOs don't have the same concerns, so they can be more direct," she said.

In recent years, Wu has been blunt in her criticism of the failure to stop promotions and covert ads online, because as a signatory of the Framework Convention on Tobacco Control, China is obliged to ban all forms of tobacco advertising.

She doesn't just target the industry, though, and has reported several officials who were seen smoking in public or had helped tobacco companies advertise their products. "Officials are a very important link in tobacco control, and they should play a leading role in the fight against smoking," Wu said.

Despite the progress made in recent years, the government needs to fully implement the Framework Convention on Tobacco Control, which it ratified in 2005, especially the comprehensive ban on all forms of tobacco advertising, she said. "Tobacco promotions still exist, and some companies even advertise their products online."

Smoking and health

Yang Gonghuan, a professor of the Peking Union Medical College, was a key figure in China's ratification of the Framework Convention on Tobacco Control. She began a personal campaign against the tobacco industry more than 20 years ago when she joined the Chinese Center for Disease Control and Prevention to focus on the economic effects of chronic illnesses. It was during that period that she noticed a link between smoking and health, something that hadn't been highlighted in China before. "I realized that the incidence of chronic disease, such as lung cancer, was rising rapidly in China," she said. "At the time, renowned experts in developed countries believed the use of tobacco could cause serious damage to health."

In the 1990s, Yang participated in a number of research programs, including a 1996 national smoking survey. "The results showed that there were more than 300 million smokers in China, and that more than two-thirds of adult males were smokers. I was shocked," she said.

Yang spent the following decade conducting research, and her experiences of working for WHO in the US in 1999 and 2000, and later as head of China's Tobacco Control Office, prompted her to actively push the anti-smoking campaign forward. "When I was working at WHO, the organization carried out a worldwide campaign for tobacco control, and I participated in the work," she said.

When she returned to China in late 2000, Yang became a member of the delegation that worked on the WHO Framework Convention on Tobacco Control.

"The experience was a big change for me," she said. "Before that, I was mainly engaged in research, but now I found I was able to help formulate policies that could affect the world."

Yang believes China has made remarkable progress in tobacco control in recent years. "For example, the regulation on tobacco control issued in November is almost as strict as the Framework Convention on Tobacco Control. That's a big move forward for us," she said. "The will of the top leaders is becoming stronger, and public awareness of health issues is also rising."

However, activists say obstacles still remain. The biggest is the State Tobacco Monopoly Administration. It controls China National Tobacco Co, which in turn produces nearly all the cigarettes sold in the country, and is highly resistant to change, Yang said.

Last year, China's State-owned tobacco industry generated a combined 1 trillion yuan ($169 billion) in profits and tax revenue, a year-on-year rise of 10 percent, according to data released by the State Tobacco Monopoly Administration in January.

"About 7 to 8 percent of China's taxes come from the tobacco industry," Yang said. "Of course, this has made some officials reluctant to impose controls."

Xu, from the Chinese Association on Tobacco Control, said the industry continues to advertise and promote its wares, and some companies use the profits to counter negative publicity and undermine campaigns for tighter controls.

Sometimes the plans backfire, though. In 2009, Shanghai Tobacco Corp donated 200 million yuan to the China Pavilion of the 2010 Shanghai World Expo. The donation prompted public objections from a large number of activists, including Xu, and as a result, the expo's organizing committee returned the money.

Lack of young activists

Industry resistance is just one obstacle. Other factors include a lack of awareness of how to defend public rights, and an overall lack of laws and regulations, Xu said.

However, for Wu, a severe shortage of funds and a lack of young talent are the biggest problems. "Most anti-smoking activists in China are volunteers or part-time workers," she said. "Without sufficient support from the government, it's very difficult for young people to stick with the cause."

Although Wu has secured some funding from WHO, she's also looking for help from nearer to home. "We hope the government will donate some of the money raised via tobacco taxes to invest in control policies," she said.

Yang, with the Peking Union Medical College, said young talent is crucial to the success of the anti-smoking lobby. "I hope to continue promoting tobacco control in different ways in the future, and I'd like to use my experience to help young activists," she said. "But right now, there's a real shortage of youngsters."

Zhang Hao, a public health student at Peking University, felt the younger generation should make its voice heard. "Young people are the leaders of tomorrow, and their attitudes will determine what the world will look like in the future. With young people's efforts, a healthy, smoke-free China can become a reality," she said.

Last year, when WHO held a competition for students to produce anti-smoking videos to be screened on social media platforms, Zhang and three fellow female students from Peking University placed first with an animated feature called Smoke-Free, Barrier-Free. So far, the short movie has been viewed almost 50,000 times.

Contact the author at: wangxiaodong@chinadaily.com.cn

Shan Juan contributed to this story

(China Daily 02/04/2015 page5)