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Tobacco Taxes Versus Needless Deaths

Dec 29th, 2007
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Prabhat Jha Updated on Dec 29, 2007 – SCMP

A global killer is ripping through the world’s poorer countries largely unchecked. Within 25 years, it will cause 10 million deaths a year – far more than malaria, maternal deaths, childhood infections and diarrhoea combined. At least half of the dead will be aged 30 to 69, losing about 25 years of life expectancy. The culprit? Smoking tobacco. The same addiction that became the top preventable cause of death in western countries has made big inroads in developing nations. Given current trends, smoking will kill about 1 billion people in the 21st century, mostly in developing countries. In India, smoking cigarettes triples the risk of death from tuberculosis in men and from respiratory disease among women.

We know now that quitting works: even those who stop smoking in their forties lower their risk of death remarkably, and those who quit in their thirties have death risks close to those of lifelong non-smokers.

So cessation by the 1.1 billion current smokers would lower tobacco deaths over the next few decades. Tobacco tax increases, the dissemination of information about the health risks of smoking, smoking bans in public spaces and workplaces, prohibition of advertising and promotion, and cessation therapies help smokers to quit and prevent youngsters from starting. Of these, tobacco taxes are as close to a silver bullet as exists in public health. Indeed, they are probably the single most cost-effective intervention for adult health in the world. A tripling of the excise tax would roughly double the price of cigarettes, preventing about 3 million deaths per year by 2030.

Most developed countries began to take tobacco control seriously in the past two decades, reducing male tobacco-related deaths. But effective tobacco control measures are not under way in developing countries. Taxes are about 80 per cent of the street price of cigarettes in Toronto, but less than 30 per cent in Beijing or New Delhi. And knowledge of the health risks from smoking is low: 61 per cent of Chinese smokers in 1996 thought tobacco did them “little or no harm”.

Spurious economic arguments against tobacco control, debunked in the west, are still commonly repeated in the finance ministries of developing countries.

Money not spent on tobacco can be spent on other goods and services. Tax increases lower consumption and raise revenue: a 10 per cent higher tax means about 7 per cent higher revenue over the medium term. These funds can be a precious resource in fighting poverty.

In China, a 10 per cent higher price would reduce consumption by 5 per cent, and raise enough revenue to pay for a basic health package for 33 million poor rural Chinese.

One common argument against tobacco control – that if people are not harming others, governments should not interfere – is at odds with both common sense and the evidence. In countries with good information about tobacco risks, by the time child smokers become adults, more than 80 per cent wish they had never started.

The agenda is clear. Governments must take tobacco seriously as a leading killer of adults worldwide. International poverty goals must include tobacco control. There are hopeful signs: more than 160 countries have signed the World Health Organisation’s global tobacco control treaty, and the Bloomberg and Gates Foundations are stepping up funding for its implementation.

If the proportion of adults in developing countries who quit smoking increases from below 5 per cent today to 30 to 40 per cent by 2020, then 150 million to 180 million tobacco deaths would be avoided before 2050 – half of these in productive middle age.

Benjamin Franklin once said, “In this world, nothing can be said to be certain, except death and taxes.” Yet we have a tax that could prevent hundreds of millions of premature deaths. It is time to use it.

Prabhat Jha is research chair of health and development at the University of Toronto

Experts Aim To Stub Out Tobacco Smuggling

Dec 29th, 2007
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Dec 29 2007 by Marie Levy, Evening Gazette

TEESSIDERS who buy cut-price cigarettes could be smoking mud, dirt and even animal excrement.

The shocking revelation was made as experts in the region joined forces to try to stub out tobacco smuggling in the area.

Hosted by Fresh Smoke Free North East, the 200-strong delegation heard from organisations including the Department of Health and Her Majesty’s Revenue and Customs on the extent of the problem and its serious impact on public health.

The summit revealed:

Up to one in five cigarettes and half of all loose tobacco in the North is sold at knockdown prices.

