Friday, February 12 1999
Thank you Judith for accepting our " rendez-vous ". May I ask you to introduce yourself ?
I am a medical graduate from Edinburgh University in Scotland, and I've 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.
I have encouraged national governments and health organizations in Asia in developing comprehensive tobacco control policies and laws, particularly in Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Malaysia, Mongolia, the Philippines, Singapore, Thailand and Vietnam.
The new Director General of WHO, Dr Gro Harlem Brundtland, has appointed me to chair the Policy, Strategy Advisory Committee for her new special cabinet project on tobacco. I work closely with Derek Yach, the Programme Manager in Geneva (RENDEZ-VOUS, February 5, 1999). I still live in Hong Kong but visit Geneva and work elsewhere on behalf of WHO much of the time. It is the first time that WHO has truly grasped the political nettle of tobacco control and there is every early sign that this will, in Dr Brundtland's words, 'make a difference.'
I have published 130 papers and addressed 250 conferences world-wide on varied aspects of tobacco control. I also write books: 'The State of Health Atlas', the first-ever Atlas on global health; chapters in 'Atlas of the Future' and I'm currently writing 'The State of Sex Atlas.' Watch this space!
I have received the WHO Medal, the APACT Presidential Award, an award from the UICC, and national awards or medals from the United Kingdom (MBE), the United States of America (the US Surgeon General's Medallion), Thailand and China (the latter presented in the Great Hall of the People).
But my greatest accolade comes from the tobacco industry, which has identified me as one of the three most dangerous people in the world. They and their supporters have threatened to sue me, sent me death threats, and have called me
'sanctimonious, dogmatic, meddlesome, puritanical, hysterical, prejudiced, vehement' and I have even been accused of having
'subliminal, repressed, sexual frustration' because I cannot bear to see the 'position of a cigarette in relation to the male mouth!'
Outside tobacco, I have campaigned for women's issues such as equal pay and terms of service for women (I earned 75% of a male doctor's salary when I first arrived in Hong Kong),
maternity leave, and separate taxation for married women. I opened the first refuge for battered women in Asia amid considerable controversy. I am a Justice of the Peace (JP),
with duties including JP visits to prisons, hospitals, refugee camps, and some curious rights such as seizing a postal worker's uniform if he/she leaves office!
I am married to a Scottish doctor and have two sons, one a medical doctor in Edinburgh and the other an environmental scientist at Cambridge University. I swim, play golf to a modest handicap, and collect jokes.
1. In a recent opinion published by the South China Morning Post you wrote: "it would not matter if every smoker In North America quit smoking tomorrow, as long as the international companies could capture the Asian market". It is true that the Asian market is huge but it also seems to me that North-America often appears as a "trend leader". Don't you think that such a big change would have a "domino effect"?
Aren't the changes in America impacting positively on the situation in Asia? Or are they making the multinationals even more agressive in Asia and elsewhere, in an attempt to compensate the decreasing sales in America?
America's success is a two-pronged issue - on the one hand as smoking decreases in the west, the tobacco industry seems even more determined to conquer the huge and expanding markets in the developing world. On the other hand, the example of tobacco control measures can be exported.
However, while the US is ahead in smoke-free areas, litigation and public debate, there are dozens of countries with much stronger legislation, ranging from Mongolia's total ban on tobacco advertising; Singapore's licensing of tobacco retailers and bans on duty free cigarettes; and Thailand's large health warnings about impotence.
2. How do you react to the merger between Rothmans and BAT? Do you think the fact that tobacco companies are getting bigger is going to make them more difficult to control or could it backfire against them, making them more vulnerable to global regulation?
I don't think it will have much impact on public health, one way or the other. It seems more like a corporate challenge to the US companies such as Philip Morris and RJR.
3. President Clinton just announced that the US Justice Department is planning a lawsuit against tobacco companies. Some other countries are starting similar litigation at home or in the US if the companies are based in America. Do you think litigation is an option for tobacco control in Asia?
Yes. As you mention, several countries, including some in Latin America, have followed the US in filing suits to recover health care costs from the tobacco industry.
This could be replicated in Asia, although there are some difficulties: many countries still have national monopolies, where suing the government would mean one government department suing another - an unlikely scenario. Litigation is also still an uncommon practice in many developing countries.
4. You have just chaired the " International Consultation on ETS and child health " organized by WHO in Geneva.
What do you expect from such meetings?
What do you think will come out of this one?
The meeting reviewed all the evidence by a group of international experts, and a WHO position paper will shortly emerge from this consultation. This will review all the health evidence as well as the policy and action required. It is clear from all the tobacco industry documents on Internet, passive smoking is the current major battleground for the industry, so it is vital that WHO takes a sound, scientific stand.
5. Allan Rock, Canada's Health Minister announced new regulations for tobacco packaging, including new enlarged warnings, up to 60% of the front. Do you think this could start a trend in other countries or lay the foundations for an international regulation?
I certainly hope so. Unless new, robust and sustained measures are taken today, the number of smokers in the world will increase from the current 1.1 billion to 1.64 billion by 2025.
Thank you Judith for taking the time to be with us today.
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