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Updated: July 19, 2011
Japan
Overview
Prevalence of Tobacco Use
Cost of Tobacco Use
Tobacco-Related Health Information
Tobacco Use in the Workplace
Tobacco Cessation Treatment Options
Resources
Citations
Overview
Despite significant investment in preventive health measures, the Japanese government has not yet fully committed to tobacco cessation efforts.1 Japan ratified the World Health Organization's Framework Convention of Tobacco Control Treaty in 2004,2 but has undermined its intent by altering the treaty language, making significant portions conditional rather than mandatory.3 Ultimately, tobacco control may contradict national economic aims.3
The Japanese government has 50.01% ownership in Japan Tobacco, Inc., the third largest cigarette exporter in the world.3,4 This leads to a national conflict of interest, in which the government treats smoking as a behavioral issue rather than a health concern.5 Currently, there are no national smoking bans and few regulations on the tobacco industry's advertising, promotion and sponsorship practices.2
Many Japanese smokers are uninformed about the dangers of using tobacco. Japan Tobacco denies that smoking causes lung cancer and discounts the risks of secondhand smoke.3 With limited education from the government, the Japanese population is distrustful of tobacco use health warnings. For example, best-selling books in Japan assert factually inaccurate information about tobacco use,5 and consumers believe that "light" or "low tar" cigarettes are safer than regular cigarettes.3
Prevalence of Tobacco Use
Japan's smoking rate (24.9%) is above the average (23%) rate for member companies of the Organisation for Economic Co-operation and Development (OECD)* .6 Japan's male smoking rates (38.9%) are the fourth highest among OECD nations.6,7 Japan is the world's fourth largest tobacco market by consumption.4 Cigarettes are the most common form of tobacco use, although smokeless cigarettes are gaining popularity.4,8
There are gender differences in smoking habits in Japan:
- 38.9% of Japanese men smoke daily.7
- 11.9% of Japanese women smoke daily.7
- Smoking rates for young women (age 20 to 30) are increasing.1
- Smoking rates for men (age 20 to 50) have remained constant since the 1990s.1
Due to the differences in smoking prevalence, Japanese men experience more tobacco-related health problems than women. Smoking is linked to 15% of all male deaths in Japan, compared to only 4% for women.9
The prevalence of smoking among minors (younger than age 20) is rising:
- 13% of male and 4.3% of female high school seniors report smoking daily.
- 21.7% of male and 9.7% of female high school seniors report smoking within the last month.
The increase in tobacco use among minors is especially concerning because historically Japanese smokers didn't begin using tobacco until their 20s.3
The number of health care professionals who smoke is also alarming. Almost one-quarter (24%) of Japanese medical personnel are current smokers, as compared to 4% in the United States.5
The Tobacco Policy and Education Division of the Japanese Ministry of Health does not promote smoking cessation among adults.10Instead, they focus on preventing minors from smoking.10 The Ministry of Health will not publicly state that they want to reduce tobacco prevalence among Japanese adults.3
* The OECD is an international organization that helps governments tackle the economic, social and governance challenges of a globalized economy.
Cost of Tobacco Use
In comparison to other developed nations, smoking is relatively inexpensive in Japan: the most common brand sold for U.S.$3.31 per pack in 2009.2 A 2010 tax increased the price of a cigarette pack by 40% (approximately U.S.$1.30 per pack).11 This was the single largest increase in tobacco taxes in Japanese history.11
The financial impact of smoking in Japan is costly. Direct health care costs of smoking in Japan include:
- 5% of all health care expenditures in 2005 were for treatment of smoking related diseases.12
- Current smokers spend 14% more on dental care than non-smokers.13
- Smokers with hypertension cause 15.6% of all medical expenses.14
Indirect costs associated with smoking in Japan include decreased worker productivity, increased absenteeism and accidental fire damage. Research has not yet been published to fully outline these costs.
Tobacco-Related Health Information
Smoking kills 130,000 Japanese people every year, accounting for 1 in 8 deaths.15,16 Smoking is a risk factor in 4 of the 5 leading causes of death in Japan.16 Heavy smokers live an average of 7 fewer years than non-smokers.9
At least 6,800 of tobacco-related deaths are due to secondhand smoke.15 More than half of these individuals were exposed to tobacco smoke in the workplace.15
Cancer and cardiovascular disease are the leading causes of death in Japan.17 Lung cancer, tracheal cancer and bronchial cancer are the most common forms of cancer in Japan, resulting in:
- 23% of all male cancer deaths1
- 13% of all female cancer deaths1
Tobacco is also a contributing factor to cardiovascular disease, causing 27% of related male deaths and 5% of related female deaths.9
Despite the high prevalence of smoking, Japan has historically experienced relatively few smoking-related deaths as compared to other industrialized nations.3 Dietary and smoking practices may explain this anomaly.3 Japanese smokers not only began smoking later in life, they also consumed fewer cigarettes, thanks to cigarette shortages following World War II.3 Green tea - a staple food item in Japan - has also been proven protective against lung and esophageal cancer.3
Although lower than in other industrialized nations, the prevalence of tobacco-related diseases in Japan is rising.3 Diseases caused by tobacco use are expected to increase rapidly in the coming decades.3 If prevalence and consumption do not decline, lung cancer deaths will double in the next 30 years.3
Tobacco Use in the Workplace
