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In this occasional series we record the views and personal experience of people who have especially contributed to the evolution of ideas in the journal's field of interest. Dr Judith (née Longstaff) Mackay was born in Yorkshire and grew up in post-war England. She is a medical graduate from the University of Edinburgh. She has lived in Hong Kong since 1967, working initially as a hospital physician, then since 1984 concentrating on public health, especially tobacco control in low-income countries, which has brought her into direct conflict with the tobacco industry. She has extensive experience of working with national governments and health organizations in Asia to develop comprehensive tobacco control policies [1].

Addiction (A):

First, let us look at ‘Mapping Mackay’, an autobiographical map, commissioned especially for this Addiction interview. You have developed a third career in authoring or co-authoring now 10 health atlases. Your first atlas, The State of Health Atlas [2], was produced in 1993 by Myriad, so this ‘Mapping Mackay’ spread is a nice celebration of the 20th anniversary of your maps and atlas production. How did you come up with the idea of producing a series of health atlases?

Judith Mackay (JM):

Myriad was already producing atlases on a wide range of topics, and between us, we came up with the idea of a health series. I have developed a complete passion for morphing complex health statistics into creative maps and catchy, engaging graphics, which can be understood by a wide range of people, from students to politicians, who then become engaged in the issues.

A:

Are you the one who has produced the largest number of maps and atlases on health, tobacco and related issues? Your Tobacco Atlases are probably among the most cited references for tobacco control.

JM:

I think I am. I do not know the exact number of citations, but the single most important influence is shown in the 2009 picture of Bill Gates holding up the second edition of The Tobacco Atlas at a Press Conference and declaring that this was the publication that had made him become involved with tobacco control.

A:

How does someone born and brought up in a small seaside village on the north-east coast of England end up working as a health advocate on tobacco control in Asia and fighting the tobacco industry? Tell me about your early childhood.

JM:

I little predicted such a future. Until I went to medical school, I lived with my parents and grandparents, attended a local school, and rarely travelled out of England. My upbringing was quite old-fashioned; my parents provided a stable, supportive and caring environment. Looking back on childhood influences that shaped my life, my late mother most certainly transmitted the fighting spirit and I am very like her in temperament. My father was one of nature's gentlemen. He went to sea in 1912 when he was only 15 years old, and he spent his whole life in the Merchant Navy. He was away at sea for all but a few weeks each year; because of World War II, he did not see me until I was almost 2 years old. He had an extensive knowledge, respect and love for the sea (which I have inherited). At home he was a calm, gentle and kind man, a good complement to my mother's more dynamic personality. As the years go by, I believe I increasingly exhibit his quieter qualities. Both encouraged me to take my work very seriously, and supported me without question to undertake the lengthy medical course at the University of Edinburgh in Scotland.

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1984: Starting out in the tobacco control world

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

You have devoted (and ‘donated’) almost three decades of your life to working full time on tobacco control, most of these years without a salary. When and why did you leave clinical medicine for public health and tobacco control?

JM:

I graduated in medicine from the University of Edinburgh when I was only 22 years old, and then moved to Hong Kong in 1967, where I trained and worked as a physician in hospital medicine for many years. I left clinical medicine in 1984 for three main reasons. First, we had a maxim on our male medical ward that we never admitted a non-smoker. In true public health philosophy, I felt that someone needed to go higher up the river to stop people falling in, not just rescuing or attempting to rescue them when they became sick. In other words, I realized that health would never be improved by focusing mainly on the late-stage ‘ambulance service’. Secondly, I was very involved with women's issues in Hong Kong, and especially in women's health. In those days this was defined in gynaecological terms, but I realized that women were being targeted by the tobacco industry, and that tobacco was killing more women than all forms of contraception combined. Thirdly, one of the transnational cigarette companies published a booklet in 1982 claiming that the ‘anti-smoking lobby in Hong Kong [only myself at the time] is largely anonymous, unidentifiable, 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.

A:

During these early days, were there other people working full time on tobacco control?

