>> WELCOME.
BEFORE WE START TODAY, I WANT TO
DO HOUSEKEEPING.
THOSE WHO HAVE PAGERS, CELL
PHONES, IPHONES, PLEASE MAKE
SURE THEY ARE TURNED OFF.
THERE IS NO FOOD OR BEVERAGES
ALLOWED IN THE AUDITORIUM, SO IF
YOU HAVE ANYTHING, PLEASE DON'T
DRINK OR EAT WHILE YOU'RE IN
HERE.
WE ARE BEING TAPED AND SO IF YOU
ASK A QUESTION OF DR. JUDITH
MACKAY, PLEASE USE THE
MICROPHONE TO PUSH THE BUTTON IN
FRONT OF YOU TO RED AND THEN
PUSH THE BUTTON OFF.
I HOPE ALL OF YOU KNOW WE ARE
HAVING A RECEPTION AFTERWARDS
AND IT WILL BE IN THE MAIN HALL.
PLEASE JOIN US FOR FOOD AND
BEVERAGES AND FOR THOSE OF YOU
WHO WANT TO TAKE THE VAN BACK TO
ROCKVILLE, IT'S GOING TO BE
LEAVING AT 4:30 PROMPTLY.
SO I KNOW MANY PEOPLE WHO COME
OVER DON'T HEAD BACK BUT IN CASE
YOU'RE PLANNING ON LEAVING, 4:30
UPFRONT.
SO WITH THAT, I WILL INTRODUCE
OUR SPEAKER, DR. JUDITH MACKAY
RECEIVED HER MEDICAL DEGREE FROM
UNIVERSITY OF ED EN BERG IN
SCOTLAND AND SHE SPENDS HER
SUMMERS THERE AS WELL AND LIVES
IN HONG KONG THE REST OF THE
YEAR WHERE SHE HAS BEEN IN HONG
KONG SINCE 1967.
SHE HAD A CAREER AS A HOSPITAL
PHYSICIAN AND UNIVERSITY IN
GOVERNMENT THERE.
1987, SHE BECAME THE FOUNDING
EXECUTIVE DIRECTOR OFyM THE HONG
KONG COUNCIL ON SMOKING AND
HEALTH.
1989, SHEç ESTABLISHED THE ASIAN
CONSULTANCY ON TOBACCO CONTROL
AND SHE IS THE SENIOR ADVISOR TO
THE WORLD 1 FOUNDATION AND
BLOOMBERG INITIATIVE, THE
DIRECTOR OF THE ASIAN
CONSULTANCY ON TOBACCO CONTROL
AND THE SENIOR ADVISOR TO THE
W.H.O.
HER MAJOR INTEREST IS IN THE
AREA OF REDUCING TOBACCO USE IN
LOW-INCOME COUNTRIES AND
REDUCING TOW PACK POE PROMOTION
IN WOMEN AND ONE OF HER MAJOR
DISTINCTIONS, AND I WISH I HAD
THIS, I'M SO IMPRESSED, SHE HAS
BEEN IDENTIFIED BY THE TOBACCO
INDUSTRY AS ONE OF THE THREE
MOST DANGEROUS PEOPLE IN THE
WORLD.
[LAUGHTER]
THAT SAYS A LOT.
SHE WORKED ON, AND HAS BEEN
INVITED TO ADVISE ON THE TOBACCO
CONTROL POLICIES ON EVERY
CONTINENT EXCEPT FOR ANT ART CA.
EUROPE, SOUTH ASIA, MIDDLE EAST
AND AFRICA.
DEEPLY INVOLVED WITH TOBACCO
CONTROL EVER SINCE IT BEGAN.
SHE WILL BE SPEAKING AT THE U.N.
IN SEPTEMBER ON THE NONCOMMUNE
CALL DISEASE MEETING THERE.
A MAJOR EVENT.
THERE HAVE BEEN ONLY A FEW OF
THOSE IN THE HISTORY OF THE U.N.
AND SHE SAID TO ME EARLIER
TODAY, THE SECOND ONE FOCUSING
ON HEALTH ISSUES.
MORE THAN 180 ACADEMIC PAPERS.
DIRECTS 450 CONFERENCES
WORLDWIDE INÑzMANY ASPECTS OF
TOBACCO CONTROL.
ON THE EDITORIAL BOARD FOR THE
BRITISH MEDICAL JOURNALS AND
AWARDED NUMEROUS PRIZES.
LI MENTION A COUPLE OF THEM.
THE 1996 LILY LECTURE SHIP BY
THE ROYAL COLLEGE OF LONDON AND
RECEIVED HONORS FOR HER WORK AND
RECOGNIZED BY THE WORLD HEALTH
ORGANIZATION COMMEMORATIVE
MEDAL, U.S. SURGEON GENERAL'S
MEDALLION AND THE INTERNATIONAL
NETWORK OF WOMEN AGAINST TOBACCO
LIFETIME ACHIEVEMENT AWARD,
SELECTED BY "TIME" MAGAZINE AS
ONE OF 60 ASIAN HEROES OVER THE
PAST 60 YEARS.
IN 2007, SHE WAS CHOSEN AS ONE
OF "TIME" MAGAZINE'S 100 OF THE
WORLD'S MOST INFLUENTIAL PEOPLE.
2009, THE BMJ AWARDED HER A
LIFETIME ACHIEVEMENT AWARD FOR
CONTRIBUTION TO THE FIGHT
AGAINST TOBACCO ACROSS THE
WORLD.
SHE HAS RECEIVED THE AMERICAN
CANCER SOCIETY'S LUTHER TERI
AWARD FOR OUTSTANDING INDIVIDUAL
LEADERSHIP.
QUICK ON AND ON.
I PROBABLY SHOULD STOP AT THIS
POINT.
JUDITH IS ONE OF MY HEROES IN
THE WORLD OF TOBACCO CONTROL.
IT'S AN HONOR TO INTRODUCE TO
YOU DR. JUDITH MACKAY.
[APPLAUSE]
>> THANK YOU VERY MUCH FOR THAT
KIND INVITATION AND IT'S JUST
REALLY0V
NATIONAL CANCER INSTITUTE AND
BEING ABLE TO TALK TO YOU TODAY.
IT'S VERY NICE TO SEE SOME OLD
FRIENDS LIKE MICHELLE BLOCK,
HERE, AND TOM GLENN IN THE
AUDIENCE AND TO MEET UP WITH
SOME MANY NEW FRIENDS AS WELL.
IT'S A GREAT HONOR AND A
PRIVILEGE TO BE HERE TO ADDRESS
YOU.
I'M NORMALLY SPEAKING MOSTLY
ABOUT TOBACCO BUT I HAVE BEEN
ASKED TO SPEAK ABOUT CANCER
TODAY AND TO SPEAK IN A FAIRLY
GENERAL WAY ABOUT CANCER AND
LOOK AT SOME OF THE ISSUES
GLOBALLY.
THE FIRST THING TO SAY IS THAT
THE FUTURE OF GLOBAL CANCER
BURDEN WILL INCREASE IN THE
FORESEEABLE FUTURE.
W.H.O. HAS PREDICTED THAT A
SUBSTANTIAL INCREASE IN THE
NUMBER OF NEW CASES OF CANCER
AND CANCER DEATHS WORLDWIDE, AT
LEAST UNTIL 2030, 2035.
THE GREATER BURD LEN LIE IN THE
LOWER-MIDDLE-INCOME COUNTRIES
AND THAT IS BECAUSE OF THE
POPULATION SIZES.
AND ALSO THERE IS A PYRAMID OF A
LOT OF YOUNGER PEOPLE WHO WILL
BE GROWING OLDER.
SO THERE WILL BE MORE OLDER
PEOPLE IN THE WORLD IN THEç
LOWER-MIDDLE-INCOME COUNTRIES
AND AGING POPULATIONS.ç
SO THOSE COUNTRIES WILL BEAR THE
GREATEST HEALTH AND ECONOMIC
BURDEN FROM CANCER RANGING FROM
HEALTHCARE COSTS TO THE
INDIVIDUAL LOSS OF INCOME.
IF WE LOOK AT THAT GRAPHIC, WE
CAN SEE THIS IS NEW CANCER
CASES.
WE CAN SEE THAT THE TOTAL AT THE
TOP ARE THE MALE AND FEMALE
CASES AND ARE ALL GOING UP MORE
OR LESS THE SAME.
MALE AND FEMALE, THE NUMBER OF
CASES IN THE WORLD.
AND IF WE TRY AND BREAK THIS
DOWN BY REGION, YOU HAVE GOT THE
AMERICAS OVER HERE, AFRICA,
EUROPE, EASTERN MEDITERRANEAN
AND SOUTH ASIA AND WESTERN
PACIFIC.
AND EVERY ONE OF THEM, THE
NUMBER OF CASES OF CANCER BY
2020 WILL BE INCREASING,
PARTICULARLY PERHAPS IN THE
WESTERN PACIFIC REGION BUT THIS
IS REAL ACROSS THE BOARD WHAT WE
ARE FACING NOW IS SAY VERY MUCH
GLOBAL EPIDEMIC.
AND I JUST USE THIS AS ONE
EXAMPLE FROM THE SOUTH CHINA
MORNING POST IN HONG KONG JUST
THIS YEAR.
SHANGHAI SEES CANCER RATES JUMP.
THE CANCER RATES HAVE TRIPLED IN
THE LAST 16 YEARS.
THE PROPORTION IN YOUNG WOMEN IS
UP EIGHT-FOLD AND SURVIVAL
CANCER IN PARTICULAR IS JUST
GOING THROUGH THE CEILING.