Smokers often think they are smoking genuine “duty free” products, but increasingly are being sold fake and counterfeit products.

The majority of smuggled tobacco is brought in from Russia and Eastern Europe where packets of 20 cigarettes cost as little as £1 but can be sold on in the UK for about £3.

Counterfeit tobacco – where copies of the bigger known brands are made – are even worse for smokers’ health. All cigarettes contain arsenic and heavy metals, but counterfeit cigarettes sometimes contain even higher levels of these poisonous substances, along with floor sweepings – including animal excrement, mud and dirt.

The North-east has become a hub for the illegal trade in contraband tobacco with unprecedented quantities entering the country via Tees Port as well as the region’s airports. Large hauls of tobacco have been found behind panels on vessels, within loads of logs, flowers, and even concrete blocks.

John Kinghorn, HMRC’s head of detection for the North of England, said: “Many smokers think they are getting a good deal but these cigarettes are usually cheap because they are not the genuine article.

“Counterfeit cigarettes are even worse for health than normal cigarettes and it is not easy to tell the difference.”

Ailsa Rutter, director of Fresh Smoke Free North East, added: “We look forward to working with a number of organisations as we develop an action plan to tackle this problem in the North-east.”

Wisconsin Increases Tobacco Tax for 2008

Dec 29th, 2007
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Posted: 4:37 PM Dec 29, 2007 Last Updated: 4:37 PM Dec 29, 2007 Reporter: Amy Pflugshaupt
Email Address: apflugshaupt@wsaw.com

One of the most common New Year’s Resolutions People make is to quit smoking and this just might be the year that many tobacco users in Wisconsin keep their resolutions.

On January 1st, Wisconsin will raise the tax on all tobacco sales. The US dollar-per-pack increase means Wisconsin smokers will now pay US$1.77 in taxes on every pack of cigarettes. It’s the 12th highest tobacco tax in the nation and it has many tobacco users saying enough is enough.

Local stores are saying many people are coming in and buying several cartons before the increase takes effect.

The campaign for Tobacco-Free Kids predicts the higher tax will stop nearly 66,000 Wisconsin children from starting smoking, and it will help more than 33,000 smokers quit. The campaign estimates the state will save about US$ 1.5 billion in long-term smoking-related health care expenses.

Wisconsin Provide Quit Smoking Starter Kits

Dec 28th, 2007
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Free stop-smoking medications available in new year

New Richmond News Published Friday, December 28, 2007

At a recent news conference in Milwaukee, the Wisconsin Department of Health and Family Services and the University of Wisconsin Center for Tobacco Research and Intervention announced an expansion of Quit Line services for Wisconsin tobacco users who want to quit.

This includes free medication for those who participate in Quit Line coaching, and a new interactive Web coaching service that provides personal tracking tools and discussion forums for those trying to quit.

These enhancements to the tried-and-true Wisconsin Tobacco Quit Line (1-800-QUIT-NOW) come at a critical time for the 800,000 tobacco users in the state.

New Year’s is a traditional time that smokers think about quitting.

Additionally, the excise tax on cigarettes in Wisconsin will increase by $1 per pack on Jan. 1. The expanded Quit Line services are designed to assist the great majority of Wisconsin smokers who want to quit and may try in response to the tax increase and the New Year.

Starting on Jan. 1, Wisconsin residents who call the Quit Line for coaching can obtain a free two-week starter kit of quit-smoking medications that will be mailed directly to their homes, either nicotine patches, gum or lozenges.

Study after study has shown that providing medications in addition to Quit Line coaching is a cost-effective way to get large numbers of smokers to make a quit attempt.

“This is an unprecedented moment for Wisconsin,” said Dr. Michael Fiore, director of UW-CTRI. “We are capitalizing on that moment. The New Year, the tax increase, Quit Line coaching and the free medication represent a combined triumph over an addictive product that kills half of the people who use it. We now have the potential to spare thousands of Wisconsin families from the pain of losing loved ones to tobacco-related disease. I’m so pleased that Gov. Jim Doyle and the Legislature provided the leadership that enables us to offer this assistance to tobacco users and their families.”