Smoking bans are rare in Japan; none exist at the national or regional level.2 Smoking is common in all public spaces, including workplaces.18 Some local authorities have enacted partial bans.18 In 2010, the first local ban was passed in the Kanagawa prefecture of Tokyo, prohibiting smoking in government offices, schools and hospitals.18
Not all tobacco cessation news in Japan is sour. Some national efforts to reduce secondhand smoke are underway. In December 2010, a Japanese Ministry of Health committee submitted a proposal to ban workplace smoking. 19 This proposal would allow designated smoking rooms19 but outlines no penalties for violations.20 The committee intends to lobby the government to financially support employers that want to transition their workplaces smoke-free.20 The proposal faces strong opposition from many in the food service industry.19
On issues of tobacco control, the Japanese government has typically relied on Japan Tobacco to self-regulate.3 The industry has gradually implemented restrictions (e.g., 2008 implementation of age-verification technology in cigarette vending machines to prevent minors from purchasing tobacco).3 In 2006, Japan Tobacco endorsed outdoor non-smoking zones or "good manners areas." These areas are framed as designated spaces that promote polite and safe smoking behaviors.3,8 As a result, smoking bans occur most frequently in outdoor rather than indoor areas and increasingly impact public spaces.3,8 Smokeless cigarettes are exempt from all outdoor bans.19
The Health Promotion Law of 2003 gave employers the authority to implement smoking bans within their facilities.3 Although this resulted to some large employers (e.g., McDonalds, Narita International Airport, etc.) implementing smoking bans,18 tobacco control remains the least common health promotion initiative offered in the workplace.21
A survey of Japanese government workers found that 60% believed workplace smoking bans with designated smoking rooms would be the best tobacco control policy.22 By contrast, in workplaces with tobacco control policies already in place, total smoking bans were popular: 73.9% of employees approved of them.22 Tobacco control policies become less popular the milder they become.22 Smokers adhere most to total tobacco bans.22
Tobacco Cessation Treatment Options
Smoking cessation assistance in Japan is available in many hospitals and clinics.2 Japan's universal health insurance covers prescription medication to assist smokers to quit.23
- Verenicline is available with a prescription.23
- Bupropion is not approved for sale in Japan.23
- Nicotine replacement therapy is available at pharmacies.23
The government does not offer direct smoking cessation assistance to individuals or employers.2
Research conducted in Japanese workplaces has shown the effectiveness of workplace tobacco cessation initiatives. Employers offering smoking cessation programs can significantly increase the number of employees who quit smoking.24 Successful programs have included informational campaigns about the dangers of tobacco use, short-term counseling, and medication for employees who desired it.24
Resources
Citations
1 Tatara K, Okomoto E. Health care systems in transition: Japan. Copenhagen: WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies; 2009.
2 World Health Organization. WHO Report on the Global Tobacco Epidemic, 2009: Implementing Smoke Free Environments. Geneva, Switzerland.
3 Kolandai MA. The Tobacco Industry in Japan and its Influence on Tobacco Control. Sydney: School of Public Health, University of Sydney; 2007.
4 Norrie J. Japan's workplace smokers, and their research foundation, lose puff. Sydney Morning Herald, February 27, 2010.
5 Tobacco Campaign. Top Ranked Japanese Books on Tobacco.
6 Organization for Economic Cooperation and Development. How does Japan compare; 2010.
7 Organization for Economic Cooperation and Development. Health Data 2010: Frequently Requested Data; 2010.
8 Kachi H. In Japan, smokeless cigarette is on fire. The Wall Street Journal, June 9, 2010.
9 Ogimoto A, Higaki J. Smoking wears away happiness: New concept, 'Smoking creates thunderclouds.' Hypertension Research.
2010;33:1104-1105.
10 National Cancer Center Research Institute: Division of Tobacco Policy and Education. What is tobacco control policy project? Updated November 22, 2010. Accessed June 2, 2011.
11 Buerk R. Japan proposes 40% cigarette tax increase. BBC News: Asia-Pacific. September 30, 2010.
12 Igarashi A, Takuma H, Fukuda T, Tsutani K. Cost-utility analysis of varenicline, an oral smoking-cessation drug, in Japan. Pharmacoeconomics. 2009;27(3):247-262.
13 Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T. The effects of smoking on dental care utilization and its costs in Japan. Journal of Dental Research. 2009;81(1):66-70.
14 Nakamura K OT, Hayakawa T, Kanda H, Okayama A, Ueshima H. Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga, Japan. Hypertension Research. 2010;30:802-807.
15 Sharper prod to stop smoking. Japan Times. October 13, 2010.
16 World Health Organization. Smoking Statistics. May 28, 2002. Accessed June 3, 2011.
17 World Health Organization Department of Measurement and Health Information. Mortality and Burden of Disease Estimates for WHO Member States in 2008.
Accessed June 16, 2011.
18 Koh Y. McDonald's to snuff out smoking in Japan. The Wall Street Journal. August 10, 2010.
19 Koh Y. Japan smoking ban: Where's the fire? The Wall Street Journal. December 10, 2010. Accessed July 18, 2011.
20 Japan plans to impose workplace smoking ban, but without penalities. Japan Today. December 13, 2010.
21 Lee JS. Assessment of worksite health promotion environments. Sangyo Eiseigaku Zasshi. 2003;45(2):57-66.
22 Mizoue T RK, Yamato H, Iwasaki A, Yoshimura T. Support for and observance of worksite smoking restriction policies: a study of municipal employees at a city office in Japan. Preventive Medicine. 1999;29(6):549-554.
23 World Health Organization Western Pacific Region. Japan: Country health information profile.
24 Tanaka H, et al. Effectiveness of a low-intensity intra-worksite intervention on smoking cessation in Japanese employees: a three-year intervention trial. J Occup Health. 2006;48(3):175-182.
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