Anti-tobacco campaigner Judith Mackay will never give up her fight
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In 1984, as a doctor at the United Christian Hospital in Kwun Tong, Judith Mackay treated people with tobacco-related diseases and wrote in a weekly column for this newspaper of the risk of smoking.
Someone she did not know sent her a copy of a document written by British American Tobacco. "The anti-smoking lobby in Hong Kong is largely anonymous, unidentifiable, entirely unrepresentative and unaccountable," it said. "The tobacco industry comprises identifiable, legal, accountable, commercial organisations."
Reading this document changed her life. "I was outraged," she said. "It was a turning point in my life. I realised that public health was the only way to save many lives. Treating patients in hospital was like band-aid; we could patch them but could not often save them."
She resigned her job to become a full-time campaigner for tobacco control, a mission she continues. "We have saved tens of thousands of lives. In Hong Kong, 200,000 people have either quit smoking or been deterred from starting."
Mackay was one of the main authors of the Framework Convention on Tobacco Control (FCTC) global treaty of the World Health Organisation, the most important piece of tobacco control legislation in history. It came into force in 2005 and 168 nations have ratified it.
She has been a major force in changing consensus in Asia. In 1984, she was a lone campaigner for tobacco control - now the cause has been adopted by governments, NGOs and academics across the region.
But, for all this progress, the number of smokers in the world is growing and 6 million people will die this year of tobacco-related diseases, 72 per cent of them in low and middle-income countries.
She remains as passionate as ever about fighting what she calls the tobacco pandemic and, at 67, has no intention of lowering her voice. "My mother lived to the age of 95 and I plan to do the same. I will not retire."
She now works as senior adviser to the World Lung Foundation component of the Bloomberg Initiative.
This role, as Asia's health ambassador, is a far cry from the seaside village in Yorkshire, where she was born in 1943 and where she remembers hiding under a staircase during bombing raids in the second world war. Her father was a captain in the British Merchant Navy, doing the dangerous work of transporting soldiers; she did not see him until she was two years old.
"My father was a heavy smoker until 1945. I had bronchitis and the doctor told him to stop smoking in front of me, which he did. He was the first life I saved," Mackay recalled, speaking in the spacious home in Sai Kung where her office is and where her family have lived for 40 years.
An outstanding student, she passed her university entrance at 16; too young to enter an English university, she studied medicine at Edinburgh, the first university in Britain to admit women to this faculty.
In 1963, as an exchange student, she treated patients at clinics in black townships outside Cape Town. "I helped to deliver many babies, one the 11th of one mother. She asked me my name and named her daughter after me."
She became an intern at Edinburgh City Hospital in 1967, working one out of every two nights. She saw John Mackay, a doctor from Hong Kong who was doing a post-graduate degree at the same hospital. "The second I saw him, I knew I would marry him. A cautious Scot, he took longer to convince." They married four months later; John returned to Hong Kong to see if it was safe for her to come in the midst of the Cultural Revolution while she completed her internship.
She joined him in the city. They had two sons and she worked part time as a doctor in an army family clinic and then three years at Queen Mary Hospital, where she passed the examination for the British College of Physicians.
Her interest in tobacco control began in United Christian Hospital. "We saw smokers die. We could not save many of them. I was moved."
In 1987, she became the first executive director of the Hong Kong Council on Smoking and Health, but stepped down in 1989 because she was in such demand from Asian countries including China, Malaysia and Cambodia.
She created and grew the role as an ambassador for tobacco control in Asia. "I was old enough to be taken seriously. I was female and seen as less threatening. I was seen as someone who knew Asia and I did not belong to one Asian country. China, for example, would not have invited a Malaysian to advise them on tobacco control.
"There were many such people in North America, Europe, Australia and New Zealand. I was alone in Asia. Philip Morris thought Asia was theirs for the taking, that the Marlboro house could ride in unchallenged, to safe and open ground."
The tobacco companies reacted with anger, hostility and threats of lawsuits. At one time, she was offered 24-hour protection by Hong Kong police. Fears for their safety was one reason to send their two sons to boarding school in Scotland, when they were 12 and 13.