St. Croix County healthcare providers have also used the Quit Line with their patients over the years and welcome the enhancements.

“We recently added the ability to fax a patient’s Quit Line request to their staff”, notes Dr. Paul McGinnis, a Western Wisconsin Medical Associates family physician in Hudson. “The patient fills out a brief form, signs it and the Quit Line will call them at a time the patient chooses. The Quit Line, and now medications, are great free benefits for those attempting to overcome tobacco addiction.” Other St. Croix County cessation opportunities can be found by visiting WiQuitLine.org.

The Quit Line is available from 7 a.m. to 11 p.m. seven days a week. At other times, callers can leave a message for a return call. Coaches fluent in many languages are available to callers. The Wisconsin Department of Health and Family Services contracts with UW-CTRI to provide services through the Quit Line.

Slowly, China tries to break tobacco habit

Dec 16th, 2007
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Slowly, China tries to break tobacco habit

That won’t be easy where even many doctors still smoke.

By Tim Johnson

McClatchy Newspapers

BEIJING – Smoking has no place at the Olympic Games. But Beijing Mayor Wang Qishan is a reluctant antismoking crusader. After all, he’s a smoker.

He has company at the Olympic Village, where the chief of the Games’ organizing committee also can sometimes be seen through a haze of cigarette smoke.

An astonishing number of China’s cabinet members and sports officials are among the 350 million Chinese whose cigarette habits support a state industry that is generating more taxes in China than any other industry.

Smoking is common even at the Health Ministry. Deputy Minister Gao Qiang smokes heavily, and surveys show that more than 50 percent of China’s male doctors and health workers smoke.

“They are under high pressure, stress, so they smoke to get relief,” said Zhi Xiuyi, the nonsmoking chief of the lung cancer center at Capital Medical University hospital.

Under growing criticism from the World Health Organization and other international bodies, China is slowly combating tobacco usage.

It has agreed to put warning labels on cigarette packs by 2009 and prohibit tobacco-related advertising and promotion by 2011. Last month, Beijing banned smoking in the city’s 66,000 taxis.

But the state tobacco monopoly keeps increasing production. It’s on course to crank out more than two trillion cigarettes this year. Smokers snap up packs of White Sand, Red Pagoda, Yellow Mountain, and 400 other national brands, adding to state coffers. The tobacco industry contributes $31 billion a year in taxes.

In March, the deputy chief of the state tobacco monopoly warned antismoking campaigners not to press too hard.

“We take very seriously the health dangers of smoking, but not having cigarettes also impacts stability,” Zhang Baozen, deputy chief of the State Tobacco Monopoly Administration, told state television.

Cigarette taxes provide Beijing with steady revenue. According to the World Bank, 8 percent of China’s central revenues come from taxes on cigarettes, compared with 3 percent in Britain, 1.8 percent in India, and 0.4 percent in the United States.

Yet there are signs that the central government is embracing limited antismoking efforts, wary of being out of step with much of the rest of the world.

Last year, Beijing ratified a World Health Organisation antismoking convention that commits it to curb smoking in public places, such as schools and buses, and further limit cigarette advertising.

Global health advocates are urging China to reexamine the economic burden of health issues tied to smoking.

The WHO says that one million Chinese die every year from diseases related to smoking and that the toll will climb to 2.2 million fatalities a year by 2020 if current rates continue. It says China faces $5 billion a year in smoking-related health-care costs, part of what it calls a “massive tobacco burden.”

Perhaps even more surprising, the World Health Organisation says that one-third of all Chinese men below the age of 30 today eventually will die of smoking-related disorders.

Part of the reason is that Chinese are smoking at a younger age and smoking more per day. In 1984, the average age when people began to smoke was 22.4 years. By 2006, it was 19.7.

As incomes rise, Chinese smoke more often. Average daily consumption has risen from four cigarettes in 1972 to 10 cigarettes in 1992 and to about 15 today.

