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Dr Judith Mackay

Hong Kong leads mainland in war to cut smoking

http://www.ejinsight.com/20161209-hong-kong-leads-mainland-in-war-to-cut-smoking/

When a person goes to buy a packet of cigarettes in Hong Kong, he or she faces two obstacles. One is the price — Double Happiness at HK$43 and Marlboro at HK$57 — the result of a tobacco tax up to 68 per cent of the price.

The other is the hideous image on the packet of the worst consequences of smoking.

A survey by the Economic Intelligence Unit earlier this year ranked Hong Kong as the eighth most expensive city in the world for a packet of branded cigarettes, at US$7.48.

Top was London with US$14.30, followed by New York with US$13.67 and Singapore with US$9.15.

These two measures, along with the creation of smoke-free areas in public and work places, have been effective in cutting the number of smokers.

According to government figures, the percentage of daily cigarette smokers aged 15 and above in Hong Kong in 2015 was 10.5 percent, down from 10.7 percent in 2012 and 23.3 per cent in the early 1980s.

The mainland, the world’s largest tobacco market with 316 million smokers in 2015, has only recently started to learn the lessons of Hong Kong.

Since 2010, the number of smokers has increased by 15 million and cigarette production risen by 35 per cent.

The health warnings are written, not visual, and appear modestly at the bottom of the packet. They would not frighten any first-time user.

In 2015, China increased the tobacco tax to 40 per cent. Consumption tax from tobacco in 2015 was 536 billion yuan, an increase of 60 billion from a year earlier. The recommendation of the World Health Organisation (WHO) is that the tax should be 70 per cent of the retail price.

“There is certainly room for future tobacco tax increase,” said Jian Shi, director of the information office of the Taxation Research Institute at the State Administration of Taxation in Beijing.

“In some western countries, the tobacco tax rate has reached 70-80 per cent. The room for the increase needs to be considered based on the development goal of the industry and the condition of national revenue.”

Health professionals argue that increasing the tobacco tax is the quickest and most effective way to cut smoking — by both preventing young people from starting and encouraging smokers to quit.

According to WHO figures, each increase of 10 per cent in the price will cause 3.7 per cent of adults and 9.3 per cent of teenagers to stop smoking.

Antonio Kwong Cho-shing, chairman of the Hong Kong Council on Smoking and Public Health, said that selective or modest hikes would not make much of an impression on smoker numbers in Hong Kong.

“Only a 100 per cent increase in tobacco tax would induce people to quit smoking,” he said. If the government accepted this proposal, an average pack would cost HK$119.

The Department of Health has proposed an enlargement of the health warning.

It said on Nov. 23 that the area of the graphic health warning shall be of a size that covers at least 85 percent of the two largest surfaces of the packet or the retail container and that the number of forms of health warning should be increased from six to 12.

The situation in the mainland is years behind. The biggest obstacle is that the State Tobacco Monopoly Administration (STMA), the world’s biggest manufacturer of cigarettes, is also the industry regulator.

This is despite years of lobbying by China’s health professionals, the WHO and the norms practised around the world. They argue that the two must be separate institutions.

According to WHO figures, 1.2 million die each year in China from smoking-related diseases; this number will double by 2025.

Jian Shi put it succinctly. “The major difficulty lies in that the related departments have quite different views on this matter, and it is difficult for them to reach agreement on this matter. That will cause obstruction to policy making and implementation.”

The STMA opposes graphic health warnings and higher taxes because they would hurt its sales and profits. Yet, simply due to global population expansion, there will be more smokers in 2040 than there are today, so it is difficult to believe that this concern is genuine.

The health lobby has had some success, in the modest increase in tobacco tax and restrictions on smoking in indoor public areas and workplaces and some outdoor areas introduced in Beijing in June 2015. Other mainland cities have taken similar measures at different times.

On Dec. 6, the Beijing Commission of Health and Family Planning said that more than 2,700 people had been fined for violating these restrictions, with total fines of 142,500 yuan, as of Nov. 30 this year.

