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November 26th, 2008:

Judith Mackay’s Tireless Crusade Against Smoking

No ifs or butts

Judith Mackay’s tireless crusade against smoking has won her global accolades – and plenty of enemies – but her work is far from done

Judith Mackay

Ella Lee – Nov 26, 2008 – SCMP

It was 1960. A young medical student at the University of Edinburgh took out her first cigarette, lit up and puffed smoke into the cool Scottish air. Her throat was a bit dry but, at that moment, the 16- year-old finally felt like an adult, a very “cool” adult. Almost half a century later, when 65-year-old Judith Mackay recalls that episode at her tranquil countryside house in Sai Kung, she laughs it off, but her tone turns serious as she explains why it helped her understand a young person’s urge to smoke.

Such knowledge is particularly important to Yorkshire-born Dr Mackay, the world’s leading anti-tobacco lobbyist and advocate, and one of Hong Kong’s few public health experts to become a global name.

“I was away from home for the first time and I was very young,” she says of her first smoking episode. “I thought smoking was sophisticated and was a doorway to becoming an adult.”

She was “fortunate”, she says, that she quit after only three months because her asthmatic roommate couldn’t stand the smoke.

“I really understand how young people feel. They smoke to be an adult, to be rebellious, to look cool. This is why school programmes don’t work. They tell children if they smoke, they will get cancers or lung diseases at the age of 60 or 70; it is completely meaningless to them,” she says.

For the past 25 years, Dr Mackay has been pushing for changes in countries where smoking is regarded as a lifestyle choice rather than a health hazard. And in recognition of those efforts, she will be made an OBE by Queen Elizabeth in a ceremony at Buckingham Palace today.

In her official capacity, she is the senior policy adviser to the World Health Organisation and senior adviser to the World Lung Foundation (WLF). The latter is responsible for taking care of the multimillion-dollar grant from Bloomberg Philanthropies, a fund set up by New York Mayor Michael Bloomberg to encourage tobacco control in poor countries.

In short, she is one of the three “most dangerous” people as far as the tobacco industry is concerned (the others are American campaigner Mike Pertschuk and Canadian Garfield Mahood).

Dr Mackay came to Hong Kong in 1967 after finishing her medical studies and has lived here ever since. Her anti-tobacco efforts began in 1984, when she quit her job at United Christian Hospital after seeing too many patients dying from smoking-related diseases. She decided she could save more lives by helping cut tobacco use.

Her battle began in earnest when she joined the Hong Kong Council on Smoking and Health as its first executive director from 1987 to 1989. She then set up what she calls the “one-woman-band” Asian Consultancy on Tobacco Control in 1989 and started reaching out to help other Asian countries.

Since 1984, she has advised the WHO on lobbying governments to introduce tobacco control measures such as taxes and advertising bans. Her impact has been felt all over East and Southeast Asia.

In 2006, her role became even more prominent when she was hired as the WLF’s project co-ordinator.

There are always two sets of curriculum vitae for Dr Mackay. One is a 70-page document listing her public health appointments, awards and published papers.

The second, a two-page file, contains the names and terms of abuse levelled at her by smokers’ rights groups and the tobacco industry.

She has been called “psychotic human garbage”, a “gibbering satan” and “an insane psychotic like Hitler” among other things. In 1993, a smokers’ rights group in the United States threatened to “utterly destroy” her.

At one time, in the 1990s, Dr Mackay was offered protection by the government because of concerns for her welfare. She also packed her two children off to high school in Edinburgh for their safety.

But none of these insults or threats have diverted her from her goal. Indeed, they have only made her more determined.

At times, she has had to keep her work itinerary secret to avoid interference, such as when she went to Mongolia in 1990 as a WHO consultant to design a national tobacco plan for the country. She was heartened to see Mongolia introduce one of the best tobacco control laws in Asia in 1994

Dr Mackay says her most rewarding achievement is the WHO Framework Convention on Tobacco Control, a milestone in the field and only achieved after she lobbied then WHO director general Gro Harlem Brundtland to make it a priority.

