INT J TUBERC LUNG DIS 15(4):453458
2011 The Union
doi:10.5588/ijtld.10.0049
A review of smoke-free health care in mainland China
Y. Lin,* T. Fraser
* International Union Against Tuberculosis and Lung Disease (The Union), Beijing, China; Tobacco Control Department,
The Union, Glenorchy, New Zealand
BACKGROUND: Male doctors in China have a high rate
of smoking (41%). Smoke-free policies and help in quit-
ting smoking in health care facilities would improve the
health of staff and patients, and reduce smoking among
doctors.
M E T H O D S : A review of smoke-free activity in the health
care sector was undertaken by conducting a search of
PubMed, Google Scholar, Google and Globalink on
smoke-free health care in China and by scanning the
print media. Relevant published and unpublished docu-
ments were also reviewed.
R E S U LT S : It is not mandatory for health care facilities
to be smoke free. However, a Ministerial Decision issued
in May 2009 requires all medical and health institutions
to be smoke free by the end of 2011, and in Beijing,
Shanghai and Guangzhou, legislation requires hospital
buildings to be smoke free. A range of initiatives have
SMOKING is one of the worlds principal causes of
illness and premature deaths,1 and despite the over-
whelming evidence of the impact of smoking on health
over the last 50 years, health professionals and ad-
ministrators in the industrialised world have been slow
to incorporate tobacco control2 and smoking cessa-
tion support into their health care structures and sys-
tems. This situation has been largely remedied over
the last decade with the implementation of effective
policies and a corresponding reduction in smoking-
related morbidity and mortality rates in the indus-
trialised world. However, the tobacco epidemic has
spread to low- and middle-income countries, which
now bear the brunt of more than 80% of the 5.4 mil-
lion deaths currently caused by tobacco use globally.3
China has 360 million smokers, more than any
other country in the world.4 Although consumption of
tobacco was relatively low in the 1970s, by 2004 it had
almost quadrupled.3 The prevalence rates of smok-
ing among the general population are high, at 28%
(53% of men and 2% of women smoke).5 Smoking is
also relatively high among male doctors in China, at
41%,6 particularly in comparison to their counter-
parts in most industrialised countries. However, there
Correspondence to: Lin Yan, International Union Against Tuberculosis and Lung Disease, Room 6-1-151/152, Taiyuan
Diplomatic Office Building, No 1 Xindong Rd, Chao Yang District, 10060 Beijing, China. Tel: (+86) 10 8532 1053. Fax:
(+86) 10 8532 1082. e-mail: ylin@theunion.org
REVIEW ARTICLE
SUMMARY
been implemented to ensure the goal of smoke-free
health care is met by the end of 2011.
D I S C U S S I O N : A limitation of this review is that it may
understate the amount of smoke-free activity that is tak-
ing place in China. There was considerable media cover-
age on clusters of hospitals planning to go smoke free
and other smoke-free health care initiatives, but cover-
age was often vague and it was therefore excluded from
this review.
C O N C L U S I O N S : Many provinces, municipalities and
cities are working towards meeting the 2011 deadline
imposed by the Ministry of Health and other health au-
thorities for all health care facilities and organisations to
be smoke free. Government and non-government fund-
ing is supporting this initiative.
K E Y W O R D S : hospitals; smoking cessation; quit smok-
ing; tuberculosis; traditional Chinese medicine
are signs that this could be changing, with rates of
smoking declining among male health workersthe
largest rate of decline across all occupational groups
from 1996 to 2002.7
As physicians hold a position of status and influ-
ence in Chinese society,8 reducing smoking among
physicians in China could contribute to an overall re-
duction in smoking.9 Interventions targeting physi-
cians are important,3 and should be included as a
component of comprehensive tobacco control pro-
grammes, particularly in countries with high rates of
smoking among physicians.
