Judith Mackay

RENDEZ-VOUS 77
Friday, August 11 2000

Nota: I met with Judith Mackay during the 11th world conference on Tobacco or Health in Chicago. A slightly different version of this interview was published in the daily journal of the conference (in the August 11th issue). We have had one previous rendez-vous with Judith on February 12, 1999.

Thank you Judith for accepting our rendez-vous. May I ask you to introduce yourself? 

Judith Mackay : I have lived in Hong Kong since 1967, initially working
as a hospital physician in university and government hospitals. In 1984 I left hospital medicine to concentrate on preventive rather than curative health, in particular tobacco control.

I was the founding Executive Director of the Hong Kong Council on Smoking and Health. I resigned in 1989 to establish the one-person Asian Consultancy on Tobacco Control, to facilitate the sharing of information, experience and expertise on tobacco control amongst countries in the Asia Pacific region.

My particular interests are countering the transnational tobacco companies in developing countries, and tobacco and women. While the industry frequently called me 'sanctimonious, dogmatic, meddlesome, puritanical, hysterical, prejudiced, vehement', the new Director General of WHO, Dr Gro Harlem Brundtland, has appointed me to chair the Policy Strategy Advisory Committee for the Tobacco Free Initiative.

Q1. What messages should we take home from the Chicago conference?

The message for developed countries is to understand that the tobacco epidemic is both expanding and is being transferred to developing countries. Some people seem to believe that the tobacco industry is on the run, and that we have somehow turned a corner towards success. Nothing could be further from the truth.

If we continue to do only 'more of the same' the number of smokers will increase from the current 1.1 billion to 1.64 billion by 2030. We must find new and robust ways to reduce the tobacco epidemic.

The message for developing countries is that, in the words of Dr Kjell Bjartveit from Norway, 'it can be done.' Some developing countries have already implemented tobacco control measures far ahead of many western countries, as I will explain in a minute. Another message is that many measures cost nothing, such as health warnings and the creation of smoke-free areas in public places. What is needed is political will.

Q2. A few governments seem concerned with what they consider the economic costs of tobacco control.

An equally important take-home message is that tobacco control is good for a nation's economy. Much of the resistance of governments to taking action is because they are mistakenly concerned about a negative economic impact of tobacco control, a view that is pushed by the tobacco industry all over the world. We now have a major global financial institution - The World Bank - both in their 1999 publication and explained so clearly at this conference, confirming that tobacco control measures are cost effective, they do not reduce tobacco taxation, do not harm the national economy, and do not put tobacco farmers and tobacco workers out of jobs. With the predicted expansion in the number of smokers globally, no tobacco farmers will be out of work for decades.

I also feel optimistic about several new initiatives. The WHO Framework Convention on Tobacco Control will move tobacco to a much higher level within governments, as it will be the whole government that will ratify the convention. A global NGO alliance formed to support the Convention is also a real opportunity for working together. A crucial take-home task for delegates - whether from governments or NGOs - is to support the Framework Convention, so that it is adopted before the next world conference.

Other new and exciting areas are litigation, continuing exposure of the industry documents, new partnerships - for example with women's organisations - and other UN agencies becoming involved with tobacco issues. Even the fact that this is the first conference for 75% of the delegates is a good sign that more people are becoming involved.

Q3. What do you think of the situation in the US ?

The US leads the world in smoke-free areas and in litigation, which has also made the tobacco industry documents available to the world. But the US is quite far behind in many other areas. Singapore, for example, banned all tobacco advertising 30 years ago, has banned duty free cigarettes, and licensed retailers so that if they sell to minors they lose their licences. Thailand has required ingredient disclosure of cigarettes, and has very explicit health warnings such as 'Smoking causes impotence.' Even Mongolia has more comprehensive tobacco control legislation that does the US. So, to answer your question, this conference is a true opportunity for us all to learn from each other.

Q4. What is your response to the tobacco companies' claim that they have changed?

The industry is certainly organizing a huge public relations effort, trying to create a new corporate image of being caring, responsible, and totally different from the past. However, I don't think there is any firm evidence yet that they have really changed, and it remains to be seen if they ever will. Because the industry documents have exposed many of their lies, they have been forced to make some admissions, which they never did voluntarily. For example, the documents show that they have known for decades that smoking is harmful, even when they denied it publicly. So now they have no choice other than to admit this in public. And they comply with the absolute minimum they have to in each country. But many presentations at this meeting show that they have not fundamentally changed at all - the basis of their business is to sell as many cigarettes as they can.

I am also not at all convinced by their youth programmes - such as their message 'Smoking can wait.' All teenagers want to be grown up, not thought of as children, and by telling them that tobacco is for adults seems to be an inducement to smoke, rather than the opposite.

I don't believe the time has yet come for us, and it may never come, to work together with the industry.

Q5. How is the situation in Asia ?

20 years ago, Singapore was the only Asian country with significant tobacco control measures. Now two thirds have some useful legislation and all celebrated World No Tobacco Day this year. Some are increasing tobacco tax for health reasons rather than just for fiscal reasons. And this is not just happening in Asia - South Africa has just implemented strong measures.

Yet, this has been achieved with almost no resources. With the exception of Thailand (where there are 30 people) there are only 10 people working full-time on tobacco control for the whole of Asia - home to half the world's smokers.

Q6. Do you have anything else you would like to add?

The bottom line is that each and every country has to develop its own national policy and enact its own tobacco control legislation. No other country can do this for them, although assistance can be given to help the process. Tackling tobacco is very difficult for many developing countries who are more used to fighting malaria.

I am impressed that this conference has sponsored about 180 scholars from developing countries, given them training and then will follow up with some seed money for projects in their home countries. This will be a good start of assistance for the poorer countries.

Thank you Judith for taking the time to be with us today.