Smoking is deeply ingrained in Chinese culture – male culture, that is.

In China, 63 percent of men smoke, while only 3 percent of women do. At weddings, the bride normally circles the reception hall, offering cigarettes to each man, a rite said to augur well for her eventual childbearing. Cigarettes are also handed out at funerals. Between courses at banquets, male diners frequently pause for a smoke.

China’s soaring economy is precisely why some antismoking activists see light ahead. They say the state-owned cigarette companies are becoming a smaller portion of total tax revenue for the government, making measures to contain smoking more feasible.

In a move that pleased antismoking activists, China last year ratified the WHO’s Framework Convention on Tobacco Control, which requires it to stiffen bans on advertising and promotion. As a result, Beijing told the television industry to cut down on unnecessary smoking scenes and pledged that the 2008 Beijing Summer Games would be smoke-free.

Tobacco Kills 100 Million

Dec 8th, 2007
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Public Health and Cancer Prevention: Success and Future Challenges in Cancer Policy

WEBWIRE – Saturday, December 08, 2007

PHILADELPHIA – Medical research has revealed much about cancer prevention, but is the information reaching all Americans, and are they acting on it? Today, at the American Association for Cancer Research’s Sixth Annual International Conference on Frontiers in Cancer Prevention Research, being held from December 5 to 8 in Philadelphia, Pennsylvania, researchers explore the question of how best to translate cancer prevention science into public health policy.

Quitting smoking and inoculation with the human papillomavirus (HPV) vaccine are two ways that major segments of the general population can drastically lower their risk of developing certain cancers, yet researchers have found that these messages are not necessarily translating into action by the public.

Policies to reduce tobacco harm: What works? Abstract no. A29

To discourage cigarette use, the strategies that are working best on a global basis are to

  • use large graphic package warning labels,
  • ban cigarette advertising,
  • institute smoke-free policies,
  • increase cigarette prices and
  • implement methods to prevent smuggling and counterfeiting of tobacco products,

say researchers at Roswell Park Cancer Institute involved in an International Tobacco Control (ITC) Policy Evaluation study. What hasn’t worked as well as hoped is mandating tar and nicotine levels in cigarettes, they add.

The researchers have been investigating progress on controlling tobacco use from the ongoing Framework Convention on Tobacco Control (FCTC), the treaty devoted to improving public health put forth by the World Health Organization.

The FCTC was adopted by WHO’s member states in May, 2003, and became legally binding for those countries that ratified the treaty in 2005. To date, 151 countries have done so, and are thus required to implement the policies within three years.

“For the first time ever, we are beginning to scientifically assess which governmental tobacco control policies are working and which ones are not” said K. Michael Cummings, Ph.D., MPH, chair of the Department of Health Behavior at Roswell Park Cancer Institute. “In the same way that evidence-based medicine has been built from rigorous evaluation of treatment options, our goal is to contribute to the development of a sound science base for tobacco control policies”

The ITC serves to study which policies are working best in countries that have imposed restrictions, says Cummings. Cummings started the study in four countries in 2002 with a $1.5 million grant from the Robert Woods Johnson Foundation, and to date, $35 million has been raised to expand the research into 15 countries, utilizing the aid of 60 investigators from 17 research institutes.

Because randomized clinical trials can’t be used to evaluate government policies, the ITC study uses as controls those countries that have implemented tobacco control policies and compares the effects on tobacco use behaviors in countries that have not, such as the United States. It is tracking tobacco use behaviors of 1,000 to 2,000 participants in each of the countries, Cummings says. “This is a new model for global public health research that can be used to evaluate other public health policies such as HIV, diet, and cancer screening” he said.

“It made sense for WHO to start off with tobacco as a focal point for action since tobacco use is the leading cause of preventable death in the world today and is a growing epidemic in the developing world” he said. Tobacco use was responsible for 100 million deaths in the 20th century, and that number is expected to grow to 1 billion in the 21st century, he says.

