Controlling tobacco use

Health-e spoke to Dr Judith Mackay, the one of the authors of the Tobacco Atlas and one of the foremost tobacco control experts in the world.

Health-e spoke to Dr Judith Mackay, the one of the authors of the Tobacco Atlas and one of the foremost tobacco control experts in the world.

Health-e: How has the tobacco atlas been used as a tool in tobacco control?

Judith Mackay: Because it morphs thousands of statistics into maps, graphics and pictures, it gives an immediate snapshot of the problems in a lively, colourful and creative manner. This makes it much more accessible to decision makers, the media, in fact anyone concerned with personal or political health, governance, politics, economics, big business, corporate behaviour, globalisation, smuggling, tax, religion, Internet, allocation of resources, poverty, gender issues, human rights, children, human development and the future.

The picture of Bill Gates holding up the second edition, attached, and saying at the press conference where he pledged funding, that he had been influenced by the atlas, shows what a powerful tool it is.

HE: Are we winning the battle?

JM: Prevalence rates are falling around the world. So, it can be done.

Systems are being put in place that will bring down this epidemic ‘€“ tax policies, legislation, anti-smuggling action, public health campaigns, etc. The World Health Organisation ‘€˜s Framework Convention on Tobacco Control, mpower* and also regional Action Plans like the 2010-2014 Western Pacific Region Action Plan on TFI*, are all powerful tools, goals and guidelines for country action.

BUT the predictions for the future are that there will be more smokers in 2030, principally because of population expansion in the low and middle income countries (LMIC). This will severely strain health systems, especially in the LMIC.

HE: You travel across the world’€¦how do you see tobacco impacting on health systems and on people’€™s lives?

JM: Tobacco-related illness and death is having a major impact on health services, even in the LMIC. People are now surviving for longer, and the health impacts of smoking and other tobacco use is becoming even more prominent.

HE: Why do you believe there is a reluctance on the part of Government’€™s to ban the selling of tobacco outright?

JM: Prohibition of alcohol in the US a century ago only lead to crime and corruption.

Also, about 1.3 billion people in the world smoke, so it would be difficult to turn them into criminals.

Better to push back the frontiers in a sustainable way with all the tobacco control measure that we know work, eg taxation, smoke-free areas, bans on all tobacco promotion

HE: Are the tobacco companies still denying that their products cause immense suffering and kill people?

JM: It is very hard for them to do this now, after the Minnesota court ruling that all their documents must be placed in the public domain, and we can all see their internal thinking and knowledge on the harmfulness of smoking. But their tactics are still to obstruct meaningful measures to reduce tobacco, so their actions have not changed much, only become more sophisticated.

HE: What methods are tobacco companies using to side-step the stricter laws in some countries?

JM: They make representation to governments and legislatures on proposed legislation, or tax increases.

In practice, the tobacco industries usually obey the letter of the law, but certainly not the spirit of the law, and do all sorts of advertising and promotion such as brand-stretching.

HE: If you could put forward one country as an example when it comes to taking the lead on tobacco control, which country would it be and why?

JM: Singapore. They have been engaged in comprehensive tobacco control measures since 1970, so it is no wonder that their smoking rates are the lowest in the world.

HE: Have the tobacco companies changed their focus to developing countries? Could you expand on this?

JM: They have been doing this for a very long time, starting in the 1950s. They saw that smoking was coming down in the west, or would come down, and eyed the huge populations of Asia in particular as their future.

HE: If we look at the impact of tobacco, what are the less obvious ‘€œcosts’€ to countries (perhaps in terms of the economy, lives lost)?


Smoking causes fires, accidents

Tobacco growing uses arable land that could grow food

Tobacco leads to deforestation, cutting down trees to cure tobacco

Billions of cigarettes, cigarettes packs, matches and lighters are discarded every day, leading to garbage/rubbish

Decreased productivity in the workplace by smoke breaks, illness and premature death

HE: Why do you think people still opt to smoke despite all the information on how damaging it is to one’€™s health?

JM:   I don’€™t believe it is a choice implied in the word ‘€œopt.’€

Children start because of peer pressure, rebellion, wanting to appear grownup or cool.

Once adults, most realize it is an addictive, dirty and expensive habit that most would prefer to quit, yet find difficult to do so.

Nicotine in cigarettes is highly addictive; it is the nicotine for which smokers smoke. This makes it very difficult for many to quit.

But on a more optimistic note, some smokers find it easier than expected.

And the benefits of quitting at any age are considerable:

1 day later

Heart, blood pressure, and circulation show improvements

1 year later

Excess risk of coronary heart disease is half that of a continuing


5 to 15 years later

Risk of a stroke is reduced to that of never-smokers

10 years later

Risk of lung cancer is reduced to less than half that of

continuing smokers; risks of many other cancers decrease

15 years later

Risk of coronary heart disease is similar to that of never-smokers,

and the overall risk of death is almost the same, especially if the

smoker quits before illness develops

HE: Is it hard to quit smoking?

JM: Yes, for some people, but (as above), some find it easier than expected.

But given it is so hard for so many, we must all work harder to prevent youth starting to smoke, and offer much more help for smokers to quit.

HE: You recently attended the LIVESTRONG summit where you released the Tobacco Atlas. Do you think this was a significant event and why?

JM: By way of background, the non-communicable diseases such as cancer, heart disease, diabetes and others, and their risk factors, receive relatively little financial support or recognition compared with the immediate drama of infectious diseases such as SARS or swine flu. This is particularly true of media coverage, where the slower, much less visible chronic diseases have little mention, even though they now kill far more people in the world compared with the infectious diseases.

I think having the value of having the persona and visibility of Lance Armstrong giving his name to global cancer issues is immense. So many young people, athletes, and top decision makers around the world all know and admire him. The fact he himself had, and beat, cancer, against all the odds, also adds to his credibility. The the summit itself gained enormous publicity around the world.

He also understands the benefits of working through existing and experience organizations and people, as witnessed by the participants from 65 countries at the Dublin summit, and the working with organizations like the International Union Against Cancer (UICC).

*MPOWER:  This acronym is commonly used to refer to the ‘€œMPOWER package’€, a list of policies that the World Health Organization considers the six most important and effective tobacco control policies in fulfilling the promise of the WHO Framework Convention on Tobacco Control (FCTC).  They were originally introduced in the WHO publication ‘WHO Report on the Global Tobacco Epidemic, 2008.’  This report is informally referenced by some as the “MPOWER report.
The first letter of each of the six policies spells out the acronym MPOWER. Here are the six policies:
– Monitor tobacco use and prevention policies
– Protect people from tobacco smoke
– Offer help to quit tobacco use
– Warn about the dangers of tobacco
– Enforce bans on tobacco advertising, promotion and sponsorship
– Raise taxes on tobacco

*TFI:  This stand for “Tobacco Free Initiative,” a program run by the World Health Organization. They organise the annual World No Tobacco Day campaign on May 31 to promote global tobacco control.  Here is a link to the TFI part of the WHO website:


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