THE MOST COMMON CANCERS AROUND
THE WORLD, I HAVE GRAPHICS AND I
CAN'T POSSIBLY GO INTO THE
DETAILS OF EVERY ONE OF THESE,
SO I JUST USE ASIA AS THE
EXAMPLE TO PULL OUT THE
COMMONEST CANCERS WE ARE SEEING
OF LUNG AND LIVER AND WOMEN OF
BREAST, CERVIX, LUNG AND
STOMACH.
ALL THOSE THOSE ARE FIGURES FROM
ASIA, THEY ARE QUITE TRUE OF THE
LOWER AND MIDDLE-INCOME
COUNTRIES.
IF WE LOOK AT THE RISK FACTORS
FOR THESE CANCERS AROUND THE
WORLD, AGAIN, WE SEE A
DIFFERENCE.
THIS IS WHAT WE USED TO CALL A
DEVELOPED CREASE, HIGH-INCOME
CREASE.
--
COUNTRIES.
TOBACCO THERE IS ABOUT 16%
WHEREAS IN THE
LOWER-MIDDLE-INCOME COUNTRIES
IT'S LESS AT THE MOMENT, JUST
10%.
INFECTIONS PLAY A MUCH SMALLER
ROLE IN THE RICHER COUNTRIES AND
A MUCH BIGGER ROLE BECAUSE OF
HEPATITIS B AND THE HELL
COPACTER AND OTHER VIRUSES.
DIET AND FEW TRICIAN ARE GREATER
CAUSES IN RICH COUNTRIES, LESSER
AT THE MOMENT AND A NUMBER OF
OTHER FACTORS.
AND ENVIRONMENTAL POLLUTION AND
OCCUPATIONAL EXPOSURE ARE GREAT
ENOUGH TO HAVE A PLACE ON THEIR
OWN ON THE PIE CHART FOR THE
RICH COUNTRIES.
AND I SUSPECT AS THE YEARS GO
BY, WE WILL SEE THESE TOO
EMERGING WITH A GREATER
IMPORTANCE IN THE
LORE-MIDDLE-INCOME COUNTRIES AS
WELL.
THE OVERALL CONCLUSION IS THAT
BY 2020, 70% OF ALL CANCER
DEATHS WILL BE IN THE LOWER AND
MIDDLE-INCOME COUNTRIES.
I'M GOING TO SPEAK JUST FOR A
MOMENT ABOUT THE TOBACCO
EPIDEMIC BECAUSE THIS IS THE
EPIDEMIC IN RELATION TO CANCER
THAT I KNOW BEST.
AND ONE OF THE REAL OR GOOD
POINTS AND THE BAD POINTS THAT
IT IS REALLY A VERY BAD POINT,
WE WILL SEE MUCH MORE OF TOBACCO
USE.
AND THEREFORE, INCREASE IN THE
NUMBER OF SMOKERS, INCREASE OF
TOBACCO CONSUMPTION AND TOBACCO
DEATHS.
AT LEAST UNTIL 2035.
THE PREVALENCE MIGHT COME DOWN.
IT'S COMING DOWN IN MOST
COUNTRIES IN THE WORLD.
WE HAVE SEEN IT FALL IN THE
WESTERN COUNTRIES AND THE 80s
AND 90s.
AND WE ARE BEGINNING TO SEE IT
FALL IN AISAIA.
THE RATES IN JAPAN, SMOKING
RATES, MALE RATES HAVE COME DOWN
FROM 80% TO 40% IN JUST A
35-YEAR PERIOD.
THEY ARE FALLING IN TAIWAN,
FALLING IN THAILAND, FALLING IN
HONG KONG AND SINGAPORE.
SO THE PREVALENCE RATES ARE
COMING DOWN AS A RESULT OF
TOBACCO CONTROL INTERVENTIONS.
AND THAT HAS TO BE THE GOOD
NEWS.
THE BAD NEWS SYSTEMS THAT THIS
FALL IN TERMS OF THE NUMBER OF
SMOKERS WILL BE COMPLETELY
OFFSET BY THE POPULATION
EXPANSION THAT I MENTIONED
EARLIER.
THIS GREAT BULK OF YOUNG PEOPLE
GROWING UP.
SO EVEN IF WE ARE ENORMOUSLY
SUCCESSFUL IN BRINGINGç DOWN THE
PREVALENCE, THERE IS NO CASE
SCENARIO PREDKc(
ANYBODY, NOT BY THE MOST
OPTIMISTIC OF PREDICTORS TO SAY
THERE WILL BE LESS SMOKERS IN
THEñr FUTURE.
THAT WILL NOT HAPPEN REALLY
UNTIL THE SECOND HALF OF THIS
CENTURY.
SO BECAUSE OF THE INCREASED
NUMBER OF SMOKERS, WE SEE
TOBACCO GOING OFF THE CHART AND
THE NUMBER OF TOBACCO DEATHS, WE
HAVE ONLY OR ABOUT FIVE MILLION
AT THE MOMENT.
THAT SHOULD BE MILLION, GOING UP
TO 8 TO 10 MILLION AS THE YEARS
GO BY.
WE WILL SEE A HUGE EXPANSION OF
THE TOBACCO EPIDEMIC.
THIS IS BAD NEWS UNLESS YOU'RE
TALKING TO GOVERNMENTS CONCERNED
ABOUT THE FARMERS.
AND CHINA THEY ARE ALWAYS SAYING
WE EMPLOY SO MANY PEOPLE AND WE
HAVE SO MANY FARMERS THAT RELY
ON GROWING TOBACCO.
AND I OFTEN SAY WHEN I GO TO
LOWER MIDDLE-INCOME COUNTRIES IN
ASIA, INCLUDING THE VIETNAM IN
THE AUDIENCE, THERE IS NOT GOING
TO BE ONE TOBACCO FARMER OUT OF
WORK IN MY LIFETIME SIMPLY
BECAUSE THERE WILL BE MORE
SMOKERS IN THE YEARS TO COME.
IF WE LOOK AT INFECTION AS THE
CAUSE OF CANCER, THE DARKER THE
COLOR HERE, THE GREATER THE
INFECTION BY HELICOBACTER.
AND MANY OF THE MAPS I WILL SHOW
YOU TODAY, THEY ALL MUST LOOK
LIKE THIS.
THEY HAVE THIS DIVIDE BETWEEN
THE NORTH AMERICA, EUROPE AND
AUSTRALIA AND NEW ZEALAND, AND
BASICALLY THE REST OF THE WORLD,
WHICH IS SUFFERING SO MUCH MORE.
AND CERTAINLY THIS IS TRUE OF
HELL COBACTERIN FENKSES WHICH IS
THE CAUSE OF STOMACH CANCER, YOU
WILL SEE THAT AGAIN IT TENDS TO
BE MOSTLY IN THE LOWER
MIDDLE-INCOME COUNTRIES.
IF YOU LOOK AT MEET CONSUMPTION
IN THE WORLD OVER A 30-YEAR
PERIOD, INDUSTRIALIZED COUNTRIES
IS GOING RIGHT UP, NOT SO MUCH
IN SOUTH ASIA BUT AGAIN IN MOST
PLACES OF THE WORLD WHERE WE ARE
EATING MORE MEAT RATHER THAN
LESS AND VERY LITTLE SIGN ON A
POPULATION SCALE THAT THAT IS
BEING REVERSED.
SO JUST AGAIN GOING THROUGH THE
DIFFERENT RISK FACTORS.
SO WHAT WE HAVE REALLY COMPLETED
IS THAT ANY MAJOR REDUCTION IN
CANCER DEATHS WILL COME FROM
PREVENTION AND NOT FROM CURE.
AND THIS ISN'T JUST CANCER.
THIS APPLIES TO VIRTUALLY ALL OF
THE NON-COMMUNICABLE DISEASES.
WHAT WE HAVE LEARNED FROM
TOBACCO, TOBACCO HAS BEEN A
QUITE SOPHISTICATED POLITICAL
ISSUE FOR A VERY MUCH LONGER
TIME THAN FOR SOME OF THE OTHER
RISK FACTORS LIKE OBESITY AND
SALT AND THE SUGAR INDUSTRY OR
THE ALCOHOL INDUSTRY, FOR
EXAMPLE.
WE HAVE LEARNED FOR THE LAST
40-50 YEARS, WE ARE DEALING WITH
A VERY DANGEROUS OPPOSITION, TO
TELL THE TRUTH, IN THE FORM OF
THE TOBACCO INDUSTRY.
THIS IS FORCED PEOPLE WORKING IN
TOBACCO CONTROL TO BECOME VERY
POLITICAL.
AND ONE THING WE CERTAINLY
LEARNED IS THIS EPIDEMIC WILL
NEVER BE REDUCED IN THE
CORRIDORS OF HOSPITALS AND
CLINICS.
NEVER T WILL BE REDUCED IN THE
CORRIDORS OF POWER OF
GOVERNMENT.
AND WHAT WE REALLY HAVE TO HAVE
IS POLITICAL WILL TO DO
SOMETHING ABOUT THIS.
AND WHAT WE HAVE LEARNED IS THAT
THIS MEDICAL MODEL IS NOT
ENOUGH.
WE HAVE TO ENGAGE WITH PARTNERS
LIKE THE WORLD BANK WHO WILL DO
ECONOMIC STUDIES ON TOBACCO.
AND AGAIN IN MY EXPERIENCE,
ALMOST EVERY GOVERNMENT IN THE
WORLD KNOWS AND THAT SMOKING IS
HARMFUL AND WE MUST DO SOMETHING
ABOUT IT.