ITC researchers have found that boosting tobacco taxes, comprehensive advertising bans, smoke-free laws, and strengthening cigarette package warnings is an effective recipe for reducing tobacco consumption. “Our research on package warnings has revealed that these warnings, especially if they are large and graphic, are more effective than anyone realized, especially in poorer countries that can’t afford expensive counter-marketing campaigns” he said.

An example of a policy that hasn’t worked, Cummings says, is the European Union’s (EU) establishment of maximum emission standards for tar and nicotine. The goal was to make cigarettes less toxic, but the testing method adopted by the EU was flawed and cigarette makers increased filter ventilation to get around the new rules. Actual exposure to toxins didn’t change. “The well intentioned, but flawed EU policy has given smokers the false illusion that their cigarettes deliver less tar and nicotine, when they don’t” he said.

The ITC has also established the first international cigarette repository, which currently holds 10,000 cigarette pack varieties from 15 different countries. This research shows that tobacco manufacturers alter their products frequently without revealing that they are doing so, he says. “Foods and drugs are regulated so that consumers are informed when the products are altered. The same should be true for tobacco products” Cummings said.

Licensing Scheme For Tobacco Sales in Hong Kong?

Dec 5th, 2007
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Breaking down Big Tobacco

Article Launched: 12/05/2007 08:17:50 PM PST

WHAT’S the No. 1 product sold at your local convenience store? Milk? Beer?

No and no. Guess again. Lottery tickets? Guess again.

OK, give up? It’s cigarettes. Convenience stores in the U.S. last year sold $56 billion worth of cigarettes, accounting for 35 percent of their sales, according to the Center for Tobacco Policy and Organizing’s 2007 State of the Industry Report.

Why are we telling you this? Because the county of Los Angeles is considering establishing a licensing policy for tobacco sellers that strikes at the heart of the convenience stores’ bread and butter. Frankly, the convenience stores are scared to death of such an arrangement because it would lead to a long-overdue tobacco-sales enforcement program that would clamp down on sales to minors.

Considering the cost of tobacco use to residents’ health, local hospitals and taxpayers (Medi-Cal and other entitlements), this figures to be a worthwhile county program. In LA County alone, the health care cost from diseases that are tobacco-related is $2.7 billion. Any drop in sales – especially to minors – would be good for the county and its residents.

Already, some cities police tobacco sales run through convenience stores. Usually, studies show, it sends scofflaws into stores located in county unincorporated areas. The county’s proposed $235-a-year license fee – set for a Dec. 11 vote by the Board of Supervisors – would help shore up this illegal tobacco loophole in unincorporated areas such as Altadena, Rowland Heights, Valinda, Hacienda Heights, etc..

For example, since Pasadena began levying a tobacco sales license fee on stores within its city limits, it has resulted in greater enforcement. Retailers selling cigarettes to minors (that’s illegal, by the way) quickly dropped from 23 percent of retailers in Pasadena to 6 percent. And recently that has gone down to zero, according to testimony given to the county Board of Supervisors from Statice Wilmore who oversees Pasadena’s program.

However, the problem may have moved. According to Day One, a nonprofit group in the west San Gabriel Valley, stings they’ve conducted using underage patrons found convenience store clerks more than willing to sell them cigarettes. The county figures that more than 30 percent of retailers sell cigarettes to minors. Day One’s 15-year-old decoy from Pasadena High School said stores in county areas such as Altadena would ask for her ID, realize she was a minor, but sell her the pack of smokes anyway.

Talk about flaunting the law. This is right up Big Tobacco’s alley: Getting more of our young people hooked on cigarettes.

It’s time to break up the axis of death between Big Tobacco and convenience stores. Because there’s nothing convenient about lung cancer and heart disease.

Tobacco industry uses dangerous additives

Nov 26th, 2007
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Published in The Copenhagen Post on the 26th of November 2007:

Research indicates cigarette makers have increased the risks of smoking by adding chemicals

A new study from the Danish Cancer Society charges the tobacco industry with knowingly adding at least 200 different chemicals to its products in order to make it easier for people to smoke.

