Rendez-vous 148
December 20, 2002
about The Tobacco Atlas
Judith is Director of the Asian Consultancy on Tobacco Control
Hong Kong
Thank you Judith for accepting our rendez-vous. May I ask you to introduce yourself?
Judith Mackay: My name is Judith Longstaff Mackay. I have lived in Hong Kong since 1967, initially working as a hospital physician, then since 1984 concentrating on tobacco control. I am currently the Director of the Asian Consultancy on Tobacco Control, and Senior Policy Advisor to World Health Organisation on tobacco issues.
My particular interests are developing countries and women. I have also published atlases in the Myriad series on health, the future, sexology and, the latest in 2002, with Michael Eriksen as co-author, the Tobacco Atlas. WHO and the CDC have now asked me to do an atlas in 2003 on Cardiovascular Diseases.
Q1. On the page 90 of the Tobacco Atlas you state: "The future looks bleak; the global tobacco epidemic is worse today than it was 50 years ago. And it will be even worse in another 50 years unless an extraordinary effort is made now." What type of effort do you have in mind?
Judith Mackay: First, a tightening of all the familiar things: a total ban on all tobacco promotion; smoke-free areas the norm, with some smoking areas allowed (a reversal of the current situation); tax on cigarettes 75% of the selling price; health education that works, especially for youth; eliminating youth access; cessation; litigation; product packaging and inserts; and action on gender and tobacco issues. Then, in addition, I would suggest three main areas of action: national economic surveys to show governments that tobacco has a huge cost to their country's economy; a strong FCTC; and comprehensive regulation of the tobacco industry. We also need more allies for example, why has the anti-globalisation movement never taken the tobacco companies to task?
Q2. You explain that China, with over 300 million male smokers (equivalent to the entire population of the USA) deserves a special mention (p.24). How do you assess the situation in China now and in the years to come?
Judith Mackay: China took many tobacco measures in the 1990s: epidemiological surveys, health warnings, health education, the establishment of a national Chinese Association on Smoking and Health, a ban on print and electronic advertisements, creation of many smoke-free areas, and the hosting of the 10th World Conference on Tobacco or Health in 1997. Like all countries, there tends to be a lull after major steps, and China is now ready for another "great leap forward." China sends a large team to the FCTC negotiations, and the FCTC might, as in all countries, "kick tobacco upstairs" in the government, so that it is not viewed only as a health issue, but as an issue of development, trade, finance, and crime.
Q3. The number of deaths linked to smoking is so big it could somehow be beyond our understanding. In the recent US national conference in San Francisco Mike Moore underlined the fact that statistics alone will not move people and he asked for champions, leaders to carry the tobacco control message in a personal(ized) way. What is your opinion? Do you see such champions emerging?
Judith Mackay: I agree with Mike Moore that statistics alone may not move people. But in a sense, that is exactly why I did the atlas, as it puts more than 20,000 statistics into lively and colourful graphics and maps, that I truly believe will reach a far greater number of people than those who would traditionally trawl through data tables or text.
Q4. There are so many interesting tables in the Atlas it is quite difficult to pick up one but I was especially intrigued by the fact that the tobacco industry has been using less and less tobacco per cigarette (p.48/49). Can you comment on that trend?
Judith Mackay: The technical answer is that because of the use of additives and other technologies, such as "fluffing" and the use of reconstituted tobacco, tobacco companies use less tobacco per cigarette. But this does NOT mean a safe cigarette, and we also need to remember that nicotine is independent of the amount of tobacco leaf used.
Q5. "The price of tobacco is the single largest factor influencing short term consumption patterns" (p.84/85). With many governments experiencing a budget crisis they now have an incentive to increase taxes. But what about the less positive consequences that are the argument that raising taxes is all that needs to be done (especially no need for increased funding for prevention) and the risk that goverrnments become very dependent on tobacco taxes? Like China where about 9% of the government income is derived from tobacco...
Judith Mackay: Research for the Atlas revealed that the percentage of total government revenues accounted for by tobacco taxes is relatively small, less than 10% in all countries, and less than 2% in most countries. Also remember, projected population expansion means that even with a decrease in prevalence, there will be more smokers in 2040 or 2050 than there are today. Our work is far from over.
Q6. Is there anything else you would like to add?
Judith Mackay: I am very grateful to the CDC in the USA for funding the Tobacco Atlas, and for WHO supporting, publishing and distributing it. The huge advantage is that it can be distributed free, especially in developing countries. We are now trying to find funds for foreign language editions, and an interactive web site format.
I sincerely hope that it is proves to be a useful policy tool for governments, legislators, other decision makers, and the media. One particular example is that many of the delegates at the FCTC discussion are treaty negotiators, lawyers, customs officials, as well as health people. For them this Atlas was written.
Thank you Judith for taking the time to be with us.
Judith was our guest for previous rendez-vous on February 12, 1999 and on August 11, 2000
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