Professor Dr Judith Mackay, based in Hong Kong and Asia’s leading anti-tobacco campaigner, said that the price of cigarettes in China is still extremely low.

“The latest small tobacco tax increase, while laudable, will not have a serious, sustained effect on reducing smoking. It is time to review the whole tobacco tax structure in China, significantly increase the price of cigarettes and thus protect the health of the Chinese people.

“In Australia, there is a regular increase of 12.5 per cent tobacco excise tax every year. The cost of a packet could soon rise to A$40 (HK$230). Hong Kong and China should both consider long-term tobacco tax planning in this way, so that tobacco control proceeds in an orderly form, and immense energy and time is not wasted year by year in campaigning for a tax increase. Otherwise, thousands will die.”

How Edinburgh University doctor Judith Mackay took on the tobacco industry in Asia

http://www.heraldscotland.com/news/14945140.Meet_the_Edinburgh_pensioner_who__39_s_the_most_dangerous_woman_in_the_world_in_the_eyes_of_Big_Tobacco/

HER’s is a career involving death threats, secret information passed from shadowy ‘Deep Throat’ figures, being held at gunpoint, and caught up in a trial in which key witnesses were murdered or mysteriously disappeared.

But it might be surprising to learn that these are not the experiences of a spy or globe-trotting investigative journalist, instead they are the experiences of a down-to-earth public health expert from Edinburgh.

Dr Judith Mackay, who studied medicine at Edinburgh University and is a member of the university’s Global Health Academy, has spent years battling the tobacco industry in Asia.

Now, for the first time the Hong Kong-based campaigner has revealed the full extent of the threats she faced in her career, during which she was branded as the most dangerous woman in the world by the international tobacco industry.

She told the Sunday Herald how she was for many years a “lone voice” in working at the forefront of tobacco control, trying raise awareness of the health risks of smoking and advising governments.

“Somebody once asked me do you have to be brave to be a tobacco control advocate today and my answer is no, I don’t think you do,” she said. “But I was the lone voice in the wilderness – I was basically the only person in Asia working on tobacco control regionally.

“The tobacco industry had just assumed it would ride its Marlboro cowboy into Asia and there wouldn’t be any opposition at all.”

Mackay, who was born in Yorkshire, moved to Hong Kong in 1967 at the peak of the Chinese Cultural revolution and spent a number of years working as a hospital doctor.

However she began to feel like the work was a ‘band-aid’ in having to treat so many people who had become ill as a consequence of smoking.

She decided to devote her career to tackling the industry full-time in the mid-1980s after a cigarette company attacked her work.

She said: “It [the company] was making a lot of threatening statements about how I was unaccountable and unrepresentative, claiming the tobacco industry was full of good sensible corporate advice. It was one of the turning points in my life.”

Mackay outlined the experiences she has gone through in a blog written for the ‘Dangerous Woman Project’ , which is being run by Edinburgh University’s Institute of Advanced Studies in the Humanities to collate stories of women who have been labelled as ‘threatening’.

She told how she has suffered verbal abuse over the years and in 1993, a US smokers’ rights group described her as a “psychotic human garbage, a gibbering Satan, an insane psychotic just like Hitler.”

The group also threatened to “utterly destroy” her – which was investigated by the FBI and led to her being offered 24-hour police protection by the Hong Kong government.

Mackay, who is a senior policy advisor for the World Health Organisation and director and founder of the Asian Consultancy on Tobacco Control, also had a chilling experience when she was an expert witness in a major trial involving cigarettes being smuggled into China.

The chief witness was murdered and eleven others disappeared – and Mackay discovered that she was being followed.

She helped the Hong Kong government take action against the importation and sale of smokeless tobacco, such as snuff, after she learned a ‘Deep Throat’ figure associated with the US tobacco industry had blown the whistle on a plan to immediately launch these products in the country.

In 1990, while she was working in Mongolia and staying at a government guest house, she found herself being held at gunpoint by suspicious Mongolian palace guards after going for an evening walk. She also found out there had been a cabinet meeting held to discuss whether she was a spy sent from the west.