Some of the chemicals also increase the addictive power of nicotine, according to Per Kim Nielsen of the Cancer Society.

He added that some of the chemicals are directly harmful to the body.

‘We know that smoking causes cancer. But some of these additives increase the risk of developing cancer,’ Nielsen told public broadcaster DR.

Scandinavian Tobacco, Denmark’s largest producer of tobacco products, categorically denied using additives in order to increase the potency of its tobacco products.

Cigar Show Air Quality

Nov 22nd, 2007
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Published in the New York Times November 22, 2007

At a Cigar Show, an Air-Quality Scientist Under Deep, Smoky Cover

By SARAH KERSHAW

The agitators met a few blocks from the target at a secret location, so as not to call attention to the devices in their bags.

They synchronized their watches. They reviewed the well-rehearsed game plan: If their bags were searched, the first operative, known as “Researcher 1 (female),” would say the device was for an asthma condition. If she was not allowed into the event with the device, she would activate Plan B: go to the ladies’ room and strap it to her body.

The man behind the subterfuge (Researcher 2, male) was Ryan David Kennedy, 34, a scrappy Canadian graduate student with crooked glasses who is studying the impact of tobacco on air quality.

He crossed the border at Buffalo on Monday morning and on Tuesday crashed the giant cigar party and trade show sponsored by the publisher of Cigar Aficionado magazine at the Marriott Marquis in Times Square.

A nonsmoking vegetarian posing as a cigar lover, Mr. Kennedy was nervous. Canadians are, for the most part, known to be earnest, demure and very law-abiding.

“I think I’m being watched,” he said before the event, known as the Big Smoke, which drew hundreds of cigar lovers and peddlers into a ballroom on the hotel’s sixth floor. He said he strongly believed his room at the Marriott had been searched.

Mr. Kennedy, who holds a master’s degree in environmental science from the University of Waterloo in Ontario and is working on a doctorate in psychology there, soon found himself in the belly of decadence. The ballroom was swarming with stogies — Bolivar, Ashton, Don Tomas and a dozen other brands — whiskey, tequila and exotic dancers.

Mr. Kennedy, who has also researched the level of particulate matter produced by smoking tobacco on outdoor patios, and Kerri Ryan (Researcher 1), a friend from college who lives in New York, sneaked their devices in the door. (Mr. Kennedy’s professor used a discretionary fund to cover the costs of the event tickets — $400 each — and other expenses.)

A tiny white plastic tube protruding from each of their bags like a hidden microphone took in the air, which was then measured for particles by the device, known as a Sidepak. The device can log 516 minutes of air sampling before the battery runs out, and is a well-established method for detecting dust and smoke.

Mr. Kennedy measured the particles in the air on Monday to obtain a baseline before the cigar smokers descended. Then on Tuesday he tested the air inside the ballroom and in various places outside the cigar party — at the elevators, in guest rooms and in the lobby. To log enough data on the air, he would need to stand in one place for 5 or 10 minutes and look busy.

If Mr. Kennedy and Ms. Ryan were lurking in one place for too long, perhaps seeming suspicious to security guards, they would say loudly, “We’re waiting for Sally.”

It was easy for Mr. Kennedy to prove his thesis: that plumes of cigar smoke lead to high levels of particulate matter in the air.

Marriott Hotels announced in July that it was making all of its hotels 100 percent smoke-free, but it has made an exception for the Big Smoke.

Opponents of smoking working with Mr. Kennedy said the exception was a glaring violation of the hotel’s own policy.

“The event is really a flagrant contradiction to their commitment to their guests and employees,” said Louise Vetter, president of the American Lung Association of the City of New York and a spokeswoman for the New York City Coalition for a Smoke-Free City. “The dangers of secondhand smoke are indisputable, and in New York City it is law to protect workers from secondhand smoke. We applauded Marriott, but to have this event in New York City and to create an exception — there’s no exception for public health.”