The implementation of a smoke-free policy with
the provision of smoking cessation support in a health
care facility10 is one such intervention, as this should
lead to a decline in smoking among hospital employ-
ees.2 Other interventions targeting smoking among
male doctors in China could include challenging the
culturally acceptable practice of cigarette gifting from
patients to doctors (an anti-cigarette gifting media
campaign is currently being aired), providing health
care workers with smoking cessation training, and en-
couraging them and their families to quit smoking.10
While reducing employee smoking is a key benefit
454 The International Journal of Tuberculosis and Lung Disease

that should result from the implementation and en- health care systems but also within the general pop-
forcement of smoke-free policies in hospitals, there ulation. Furthermore, reductions in smoking among
are many other benefits, including the protection of doctors are likely to lead to reductions in smoking
staff, patients and visitors from exposure to tobacco among the general population.9
smoke; a reduction in smoking among patients dur-
ing hospitalisation;11 a reduced incidence of wound METHODS
infections among patients who have quit smoking for
We conducted searches of PubMed, Google Scholar,
at least 4 weeks;12 raised awareness of nicotine de- Google and Globalink (an international list serve for
pendence among staff and patients;13 the opportunity people working in tobacco control) in English and
to encourage quitting smoking post discharge;14 re- Mandarin, using a variety of search terms, including
duction in the risk of fire; and reductions in cleaning smoke-free, health care, hospitals, smoking cessa-
costs.11 tion, quit smoking, tuberculosis (TB), traditional
Chinas health care system is a vast network of a Chinese medicine (TCM) and China. We scanned
variety of health care institutions and organisations the China Public Health and Tobacco Control Daily
managed or overseen by a number of government News Monitoring summaries from March 2008 to
and non-government agencies at national, provincial January 2010. These summaries are produced fort-
and local level. At central government level, the Min- nightly by the Campaign for Tobacco-free Kids, a
istry of Health (MoH) is the key department provid- non-government organisation (NGO) based in Wash-
ing policy direction to general hospital administra- ington, DC, USA. We also identified and accessed un-
tors, whereas at provincial, prefecture and county published documents related to smoke-free health
level, health bureaux manage the hospitals in their care that were known to the authors.
own areas (Table 1). The definition used of smoke-free health care facil-
There are currently approximately 5.03 million ities was as follows: no smoking inside facility build-
medical and health professionals, 2.08 million physi- ings, and preferably not in the grounds. If smoking is
cians (including assistant physicians) and 1.65 mil- allowed in the grounds it must be in a specifically des-
lion nurses in China, and the annual number of pa- ignated area for patients and visitors only. This is not
tient visits to hospitals in 2008 was approximately ideal, but very few health care administrators in China
3.1 billion, with 11 483 million hospital stays.1517 are prepared to make both their facilitys grounds as
The objectives of this review are to show that well as the buildings smoke free. Smoking cessation
smoke-free health care facilities with systems to enable support must also be provided as a component of the
the provision of smoking cessation support to staff smoke-free policy.
and patients have the potential to contribute to re- Inclusion criteria for the review was that any smoke-
ductions in smoking rates in China, not just within free legislation, regulations, directives, programmes
and activities relating to health care must require en-
Table 1 Structure of health care in China vironments to be smoke-free at least inside the build-
ings. Documents or activities that have contributed
Health care Health care
providers authority Governing body to smoke-free health care facilities were also included,
such as draft smoking cessation guidelines, and the
Private clinics Community health District/township
ofces government review only included data on smoking bans that had
Community health Community health District/township already taken place or were required to take place by
centres ofces government a specified date.
City/county hospitals City/county health City/county
bureaux government RESULTS
General hospitals Provincial health Provincial government
bureau We found scarce published data on smoke-free health
Medical centres Ministry of Health Central government care in China, but a reasonable amount of media cov-
Traditional Chinese Chinese Association Provincial/city/district/ erage and unpublished data on the topic were avail-
medicine hospitals of Traditional county government able. We analysed the published and unpublished data
Chinese Medicine
with the aim of assessing progress towards smoke-
Traditional Chinese Chinese Association Provincial/city/district/
medicine clinics of Traditional county government free health care across a variety of health systems in-
Chinese Medicine cluding general hospitals, TCM hospitals, and TB
Tuberculosis centres Provincial centres National Centre for centres at central government, provincial and munici-
for disease Tuberculosis Control pality level in China.
