Elsevier

Social Science & Medicine

Volume 49, Issue 5, September 1999, Pages 581-600
Social Science & Medicine

Policy and politics of smoking control in Japan

https://doi.org/10.1016/S0277-9536(99)00087-8Get rights and content

Abstract

The tobacco industry took root well before the hazards of its products were proven scientifically. As elsewhere, smoking control policy has not proceeded automatically nor smoothly in Japan. Examination of the past political process discloses that the failure to enact effective smoking control is attributable to several factors, including the political environment, administrative inadequacy and an inactive medical community. Especially remarkable in this failure have been: the political leverage of the tobacco industry; a lack of clear leadership by the health ministry; the successive rejection of law suits in the courts; and the relatively weak health advocacy groups in Japan. The Diet had been effectively immobilized by pro-tobacco interests and without support from the government, administrative agencies have remained inactive. Since the late 1970s, a series of smoking control measures has been introduced by government agencies, propelled by the social movement. However limited, the introduction of smoking control measures was accomplished with, or at least facilitated by the following: the advocacy of local and international groups and organizations; the continuous visibility of the issue in the media; and changing public attitudes. Involvement of the Diet and the Ministry of Health and Welfare (MHW) was essential in translating commitments into government action. Nevertheless, the resulting measures were not comprehensively legislated. Moreover, they were not subject to continuous evaluation. Consequently, they have been mostly ineffective in decreasing the prevalence of smoking among the populace. Clearly, leadership by the health ministry coupled with political support are the key to advancing effective smoking control.

Introduction

The health hazards of smoking tobacco have been known for decades, yet many countries have faced difficulties in controlling smoking American Cancer Society, 1990, Kluger, 1996. Although the Japanese government has taken some steps in an attempt to control cigarette smoking, Japan has had, and continues to have, one of the highest prevalence among the industrialized countries. Furthermore, lung cancer has become the most prevalent cancer among males in the nation. In order to understand the present situation in Japan it is necessary to examine the policy and the politics regarding smoking control. Government policy on health issues, in general, is rarely a product of technocratic processes and instead is mostly a product of politics. This paper documents the historical evolution of smoking control and its consequences since the 1950s. It then reviews past findings on smoking control policy and politics in other countries, proceeds to a discussion of the reasons why the present set of smoking control policies in Japan is ineffective and why this ineffectiveness exists. Finally, it seeks to elucidate the critical factor in the promotion of smoking control in Japan and other countries.

Section snippets

History of tobacco in Japan

Tobacco was first brought to Japan by the Portuguese early in the 16th century. Besides the importation of tobacco leaves, the seeds of the plant were put into the ground almost simultaneously. At first, tobacco planting in rice fields was strictly prohibited by local governors. In spite of this, by the early 17th century the cultivation of tobacco had spread throughout the country as far as the northern part of mainland Japan. In 1615 and 1616, the Shogun started issuing proclamations that

1950–1975: subgovernment politics before the nonsmokers' right (NSR) movements

Since the mid-1950s, medical findings on the hazardous effects of smoking have been on the increase in the US and in Europe, and the issue of smoking and health increasingly has attracted public notice ever since. Early in this period there were some especially significant alarms sounded: the 1954 statement by UK Health Minister Macland that smoking and lung cancer were statistically associated; the 1957 American Cancer Association report stating that smokers die at younger ages; and the 1957

Knowledge and opinion

Available data shows that public knowledge about smoking hazards increased over several decades, although no consecutive, well-designed survey has been conducted to monitor this. The following is a summary of fragmentary findings from past studies: In 1970, 53% of those responding to surveys said they knew that smoking causes lung cancer (PMO, 1973, p. 351). In 1978, about 65% of people knew that smoking is associated with lung cancer, while more than 85% did so in 1987. The knowledge about its

Discussion

Prevalence is the most useful indicator for assessing a smoking control program (Lopez et al., 1994). In the past, several countries have experienced a substantial decline in smoking prevalence. In the US, overall smoking prevalence declined from 40.4% in 1965 to 29.1% in 1987. The rate of decline between 1965 and 1985 was 0.84 percentage points per year Fiore, 1989, Pierce, 1989. Between 1974 and 1987, the average rates of change in smoking prevalence were −0.91 among males and −0.33 among

Conclusion

The tobacco industry took root well before the hazards of its products were proven scientifically. As elsewhere, smoking control policy did not proceed automatically and smoothly in Japan. Examination of the past political process discloses that the failure to enact effective smoking control is attributable to several factors, including political environment, administrative inadequacy and an inactive medical community. Especially remarkable has been the political leverage of the tobacco

Acknowledgements

The author appreciates the early review of and comments on this paper by Professor Michael Reich, Professor John Montgomery and Professor Allan Brandt of Harvard University. Generous support provided by Professor Shunichi Araki of the University of Tokyo is also acknowledged.

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