Under the state law, smoking is banned in most indoor places, including the Marriott ballroom (though there is no legal ban on smoking in guest rooms). But the law allows an exception for tobacco promotional events “where the public is invited for the primary purpose of promoting and sampling tobacco products.”

Cigar bars that were open in the city before Dec. 31, 2002, and can prove that they generated at least 10 percent of their gross income from the sale of tobacco products are also exempt; they can extend their registration each year if they continue to meet those criteria and do not expand or change location.

Kathleen Duffy, a spokeswoman for Marriott Hotels, said the company was honoring a longstanding contract with the publisher of Cigar Aficionado, Marvin R. Shanken, and had been the host of the Big Smoke at the Marriott Marquis for at least 10 years.

“We are not going out and booking smoking events at any of our hotels,” she said. “We did announce we would be smoke-free, but with this client we had an obligation.”

She said “we tripled our efforts” to keep the smoke contained, banning smoking outside the ballroom and increasing the filtration in the room, so that the smoke was funneled outside the hotel through air vents.

Under Environmental Protection Agency guidelines, air with fewer than 15 micrograms per cubic meter is considered good quality; air with more than 251 micrograms per cubic meter is hazardous.

Mr. Kennedy’s preliminary findings showed that the average level of particulate matter in the hotel the day before the event was 8 micrograms per cubic meter, 40 micrograms where he was waiting to get in line for the event and 1,193 micrograms inside the ballroom.

About 10 p.m., after one last measurement — “Elevators, 9:44!” Mr. Kennedy said to his assistant — he was bloodshot and stinky, but he declared the experiment a success.

Dr. Judith Longstaff Mackay

Nov 5th, 2007
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Published in Time Sunday, Nov. 05, 2006

Judith Mackay
By Liam Fitzpatrick

Dr. Judith Longstaff Mackay is a witty and loquacious Englishwoman, who works as a tobacco-control advocate and senior policy adviser to the World Health Organization (WHO) out of her house in a bucolic Hong Kong suburb. Visitors are shown to a living room that, with its working fireplace and comfortable armchairs, seems to spring from the platonic ideal of a family home. As she pours you a glass of iced water it seems ludicrous to think that a leaked tobacco-industry document once named her as one of the three most dangerous people in the world. Even more absurdly, she has been described by a U.S. smokers’ rights group as “a gibbering Satan.” Mackay loves this sort of thing. She keeps a list of all the insults that smokers and tobacco executives have leveled at her over the years.

The tobacco industry has got it wrong, of course. Mackay isn’t merely one of the three most dangerous people. She’s probably the most dangerous. Just last week, financial-media tycoon and New York City Mayor Michael Bloomberg announced that he will donate $125 million to five tobacco-control groups. The lion’s share is slated to go to the World Lung Foundation, earmarked for programs in developing countries, over half of which are in Asia. As the foundation’s project coordinator, Mackay will determine how that money will be spent. “For many Asian tobacco-control groups, this is the first time they will have had any significant money,” she says. Given what Mackay has achieved with negligible funding to date, it’s tantalizing to imagine what she will do now with real financial clout.

Her biggest triumph so far has been the 2003 Framework Convention on Tobacco Control, drawn up between all 192 member states of the WHO and stipulating restrictions on tobacco ads and public smoking. Mackay was instrumental in persuading states to sign it and in framing its provisions. Prior to this, she spent years advising the governments of China, Hong Kong, Indonesia, Japan, Laos, Malaysia, Thailand, South Korea, Singapore, Taiwan and Vietnam on tobacco-control policies and legislation. A gifted diplomat, she charms her way to the top, exerting influence where it matters most. She’s also unafraid of artful compromise. “If a health minister tells me that he can’t ban tobacco advertising on TV, then I’ll ask them to ban it between 4pm and 8pm, or whatever. They almost always agree.” As cigarette firms know, there is no more dangerous weapon in the fight to save smokers’ lives than the quiet persuasiveness of Judith Mackay.

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