As the lawsuit fought by HIV-infected hemophiliac patients against the state and five drug makers comes to a close, another drug-induced public health tragedy is developing in Japan. Once again Japan's bureaucrats can be seen giving priority to fiscal and economic considerations over public health. But with this new case, despite the fact that the number of potential victims rises into the millions, the public's consciousness about the problem remains near zero. And what drug is responsible for the impending epidemic? Nicotine, which is delivered to an estimated 35 million users in Japan by cigarettes. Unlike AIDS victims however, smokers won't suffer alone. Environmental tobacco smoke will spoil the health of countless non-smokers in Japan as well.

Japan's tobacco industry and the national government have been united for nearly 100 years. In 1904, the government passed the Tobacco Monopoly Law to strengthen its ability to collect tax revenues from tobacco users while conveniently evicting foreign tobacco companies doing business here. (Foreign tobacco companies didn't make it back onto Japanese soil for 80 years.) From 1904 to 1947, the Ministry of Finance's Monopoly Business Section was the tobacco industry in Japan. In 1947, the business was spun off to a new "public corporation", the Japan Tobacco and Salt Public Corporation (much like the Japan National Railways (now JR) and Nippon Telephone and Telegraph (NTT)). And after 1985, when this public corporation was liquidated and its assets transferred to Japan Tobacco Inc.(JT), the Minister of Finance remained 100% shareholder of JT's stock until 1994.

Privatization has hardly changed the close link between Japan's tax collectors at the Ministry of Finance and the tobacco industry. Even today, the Minister of Finance, in his official capacity, owns nearly 82% of JT's stock, and the law requires him to hold at least two-third's of the stock "for the time being" and one-half of JT's stock "in perpetuity".

Thus, it is hardly surprising that all three presidents of JT appointed since "privatization" have been former elites from the tax divisions of the Ministry of Finance, slipping into comfortable amakudari positions. Furthermore, close ties between the Ministry and JT are developed at lower organizational tiers. Each year, a number of "rising star" employees are exchanged between the two organization for short-term postings. The young executives and bureaucrats involved in these exchanges are expected to establish close relationships with their age-group peers at the other organization, which relationships will then be maintained throughout their respective careers after returning back "home".

(It is rather suprising, however, that the National Fire Prevention Agency chose to locate its offices in JT's new ¥58 billion Tokyo office tower. After all, tobacco routinely ranks as the number one or two cause of all fire fatalities in Japan each year. It is also surprising that the Ministry of Education allows public school groups to take class trips to JT's lavish Tobacco and Salt Museum in Tokyo. Are middle school children touring beer breweries as well?)

Japan's finance bureaucrats could argue that they are just doing what they've been told to do – by the national Diet. Article 1 of the 1984 Tobacco Industry Law makes the "sound development of our nation's tobacco industry" a national legislative policy goal, "to ensure stable fiscal revenues" and for "the sound development of the nation's economy". But whatever the reason for the financial bureaucrats' favoritism towards tobacco, their power is enhanced exponentially by their position at the pinnacle of Japan's governmental system. Using the Ministry's virtually complete control over the annual fiscal budget process to steer agency funding in accordance with its preferences, the Ministry of Finance has been consistently able to influence other governmental agencies action towards tobacco industry promotion and away from health-oriented tobacco counter-measures.

Thus, to put it simply, Japan has the highest percentage of smokers among all democratic industrialized nation, and the laxest tobacco regulatory system, because tax revenues and economic growth take top priority when policy makers are making their choices.

The numbers are staggering in every way. Even aside from the government's indirect profiteering as 82% shareholder of JT, roughly 60% of the price of every box of cigarettes sold in Japan is immediately collected as tax revenues. In 1993, direct tobacco taxes generated approximately ¥2 trillion, subsequently shared in roughly equal halves between the national and local governments. The national government's portion alone equaled approximately 1.8% of all 1993 national tax revenues, and if that portion were eliminated, a 1% increase in the unpopular national consumption tax would have been necessary to make up the shortfall.