control and Prevention,
China Centre for While smoke-free health care facilities have not
Disease Control been mandated by legislation, the Ministry of Health
Tuberculosis control Centres of Various governing and National Patriotic Health Campaign Committee
institutions tuberculosis bodies (NPHCC) have shown significant leadership in this
control
area, as have key medical professional organisations,

Table 2 Smoke-free health care and smoking cessation
activities in China
Regulations/policies/programmes/
Level smoking cessation support
National The Standard for Smoke-free Medical/Health Care
Organisations has been revised and now
requires health care facilities to be smoke-free
in the buildings
Technical guidelines have been developed to
implement the Standard
Two national tobacco control and smoking
cessation groups for doctors have been
established
A decision to ban smoking completely within the
medical and health system by 2011 has been
announced: 50% of health care facilities must
now have smoke-free buildings
An implementation plan for the above decision
has been issued with an accompanying scoring
table for health care administrators
The 2007 Smoking Cessation Guideline for China
(trial version) is under revision
A smoke-free health care website has been
established (www.smokefreehealthcare.org)
A smoke free health care public service
announcement has been developed for health
care administrators to air on mobile media
screens in health care facilities
An international tobacco-free health care guide
has been translated into Mandarin and a
complementary tobacco-free health care
training package is available in English
Provinces and municipalities
Liaoning All health care facility buildings must be
smoke free
Hunan TB centres in seven prefectures are smoke free
and smoking cessation support is provided for
patients
Beijing Hospital buildings must be smoke free by law
Shanghai Regulations require all hospital buildings be
smoke free; the grounds must also be
smoke free in womens and childrens hospitals
Guangzhou Regulations require all hospitals to be smoke free
Chongqing All hospital buildings are smoke free in each
county and district
some provincial, municipality and city legislators and
non-governmental organisations (NGOs; Table 2).
Smoke-free health care activity at national level
By 2008, there was increasing interest in implement-
ing smoke-free policies in health care facilities within
the MoH and the NGO health sector. As the Stan-
dard of Smoke-free Medical/Health Institutions that
had been developed permitted smoking rooms, it was
recently revised to reflect best practice for smoke-free
health care facilities. A national NGO, the Chinese
Association on Tobacco Control (CATC), facilitated
the revision, and this was followed by the develop-
ment of technical guidelines to implement the revised
Standard. Both the technical guidelines and the re-
vised Standard were endorsed by the MoH and the
NPHCC.18
In May 2009, the MoH, the State Administration
of TCM, the Health Bureau of the General Logistics
Department of the Peoples Liberation Army, and the
Logistics Department of the Armed Police Forces
Smoke-free health care in China 455
took the next step in the process towards ensuring
that all health care facilities will be smoke-free in the
future, by issuing a joint Ministerial Decision, the
Decision to ban smoking completely in the medical
and health system by 2011.19 A ban on smoking has
now been imposed inside health administration office
buildings, and at least 50% of all health care facilities
are required to be smoke-free buildings, but to date
no data have been collected to validate this require-
ment. The remaining 50% of health care facilities are
to be smoke-free by the end of 2011. This Ministerial
Decision adds to the revised Standard and technical
guidelines, and should send a very strong message to
hospital administrators that banning smoking in all
health care facility buildings will be required practice
in the future.
An implementation plan for the requirements of
the Ministerial Decision has been issued by the MoH
as an official document.20 A scoring table accompa-
nies the plan as an appendix, and health care facilities
need to gain 80 points out of 120 to reach the re-
quired smoke-free standard (see Figure). These docu-
ments are available on several websites, in particular
the smoke-free health care website developed by Chao
Yang Hospital (www.smokefreehealthcare.org), and
have been distributed to all provincial, prefecture and
city health bureaux.
As a result of the Ministerial Decision, the Chinese
Association of Chinese Medicine (CACM) wrote a
national plan for the systematic implementation of
smoke-free policies in all TCM health care facilities
by the end of 2011. A national resource centre and
website was established at the end of 2010 to guide
and assist with the implementation process.
As well as high-level government activity in smoke-
free health care, a number of medical professionals
have taken on the role of key advocates in promoting
a range of tobacco control strategies, and are emerg-
ing as leaders of tobacco control, not only in the
health care sector but also across a variety of sectors.
Two national tobacco control groups of doctors have
been established. The first, a tobacco or health sub-
group of the Chinese Society of Respiratory Disease
(under the umbrella of the Chinese Medical Associa-
tion) was established in 2008 and has 24 members. It
has to date organised tobacco control and smoking
cessation conferences, seminars and training work-
shops throughout China. The second, Medical Pro-
fessionals Against Tobacco, is a growing network of
respiratory physicians and cardiologists established
to speak out in the media on tobacco control issues
and communicate on upcoming tobacco control con-
ferences, seminars and workshops.