But Mackay said her experiences had not deterred her from the fight against tobacco.

She said: “I have said – even to my lawyer – that if I were to disappear or to be found under a bus, this is not of my own doing.

“I think if anything I got very empowered by all these things that happened – it made me more determined, rather than less determined.

“But I did take some practical steps – one of which was to send our two boys when they were teenagers back to Scotland to school.

“I just felt they were safer back in the UK to finish their schooling.”

Mackay, whose husband is from Lossiemouth, still spends three months of the summer every year in Edinburgh.

The recognition for her work includes being named as one of the most influential people in the world by Time magazine in 2007. She was also awarded an honorary degree by Edinburgh University in July this year.

At the age of 73, she practises tai-chi and has no intention of giving up her work.

Mackay said while much progress has been made in tobacco control, she believes she will still be tackling the tobacco industry for years to come.

“The tobacco industry is certainly as formidable as it ever was – it has just somewhat changed its tactics in terms of what it does,” she said.

“What they now do is to issue legal challenges and trade threats to governments.”

She added: “I have often said I am going to be working until I am 100 and I think that is probably true.”

China: the tipping point in tobacco control

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Proud to be a dangerous woman – Prof Judith Mackay

Professor Judith Mackay is a member of the GHA and is a Hong-Kong based tobacco control researcher and activist.

http://blogs.sps.ed.ac.uk/global-health-academy/

She is Senior Advisor, Vital Strategies/Bloomberg Initiative to Reduce Tobacco Use; Director of the Asian Consultancy on Tobacco Control; and Senior Policy Advisor to World Health Organisation.

She has authored 12 atlases on health topics. In addition to many international awards, ranging from the WHO Commemorative Medal and the TIME 100 award to the first BMJ Group Lifetime Achievement Award, she has been identified by the tobacco industry as one of the three most dangerous people in the world.

She recently contributed to the Dangerous Women project, an initiative of the Institute for Advanced Studies in the Humanities at the University, which analyses the dynamics, conflicts, identities and power relations with which women live today.

Read Judith’s contribution here …

“It wasn’t my intention to be a dangerous woman or to find myself in danger, simply by being committed to gender equality and better health.

There was nothing in my medical degree course at the University of Edinburgh in the 1960s to predict that I would be labelled by the tobacco industry as one of the three most dangerous people in the world, or that I would need to be offered 24-hour police protection by the Hong Kong government.

Perhaps the first hint of danger in my life was when I arrived in Hong Kong in 1967 at the peak of the Chinese Cultural Revolution – which spilled over into Hong Kong – with Communist schools and banks barricaded and manufacturing bombs, and big character posters saying ‘Down with imperialists’ and ‘British go home.’ Street riots rocked the colony, bringing with them waves of bombings, looting and arson attacks. British rule became precarious, but held – only just – when Chinese Premier Chou Enlai reined in the HK Red Guards.

A Dangerous Feminist

I became a committed feminist at about the same time (and still am today, 50 years on), and this did not lie easily in colonial Hong Kong, where even senior government figures and judges would joke about rape. People viewed me as dangerous and subversive (and wrote many letters to the press saying just that). This could spill into physical abuse, such as when a friend’s husband twisted a necklace (engraved with the sign for women) round my neck, lifted me off the floor and snarled that “Women will never be the equal of men as they are not as strong,” while I dangled helplessly in the air, powerless. I determined never to let that happen to me again. Even more bizarrely, another woman friend only recently told me that the husband of a mutual friend had tried to rape her, saying ‘This is for Judith Mackay,’ as he perceived his wife was coming under my feminist influence.