The tobacco economy is also vast. Despite an overall recession, 1995 cigarette sales in Japan generated revenues of almost ¥4 trillion, of which JT captured nearly 80%. In 1993, tobacco supported nearly 30,000 tobacco farming families, 280,000 retail outlets, and JT itself directly employed 23,600 persons. Media and advertising interests also share the wealth, absorbing massive promotional budgets, such as JT's in 1992, which was approximately ¥75 billion.

But what of the costs? Because tobacco-related disease has been lower in Japan than in most Western nations, some argue that Japanese people may somehow be racially or culturally exempt from tobacco's harms. But another explanation offers the real story. Heavy tobacco consumption is a recent phenomenon in Japan and so the tsunami of tobacco's long-term harms has yet to reach the shore. Yes, it is true that the percentage of men smoking in Japan reached almost 84% in 1966 (and is only 59% today), but per capita tobacco consumption has increased tenfold in the post-war period and 30% since the peak days of 1966.

Accordingly, symptoms of the epidemic of tobacco's damage are just starting to be seen in Japan. For example, in 1993, lung cancer surpassed stomach cancer as the number one cancer killer of men. In another view, estimates by the World Health Organization (WHO) put tobacco consumption related deaths at 18% of Japanese male and 5% of female deaths in 1995, which are both less than similar estimates for the U.S. and England. But in the U.S. and England the numbers are sharply declining, while Japan, on the other hand, is witnessing a dramatic upsurge. And Japan’s future appears bleaker. Researchers at Japan's National Cancer Research Center have estimated that lung cancer deaths in Japan will double or triple by the year 2015.

Lung cancer statistics are merely the tip of the iceberg. The Ministry of Health's 1993 White Paper on Smoking and Health identifies tobacco as a factor increasing the incidence of numerous other cancers, coronary heart disease and cardiovascular disease, emphysema, diabetes, osteoporosis, infertility, miscarriages, low birth weight, sudden infant death syndrome, reduced muscle strength, and impotence. As early as 1979, researchers were estimating that tobacco-related medical care and lost productivity annually due to tobacco-related employee illness was costing Japan at least ¥1.6 trillion. Meanwhile, annual consumption has increased almost 10% since 1979.

As with Japan's HIV disaster, the media has been slow to pick up the news. Owing to tobacco's vast economic contribution to advertising and media interests, reporting on tobacco problems has been meager in Japan. In 1992, a documentary television program reporting much of what is written here was canceled by Nippon Television under pressure from tobacco industry interests. Only after a heated battle with one of the company's employee unions was the program broadcast, and then only after portions of the program were edited out. While stunning events have been taking place regarding the tobacco industry in the U.S. in the past few weeks, news of these events have also received only minimal coverage in Japanese-language newspapers and television reports.

Immediate policy changes are necessary to slow the coming epidemic of tobacco deaths. Some, such as taking cigarette vending machine out of public spaces, restricting tobacco advertising, increasing public education, strengthening the health warning on tobacco advertising and packages, offering support for smoking cessation, and raising tobacco taxes, would merely place Japan in line with virtually all other WHO member nations. Other changes might be more "Japanese" in approach, such as an industrial policy designing a soft landing for tobacco-addicted economic interests. Sadly, however, little is being done. A few non-smoking areas are being set up, outdoor tobacco vending machines will be shut off between 11:00 p.m. and 5:00 a.m., and television and radio advertising are being "reduced". But Japan's government agencies, its business interests, and its medical experts are not doing enough. Once again, ethical and moral duties to protect the Japanese people's lives and health are being tragically ignored.

© 1996, Mark A. Levin, Assistant Professor, William S. Richardson School of Law, The University of Hawaii at Manoa, Honolulu, HI 96822

(translation by Vicki L. Beyer)

Temple University Japan