© Hong Kong Academy of Medicine. CC BY-NC-ND 4.0
From the fringes of public health to the forefront of the fight against tobacco: Dr Judith Mackay
Zareen Chiba, Khin-Shwe Eu, Edward Tam
Year 4, Faculty of Medicine, The University of Hong Kong
 Full paper in PDF

Dr Judith Mackay
Global health circles, through resolutions and campaigns, have announced that this is the decade of non-communicable disease, of gender equality, and of trade-related aspects of health. However, it was one advocate, a female British physician from Hong Kong, who was to become one of the few visionaries who saw and fought for these pertinent issues decades before the big chambers of the World Health Organization.
Dr Judith Mackay, SBS, OBE, JP, received her medical education at the University of Edinburgh and moved to Hong Kong in 1967, and spearheaded Hong Kong’s anti-tobacco movement. She cites three main reasons for making the shift from clinical medicine to public health advocacy. During her work as a physician in the 1970s and 1980s, she felt that clinical work was “like a band-aid”, a step too late in preventing morbidity and mortality, and did not address the cause of many hospitalisations at the time. Second was her fundamental belief that women’s health involved much more than gynaecological and birth control issues, and that female smoking-related morbidities were far more significant than perceived. This was pertinent as women were being pushed into the advertising spotlight by the tobacco industry at a time and in a region where the majority of smokers were men. What finally galvanised her crusade to combat tobacco use in Hong Kong was what she described as “the wrath of the tobacco industry” that descended upon her after the publishing of relevant op-eds* in the South China Morning Post in the 1980s.
*An op-ed, or opinion editorial, is a narrative essay that presents the writer’s opinions or thoughts about an issue. Op-eds are often appear opposite of the editorial page of newspapers and magazines. They can raise awareness about a particular topic.
Gender and global health
Dr Mackay recounts the challenges she initially faced when donning the mantle of a public health policy-maker: the tobacco industry had already established its foothold in national trade and local mindsets, and her work was initially very much a “fringe activity” with little structure, support, and virtually no pay. A pioneer in her field, Dr Mackay and her work were rapidly recognised: by 1989, she was in high demand and inundated with requests from governments of other Asian countries for advice on how to initiate tobacco reform. Governments could see that the extended trade and political nuances of tobacco issues required them to ratify her suggestions for tobacco control. That same year Dr Mackay founded the Asian Consultancy on Tobacco Control, and to this day she serves as its director.
As her influence grew, Dr Mackay was also able to push for equal gender representation in public health policy-making; when invited to counsel the 10th World Conference on Tobacco or Health held in Beijing in 1997, she stipulated that she would work pro bono so long as at least half of the keynote plenary speakers, chairmen, and committee were female. Despite initial hesitation from organisers, the event turned out to be the “best conference ever” and set the standard for subsequent conferences to follow the goal of gender equality in conferences and smart legislation. “I really promote women [in the selection of awards] because if women are not in those positions, then the issue of women in tobacco gets ignored.” In other international events, and with the understanding that “women get forgotten and sidelined” among discussions of health data and demographics, she also advocated for the separation of data collected on women and children to ensure the proper representation of women in tobacco and health-related studies in a manner that would provide specific solutions to both demographics.
Influential and dangerous
On a global front, Dr Mackay is senior advisor to the World Lung Foundation and the World Health Organization Tobacco Free Initiative. She adopts a pragmatic and conscientious approach in assisting regional leaders to combat tobacco, taking small steps at a time. Quoting her, “Foreign countries seem to like me; I don’t come in and tell them what to do”. Claiming that ‘should’ is not a word in her vocabulary, Dr Mackay believes the ultimate goal is for regional countries (especially low- and middle-income nations, Big Tobacco’s new targets of recent decades) to become empowered, to learn to stand up for themselves, and to not legislate in a submissive manner with respect to multinational industry.
When asked what she believes to be her most meaningful achievement, Dr Mackay humbly responded that no single accolade was most significant, although she did say her culminating personal achievement was being named in 2007 as one of TIME magazine’s “100 most influential people in the world”. However, she wears no greater badge of pride than being named one of the three most dangerous people to the Big Tobacco. This exemplifies her efforts in 200 papers and 460 addresses to tobacco control conventions as a job well done, and that she and public health are worthy adversaries of one of the most aggressive industries in the world. In recognition of her work, Dr Mackay has also recently received an Honorary Degree from Hong Kong Shue Yan University—the first medical doctor in Hong Kong to have been thus honoured since the institution was established.
A not-so hazy future
Looking to the future, Dr Mackay is optimistic about the outlook for global anti-tobacco efforts. To this day, her three main commitments in tobacco control are to empower women, ensuring that they are not neglected and pushing for gender equality; to assist low- and middle-income countries; and to ultimately bring the fight to the tobacco industry. Her wishes for the near future, locally, are to see China implement a national smoke-free law and for the Hong Kong SAR Government to set up legislation to involve and incentivise owners of entertainment establishments in the enforcement of smoke-free zones. In keeping with modern trends, she also holds strong opinions on the rising popularity of e-cigarettes and shisha as alternative forms of tobacco consumption, and acknowledges such habits as a challenge to legislation and smoking cessation. Thus, timely is her contribution to the 5th edition of The Tobacco Atlas, her 10th health atlas, a document filled with infographics and explanations of the wide spillover influence of the tobacco epidemic on international politics, trade, health, and the environment. With her maxim “If you can’t measure it, you can’t manage it”, she contributed with the aim to gather good data, to best inform and inspire action in the reader.
She currently resides with her loving husband, also a doctor, in Hong Kong, and finds time to practise tai chi and collaborate on new health atlases while remaining more than ever an enthusiastic activist and inspiration to public health circles. She has no plans of slowing down, emphasising that she is merely doing “more of the same”, adding that “I’m going to be working when I’m a hundred years old.” In this first HKMJ issue of 2016, we wish her every success in her future campaigns, and hope that her dedication and triumphs over powerful adversaries can inspire a future generation of public health advocates to confront the vital challenges of global health.

Dr Mackay with student reporters (from left): Zareen Chiba, Edward Tam, Dr Mackay, Khin-Shwe Eu