THE PRINCIPLE CONCERN ABOUT
GOVERNMENT'S IS THEY ARE
MISPERCEIVED ECONOMIC CONCERNS.
THEY THINK THAT IF YOU PUT UP
THE TAX ON TOBACCO, IF YOU
CREATE SMOKE-FREE AREAS, THAT
THE ECONOMY WILL SUFFER.
THEY'LL HAVE LESS TAX REVENUE,
THEY'LL HAVE PEOPLE OUT OF WORK.
THEY'LL HAVE FARMERS WITH NO
JOBS TO DO.
NONE OF THESE ARE TRUE.
NONE OF THESE ARE TRUE.
BECAUSE TOBACCO OVERALL FOR
VIRTUALLY EVERY COUNTRY IN THE
WORLD IS A DEBIT TO THE ECONOMY.
GOVERNMENT'S DON'T SEE IT THAT
WAY.
THEY SEE THE TAX COMINGkO IN.
SO TO HELP PARTNERS LIKE HEALTHY
COM NoRu IN PARTICULAR, WHO CAN
REALLY LOOK AT THE ECONOMIC
ARGUMENTS AND THE TRACKS
STRUCTURES IS VERY VITAL TO SIT
WAIT GOVERNMENT'S.
WE NEED TO LOOK AT TAXATION, OF
COURSE.
WE NEED TO LOOK AT THINGS LIKE
LEGISLATION AND LITIGATION
BECAUSE ONE THING THAT HAPPENED
IN THE TOBACCO CONTROL IS THAT
THE TOBACCO COMPANIES HAVE BEEN
TAKEN TO COURT.
THE RATE OF SUCCESS OF THESE
CASES IS ALMOST NEGLIGIBLE.
WHAT IT HAS DONE IS IT BROUGHT
THE TOBACCO COMPANIES TO BOOK.
IT BROUGHT THEM IN FRONT OF
JUDGES.
THEY HAD TO DISCLOSE SOME OF THE
THINGS THEY KNOW ABOUT TOBACCO
AND IN FACT IT LED TO A WEALTH
OF DOCUMENTS BEING EXPOSED BY
CASES IN THE U.S. ABOUT A DECADE
AND A HALF AGO.
SO IT HAS ENORMOUS USEFULNESS
AND A PR VALUE FOR PEOPLE TO
REALIZE THAT THE TOBACCO
INDUSTRY IS NOT 8 MIGHTY
INDUSTRY THAT CAN'T BE NIBBLED
AWAY AT AND MORE AND MORE
COUNTRIES ARE INTRODUCING THE
IDEA OF TAKING THE TOBACCO
INDUSTRY TO COURT.
IN FACT THE, THE EUROPEAN UNION
DID SOMETHING RATHER AMAZING AND
THEY TOOK THE TOBACCO INDUSTRIES
TO COURT FOR THE LOSS OF
TAXATION DUE TO SMUGGLING,
TOBACCO SMUGGLING, BY THE
TOBACCO COMPANIES THEMSELVES.
SO THESE CASE THAT IS HAD QUITE
A DIVERSE APPROACH, SOME OF THEM
ARE INDIVIDUAL.
SOMEBODY MAY HAVE DIED FROM LUNG
CANCER AND THEIR FAMILY TAKES
THEM TO COURT.
SO LITIGATION AND LAWYERS IS
IMPORTANT.
SMUGGLING IS ALSO --
WHEN I FIRST TRAINED, NOT ONE
PERSON AT UNIVERSITY GAVE ME ANY
TRAINING IN UNDERSTANDING
SMUGGLING.
I CAN TELL YOU.
BUT ACTUALLY ABOUT A THIRD OF
ALL TRADED CIGARETTES IN THE
WORLD ARE SMUGGLED.
AND THIS IS NOT BY LITTLE MEN IN
BOATS.
THIS IS BY THE TOBACCO COMPANIES
THEMSELVES.
AND W.H.O. SAY SO AND ALL THE
ECONOMISTS SAY SO AND THE WORLD
BANK SAYS SO.
IT'S DONE ON A MASSIVE SCALE FOR
THE REASON OF INVADING
RESTRICTIONS LIKE HEALTH WARNING
ON CIGARETTES, FOR SELLING
CIGARETTES CHEAP AND FLOODING
THE MARKETS AND GETTING MORE
YOUTH SMOKERS.
SO WE ARE HAVING TO LIAS WITH
THE CUSTOM OFFICIALS AROUND THE
WORLD.
WE ALSO REALIZE THAT WE HAVE TO
ADDRESS THIS ISSUE OF GROWING
TOBACCO AND IN MANY PLACES OF
COURSE IT IS BEING GROWN IN
PLACE OF SUSTAINABLE CROPS.
IN CHINA, IT'S A VERY GOBBLE
EXAMPLE.
CHINA HAS TO IMPORT GRAIN
BECAUSE IT CAN'T FEED ITSELF AND
THEREFORE IT'S NOT JUST AN
ECONOMIC PROBLEM, IT'S QUITE
POLITICAL.
COUNTRIES REALLY GROW SO MUCH
TOBACCO THAT THEY CAN'T USE THAT
LAND OR AT LEAST SOME OF THE
THAT LAND TO GROW FOOD FOR THEIR
PEOPLE.
WE ARE ALSO REALIZED WE NEED A
LOT MORE PARTNERS.
THERE ARE MANY GENDER ISSUES
WITHIN TOBACCO.
FOR EXAMPLE, THE WAY THAT THE
TOBACCO INDUSTRY RECRUITS AND
ADVERTISES TOWARDS WOMEN WITH
ALL THESE MESSAGES OF
EMANCIPATION.
YOU COME A LONG WAY BABY WITH A
SLOGAN IN THE U.S. ABOUT 30
YEARS AGO.
IT'S ALIVE AND WELL IN ASIA
WHERE THEY CAN ADVERTISE.
THEY USE THE SAME SLOGANS OF
WOMEN BEING MORE INDEPENDENT,
MORE EMANCIPATED, YOU'RE A WOMAN
ON YOUR OWN NOW WITH YOUR OWN
VOLITION.
YOU DON'T HAVE TO LISTEN TO WHAT
YOUR PARENTS DO.
THE SAME MESSAGES ARE BEING
PROPAGATED ANYWHERE.
AND THEN OF COURSE
ENVIRONMENTAL.
FRIENDS OF THE EARTH,
ENVIRONMENTAL GROUPS ARE VERY
NATURAL PARTNERS BECAUSE IF YOU
LOOK AT LITTER IN THE WORLD, AN
ENORMOUS AMOUNT OF, BILLIONS OF
CIGARETTE ENDS AND PACKETS AND
MATCHES AND LIGHTERS ARE THROWN
AWAY EVERY DAY OF THE YEAR.
THERE ARE TREES CUT DOWN IN THE
WORLD TO CURE TOBACCO AND THEY
ARE NOT REALLY BEING REPLANTED
EXCEPT IN VERY, VERY FEW PLACES.
IF YOU LOOK AT FIRES, A THIRD OF
FIRES IN THE WORLD ARE CAUSED BY
CARELESS SMOKERS.
I'M JUST GOING INTO THIS SLIDE A
LITTLE BIT TO SHOW HOW IN A
SENSE OF SOPHIST INDICATION
THOSE OF US WORKING IN TOBACCO
SPREAD TO REALIZE THIS ISç HIGHLY
POLITICAL AND WE HAVE GOT TO
ENGAGE WITH MANY OF THESE 
PARTNERS.
THERE ARE MANY OBSTACLES, NOT
JUST TOBACCO BUT CANCER CONTROL
AND I'LL JUST RUN THROUGH THESE.
THERE IS A LACK OF AWARENESS OF
THE RISK FACTORS.
I DID A CANCER AT LASS IN 2006
WHICH WAS GLOBAL AND MANY OF THE
PICTURES YOU SEE HERE TODAY ARE
FROM THAT ATLAS.
IT WORKS BOTH WAYS.
I CAN REMEMBER ONE OF MY
AMERICAN FRIENDS SAY LIVER
CANCER --
THERE IS ALMOST NO LIVER CANCER.
WHAT ARE YOU TALKING ABOUT?
WHEN IT'S THE FIFTH MOST COMMON
CANCER IN THE WORLD BECAUSE IT'S
IN THE LOWER-MIDDLE-INCOME
COUNTRIES.
BOTH SIDES HAVE A LOT TO LEARN
FROM EACH OTHER.
BUT MANY PEOPLE HAVE A LACK OF
AWARENESS OF THE RISK FACTOR.
A PREOCCUPATION WITH MANY OTHER
DISEASES AND IN HONGxD KONG, CHINA
WENT ON TO OVER DRIVE AND BUILT
AN ENTIRE HOSPITAL IN A MONTH.
THAT VERY ACTION TO AN ACUTE
CRISIS.
IT'S NOT THAT SAME KIND OF
MEDEIACY AND CONCERN AND ACUTE
REACTION TO THINGS THAT ARE
HAPPENING WITH CANCER.
BECAUSE MANY PEOPLE WITH CANCER
ARE OLDER WHEN THEY DIE.
THEY DIE QUIETLY IN HOSPITALS.
NOT THAT EXCITEMENT AND
IMMEDIACY EVEN WITH ROAD TRAFFIC
ACCIDENTS AND THIS IS A PROBLEM
IF YOU'RE TRYING TO PERSUADE
GOVERNMENT'S.
CANCER MAY NOT YET CAUSE MANY
DEATHS.
AND I WOULD REMIND IF YOU MANY
COUNTRIES IN THE WORLD IN AFRICA
AND IN FACT NOT SO MUCH IN ASIA
NOW BUT LIFE EXPECTANCY IS NOT
MUCH ABOVE 45.