JM:

There were some in the high-income, western countries, but even of these, few worked full time in tobacco control. When I started working in tobacco control in Asia more than a quarter of a century ago it was a lonely job, with no career structure and no pay. I do not think there was even another person working full time on tobacco control. I also faced formidable opposition from transnational tobacco companies who had their future in Asia, with its large populations of smoking men, who might be persuaded to change to international brands, and very low prevalence rates among women, who might be persuaded to smoke.

A:

You started your tobacco control advocacy in Hong Kong and became the founding executive director of Hong Kong Council of Smoking and Health (COSH) from 1987–1989. What were your major achievements in Hong Kong then?

JM:

The Council was the first such government-funded council in Asia and was thus a pioneer and an exemplar, even the early influence of which spread much further than the 7 million population of Hong Kong [3].

A:

Did you receive any threats when you started working in tobacco control in the 1980s?

JM:

My work brought me into direct conflict with the tobacco industry and its supporters and I certainly received threats and abuse. At one time, the Hong Kong government offered me police protection because they were seriously concerned about my personal safety, but I declined to have a policeman at my side for 24 hours a day. The government then said they would ‘let it be known’ that if anything were to happen to me, they would launch an enquiry. I did not receive support or protection from the British overseas diplomatic corps: the British government was supporting British industry and, in those days, that included the British tobacco companies. British cigarettes even carried a Royal Seal, now long gone.

A:

When did you set up the Asian Consultancy on Tobacco Control, and what does it do?

JM:

I set up this personal consultancy in my own home office in 1990, with no secretary or any other support staff. Its goals were to focus on tobacco control in Asia, and to assist Asian countries to undertake tobacco control measures, especially legislation and tobacco taxation.

A:

Can you outline some of your work on tobacco control?

JM:

I worked in North America, Europe, Africa, the Middle East, but particularly in Asia, encouraging anti-tobacco policy and legislation, meeting with senior health officials, members of government and speaking at conferences, for example in the United Kingdom, United States, Argentina, Cyprus, France, Finland, Sweden, Norway, Hungary, Switzerland and South Africa; in Asia: Cambodia, the People's Republic of China, Indonesia, Japan, Republic of Korea, Laos, Malaysia, Mongolia, the Philippines, Singapore, Taiwan, Thailand and Vietnam; and in Australasia: Australia and New Zealand. I had no less than 20 working visits to China on tobacco control in the decade between 1987 and 1997, in locations as diverse as Beijing, Shanghai, Wuhan, Guangzhou, Baoji, Shanxi, Hangzhou and Jiangxi, and even one national meeting on tobacco that was held on a boat on the Yangtze River before it was blocked off to construct the Three Gorges Dam. These visits were usually under the auspices of the World Health Organization (WHO) or the Union for International Cancer Control (UICC), or at the invitation of the Ministry of Health or the National Academy of Preventive Medicine in China.

A:

You were, of course, very active in those areas?

JM:

In addition to representations to the government and Legislative Council in Hong Kong, too numerous to mention, in 1989 I was invited to act as adviser to the Ministry of Health in China to help draft its tobacco legislation and establish a national body for smoking control, the Chinese Association on Smoking and Health. In 1990 I was appointed by the Minister of Public Health in China as one of only two foreign Senior Advisers to the Association.

Going forward

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References

In 1990, I was invited by WHO to prepare a national tobacco control programme for the government of Mongolia, including drafting a National Tobacco Act. In 1992 I was invited to become an Adviser to the Department of Health in Taiwan in relation to the challenging of the national advertising ban by the United States Trade Representative.

A:

Tobacco trade policy?

JM:

I have made representation on tobacco trade policies to the Inter-agency Committee Meeting (1988) convened by the US Surgeon General; to the US General Accounting Office (GAO), National Security and International Affairs Division; to staff of the US Senate Committee on Labor and Human Resources in 1989; before the Committee of Commerce, Subcommittee on Health and the Environment, in 1990; and to the USTR in 1992 regarding China and Taiwan. I was invited by the Ministry of Health of the Philippines to appear before Senate hearings on health warnings in 1994.