In March 2009, the Chinese Preventive Medicine
Association launched a Double Ten initiative. As a
result of this initiative, by the end of 2009, 10 major
health associations and medical schools and their af-
filiated hospitals were smoke-free. In addition, physi-
cians in these hospitals have been requested not to
456 The International Journal of Tuberculosis and Lung Disease
Figure Scoring form based on evaluation standards for
smoke-free medical and health care institutions. Adapted from
Ministry of Health/State Administration of Traditional Chinese
Medicine/Health Department of the General Logistics Depart-
ment of the Peoples Liberation Army/Logistics Department of
the Armed Police Forces.20
smoke because they are role models for the general
population.
A range of resources is also now available to assist
health administrators in implementing smoke-free pol-
icies in their health care facilities, such as the smoke-
free health care website, the Tobacco-free Healthcare
Guide,10 the 2007 Smoking Cessation Guideline for
China (Trial Version, currently under revision), the
revised Standard and technical guide to implement it,
and the implementation plan and scoring table for the
Ministerial Decision. A public service announcement
has recently been developed promoting smoke-free
health care; it is available for hospitals to display on
their mobile media screens. These resources are use-
ful tools for health professionals and administrators
involved in implementing smoke-free policies and/or
for providing smoking cessation support in health
care facilities.
Smoke-free health care activity at province and
municipality level
Very little information has been published on smoke-
free activity at province level. Liaoning Province
would appear to be the only province in China that
requires hospitals to be smoke-free. However, as a
result of the Ministerial Decision, the MoH has es-
tablished an independent special task force to check
that hospitals and health administrations are enforc-
ing smoke-free policies. Funds were also allocated to
provincial health administration offices to distribute
as a one-off payment to tertiary and second-class hos-
pitals, maternal and child care service centres, China
Centres for Disease Control and Prevention and
health education institutions.21 The funding was pro-
vided to establish smoking cessation clinics in major
hospitals and conduct smoke-free health care train-
ing during 2010.
The National Centre for TB Control and Preven-
tion in the China Centre for Disease Control and
Prevention recently completed a project that has re-
sulted in all TB centres in seven prefectures (Chang-
sha, Changde, Chenzhou, Shaoyang, Xiangtan, Yuey-
ang and Yiyang) in Hunan Province going smoke-free,
with the physicians providing smoking cessation sup-
port to the patients.
Seven universities with public health schools inte-
grated within their medical schools (Zhejiang, Beijing,
Harbin, Nanjing, Guangzhou, Ninxia and Shanxi)
have made their campuses smoke-free and have in-
corporated tobacco control into their curricula for
public health students. A group of public health and
education experts are now promoting and encourag-
ing all universities to make their campuses smoke-
free, and those with public health departments to
deliver tobacco control courses as part of their cur-
riculum. A smoke-free universities website (www.
tfcampuschina.com) has been launched to provide
useful information and resources for this initiative.
Zhejiang University is simultaneously building on the
seven smoke-free universities initiative by expanding
it to another 24 universities, with the aim of having
at least one major university (with a public health
department) smoke-free and offering tobacco control
as part of their public health curriculum in every
province by the end of 2011.

Since 2008, the CATC has been advising and sup-
porting 60 hospitals in going smoke free in Beijing,
Shanghai and Guangzhou. All hospitals in these three
municipalities are now required by legislation to have
smoke-free buildings. Shanghai also requires the
grounds of maternal/child health institutes (clinics)
and childrens hospitals to be smoke free.2224 How-
ever, legislation is no guarantee of compliance: a recent
inspection in Shanghai (December 2010) found an in-
cidence of smoking in maternal/child health institutes
of respectively 44% and 70% in Class III hospitals.
Chao Yang Hospital has assisted 41 large tertiary
hospitals to go smoke free and is currently aiding an-
other 20 hospitals to do so in support of the Ministe-
rial Decision. Likewise, the CACM is providing advice
and support to 20 TCM hospitals, some of which are
already smoke free and the remainder will be by the
end of 2011. These hospitals are strategically placed
across most of the provinces and municipalities in
China.
The World Health Organization (WHO) held cer-
tificated smoking cessation training courses for almost
60 doctors from more than 40 hospitals in 20 prov-
inces in late 2010. It was reported at these courses
that more than 800 hospitals across China have es-
tablished smoking cessation clinics.
DISCUSSION
A limitation of this review is that it may understate
the amount of smoke-free activity that is taking place
in the health care sector in China. There was signifi-
cant media coverage of clusters of hospitals planning
to go smoke free and smoke-free health care initia-
tives in some districts in municipalities and cities, but
it was difficult to assess the timeframe and what ex-
actly was required of the hospitals. However, there is
a real sense that government health officials, health
administrators and medical professionals are very sup-
portive of the principles of smoke-free health care and
the provision of smoking cessation support in health
care facilities. There were also many articles on medi-
cal professionals, particularly physicians, taking a lead
by quitting smoking and encouraging others to do so,
and on the emergence of smoking cessation clinics
throughout China.