SO YOU'RE GOING TO HAVE NOT THAT
MANY PEOPLE YET GETTING IT.
WHEN I FIRST WENT TO LOUSE ABOUT
20 YEARS AGO, THE GOVERNMENT
ASKED ME TO CALCULATE HOW MANY
DEATHS WERE THERE FROM TOBACCO
IN THE COUNTRY AT THAT TIME.
AND I THINK IT WAS SOMETHING
LIKE 50 OR 60 THAT I CAME UP
WITH.
IT WILL BE A GREAT DEAL MORE
NOW.
OTHER THINGS LIKE MALARIA, OF
COURSE AND CHILDBIRTH ARE
KILLING PEOPLE.
THERE IS AROUND THE WORLD, THIS
FOCUS ON CURATIVE MEDICINE AND
NOT PREVENTION.
I DON'T THINK THERE IS ANY
COUNTRY THAT IS NOT GUILTY OF
THAT.
I DON'T THINK THERE IS ANY
MEDICAL SYSTEM THAT IS NOT
GUILTY OF THAT.
THE MONEY GOES INTO CURATIVE
MEDICINE OR BASIC RESEARCH.
IT DOES NOT GO INTO REALLY
LOOKING INTO PUBLIC HEALTH.
PUBLIC HEALTH IS SERIOUSLY
UNDERFUNDED EVERYWHERE AND IT'S
ALSO SERIOUSLY UNDERSTAFFED.
SOME PEOPLE SEE SMOKING, ALCOHOL
AND DIET AS A PERSONAL BEHAVIOR.
SOME PEOPLE SAY TO ME, THOSE MEN
GATHNER PARKS, IT'S THE ONLY
PLEASURE THEY HAVE LEFT.
IT'S SOMETIMES SEEN AS A
PERSONAL BEHAVIOR.
BUT IF YOU GO AND GET LUNG
CANSER FROM A PERSONAL BEHAVIOR,
THAT'S YOUR PROBLEM.
YOU HAVE BROUGHT IT UPON
YOURSELF, KIND OF PHILOSOPHY,
RATHER THAN IT BEING A PUBLIC
HEALTH PROBLEM.
THERE ARE A FEAR SOMOPPOSITION
WITH PROMOTIONS, DISTORTION OF
THE HEALTH AND ECONOMIC
EVIDENCE, THEY HAVE TREMENDOUS
FINANCIAL MIGHT.
THEY HAVE GOT PROFITS AND THEY
HAVE GOT BALANCE SHEETS THAT ARE
GATOR THAN THE GDP OF MANY
COUNTRIES IN THE WORLD, LIKE
PORTUGAL, EVEN.
THEY CHALLENGE AND THREATEN
GOVERNMENT'S AND INDIVIDUALS, I
MIGHT SAY.
THEY CHALLENGE GOVERNMENT'S IF
YOU PASS THIS LAW BANNING
TOBACCO ADVERTISING, WE WILL
TAKE YOU TO COURT.
THEY CHALLENGE MANY, MANY
COUNTRIES LIKE THAT.
AND I HAVE TO SAY THAT I HAVE
REALIZED MORE RECENTLY THAT MANY
OF THE OTHER INDUSTRIES ARE NOT
THAT FAR BEHIND LOOKING AT THE
ALCOHOL INDUSTRY FOR EXAMPLE.
THE WAY THAT THEY PROMOTE THEIR
PRODUCTS, THE WAY THEY HAVE
DESIGNED DRINKS THAT APPEAR TO
THE YOUNG PEOPLE, THESE SORT OF
ALCOHOL-KINDS OF DRINKS.
THE WAY THAT THEY SHY AWAY FROM
ANYTHING TO DO WITH LEGISLATION
AND TALK ABOUT VOLUNTEER
ORGANIZATIONS.
THEY ARE MORE AND MORE BEHAVING
LIKE THE TOBACCO INDUSTRY AND
THE SUGAR INDUSTRY IS NOT FAR
BEHIND AND EVEN THE SALT
INDUSTRY.
ALL THE THINGS THAT ARE RISK
FACTORS TO THE NONCOMMUNICABLE
DISEASES.
SO I THINK THE E+áQ)IENCE THAT
WE HAVE GAINED IN TERMS OF WHAT
WORKING AGAINST THEç TOBACCO
INDUSTRY WILL PROBABLY BE
HELPFUL TO OUR PARTNERS IN OTHER
AREAS.
MANY GOVERNMENT'S SEE THE
TOBACCO AND ALCOHOL TAX COMING
IN YEAR BY YEAR, BUT THEY ARE
LESS SORT OF MOTIVATED BY THE
FACT THAT IF YOU LOOK AT THINGS
OVER A LONG TERM, THEN IT'S
GOING TO BE AN ECONOMIC DEBIT.
AND THERE IS ALSO LACK OF FUNDS
FOR RESEARCH AND INTERVENTION.
THEY GO INTO MUCH MORE
COMMUNICABLE DISEASES AND
TRADITIONALLY FUNDING HAS DONE
THE SAME.
THE TOBACCO INDUSTRY, I PUT UP
HERE, THE TOBACCO INDUSTRY HAS
NOT CHANGED ITS SPOTS.
IT'S ACTUALLY CHANGED BUT
FUNDAMENTALLY IT'S THE SAME
INDUSTRY.
WHAT IT WILL NOW SAY TO YOU,
INSTEAD OF ACCUSING OF BEING A
DANGEROUS PERSON IN THE WORLD
AND SAYING I HAVE GOT A LIST OF
ALL THE NAMES THE TOBACCO
INDUSTRY EVER CALLED ME, AND
IT'S HUMOROUS BUT IT'S REALLY
ALL TO DO WITH DENIGRATION OF
SOMEBODY LIKE MYSELF WORKING IN
PUBLIC HEALTH.
VERY PUBLICLY CALLING ME
EVERYTHING FROM A NANNY TO
HITLER IN THE WAY THAT I DEAL
WITH THE TOBACCO ISSUE.
THEY STOPPED DOING THAT AND WHAT
THEY NOW SAY IS, THEY COME TO
YOU WITH THE EQUIVALENT OF A
BOUQUET OF FLOWERS.
THEN WAS THEN AND NOW IS NOW.
WE WANT TO WORK WITH YOU.
WE WANT TO NOT WORK AGAINST YOU.
SOME OF OUR VIEWERS MIGHT
SURPRISE US.
I'M QUOTING THEM.
W.H.O. HAS A VERY STRICT POLICY
ON WORKING ON ANYTHING TO DO
WITH THE TOBACCO INDUSTRY.
THEY PUT IN A FIREWALL BETWEEN
W.H.O. AND THE TOBACCO INDUSTRY
ON THE BASIS THAT THE TOBACCO
INDUSTRY TRIED TO INFILTRATE
W.H.O. THROUGH THE FOOD PROGRAM
AND EXERT INFLUENCE THERE.
SO BECAUSE I'M A SENIOR POLICY
ADVISOR TO W.H.O., I CAN'T MEET
WITH THEM NOR WOULD I BECAUSE
THE DANGER FOR ME WOULD BE I
WOULD GO DO A COUNTRY LIKE --
THEY WOULD GO TO A COUNTRY LIKE
VIETNAM AND THEY WOULD SAY I MET
WITH DR. JUDITH MACKAY IN KONG
KONG AND WE ARE WORKING TOGETHER
WITH THIS AND THEN THEY WOULD
TRY AND UNDERMINE THE REALLY
USEFUL THINGS IN TOBACCO
CONTROL.
AND REALLY USEFUL THINGS ARE
TAXATION AND SMOKE-FREE AREAS
AND BANS ON PROMOTION.
THOSE ARE THE THINGS THEY WOULD
TRY TO UNDERMINE.
SO I HAVE NOT MET WITH THEM IN
SPITE OF BEING WOOD ALMOST LIKE
A TEENAGED GIRL.
--
ONE OF THE THINGS THAT HAVE
SPRUNG UP NOW IN THE LOWER
INCOME COUNTRIES SUDDENLY IN THE
LAST EVEN 2-3 YEARS ARE THESE
NEAR LIBERTARIAN GROUPS THAT
TALK ABOUT A NANNY-STATE.
WE WANT LESS GOVERNMENT.
THEY TALK ABOUT PERSONAL
FREEDOM.
YOU'RE USED TO THIS KIND OF
ARGUMENT HERE IN NORTH AMERICA.
BUT ASIA HAS NOT REALLY HAD THIS
KIND OF ARGUMENT BEFORE.
IF YOU LOOK BEHIND THESE GROUPS
AND HERE THEY FOR HONG KONG,
SORT OF DEMONSTRATING.
THIS ONE HAS A MASK OF OUR
MINISTER OF HEALTH ON HIS FACE
WHEN NEWS WAS PRESENTED BY A
MEDAL FROM THE W.H.O. AND
DEMONSTRATED OUTSIDE.
THEY GO ON MARCHS.
THEY REALLY ARE QUITE A
DANGEROUS GROUP WITH THE
ARGUMENTS WHICH ON THE FACE OF
IT CAN BE A BIT PERSUASIVE.
IF YOU LOOK BEHIND THEM, WHO IS
FUNDING THESE GROUPS, THEN IT IS
VERY CLEAR THAT THESE ARE FRONT
GROUPS FOR THE TOBACCO INDUSTRY.
THEY ARE BEING PAID FOR BY THE
TOBACCO INDUSTRY.