A:

Other contacts?

JM:

Since 1994, I have made innumerable representations to the United Nations (UN), WHO and national governments. One recent example was an address in 2008 at the UN in New York for the buildings to become smoke-free (which was implemented).

Computer literacy

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

You were among the first in Asia to use a computer, a portable printer and other equipment when you travelled, taking down notes of meetings and conferences directly onto the computer and writing your reports even before flying back to Hong Kong.

JM:

Working on my own, I had to learn to be computer-literate and self-sufficient. I learned to use a computer in the days before hard disks—there were two floppy disks inserted into the side of the computer, one for the Wordstar programme, and a second of 2 MB for data! I undertook the only computer course on offer in Hong Kong in the early 1980s, but it was in Cantonese, so it was very tough. Computers crashed every half-page in those days, deleting the green characters on a black background—long before the days of graphics. It is just so much easier nowadays, although I sometimes feel that computers and e-mails are in danger of exerting a tyranny over our lives.

Personal advantages

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

You have said you felt there was an advantage of being a woman in your unique job, especially when you visited and talked to high-level government officers around Asia.

JM:

Being female and ‘foreign’ was a double advantage. I was sometimes the first western consultant to visit some countries, such as Mongolia, and I think that many countries found me less intimidating than if I had been a man; and, while I was, and am, perceived to be part of Asia (many colleagues call me an honorary Asian), not being from one particular country or nationality made me seem less partisan. For example, it is unlikely that China would have asked a Malaysian or Indonesian man or woman to advise them on national policy. Being British but being a long-term resident in Hong Kong was the perfect combination.

A:

You learnt Cantonese and then started learning Putonghua (Mandarin) long before many local Hong Kong people did, and you started your speeches with Putonghua greetings in conferences on the Chinese Mainland. Why did you do that?

JM:

My remarks in Putonghua at Opening Ceremonies were always applauded enthusiastically by the hosts and the audience. They perceived the real effort I was making, but did once remark that I spoke Putonghua with a Cantonese accent. I still continue to start my talks in Putonghua, but I am also astonished at the rapid increase in the use of English in China itself.

A:

Your first attendance at a conference in China was the symposium on smoking and health in Tianjin, China in 1987. What was the significance of this meeting?

JM:

The Tianjin meeting (May 1987) was the first tobacco control conference in China, and the subject was deemed so sensitive that it could not be held in Beijing, so we all trooped down the river to Tianjin. It was a critical event, in that it was at this meeting that the idea of a tobacco control law in China emerged, and even the elements of what it should contain were drafted in Tianjin. It was an amazing privilege, looking back, to be involved at the birth of tobacco control in China, along with colleagues such as Richard Peto and T. H. Lam.

‘It was an amazing privilege, looking back, to be involved at the birth of tobacco control in China, along with colleagues such as Richard Peto and T. H. Lam.’

A:

What of other early landmark meetings?

JM:

My first World Conference on Tobacco or Health was in Tokyo (November 1987), and I have participated in all since then; but I must mention that that World Conference was preceded by the first international planning meeting in 1985 in Washington DC, organized by the American Cancer Society, rather grandly called ‘The First International Summit of World Smoking Control Leaders’. It was particularly important for me as I met colleagues from China for the first time, such as Professor Weng Xinzhi, who organized the first national smoking survey in China.

A:

You had meetings with top officials in China (and other countries). Why?

JM:

Tobacco control in Asia (like governance in general) is more top–down, and it is critically important to gain the approval and support of the top leaders. In China, I met personally with both Premier Li Peng and also President Jiang Zemin.

A:

Did you bring in funding to support meetings and tobacco control work in Asia?

JM:

In the early days, the UICC was the main funding agency for national tobacco control conferences in Asia, giving me US$10 000 to organize each meeting. I travelled extensively in Cambodia, China, Indonesia, Japan, Korea, Laos, Macau, Malaysia, Mongolia, Philippines, Singapore, Thailand and Vietnam. In those days, US$10 000 paid for the meeting and even allowed seed money to be left in the country for ongoing research and activities. Through the 1980s and 1990s I also spoke at many international meetings world-wide, always with the focus on low- and middle-income countries.