During a trial over cigarette smuggling in Hong Kong, at which she testified as an expert witness, she was followed by a woman whom she believes was sent by British American Tobacco. "There was always an issue of surveillance."
She received hate mail, such as a letter from Carol Thompson of the Smokers' Rights Action Group of Madison, Wisconsin, dated November 14, 1992. "Your `health data' are the trumped-up production of psychotic human garbage ... you are all insane psychotics just like Hitler ... you are devoid of any sanity, morality or human-being-ness of any kind ... if you think that we exist to be slaves to your statistics, we should turn on you and your filthy, evil profession and utterly destroy you."
The FBI visited Thompson and warned her that, if she wrote such a letter again, she would be arrested.
In her advocacy work, Mackay chose to concentrate on dealing with governments.
"Governments are fundamental to solving the epidemic. Only governments can introduce tax policy, ban advertising and mandate smoke-free areas."
Working with the WHO, the Union Internationale Contre le Cancer and advocacy groups in each country, she met ministers, prime ministers and heads of state, including Li Peng and his wife, Zhu Lin. "Li used to smoke but gave up. He and his wife were very supportive of what I was doing. A nod from the top is very important in Asia."
Her method is not confrontational but diplomatic, persuasive and witty. Whenever she visits a country, it is always upon invitation. "Criticise people and tell them what to do - you will not succeed. Discuss with them what other countries are doing and ask what they consider the next possible steps. Do not offend people. I have become Asian."
After the Soviet withdrawal in 1990, the Mongolian government invited her to write its tobacco control law, which it passed in 1994.
Her greatest legal achievement is the FCTC, which was first proposed by Ruth Romer, an American professor of health law. Mackay presented the idea to then WHO director general Dr Gro Harlem Brundtland, who accepted it.
It took 10 years and thousands of hours of meetings to approve. "The US had two faces. The Department of Health and Human Services and Centres for Disease Control and Prevention wholeheartedly supported it, but the State Department, the government negotiator, tried to thwart and weaken in on many occasions. Many countries were very disappointed at this hypocrisy - promoting tobacco control at home but not abroad.
"The US proposed that countries could opt out of certain clauses, which would have undermined the treaty. Its tactics were so offensive that many small and medium-size countries voted for the treaty. They felt that the FCTC would give them protection against multinational tobacco companies."
The treaty places countries under international legal obligations to implement tobacco control measures. The US has signed it - but is not among the 168 countries that have ratified it.
Since 1993, Mackay has also authored or co-authored a series of health atlases, which present the terrifying facts of the pandemic in clear maps and graphics with a minimum of text for easy understanding. She has sent these atlases to nearly all governments in the world.
She has devoted more time to China than any other country. It has 350 million smokers, a third of the global total, and its government is the world's largest tobacco company. Although it has ratified the FCTC, it has not reduced the numbers of smokers, unlike Japan, Taiwan, Malaysia and many other countries in Asia.
"It will be a long, hard struggle. It is getting the system in place. The Beijing Olympics and World Expo in Shanghai were smoke-free. Guangzhou aims to be the first smoke-free city in China, banning it in the workplace," she said.
She has received many awards for her work, including the Chinese National Medal Award in 1991 from the minister for health, a medal from the king of Thailand in 2000, the Silver Bauhinia Star from the Hong Kong government in 2006 and an OBE from Britain's Queen Elizabeth II in 2008. In 2007, Time magazine selected her as one of the "100 most influential people who shape our world". Last year, she received the British Medical Journal Group's first lifetime achievement award.
"My biggest contribution has been motivating and supporting others, moving tobacco control in low-income countries from the very lonely job in the last century to one today involving hundreds of people," she said at the award ceremony in London.
Away from her work, she enjoys golf, tai chi, swimming and family life: her husband has retired from his work as a doctor and is a keen mountain trekker. They spend the summer holidays with their two sons, who are happily married and settled in Britain, where one is a doctor and the other an environmentalist.
"Away from the tobacco companies, I believe in harmony."
Source: www.scmp.com