AND I MIGHT SAY THEY ARE BEING
PAID FOR BY OTHER BIG INDUSTRIES
AS WELL.
LIKE THE OIL INDUSTRY AND PEOPLE
LIKE THAT.
SO ALL OF THESE SORT OF THINK
TANKS, THESE THINK TANKS AND
NEAR LIBERTARIAN GROUPS.
WE HAVE NOT ACTUALLY HAD MUCH
EXPERIENCE WITH THEM IN THE
LOWER AND MIDDLE-INCOME
COUNTRIES UNTIL NOW.
SO MAYBE IT'S A SIGN OF
DESPERATION WE ARE DOING RATHER
WELL AND THEREFORE THEY NEED TO
GO TO THIS KIND OF OR RESORT TO
THESE TACTICS.
I'D LIKE TO LOOK IN TERMS OF
CANCER HOW WE ARE MAKING
PROGRESS.
WE HAVE MADE PROGRESS IN THE
WORLD.
IN OTHER WORDS, THESE ARE THE
THINGS THAT WE ARE DOING NOT TOO
BADLY AT.
THE FIRST OF THOSE IS NATIONAL
CANCER ORGANIZATIONS, THE
HEPATITIS Bç IMMUNIZATIONS AND
TOBACCO CONTROL.
SO IF YOU LOOK AT CAJ
ORGANIZATIONS, YOU'LL SEE THAT
REALLY WITH THE EXCEPTION OF
AFRICA, MOST COUNTRIES HAVE GOT
A CANCER ORGANIZATION IN THE
COUNTRY.
OF COURSE THERE IS THE UICC THAT
NOW IS OF COURSE VERY GLOBAL AND
THESE ARE MEMBERS OF THE UICC,
INTERNATIONAL UNION AGAINST
CANCER BASED IN GENEVA.
AND THERE IS A WORLD CANCER DAY
EVERY YEAR THAT IS CELEBRATED BY
MOST COUNTRIES WHO HAVE GOT A
CANCER ORGANIZATION.
SO IN THIS RESPECT, THE WORLD
APART FROM AFRICA AND THE FEW
COUNTRIES IN ASIA, THE WORLD IS
NOT NOW BADLY COVERED.
AND THIS IS OF COURSE GROUPS NOT
GOVERNMENTAL, NGO GROUPS ARE
WORKING ON CANCER CONTROL.
SECONDLY, IF YOU LOOK AT THE HEP
TIGHTIS B VACCINATION RATES.
AGAIN YOU CAN SEE THAT APART
FROM AFRICA, THESE ARE NOT BAD
NOW.
THE RATES ARE OVER 80% IN A
GREAT MANY COUNTRIES IN THE
WORLD.
AND I DON'T KNOW HOW MANY OF YOU
ARE AWARE OF THE PROBLEMS WITH
HEPATITIS B.
IT'S VERY LINKED TOWARDS PRIMARY
LIVER CANCER AND IMMUNIZING
CHILDREN AT BIRTH IS A GREAT
THING TO DO EVEN IF THE WOMAN IS
HEPATITIS B POSITIVE.
SO THIS IS BEING OVER THE LAST
20 YEARS, A QUITE SURPRISINGLY
SUCCESSFUL PROGRAM.
IF YOU HAVE TOBACCO --
TOBACCO IS UNIQUE IN NOW THAT WE
HAVE W.H.O. CONVENTION.
SINCE W.H.O. WAS FORMED IN THE
1940s, THIS IS ALWAYS HAD THE
ABILITY TO HAVE THE CONVENTION
LIKE THE CONVENTION ON THE
RIGHTS OF THE CHILDLIKE THE
MARITIME RIGHT OF THE SEA, THE
CONVENTION OF THE ELIMINATION
DISCRIMINATION AGAINST WOMEN.
IT IS ALWAYS HAD THE ABILITY TO
HAVE A CONVENTION BUT IT NEVER
DID HAVE ONE UNTIL THIS ONE CAME
INTO FORCE IN 2005.
AND NOW, WE HAVE OUT OF 192
COUNTRIES IN THE WORLD, 174 HAVE
RATIFIED THIS CONVENTION.
THIS HAS TO BE THE FASTEST TRACK
U.N. CONVENTION OF ALL-TIME.
I DON'T THINK ANY OTHER U.N.
CONVENTION HAS GONE EVEN
REMOTELY AT THIS PACE THAT
WITHIN FIVE YEARS YOU HAVE GOT
174 COUNTRIES RATIFIED.
AND THE WESTERN PACIFIC, THAT'S
INDONESIA WHICH IS PART OF
ANOTHER W.H.O. REGION, THE
WESTERN PACIFIC IS THE ONLY
WORLD REGION WHERE EVERY SINGLE
COUNTRY IS RATIFIED THE
CONVENTION.
AND I THINK IT SHOWS THAT THESE
LOWER-MIDDLE-INCOME COUNTRIES
RECOGNIZE THAT THEY NEED THIS
CONVENTION.
THEY NEED IT TO PROTECT
THEMSELVES AGAINST THE
TRANSNATIONAL TOBACCO COMPANIES.
I'M HUGELY IN FAVOR OF
CONVENTIONS.
I REALLY LIKE THEM AND OF COURSE
THEY ARE LEGAL INSTRUMENT.
THEY ARE AN ECONOMIC INSTRUMENT
BUT PRINCIPALLY A LEGAL
INSTRUMENT BECAUSE THERE IS A A
REPORTING PROCESS.
PROTOCOL BEING ADDED TO THE
CONVENTION.
THE FIRST ONE IS GOING TO BE ON
SMUGGLING.
AND IT IS VERY INTERESTING TO
SEE THAT IT IS THIS KIND OF
CONVENTION THAT WE NEED TO TRY
AND STOP THE EPIDEMIC.
AND THE REASON I PUT IN THE FOOT
BALL, KICKING THE FOOT BALL UP
INTO THE HEAVENS IS BECAUSE IN
PRACTICAL TERMS IN THE LOWER
MIDDLE-INCOME COUNTRIES WHAT
THIS CONVENTION HAS DONE IS TO
ELEVATE THE STATE US OF TOBACCO.
TOBACCO IS USUALLY WITHIN A
MINISTRY OF HEALTH, IT'S USUALLY
QUITE FAR DOWN.
BUT ONCE YOU HAVE AN
INTERNATIONAL CONVENTION THAT IS
A WHOLE OF GOVERNMENT POSITION,
THEN TOBACCO GETS KICKED UP
STAIRS.
IT GETS KICKED UP STAIRS TO BE
CONSIDERED BY HIGH LEVELS
RESEARCH AND DEVELOPMENT
COMMISSIONS IN CHINA AND IN
PLACES LIKE THAT.
THE CUSTOMS PEOPLE BECOME
INVOLVED.
THE FINANCE PEOPLE, THE TREASURY
BECOME INVOLVED.
IT ACTUALLY ELEVATES THE STATUS
OF THE ISSUE QUITE SURPRISINGLY,
MORE SO THAN I ORIGINALLY WHEN
WE STARTED NEGOTIATING THIS
TREATYç 15 YEARS AGO EVER DREAMT.
THIS IS A GOOD EXAMPLEç AS TO HOW
A LEGAL INSTRUMENT CAN BE USED
TO FURTHER PUBLIC HEALTH.
SO WHAT IS IT?
I WON'T GO THROUGH THIS BUT IT
READS JUST LIKE A GOOD NATIONAL
TOBACCO CONTROL LAW.
YOU TAX IT, BAN ADVERTISING,
CREATE SMOKE-FREE AREAS, DO
RESEARCH, MASS MEDIA CAMPAIGNS,
LOOK AT LITIGATION, FUND IT.
ALL THE GOOD THINGS IN A
NATIONAL PROGRAM ARE ALL
ENSHRINED IN THIS FRAMEWORK
CONVENTION.
SO ONE OF THE THINGS, ONE OF THE
MAIN THINGS IS TO BAN TOBACCO
PROMOTION.
THIS KIND OF PROMOTION NOW IS
SEEING FROM CHINA, LAS PAL MAS
AND THE PHILIPPINES, THIS IS SO
DISGRACEFUL.
THE ONE CATHOLIC COUNTRY WE HAVE
IN ASIA AND THEY USE THE MADONNA
TO --
THESE ARE ALL CIGARETTE PACKAGES
LYING OUT IN FRONT OF ALL OF US
LIKE A CINEMA WITH A TRAILER OR
SOMETHING.
SHE IS PRESIDING OVER ALL THESE
CIGARETTE PACKETS.
THIS ADVERTISING IS SEEN MUCH
LESS NOW.
IT IS SEEN MUCH LESS AROUND THE
WORLD.
IT'S MUCH MORE SUBTLE NOW.
THEY ARE PUTTING PUBLIC
PLACEMENT INTO FILMS.
EVERY TIME YOU SEE SMOKING IN
FILMS, YOU NEED TO BE AWARE THAT
THIS IS NOT JUST A STORY LINE.
IT'S NOT ACCIDENTAL.
ALMOST CERTAINLY THE ACTORS AND
PRODUCERS ARE BEING PAID FOR IT.
IT'S A HIDDEN FORM OF
ADVERTISING.
THE PROBLEM BEING OF COURSE THAT
A LOT OF PEOPLE DON'T REALIZE IT
IT'S AN ADVERTISEMENT.
THEY THINK IT'S PART OF THE
STORY LINE.
THEY FUND POP CONERTS AND THINGS
LIKE THAT.