Life on the road

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

Tell us about your first visit to Mongolia.

JM:

I first arrived in Mongolia in 1990, the very week the Russians left and the very day the new Mongolian Parliament opened. The Ministry of Health had prepared an education project in schools to demonstrate to me. However, I asked so many questions about the economic aspects of tobacco—import, taxation, employment, fires caused by careless smoking, etc.—that the Minister of Health later told me that they had suspected I might be a western spy and had held a cabinet meeting to discuss this possibility. I later asked him what their conclusion had been and he said they decided I was not, but my questions had opened their eyes to the political, trade and economic aspects of tobacco. The Minister also asked me to prepare a first draft of a tobacco control law—the night before I was leaving. I was up all night, but delivered it just before I took the then once-weekly flight out of Ulaan Baator. It became law a couple of years later, being one of the most comprehensive tobacco control laws in the world.

A:

The map shows your three most dangerous moments. Were there more?

JM:

Public health is usually thought of as rather staid, even boring, compared with the excitement of working in intensive care, for example, but in the course of my career, in addition to having, as shown on the map, been held at gunpoint by Presidential guards in Mongolia, I have been taken hostage in caves in Ha Long Bay, Vietnam, vilified by the tobacco industry, likened to Hitler, threatened with lawsuits and received death threats from smokers' rights groups; I have also worked through martial law in Thailand; kept speaking throughout a typhoon in Hong Kong; continued with a PowerPoint presentation when a large explosion shook the building in Cambodia and the ceiling started to come down, which turned out to be the detonation of an ammunitions dump; and broken my ankle in three places from tripping over a step at a conference in Korea

‘…in the course of my career … been held at gunpoint by Presidential guards in Mongolia … taken hostage in caves in Ha Long Bay, Vietnam…’

A:

Do you have any other unforgettable memories of country visits?

JM:

Many—public health is certainly never dull, and sometimes has involved hardship as well as fun. In the 1980s and 1990s, I slept in rooms in a Ministry of Health guest house with earthen floors and a single, faint light bulb strung from the ceiling, with cockroaches the size of small mice; in another location, my room was under 6 inches of water throughout my visit; in several places my sleep was destroyed by smokers coughing all night in surrounding rooms; in my first 2-week visit to Mongolia I was served mutton for every single meal, including breakfast, as no fruit or vegetables were then available. On a World Bank visit to an Asian country, there was a mass birth of hundreds of baby cockroaches in the hotel, and I had to go to bed with my ears blocked with cotton wool and sleep under the covers in fear of them ‘invading’ me. Another was the Rural Farmers Quitting project in China in 1992, when an entire village followed me into the communal barn-like toilet to watch! On the same project an elderly woman with bound feet asked me if I was Japanese; she knew I was not Chinese, but the only other foreigners that she knew of were the Japanese.

A:

In addition to passion, do you need courage to work on tobacco control?

JM:

Younger colleagues who work in tobacco control are exceptional, committed and enthusiastic and, only recently, there have been threats to those involved with exposing tobacco industry behaviour and tactics and those promoting plain packaging: the battle is far from over.

Drafting

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

You have been drafting resolutions or recommendations for international conferences and countries. How have these evolved from simple measures to the most recent and much more stringent ones, such as the resolutions for the 2012 World Conference in Singapore?

JM:

I seem to have been drafting laws, resolutions, recommendations and constitutions for countries, conferences, organizations for decades! The first was in 1987 in Tianjin helping draft the first tobacco control law in China.

There is a clear trend towards these laws becoming tighter, more specific and measureable, so the days of a conference recommendation stating a rather vague notion of reducing smoking has been replaced by ‘10 countries will introduce plain packaging before the next world conference’. Bans on tobacco promotion, for example, have had to be tightened as the tobacco industry becomes increasingly ingenious in thinking up new methods of promotion, such as using the new media.