While there is good access to media coverage, there
is a general lack of access to grey literature, such as
internal and unpublished reports and documents. If
this information was more accessible it could be very
useful for those working in tobacco control. An elec-
tronic tobacco control and smoking cessation clear-
ing house for China would be useful for those work-
ing in the sector. This is a task for which an existing
NGO could take responsibility.
A second limitation of this paper is that we cannot
yet describe the impact of the smoke-free activities in
the health care sector. Evaluation and research will be
required to assess the impact of these initiatives and
Smoke-free health care in China 457
activities. The indications from similar activities in
industrialised countries and early indications in China
are that the impact will be significant, particularly as
the health care sector is taking a leading role in the
implementation of smoke-free indoor environments
in China.
Apart from some progress being made in creating
smoke-free health care facilities throughout China,
there has also been an increase in the number of cities
that are revising their smoke-free legislation or regu-
lations to create more non-smoking areas in public
places. Although progress has been quite slow, there
has been a significant amount of media coverage and
increasing public support for smoke-free environ-
ments. This activity is helping to build anti-tobacco
norms in China, and over time, in combination
with smoke-free health care facilities, it should encour-
age quitting behaviour, at least within health care
settings.
As with many countries, there has been an un-
planned approach to smoke free health care in China.
While there is currently no national law requiring
health care facilities to be smoke free, China has
signed and ratified the WHO Framework Conven-
tion on Tobacco Control (FCTC),25 which required
all workplaces and public places to be smoke free by
January 2011, and the Ministerial Decision requires
all health care facilities to be smoke free by the end
of 2011. Although China is not yet complying with
the FCTC, both the FCTC and the Ministerial Deci-
sion are providing the impetus health administrators
need to ensure that they continue to promote the im-
plementation of smoke-free policies in health care
facilities.
Some leadership in tobacco control is coming from
the health sector, particularly at the national level,
and interest and a reasonable level of smoke-free ac-
tivity in the municipalities; however, provincial gov-
ernments have been very slow in imposing province-
wide smoke-free health care. However, it would appear
that most have plans in place to comply with the
Ministerial Decision to make their health care facili-
ties smoke free by the end of 2011.
Smoking cessation clinics and services are being
established in large hospitals throughout China. How-
ever, it is not clear how accessible the clinics are to
smokers nor how often or how long they are open.
There would appear to be a lack of demand for smok-
ing cessation services among staff and patients who
smoke, as many of the services are underutilised.
However, this could be an indication that, while some
hospitals are implementing smoke-free policies and
establishing smoking cessation services, they are not
necessarily developing processes for referring patients
to them. It is also likely that staff and patients are not
fully aware of the range of harm that is caused by
smoking and of the need to quit smoking. Tobacco
control is still in its infancy in China, and quit smok-
ing campaigns are rare.
458 The International Journal of Tuberculosis and Lung Disease
CONCLUSION
The Ministerial Decision to ban smoking in health
care facilities by 2011 has been widely embraced by
the health sector. This should be sending a strong sig-
nal to provincial, municipal and city government ad-
ministrators to ensure that smoke-free hospitals are
part of any new or revised smoke-free regulations. It
is a very positive step that the MoH has provided
funding and a special task force to monitor the im-
plementation of smoke-free policies in health care
facilities.
The crucial role for NGOs and government health
agencies will be to ensure that implementing a smoke-
free policy in health care facilities is more than just
displaying no smoking signs inside the health care
facility buildings. Appropriate resources and funding
will need to be available for health administrators
to facilitate the implementation and enforcement of
smoke-free policies in health care facilities and to en-
sure smoking cessation support is provided for staff
and patients.
If China succeeds in making all its health care fa-
cilities smoke free by the end of 2011, it is likely that
there will be a simultaneous significant reduction in
smoking among medical professionals, which will in-
crease their credibility among their patients when they
offer them help in quitting smoking. Smoke-free doc-
tors will also act as positive role models for the rest
of the community and, in combination with smoke-
free health care facilities and the provision of smok-
ing cessation support, a reduction in smoking among
the general population should soon be visible.