INCREASINGLY THEY HAVE GONE ON
TO THE INTERNET SO YOUTUBE AND
TWITTER AND ALL OF THESE SOCIAL
MEDIA PAGES ARE ABSOLUTELY FULL
OF PEOPLE, SUPPOSEDLY SOME YOUNG
LADS SAYING, I'M OFF TO SMOKE
WITH MY FRIENDS NOW.
OR THERE IS ADVERTISING IN SALES
OF TOBACCO AS WELL BUT VERY
SUBTLE, QUITE DIFFICULT TO TRACE
USE OF THE SOCIAL MEDIA, IT'S
ONE OF THE WAYS THEY PROMOTE
THEIR PRODUCTS.
SMOKE-FREE LAWS.
GAINING A PACE AGAIN.
THERE IS LITTLE DIFFERENCE
BETWEEN THE RICH AND THE POOR
COUNTRIES IN TERMS OF SMOKE-FREE
LAWS EXCEPT WHEN THEY ARE
SPREAD.
ALMOST ALL COUNTRIES NOW, 95%
HAVE GOT SOME SMOKE-FREE AREAS.
IT'S JUST THAT THE RICH
COUNTRIES HAVEÑi GOT MORE AND
STRICTER AND BETTER IN GENERAL.
AND ONE OF THE ARGUMENTS ALWAYS
AGAINST IT IS HOW IT WOULD HARM
THE RESTAURANT PEOPLE.
YOU FOLK IN CALIFORNIA HAVE DONE
VERY WELL SHOWING HOW WHEN YOU
BAND IN RESTAURANTS AND BARS,
ALL THE RECEIPTS WENT UP.
AND WE DECIDED SOMEBODY NEEDED
TO DO THIS IN THE ASIA AS WELL.
SO WE LOOKED AT THE BAN THAT
HONG KONG RESTAURANT TAX
RECEIPTS GOING INTO GOVERNMENT
JUST BEFORE THE BAN AND THEN
JUST AFTER AND THE TAX RECEIPTS
WENT UP IN A TWO-YEAR PERIOD BY
31%.
COMPLETELY DISPROVING THAT
BANNING SMOKING IN RESTAURANTS
ACTUALLY HARMS THE RESTAURANT.
AND OF COURSE WE FRAMED IT VERY
MUCH AS LABEL LEGISLATION.
IT'S NOT FOR PEOPLE GOING IN AND
OUT OF THE RESTAURANT.
IT'S THE PEOPLE WORKING THERE.
NOBLE LEGISLATION TO PROTECT
PEOPLE LIKE THIS.
PACK WARNINGS.
THERE IS ABOUT 40 COUNTRIES IN
THE WORLD HAVE GRAPHIC WARNINGS
ON THEIR CIGARETTES.
I DON'T KNOW THAT YOU HAVE THAT
IN THE U.S. AS WELL.
DO YOU HAVE PICKITORIAL WARNING
ON YOUR CIGARETTE PACKETS?
MAYBE YOU'RE NOT SMOKERS?
>> [OFF MIC]
>> NEXT YEAR?
40 CREASE NOW.
SOME --
40 COUNTRIES NOW.
ONE OF THE THINGS WE LEARNED
ABOUT HEALTH WARNINGS IN THE
WORLD IS THAT THE TOUGHER THEY
ARE, THE MORE GRUESOME THEY ARE,
THE GREATER AFFECT IT SEEMS TO
HAVE ON SMOKERS.
IN HONG KONG WE CHOSE A MIX.
THEN THE WORLD LUNG FOUNDATION
WHERE MY WORK IS PART OF THE
BLOOMBERG INITIATIVE HAS A MASS
MEDIA CAMPAIGN AND WHAT IT DOES
IS GATHERS TOGETHER ALL THE MASS
MEDIA CAMPAIGNS BEING EVALUATED
AND SEEç HOW THEY CAN BE TURNED
á"TO DIFFERENT LANGUAGES AND(
áQ'T SETTINGS.
IN OTHER WORDS, REALLY GIVE A
KICK START TO COUNTRIES WHO ARE
LOOKING TO DO MASS MEDIA
CAMPAIGNS.
SOME REALLY EASY.
THERE IS ONE OF A BEAKER LIKE IN
A CHEMISTRY LAB AND SOMEBODY
SQUEEZING A SPONGE AND YOU SEE
THE TAR COMING OUT OF IT.
THAT CAN TRANSLATE IN ANY
COUNTRY.
ONLY NEED A VOICE.
THERE ARE WAYS THE BLOOMBERG
INITIATIVE AND IN PARTICULAR ARE
REALLY TRYING TO SORT OF GET
SOME COUNTRIES A KICK START.
QUITTING REDUCES CANCER RISK.
IT REDUCED LESS THAN HALF OF
THAT OF CONTINUING SMOKERS
WITHIN 10 YEARS AND BY ABOUT 15
YEARS IT IS BETTER AND THE
MESSAGE THERE IS THAT IT'S NEVER
TOO LATE TO QUIT.
THAILAND EARMARKED 2% OF ALL
TOBACCO AND ALCOHOL TAX TO
HEALTH PROMOTION AND THIS MAY
NOT SOUND VERY MUCH BUT IT IS AN
IMMENSE AMOUNT OF MONEY.
THAILAND DOESN'T KNOW WHAT TO DO
WITH ALL THE MONEY FOR THIS.
AND IT IS A VERY GOOD WAY.
WE CAN'T FINANCE PUBLIC HEALTH,
GET THEM TO TAX TOBACCO AND TAX
ALCOHOL AND IT'S GOT
APPLICATION.
GIVE A PERCENTAGE OF THAT TAX
TOWARDS HEALTH PROMOTIONS.
RAISING TAXES.
AGAIN, WE COME BACK TO ECONOMICS
TIME AND TIME AND TIME AGAIN
LIKE THE NCD EPIDEMICS.
WE KNOW THAT THE ECONOMIC
MESSAGES THAT TOBACCO IS A DEBIT
TO ALL ECONOMIES.
TOBACCO CONTROL IS COST
EFFECTIVE.
A LOT OF IT IS FREE PUTTING A
HEALTH WARNING, PUTTING
PICKITORIAL WARNINGS ON PACKETS.
DON'T PAY ANYTHING.
PRICE INCREASES ARE THE MOST
EFFECTIVE.
TOBACCO TAX DOES NOT DECREASE
GOVERNMENT REVENUE.
IT DOES NOT LEAD TO INCREASED
SMUGGLING AND I THINK ONE OF THE
THINGS WITH THE NCD COMING
TOGETHER AS THEY ARE THIS YEAR,
IT'S TO LOOK AT TAXATION ON
OTHER CAR SINIGENCE LIKE
ALCOHOL, FOODS, WHETHER TO
DECREASE TAX ON VEGETABLES.
TAXATION POLICY SEEMS TO HAVE A
MAJOR AFFECT ON HABIT.
BECAUSE OF THE FRAMEWORK
CONVENTION, WE HAVE PRIVATE DO
NORS COMING IN.
MICHAEL BLOCK BERG, BILL GATES,
GIVING SERIOUS MONEY, 500
MILLION, OVER A THREE-YEAR
PERIOD TO TOBACCO CONTROL
GLOBALLY.
FUNDING FROM GOVERNMENT'S IS
STILL COMPLETELY INADEQUATE.
IF WE LOOK AT WHAT MORE NEEDS TO
BE DONE IN TERMS OF CANCER
CONTROL, GOVERNMENT SPENDING ON
NCDs AND CANCER CONTROL IS
STILL WOEFULLY INADEQUATE.
WE ARE NOT DOING QUITE SO WELL
ON CANCER REGISTRIES, EARLY
DETECTION, CANCER TREATMENT AND
TERMINAL CARE AND CANCER
SURVIVORS.
I'LL JUST GO THROUGH THESE.
THIS IS AN UPTO DATE MAP THIS
YEAR LOOKING AT THE PERCENTAGE
OF THE POPULATION COVERED BY
CANCER REGISTRIES BY DISTRICT.
YOU CAN SEE AMERICA IS VERY
HIGH.
85%.
82% IN AUSTRALIA.
NOT BAD IN EUROPE.
IN AFRICA, LESS THAN 8% OF THE
POPULATION IS COVERED BY ANY
KIND OF CANCER REGISTRY AND IN
FACT THE TOTAL, GLOBAL TOTAL IS
THAT ONLY 17% OF THE WORLD'S
POPULATION IS COVERED BY A
CANCER REGISTRY.
THIS IS WHY MANY OF THE
STATISTICS ARE ESTIMATES.
BUT THIS IS A GREAT SAVING
BECAUSE THERE IS A MAX IN THE
MARKETING WORLD IF YOU CAN'T
MANAGE IT, IF YOU CAN'T MEASURE
IT, YOU CAN'T MANAGE IT.
AND THAT IS WHY IT'S SO
IMPORTANT TO ACTUALLY HAVE
CANCER REGISTRIES TO MEASURE IT
AND THEREFORE KNOW HOW TO MANAGE
IT BECAUSE IF YOU HAVE NO IDEA
WHAT KIND OF CANCER YOU HAVE IN
YOUR COUNTRY, YOU CAN'T PLAN
HEALTH SERVICES.
YOU DON'T KNOW HOW TO PUT YOUR
FUNDING IN.
THAT'S NOT VERY GOOD.
THIS IS CANCER SCREENING.
AGAIN THE WEALTHY COUNTRIES
DOING PRETTY WELL.
THE POORER COUNTRIES DOING
EXTREMELY BADLY AND SURVIRE
CANCER NOW HAS BECOME EMERGING
WITH THE REAL PROBLEM INç THE
LOWER TO MIDDLE-INCOME
COUNTRIES.