A Dangerous Subversive in The Medical Profession

In the 1980’s, I earned the fury of my own medical profession by writing a health series in the South China Morning Post, Hong Kong’s leading English language newspaper. The article broke the then-traditional power mode of doctor-patient relationships by encouraging women, in particular, to keep their own personal health record, and participate in their own health care decisions. ‘When your doctor tells you…’ became ‘When you and your doctor decide…’ A senior gynaecologist stormed up to the hospital where I worked, found me in Medical Outpatients, pinned me against a wall, and said ‘This newspaper series has to stop or you will be in trouble.’ I said that this sounded like a threat, and he said ‘You have powerful enemies in the medical profession, and had better watch out.’ He went on to say that only that morning he was inserting a copper intra-uterine device in a patient, who had meekly asked ‘Is this a copper coil?’ and he was furious – asking her ‘Have you been reading Dr. Mackay’s column in the SCMP?’ – the trigger to his visit.

A Danger to Big Tobacco

I’ve faced the greatest danger since moving from clinical to preventive medicine. There were three main reasons for making the shift from hospital medicine to public health. First, during my work as a physician in the 1970s and 1980s, I came increasingly to feel that clinical work was like ‘a band-aid.’ In fact, we had a maxim on our male medical ward that we never admitted a non-smoker, our wards being full of people with end-stage tobacco illnesses, often too late to prevent morbidity and mortality.

Second was the realisation that although women’s health in those days was defined as reproductive health, tobacco was killing far more women than were dying from birth control – and the tobacco industry was actively recruiting women with promises of beauty, slimness, popularity and emancipation.

What finally galvanised my determination to combat tobacco use was the response to a piece I wrote on tobacco as part of my series on women’s health in the South China Morning Post. One of the British transnational cigarette companies published a booklet labelling me as ‘entirely unrepresentative and unaccountable.’ In contrast, the self-promotional booklet claimed ‘the tobacco industry comprises identifiable, legal, accountable, commercial organizations.’ This booklet, denying the health evidence (‘it has not been proven that these illnesses are actually caused by smoking’) and claiming to be an ‘important source of reliable information’ on smoking, so enraged me that from that moment on I worked on tobacco control, abandoning curative hospital medicine in 1984.

Why was my job so dangerous? It was partly location. The tobacco industry thought they could gallop their Marlboro cowboy into Asia, and it was theirs for the taking. They even said ‘What do we want? We want Asia,’ with the dream of converting the 60% of men who smoked local cigarettes to switch to international brands, and the second dream of persuading Asian women to start smoking. Given the numbers concerned, it would not have mattered if every smoker in the UK had stopped smoking the next day, if they could have captured the massive Asian markets.

There was no career structure and no pay, but I set about thwarting their goals. I was in touch with colleagues in the UK and elsewhere who were unstinting in their assistance, but it was a lonely job in Asia in the 1980s.

This brought me into conflict with one of the world’s most wealthy and powerful industries – and its supporters. I’m frequently subjected to verbal abuse and have been described over the years as sanctimonious, dogmatic, pontificating, meddlesome, heretic, puritanical, hysterical, prejudiced, a ‘Nanny,’ and more recently a ‘jihadist’.

In 1993, a smokers’ rights group in the USA described me as ‘psychotic human garbage, a gibbering Satan, an insane psychotic just like Hitler, using fatuous, smarmy drivel and distortions, and diatribes full of putrid corruption, lies, conspiracy, and total censorship.’ They concluded by stating that I was ‘devoid of any sanity, any morality, or any human-being-ness of any kind’, was ‘nothing more than an evil-possessed, power-lusting piece of meat’ and they threatened to ‘utterly destroy’ me!

The group had made similar threats to a US government health official, so the last sentence – perceived by the FBI as a death threat – had to be investigated by the agency, and I was added-on to that investigation. At this point, I was offered 24-hour police protection by the Hong Kong government.

The industry twice threatened, very publicly, to take me to court. Nothing came of it, of course – I was on rock-solid ground on the facts – but such tactics were attempts to intimidate me, and a ploy to cast doubt on my credibility in the minds of the public.

Such offensive words, the death threat, and the menace of litigation, completely failed to divert me. I said, robustly and publicly, that I was absolutely not a suicidal type, and that if I were to be found ‘knocked down by a bus,’ the tobacco industry was guilty until proven innocent!