A:

You also participated in meetings to decide on bids to hold international conferences on tobacco or health: are there now more bids, making decisions more difficult but, at the same time, showing expanding enthusiasm from more and more countries?

JM:

For the last 20 years I have been a member of the International Liaison Group on Tobacco or Health, the organization that selects the venues for the triennial world conferences, and serving as chair from 2003 to 2009.

A:

How are the bids considered by this Group?

JM:

The bids are complex, as there are many factors to be taken into consideration: the infrastructure to support a bid (e.g. hotels, accessibility such as air flights), government support, costs, funds, staff, geographic location as we try to move the meetings around the six WHO regions, even issues such as allowing all nationalities to enter a country. It is a great logistical and financial undertaking to organize a world conference, as I found when assisting the 1997 World Conference in Beijing. However, more countries are keen to host, which is a good sign.

Also, by the way, we had feared that the tobacco control movement was ageing, but the Mumbai (2009) and Singapore (2012) World Conferences were attended by many younger delegates. This is probably a direct result of the Bloomberg Initiative, now joined by the Bill and Melinda Gates Foundation, in creating career paths and funding in tobacco control in the low- and middle-income countries.

A:

Have you worked with many international organizations?

JM:

Since 2006, I have been working with the Bloomberg Initiative and its key partner organizations—the Campaign for Tobacco-Free Kids, the CDC Foundation, the Johns Hopkins Bloomberg School of Public Health, WHO and especially World Lung Foundation. I work with many other international organizations, such as the Bill and Melinda Gates Foundation, the UICC, the World Heart Foundation, the Global Smokefree Partnership, the Asia Pacific Association for the Control of Tobacco (APACT) and South East Asia Tobacco Control Association (SEATCA), as well as many national organizations.

A:

You are interested in women's issues?

JM:

I have always been particularly interested in women's issues, and in 1990 was a founding member of the International Network of Women Against Tobacco (INWAT), a network currently of more than 1800 members in 100 different countries working towards the elimination of tobacco use and exposure among women. I have done my best to ensure that women are represented on committees, at conferences, at the highest level of policy and decision-making, to make certain that the issue on smoking and women will be kept firmly on the agenda. For example, when China asked me to help them organize the 10th World Conferences on Tobacco or Health in Beijing in 1997, I said I would do so on one condition—gender equity. When asked what that meant, I said it meant equal men and women as plenary speakers, chairs, on committees and, if low-income countries asked for financial funding, then they should submit equal numbers of men and women. China initially said it could not be done, but I said it could, I would show how, and we did. Since then, all World Conferences have adopted the principle of gender equity.

The WHO Framework Convention on Tobacco Control (FCTC)

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

What was your role with the WHO FCTC?

JM:

The initial idea for a Framework Convention was seeded far from Geneva, in an academic paper. In 1993 Allyn Taylor, in the American Journal of Law and Medicine, called upon WHO to use legal mechanisms to attain its goal of ‘Health for All by the Year 2000’. The late Ruth Roemer saw the article, met with Taylor, and suggested to her the possibility of applying her ideas to develop a specific international regulatory mechanism for tobacco control, a field in which WHO had a strong, established policy. On 26 October 1993, Ruth Roemer invited me for a breakfast I shall never forget, during the annual American Public Health Association conference in San Francisco, and suggested I convey the idea of a Convention to WHO in Geneva and to UNCTAD (UN Conference on Trade and Development and the then UN focal point for tobacco). The idea of a convention that utilized international law to further public health was new. The initial reaction outside the tobacco unit was cautious, ranging from neutral to negative. Despite the initial lack of enthusiasm from most quarters for the idea of international law for tobacco, Roemer persisted in promoting the idea around the world, as did I.

‘On 26 October 1993, Ruth Roemer invited me for a breakfast I shall never forget … and suggested I convey the idea of a Convention to WHO … for tobacco … Despite the initial lack of enthusiasm from most quarters for the idea of international law for tobacco, Roemer persisted in promoting the idea around the world, as did I.’