AVAILABILITY OF
AND THIS MAP SHOWS THE NUMBER OF
PEOPLE SERVED BY A SINGLE RADIO
THERAPY CENTER.
AND YOU CAN SEE IT VARIES FROM
0.5 TO 20 MILLION.
A HUGE DISCREPANCY BETWEEN THE
RICHER COUNTRIES AND AFRICA AND
SOME PARTS OF ASIA.
SO THEY ARE TREMENDOUS IN
EQUALITIES AND CHALLENGES THAT
LIE AHEAD IN TERMS OF TREATMENT
EVEN.
AGAIN, IF YOU LOOK AT CANCER
SURVIVORS, THE RED COLORS DO THE
WORST AND IT'S THE SAME MATH
AGAIN.
THE AFRICA AND ASIA WHERE CANCER
SURVIVORS, THIS IS PER 1,000
PEOPLE, ARE NOT DOING NEARLY AS
WELL AS THEY ARE IN THE WESTERN
COUNTRIES.
IF YOU LOOK AT HEALTH SPENDING,
AGAIN, THE SAME MAP EMERGES THAT
THE HEALTH SPENDING IS AT THE
CENTER OF GDP AND MUCH, MUCH
LOWER IN THE MIDDLE PART OF THE
WORLD THAN IT IS IN NORTH
AMERICA OR IN EUROPE.
EVEN IF YOU LOOK AT THE NUMBER
OF PHYSICIANS WORKING IN
NONCOMMUNICABLE DISEASES, I
DON'T HAVE FIGURES FOR PEOPLE
WORKING PURELY IN CANCER.
THESE ARE FIGURES FOR PHYSICIANS
WORKING IN NONCOMMUNICABLE
DISEASES.
YOU CAN SEE THAT IN AMERICA AND
EUROPE, THESE ARE HIGH.
IN AFRICA IT'S REALLY ONLY 21
PER 100,000 POPULATION.
IF YOU LOOK AT THE W.H.O.
REGIONS.
INCREASINGLY NOW, WE ARE LOOKING
AT MANY OF THESE NONCOMMUNICABLE
DISEASES TOGETHER.
THIS IS ONLY REALLY HAPPENED IN
THE LAST COUPLE OF YEARS.
AND IT'S HAPPENED BECAUSE THERE
IS IN SEPTEMBER THIS YEAR, GOING
TO BE A MEETING AT THE U.N.
WHICH I'LL COME TO.
AND THIS CHART WAS PUT TOGETHER
BY W.H.O. SHOWING HEART DISEASE,
DIABETES AND CANCER AND CHRONIC
LUNG DISEASE.
LOOKING AT RISK FACTORS OF
TOBACCO USE AND HEALTHY DIET,
PHYSICAL INACTIVITY, THEY CALL
IT THE HARMFUL USE OF ALCOHOL.
I THINK, I SUSPECT IN TIMES TO
COME, IT WILL BE JUST ALCOHOL.
BUT YOU CAN SEE THE RISK FACTORS
HERE ARE VERY, VERY COMMON AMONG
ALL OF THEM.
AND I THINK THIS IS WHY THE U.N.
IS GOING TO BE HOLDING A SUMMIT
LOOKING AT NONCOMMUNICABLE
DISEASE NO, SIR GENERAL.
W.H.O. HAS COME UP WITH --
DISEASES IN GENERAL --
COME UP WITH A CONVENTION.
A GLOBAL STRATEGY ON HEALTHY
DIET, PHYSICAL ACTIVITY AND
HEALTH AND A GLOBAL STRATEGY ON
ALCOHOL.
NOT A FULL CONVENTION.
ALTHOUGH SOME PEOPLE ARE
BEGINNING TO THINK MAYBE WE NEED
A CONVENTION ON ALCOHOL JUST
LIKE WE DO ON TOBACCO GIVEN ITS
RISK IN TERMS OF MANY WAYS IN
LIFE.
THIS U.N. SUMMIT IS GOING TO BE
HELD ON THE 19th-20th OF
SEPTEMBER, THIS YEAR.
JUST TWO MONTHS FROM NOW.
THE WHOLE OF THE HISTORY OF THE
U.N. SINCE IT WAS FORMED IN THE
1940s IS ONLY BEING 28 SUCH
MEETINGS AT THE U.N. AND ONLY
ONE ON HEALTH BEFORE WHICH WAS
ON AIDS AND THAT LED TO A GREAT
EXPANSION OF COMMITMENT TOWARDS
AIDS AND FUNDING AND RESOURCES
PUTS TOWARDS IT.
SO THIS IS THE SECOND ONE ON
HEALTH.
THERE HAS BEEN IN THE LAST 50
YEARS.
IT'S HARD TO SEE WHETHER
OPPOSITION IS.
IT'S 135 COUNTRIES CO-SPONSORINGñr
IT.
AND THERE SEEMS TO BE LESS
APPROVAL.
NOBODY IS ENGAGED IT THAT WE
KNOW.
WE DON'T KNOW.
I HAVE TO SAY WHAT THE TOBACCO
INDUSTRY IS DOING ABOUT IT AND
SOME OF THE OTHER INDUSTRIES.
CERTAINLY GOVERNMENT LEVEL AND
IT'S A GOVERNMENT WHO IS HEAD OF
STATE WHO WANT TO NEGOTIATE
THIS.
THEY SEEM TO BE FAIRLY MUCH IN
APPROVAL OF IT.
TO HAVE AN OUTCOME DOCUMENT IS
REALLY CRITICAL.
NOT A DECLARATION OR
RECOMMENDATION, AN OUTCOME
DOCUMENT I NOW KNOW IN THE U.N.
SYSTEM HAS IMPLICATIONS FOR
FUNDING.
IT HAS IMPLICATIONS FOR
REPORTING.
IT HAS IMPLICATIONS FORç THINGS
LIKE TARGET.
SO OUTCOME DOCUMENTS IS THE NAMEç
TESTIFY.
BECAUSE IT LOCKS COUNTRIES INTO
COMMITMENT.
IT'S AS SIMPLE AS THAT.
WHEREAS RECOMMENDATIONS AND
RESOLUTIONS DON'T DO IT TO THE
SAME EXTENT APPARENTLY.
AND THERE IS A CALL TO PUT
NONCOMMUNICABLE DISEASES INTO
THE NEXT ROUND OF THE MILLENNIUM
DEVELOPMENT GOALS.
THE PRESENT MILLENNIUM GOALS GO
TO 2015 AND THEN THERE WILL BE A
NEW ROUND NEGOTIATED.
THE PRESENT MILLENNIUM
DEVELOPMENT GOALS, CAN YOU
BELIEVE, DON'T EVEN MENTION
NCDs NOT AT ALL.
ALL FOCUSING ON THE COMMUNICABLE
DISEASES AND FAIR ENOUGH THINGS
LIKE POVERTY AND WOMEN'S HEALTH
AND THINGS LIKE THAT, BUT
NONCOMMUNICABLE DISEASES GIVEN
THAT 60% OF DEATHS IN THE WORLD
NOW, THE WORLD, ARE CAUSED BY
THE NONCOMMUNICABLE DISEASES.
SO THIS IS COMING UP AND I
WOULDN'T SAY IT'S FORCING.
IT'S BRINGING THE CANCER PEOPLE,
THE HEART PEOPLE, THE LUNG
PEOPLE, AND OTHERS TOGETHER.
THERE ARE MANY OTHER
NONCOMMUNICABLE DISEASES LIKE
MENTAL HEALTH AND THINGS LIKE
THAT THAT HAVE NOT QUITE GOT
THEIR RIFLE PLACE IN THIS.
THE FOCUS IS ON THE BIG FOUR.
I THINK IT'S VERY IMPORTANT THAT
WE DON'T LOSE SIGHT OF THE FACT
THAT THERE ARE A LOT OF OTHER
THINGS ORAL HEALTH IN
PARTICULAR.
SO WHAT WE SORT OF THINK WE NOW
NEED TO DEAL WITH DISEASE, NOW
ADAYS AND FOR THE FUTURE IS A
NEW PARADIGM.
WE NEED THESE INTERNATIONAL LAWS
AND TREATIES.
WE RECOGNIZE THE CRUCIAL ROLE OF
GOVERNMENT AND POLITICAL WILL.
WE UNDERSTAND THE EXTRAORDINARY
REACH OF THE ISSUES FROM
CORPORATE CRIMINALITIY LIKE THE
TOBACCO INDUSTRY BEING INVOLVED
WITH SMUGGLING TO PUBLIC
ALLEVIATION AND THEREFORE WE
NEED NEW PARTNERS TO WORK WITH.
WE NEED POLITICAL MAPPING OF THE
OBSTACLES.
THESE ECONOMIC CONCERNS AND WHAT
ARE THESE INDUSTRIES UP TO, WHAT
ARE THEY DOING?
SO WE HAVE TO HAVE W.H.O.'S
SUPPORT.
WE MUST HAVE SCIENCE.
IF WE STRAY AWAY FROM SCIENCE,
WE ARE DEAD IN THE WATER.
WE HAVE GOT TO KEEP THAT
RESEARCH COMPONENT GOING.
IT'S REALLY, REALLY
EXTRAORDINARILY IMPORTANT.
AND I WOULD ALSO JUST SAY HERE
THAT MUCH OF THE RESEARCH THAT
YOU'RE DOING IN THE U.S. IS
BEING USED GLOBALLY.
BECAUSE THERE ARE MANY COUNTRIES
THAT REALLY DO OR THEY JUST
DON'T HAVE ANYTHING LIKE
RESOURCES NEEDED TO DO THE KIND
OF RESEARCH THAT YOU'RE DOING
HERE.