A total of 168 countries have signed the convention, which came into force in February 2005 and commits them to reduce tobacco use through legislation, taxation and public education. So far, 160 have ratified it.

Dr Mackay gives the government an “A-minus” for its tobacco control performance.

“In the 1980s and 90s, Hong Kong passed some important legislation on smoke-free areas and advertising bans [and] it was also one of the 20 countries and cities that introduced pictorial health warnings on cigarette packs,” she says.

“But, in the past eight years, Hong Kong has been lagging behind others in terms of taxation. We have not raised the tobacco tax to a significant level.”

She intends to lobby for a “plain packaging” law for cigarettes, meaning that the pack can only carry the brand name and a health warning.

Dr Mackay says her success is due to three elements, being “determined, optimistic and realistic”.

“I understand politics, that sometimes governments have to compromise,” she says.

“For example, when the Hong Kong government tried to push through the smoking bill in Legco two years ago, some bars asked for various kinds of exemptions. In that political atmosphere, the government could not have passed the bill without making some exemptions.

“I can’t say I accept this compromise but I understand it. It is what I mean by being realistic.” Building trust is also a key to successful lobbying.

“I think governments trust me because I never shame or embarrass them. I encourage them and support them.”

Aside from professional satisfaction, her efforts have won her local and international recognition.

Dr Mackay is also the proud recipient of the WHO Commemorative Medal, Hong Kong’s Silver Bauhinia Star award, the MBE, the US Surgeon General’s Medallion award and an award from the King of Thailand.

In 2006, Time magazine selected her as one of the 60 Asian heroes from the previous 60 years. In 2007, the same magazine named her one of the world’s 100 most influential people.

With all these accomplishments, she was at professional crossroads two years ago and considering taking a backseat.

“I thought I had done my best and it was time for a new wave of advocate to take up my job,” she says.

But a telephone call changed everything. A representative for Mr Bloomberg called her and offered her the position as senior adviser for the WLF. The initial, two-year US$125 million donation from Mr Bloomberg had not been made public at the time. She was given 24 hours to decide.

“My elder son, who is a doctor, said that if I take the job there will be many times I will regret it because there will be many people asking for money or jobs from me. But he also said, if I don’t take it, I will always regret it.” She accepted and since then has been working “close to burnout” to lay down the infrastructure for the project.

In July, Mr Bloomberg and Microsoft founder Bill Gates committed a combined US$500 million to tobacco control. The targets are low- to middle-income countries where between 10 and 25 per cent of all male deaths over 35 are tobacco-related.

The WLF, which gets the biggest slice of the funding, works with other partners including the WHO, the Centers for Disease Control and Prevention, the Campaign for Tobacco-Free Kids and the Johns Hopkins Bloomberg School of Public Health.

Dr Mackay says the Bloomberg initiative is the “first big funding for non-communicable diseases that makes something happen”.

“Many governments have been talking about [tobacco control] but there is no money to support it.”

Dr Mackay says the Bloomberg initiative has a clear target – to reduce smoking prevalence in countries with big smoking populations. “A small change in a big population means a lot. If you get 1 per cent of smokers to stop smoking in China, it is far more than stopping 99 per cent of smokers in Mongolia.”

She said tobacco control should be top of the agenda for Beijing because mainland smokers consumed one in three of the world’s cigarettes.

Dr Mackay said another impact of the Bloomberg initiative is that it created a profession and a paid career path for tobacco control personnel.

Her position with the WLF is her first paid job since she left the Hong Kong Council on Smoking and Health. She claims only expenses from organisations that she helps.

“My husband is a private doctor, he had been supporting me, but now he has retired, it is my turn to support him.”

A hectic life means Dr Mackay usually spends a quarter of each year overseas attending about 20 conferences. During a trip to a conference in South Korea two months ago, she fell and broke her ankle and leg. She was in a wheelchair for two months.

“I have prepared a nice cane to use at the OBE award ceremony,” she says. “I will wear a Chinese-style jacket to show my link with Hong Kong.”

As for her future plans, there is no stopping her yet. “I am always a working person. I enjoy every day.”