The non-governmental organizations (NGOs) embraced the idea immediately. In October 1994, the 9th World Conference on Tobacco or Health in Paris passed a resolution which Roemer had drafted and asked me to introduce. It read: ‘This conference resolves that National Governments, Ministers of Health, and the World Health Organization should immediately initiate action to prepare and achieve an International Convention on Tobacco Control to be adopted by the United Nations …’.

My main role was therefore as a messenger, go-between and supporter of the FCTC, and I saw it evolve from the seed of an idea that Ruth Roemer passed on to me to carry to WHO in 1993 to a fully fledged UN convention, which entered into force in 2005.

I chaired various WHO Committees, attended all the FCTC negotiation meetings, worked with countries to assist in steering the process, and supported the FCTC with triennial editions of The Tobacco Atlas, first published by WHO [4].

I was on Dr Gro Harlem Brundtland's Transition Team before she took over as Director General of WHO in 1998 (–2003), Perhaps one of the greatest professional moments in my life was that Dr Brundtland, after she heard representation from Richard Peto, Neil Collishaw and myself on the importance of tobacco, created the Tobacco Free Initiative (TFI) as a Cabinet project, and revitalized the FCTC. It then became one of the fastest-tracked UN conventions of all time.

I did not want to move from Hong Kong to work in Geneva, so Dr Brundtland appointed me a Senior Policy Adviser to WHO, and this was maintained by Dr Lee Jong-wook (2003–2006) and Dr Margaret Chan (2006–present). The FCTC has led to a sea-change in that governments, academia and non-governmental organizations have addressed the public health and economic challenges of the tobacco epidemic, and it led to the first serious funding for tobacco control in low- and middle-income countries from the Bloomberg Initiative, the Bill and Melinda Gates Foundation and others, which I mentioned earlier. This has enabled hundreds of newly created job opportunities in tobacco control, the funding of huge numbers of grant programmes and created regional centres.

Many contributed towards the WHO FCTC: WHO, other UN agencies, Member States, NGOs, academia, individuals and the media, exemplified by the words of the Zen poet Ryokan (1758–1831):’In this one bowl, there is rice from a thousand households’.

Awards

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References
A:

The map shows that your first award was a WHO medal in 1988. Do you know who nominated you? How important it was for you then and thereafter?

JM:

I do not know who nominated me. Nominations go through or by governments, so it could well have been the Hong Kong government. It was my first international award so it was incredibly important and, as it was a WHO award, it gave me credibility when dealing with governments.

A:

Your most recent award was the British Medical Journal (BMJ) Group Award in 2009, where open voting was the method of selection of the 10 candidates shortlisted by the BMJ.

JM:

The first Lifetime Achievement Award was a marvellous recognition of public health, prevention, global health issues and tobacco control. Public health has always been the poor relation to curative medicine when it comes to prestige and funding, yet far more lives are saved by public health than by even the most skilled surgeon.

Many colleagues supported me for the BMJ Award. I was extremely touched by the outpouring of support from the international public health community, tobacco control organizations and individuals from Vanuatu to Venezuela, from China to Scotland, including several national governments and senior journalists; but one of my most treasured awards was being named by the tobacco industry as one of the three most dangerous people in the world.

A:

What is your biggest contribution to health?

JM:

My biggest contribution was definitely not the 15 years I spent in clinical practice but was, instead, public health. Apart from helping with the FCTC, perhaps my biggest role has been motivating and supporting others; I should also include my financial contribution in working for more than 20 years in tobacco control for no pay, in terms of lost salary, but I do not regret one minute of it.

A:

You often cite Sun Tzu (the ancient Chinese writer on military strategies): how useful was this during your early days and now?

JM:

I have always felt that Sun Tzu's ‘Art of War’ Battle Strategies reads like a modern-day public health strategy, including assessing the enemy (i.e. the tobacco industry):

  • 1
    Measure the distances
  • 2
    Estimate the expenses
  • 3
    Evaluate the forces
  • 4
    Assess the possibilities
  • 5
    Plan for victory
A:

The softer side: how do you keep healthy and fit for all this work and travel?