That is not hyperbole. I had to give evidence as an expert witness in a major tobacco smuggling trial, involving British American Tobacco cigarettes being smuggled into China. The chief witness was murdered, and eleven others disappeared. Another witness jumped out of a window – on the 22nd floor. I had to report to the Independent Commission Against Corruption that I was being followed. They put a stop to it, but it was an eerie experience, as was being cross-examined by a tobacco industry lawyer.

There have also been clandestine aspects to my work. In 1986, a go between phoned to tell me that a ‘Deep Throat’ associated with US Tobacco had informed him of a plan to imminently launch smokeless tobacco (sucking, chewing tobacco and snuff) in Hong Kong. To this day, I do not know the identity of ‘Deep Throat,’ not even whether it is a ‘she’ or a ‘he.’ Immediately, I contacted the Hong Kong government and helped to plan a ‘pre-emptive strike’ – a ban on the importation, manufacture and sale of smokeless tobacco products. Other whistle-blowers have contacted me from within the tobacco industry, always a sensitive and potentially explosive situation. For their safety, I will say no more.

Working In Dangerous Places

I have also worked in some very dangerous areas in Asian countries, some under martial law, some at war, some under attack by rebels in their own countries. I was in Cambodia giving a slide presentation when there was an almighty explosion and the ceiling started falling down. Everyone else dived under the tables. Perhaps my finest hour as a Brit: I simply said, ‘Next slide please.’ It turned out to be a captured ammunition cache that had been placed in the central square and blown up by the government, but with no notice to anyone.

In 1990, I was held at gunpoint by armed Mongolian palace guards who, seeing me appearing out of the dark at the Government guest house after an evening walk, had no idea who I was or what to do. I had to gently talk them down, in a language they did not understand. Incidentally, the Minister of Health in Mongolia told me that during that first visit, they held a cabinet meeting as they thought I might be a spy sent from the west. They had prepared a school project to present to me, but I was much more interested in the tax, economic and political issues regarding tobacco, even their border security in preventing smuggling. He said the cabinet had concluded I was not a spy, and instead I had highlighted the breadth of issues involved in tobacco control.

More recently, I have worked with the North Korean (DPRK) government on tobacco control on three occasions, but am probably safer there than in London.

Promoting Gender Equality

Less dangerously, I have been able to push for equal gender representation in public health policy-making, including data collection and in the wording and clauses of the WHO Framework Convention on Tobacco Control. I have been able to promote women for various international awards, to serve on international committees and to be invited to speak at major conferences. For example, when invited to assist the 10th World Conference on Tobacco or Health held in Beijing in 1997, I stipulated that I would work pro bono as long as at least half of the keynote plenary speakers, chairmen, and committee were female. Despite initial uncertainty from the organisers, the event turned out to be the “best conference ever” and set the standard for subsequent conferences.

I promote women because if women are not in those positions, then the issue of women and tobacco gets ignored. This resulted in some resentment from male (never female) colleagues in the early days, some of which I found very hurtful. Ultimately, though, I have found it useful being female. Some countries embarking on tobacco control found it less threatening to invite me to be an Advisor – and it’s my knowledge, experience and expertise, valued in Asia in both sexes, that gets results. In addition, being based in Asia and knowing Asia, but being British rather than Asian, helped me to be seen as politically neutral.

I have wondered if working in tobacco control today is as dangerous as it was. I think not. It does require a certain type of interested and involved person to go into the field, but public health has now moved to the mainstream of health sciences. There are also many more people working in the field – it is not as isolated as it was 40 years ago. Personally, I intend to work until I am 100 – I practice Tai Chi (taiji) and reserve my two sword programmes’ cut and thrust for continuing to fight the tobacco industry.

I have worn the ‘dangerous’ label as a badge of honour, but hope the day is near when women aren’t labelled “dangerous” simply for standing up to advocate for issues like health or gender equality. We wait.”