Acknowledgements
The authors are grateful to the staff based in the China Office of
the International Union Against Tuberculosis and Lung Disease
who provided advice on the review. Thanks also to S England
from the World Health Organization, China, for her advice.
Declaration of competing interests: LY and TF provide techni-
cal advice and support to Bloomberg Initiative grantees in China.
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CADRE : Le taux de tabagisme est lev, 41%, chez les
mdecins chinois de sexe masculin. Les politiques non-
fumeurs et daide larrt du tabagisme dans les services
de sant pourraient amliorer la sant du personnel et
des patients et rduire le tabagisme parmi les mdecins.
M T H O D E S : On a entrepris une revue des activits non-
fumeurs dans le secteur des soins de sant en menant une
enqute sur PubMed, Google Scholar, Google et Globa-
link concernant les soins de sant non-fumeurs en Chine.
On a galement scann des documents pertinents pub-
lis ou non publis ainsi que la presse crite.
R S U LTAT S : Il nest pas obligatoire que les services de
soins de sant soient non-fumeurs. Toutefois, une dci-
sion ministrielle publie en mai 2009 requiert linter-
diction complte de fumer dans les systmes mdicaux
et de sant dici la fin 2011. Dans les rgions de Pkin,
Shanghai et Guangzhou, tous les btiments hospitaliers
M A R C O D E R E F E R E N C I A : Los mdicos hombres en
China presentan una alta tasa de tabaquismo de 41%.
Las polticas en favor de los ambientes sin humo y de
ayuda al abandono del tabaquismo en los centros de aten-
cin sanitaria contribuiran a mejorar la salud del per-
sonal sanitario y de los pacientes y a disminuir el taba-
quismo entre los mdicos.
M T O D O : Se evaluaron las medidas en favor de un am-
biente sin humo en el sector de la atencin de salud, me-
diante una bsqueda de artculos relacionados con el
tema en China en Pubmed, Google Scholar, Google y
Globalink. Se analizaron adems documentos publicados
o inditos sobre el mismo tema, incluso la prensa.
R E S U LTA D O S : Ninguna ley nacional exige que los esta-
blecimientos sanitarios sean ambientes sin humo. Sin em-
bargo, la decisin ministerial emitida en mayo del 2009
prohbe totalmente el tabaquismo en el sistema sani-
tario y de atencin mdica al fines de 2011, y en Beijing,
Shanghai y Guangzhou, segn las leyes los edificios hos-
Smoke-free health care in China i
RSUM
doivent galement tre non-fumeurs. De nombreuses
initiatives contre le tabagisme dans les centres de sant
ont t prises afin datteindre le but dun systme de
soins de sant sans fume avant fin 2011.
D I S C U S S I O N : Une limitation de cette revue est quelle
pourrait sous-estimer la quantit dactivits non-fumeurs
existant en Chine. La couverture des mdias sur des
grappes dhpitaux envisageant de bannir la fume et
ayant pris dautres initiatives de soins de sant non-
fumeurs a t considrable, mais cette couverture est fr-
quemment vague et est de ce fait exclue de notre revue.
C O N C L U S I O N S : Un grand nombre de provinces, de mu-
nicipalits et de villes travaillent arriver lchance de
2011 impose par le Ministre de la Sant concernant
linterdiction de fumer dans les services et organisations
de soins de sant. Cette initiative est soutenue par des
fonds gouvernementaux et non-gouvernementaux.
RESUMEN
pitalarios deben ser sin humo. Varias iniciativas han sido
implementadas para asegurar que el objetivo de una aten-
cin mdica sin humo sea alcanzado al fines de 2011.
D I S C U S I N : Una limitacin del presente anlisis es que
puede subestimar las medidas en favor de los ambientes
sin humo que se estn aplicando en China. Se dio gran
cobertura en los medios de comunicacin a algunos
grupos de hospitales que planean convertirse en am-
bientes sin humo y a otras iniciativas a favor de una
atencin sanitaria sin humo, pero se excluyeron del an-
lisis debido a que presentaban con frecuencia un carcter
impreciso.
C O N C L U S I N : En muchas provincias, municipios y ciu-
dades se est trabajando con el fin de cumplir con el plazo
del 2011 impuesto por el Ministerio de la Salud y otras
autoridades sanitarias, para lograr que todos los estable-
cimientos de atencin de salud sean ambientes sin humo.
Esta iniciativa est financiada por fondos gubernamen-
tales y no-gubernamentales.