JM:

I play golf with my husband John. I walk and I have been practising Taichi for 7 years—my favourite is the Taichi sword. I do some gentle mountain trekking, such as in Myanmar, or Table Mountain in Cape Town or Mount Kosciuszko in Australia, but John is the real trekker in the family and has climbed many of the peaks in Asia. We are very fortunate to have a wonderful family: two sons, Andrew and Richard, now in their 40s; two marvellous daughters-in-law, Beverley and Emily; and three grandchildren, Kate, Robbie and (in the Scottish vernacular) ‘wee’ Ellen, all non-smokers!

A:

Many world-renowned tobacco control advocates have stayed in your house in Hong Kong, or had lunches or dinners there. How long have John and you been living there?

JM:

We have lived in the same old colonial bungalow in the Sai Kung area of Hong Kong since 1971—it is a green oasis near to the busy city and offers a rural refuge to myself and other colleagues who have stayed. Many people are surprised to find that Hong Kong is not the concrete city they expected. I have often said that my greatest hazard in driving in Hong Kong is hitting a cow!

A:

Many people, especially those from Hong Kong, were quite alarmed that you were leaving Hong Kong as they heard you had bought a house in Edinburgh and would be staying there for long periods.

JM:

John and I are both University of Edinburgh Medical School graduates so we have strong affiliations with Edinburgh. John is Scottish and I am from the north of England; for fun, we had our genes checked a few years ago and John is 95% Celtic and 5% Norwegian, and I am 75% Celtic and the other 25% is half Anglo-Saxon and half Danish.

One of the concerns of being an expatriate is the care of parents in the home country, and I used to travel backwards and forwards between Hong Kong and the United Kingdom many times each year, combining professional visits, for example to WHO in Geneva, to visits to increasingly ageing parents. When our final parent died we decided to spend most of the year in Hong Kong, and return to Edinburgh for 2 or 3 months. Our two sons (and now their families) live in the United Kingdom, so this was part work relocation, part family visit and part vacation, getting the best of the British summer and avoiding the extreme heat of the Hong Kong summer.

A:

You have catalogued all the documents and photographs pertaining to tobacco control in Asia: where are these now?

JM:

In 2012, I donated my tobacco control archive to a newly established WHO Collaborating Centre in Hong Kong, set up with the Hong Kong Department of Health (DoH). The DoH have kindly named it ‘The Mackay Library’. I think it is true to say there is no other collection like it in the world, as every conference, publication, event on tobacco in Asia is in the collection. I will be working with the DoH not just organizing the archive, but also on how to make it interactive, so that students and others can use it fully.

A:

Obviously, your husband John is your greatest supporter. Who was your mentor?

JM:

The late Sir John Crofton of the University of Edinburgh was my mentor since 1963. I have a suspicion that, like him, I will be working into my 90s.

A:

What advice would you give to a young aspirant thinking about an addiction career?

JM:

Think carefully about where you can do the greatest good. With the best will in the world, a cardiac surgeon or an ICU specialist can save only just so many lives by curative care. In public health, millions of lives can be saved. Tobacco use kills one in two smokers who fail to stop, and nothing in life resembles that degree of risk. That is the fundamental rationale of preventive health.

Acknowledgement

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References

With grateful thanks to Myriad Editions, especially Corinne Pearlman, Creative Manager and Graphics Editor, for the creation and design of ‘Mapping Mackay’ and Candida Lacey, Publisher and Managing Director, for her editorial support.

Note

The opinions expressed in this interview reflect the views of the interviewee and are not meant to represent the opinions or official positions of any institution or organization the interviewee serves or has served.

References

  1. Top of page
  2. 1984: Starting out in the tobacco control world
  3. Going forward
  4. Computer literacy
  5. Personal advantages
  6. Life on the road
  7. Drafting
  8. The WHO Framework Convention on Tobacco Control (FCTC)
  9. Awards
  10. Acknowledgement
  11. References