Read Judith’s original blog here: http://dangerouswomenproject.org/2016/08/11/judith-mackay/

Proud to be a dangerous woman – Dangerous Women Project
dangerouswomenproject.org

Today we hear from Dr Judith Mackay, identified by the tobacco industry as one of the three most dangerous people in the world.
Prof Judith Mackay’s GHA profile:

http://www.ed.ac.uk/global-health/communities-practice/members/global-members/professor-judith-mackay

DEGREE OF DOCTOR HONORIS CAUSA – Judith Mary Mackay

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World-leading tobacco campaigner congratulated on honorary degree

http://www.ashscotland.org.uk/media/news/2016/07/world-leading-tobacco-campaigner-congratulated-on-honorary-degree/

Health campaigners have congratulated Dr Judith Mackay, one of the world’s foremost tobacco researchers and campaigners, on her receipt of an honorary doctorate from the University of Edinburgh on Friday 1 July 2016.

Dr Mackay received her medical degree from the University of Edinburgh in 1966, before moving to Hong Kong in 1967. There, she became one of the world’s leading advocates of tobacco control measures. Over a long career in South East Asia and around the world, she has advised many governments, NGOs and international organisations on how and why they should implement policies to protect against the harm of smoking.

Perhaps her greatest achievement has been the implementation of the Framework Convention on Tobacco Control, the world’s first international treaty on public health. An initiative of the World Health Organisation, Dr Mackay’s efforts as senior policy advisor to that body helped to shape the treaty and take it from an idea to a reality which now helps to protect more than 90% of the world’s population.

In recognition of her efforts she has received many international rewards, including the WHO Commemorative Medal and the BMJ Lifetime Achievement Award, and was recognised in 2007 as one of TIME Magazine’s 100 people who shape the world.

Speaking about the award, Sheila Duffy, Chief Executive of ASH Scotland, said:

“Judith is an inspiration to everyone working to protect people from the harms of tobacco. Thanks to her tireless efforts, countless people in Asia and around the world have lived longer, healthier lives. I can’t think of a better legacy to celebrate than that, nor of a better inspiration for Scotland’s ongoing work to reduce the harms of tobacco”.

Dr Mackay herself said:

“It is with deep gratitude that I accept the honorary doctorate. It is an especial honour to share this occasion with today’s graduates, looking towards their future.

“My medical degree has taken me in unimaginable directions. I found myself in pitched battle with one of the most powerful commercial companies in the world. It has been as a particular honour to be identified by the transnational tobacco companies as one of the three most dangerous people in the world!

“I had to learn – on the job – how to become:

An economist, as economic arguments are what sway governments more than health arguments
Skilled in tax issues, in lobbying Ministers of Finance
An expert witness, cross-examined in court by tobacco industry lawyers in a brutal cigarette smuggling trial
A media expert, making public health newsworthy
An expert in law and trade, navigating UN treaties, free-trade disputes and litigation
A historian, utilising Sun Tzu’s 500BC “Art of War” strategies to counter ‘big tobacco’.

“The world is smaller than I thought: my work is surprisingly similar in different population countries, different political systems, and different stages of economic development. It is the same product, same harm, same obstacles and same actions that need to be taken.

“In my own profession, a medical degree enables graduates not only to become family doctors or specialists, in the UK or elsewhere, but to work in forensic pathology, population health, fathoming the workings of the human mind, or with DNA and life itself. In health sciences and in education also, your degree is a passport – you can use it to travel to many different destinations. My warmest wishes for your future, and thank you again.”

ENDS

For further information please contact ASH Scotland on 0131 225 4725 or enquiries@ashscotland.org.uk . Out of hours mobile 07776 142 299

Notes for Editors

Further details and photographs from the event (11am Fri 1st) from Edinburgh University press team:

http://www.ed.ac.uk/communications-marketing/press-and-pr/press-and-pr

Further details about honorary degree awards are available at http://www.ed.ac.uk/student-administration/graduations/honorary/future-honorary-grads

Action on Smoking & Health (Scotland) (ASH Scotland) is an independent Scottish charity working in partnership to protect people from the harm caused by tobacco. Registered Scottish charity number SC 010412.

Jury is still out on e-cigarettes

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