SO DON'T FORGET THAT RESEARCH
DONE IN THE U.S. HAS GOT VERY
MUCH A GLOBAL REACH.
WE NEED TO LOOK AT COMPREHENSIVE
POLICIES, COMMON RISK FACTORS.
WE NEED TO LOOK AT ENFORCEMENT
AFTER LEGISLATION BECAUSE THIS
ISN'T ALWAYS EASY.
IT'S A SIMPLE THING LIKE
LABELING FOOD.
WE NEED TO ENGAGE NGOs AND
INDIVIDUALS AND EMPLOYERS AND
COALITIONS.
WE HAVE TO EFFECTIVE ADVOCACY
AND WE MUST NEVER FORGET THE
ROLE OF THE MEDIA.
SO, IN MANY WAYS, I THINK THE
FEELING IS LOOKING FORWARD AT
NONCOMMUNICABLE DISEASES.
WE NEED THIS NEW PARADIGM.
BUT JUST TO SHOW YOU THAT
ACTUALLY MAYBE IT'S NOT QUITE SO
NEW, THIS IS A GENERAL WHO WAS
ACTIVE THOUSANDS OF YEARS AGO IN
CHINA.
HE HAD A BATTLE STRATEGY THAT
REALLY TO ME SEEMS TO READ LIKE
A GRANT APPLICATION OF TODAY
THAT YOU MEASURE THE DISTANCES
AND ESTIMATE THE EXPENSES,
EVALUATE THE FORCES, ASSESS THE
POSSIBILITIES AND PLAN FOR
VICTORY.
SO MAYBE IN SOME WAYS, IT'S NOT
THAT DIFFERENT THAN WHAT WE ARE
DOING THAN WHAT IS BEING DONE
HISTORICALLY.
AS I SAID, THE POLITICAL INPUT
AND POLITICAL WILL IS REALLY
IMPORTANT.
I TALKED A LOT ABOUT GOVERNMENT
BUT I'LL JUST SHOW TWO MORE
SLIDES.
ONE IS ON THE EMPLOYERS AND ONE
ON THE INDIVIDUAL.
EMPLOYERS HAVE A TREMENDOUS ROLE
FOR ACADEMICS TO MAKE THEIR
PREMISES CANCER FREE.
AGAIN, THE ARGUMENTS FOR
EMPLOYERS AGAIN ARE SURPRISINGLY
ECONOMIC.
IT'S WHAT THEY BEST RESPOND TO.
MEDICAL AND HEALTHCARE COSTS,s
HIGHEST SICKNESS RATES, LOSS OF
SKILLED WORKERS, EARLYç
RETIREMENTS AND RISKS OF
SECOND-HAND SMOKE AND THEN THE
ECONOMIC COSTS.
EVERY SEVEN MINUTES OF A SMOKE
BREAK COSTS AN EMPLOYER.
THERE IS LOSS PRODUCTIVITY,
FIRES CAUSED BY CARELESS
SMOKING, DAMAGE TO BUILDINGS AND
A LOT OF LITTER AND THE RISK OF
BEING SUED F YOU HAVE GOT A
WORKPLACE THAT HAS CARCINOGENS
IN IT, YOU'RE LIKELY TO BE SUED.
SO, I THINK WE HAVE TO ENGAGE
WITH EMPLOYERS AS WELL TO WORK
HAND-IN-HAND WITH GOVERNMENT AND
IMPLEMENT MANY OF THE POLICIES
TO HAVE SMOKE-FREE
CARCINOGEN-FREE SMOKE PLACES AND
SO ON.
AND THEN AS FAR AS INDIVIDUAL
GOES, AN INDIVIDUAL
RESPONSIBILITY IN CANCER.
IN TERMS OF TOBACCO, ALCOHOL,
DIET, WEIGHT, THE A. HAVING
IMMUNIZATIONS, HEPATITIS B,
OFFERED TO THE SURVIVOR CANCER
VIRUS AND COMPLY WITH TREATMENT
WHEN IT'S GIVEN TO YOU.
THE RESPONSIBILITY OF THE FUTURE
OF CANCER EPIDEMIC IS SPREAD
ACROSS THE WORLD.
WHAT WE NEED TO DO, THE REASON
WE FOR THIS BUSINESS, JUST TO
SHOW THREE PICTURES TO END WITH,
THE WHOLE REASON WE ARE IN THIS
BUSINESS IS BASICALLY TO TRY AND
PROTECT LITTLE PEOPLE LIKE THIS
AT THE AGE OF WHAT LOOKS NOT
EVEN THREE, IS SMOKING LIKE A
SEASONED TROOPER.
AND THIS IS A LITTLE BOY LIKE
THIS WILL BE SORT OF LAUGHED AT
IN CHINA.
THEY THINK IT'S CUTE, FUNNY.
THIS WAS IN INDONESIA RECENTLY.
THAT WAS A SMALL CHILD WHO CAME
ADDICTED TO CIGARETTES.
WE HAVE TO CHANGE THAT MIND
THINKING.
IT'S LIKE GIVING ALCOHOL TO A
CHILD WHICH IN FACT WAS ON MY
LAST SLIDE.
AND AGAIN, WE JUST NEED TO SHIFT
A WHOLE LOT OF RISK FACTORS, NOT
JUST TOBACCO BUT OBESITY AND
EXERCISE AND IN PARTICULAR,
ALCOHOL.
SO THIS IS MY LAST SLIDE SAYING
THE FIGHT FOR CANCER CONTROL
WILL CONTINUE AND A PICTURE OF
ME ON THE ROOF OF WHERE I LIVE
IN HONG KONG DOING TAI CHI.
SO THANK YOU VERY MUCH.
[APPLAUSE]
I WOULD BE HAPPY TO TAKE ANY
QUESTIONS.
I THINK THAT'S THE IDEA.
>> I'M SURE OTHER PEOPLE WILL
COMMEND YOU FOR YOUR
PRESENTATION.
I MUST LOOK AT THE SAD PART OF
THE STORY.
YOU MENTIONED THAT THE RATE OF
CONSUMPTION PER PERSON OF
TOBACCO GOING DOWN BUT THE
NUMBER OF PEOPLE WHO HAVE BEGIN
TO SMOKE HAS GONE UP.
SO SORT OF OFFSETTING THE GAINS.
THE QUESTION NOW BECOMES, WHAT
ARE THE MEASURES WHICH ARE BEING
DISCUSSED TO DEAL WITH THIS
UPTAKE OF NEW SMOKING?
ONE CASE WHICH I WAS SURPRISED
ABOUT NOT LISTED IN YOUR
ARTICLE, ALTHOUGH YOU MENTIONED
THEN, A FAMILY HISTORY OF
SMOKING.
I THINK MY IMPRESSION OF THE
ASIAN COUNTRIES IS THAT IT IS A
VERY STRONG FACTOR.
ARE THERE MEASURES BEING
DISCUSSED HOW TO CURTAIL THAT
KIND OF THING?
>> WELL, IF YOU ANSWER THAT
QUESTION AT ITS MOST RADICAL,
THEN ALL OF US IN CANCER CONTROL
SHOULD MOVE TOWARDS POPULATION
CONTROL TO TRY AND KEEP THE
POPULATION DOWN BECAUSE AS LONG
AS THE WORLD'S POPULATION IS
GOING TO BE INCREASING AND
INCREASING AND INCREASING, WE
ARE GOING TO HAVE MORE OF
EVERYTHING.
SO, I MEAN, I SAY THAT NOT
ENTIRELY FE SERIOUSLY.
IF FOR EXAMPLE, CHINA, HAD NOT
HAD THE ONE CHILD POLICY, THERE
WOULD BE ABOUT HALF A BILLION
MORE PEOPLE IN THE WORLD.
SO, ALL OF THESE, THE USE OF
FUEL, THE USE OF FOODS, THE
ENVIRONMENTAL CONSEQUENCES, THE
NUMBER WHO WILL SMOKE AND GET
CANCER AND HEART DISEASE WILL BE
EXTREMELY HIGH.
SO, AS Iç SAID, THAT IS NOT
EXACTLY THE MOST PRACTICAL
ANSWER BUT MYç SECOND ANSWER IS,
YES, I THINK ALL OF THE WEAPONS
THAT WE HAVE AT OUR DISPOSAL, WE
KNOW WHAT WORKS AND WHAT DOESN'T
WORK IN TERMS OF TOBACCO
CONTROL.
WE KNOW FOR EXAMPLE, THAT
HEALTH, EDUCATION IN SCHOOLS HAS
GOT NO OR VERY, VERY LIMITED
AFFECT THE WAY IT IS BEING DONE
AT THE MOMENT.
AND THERE IS MANY REASONS FOR
THAT.
FOR EXAMPLE, IT TENDS TO BE
TAUGHT YOU WILL GET CANCER WHEN
YOU'RE 60 OR A HEART ATTACK WHEN
YOU'RE 70 WHICH IS MEANINGLESS
TO AN 11-YEAR-OLD.
WE HAVEN'T FOUND THE RIGHT WAY
TO DO IT YET, TO TRY AND TEACH
IN SCHOOLS.
WE KNOW THAT SERVING TO MINORS
IS USELESS.
NO DIFFERENCE IN SMOKING RATES
AMONG YOUNG PEOPLE WHETHER YOU
BAN IT TO MINORS OR NOT.
THEY GET THE CIGARETTES ANYHOW.
THESE ARE THE TWO PROGRAMS THAT
FULLY SUPPORTED BY THE TOBACCO
INDUSTRY.
THE REASON IS TO SUPPORT THEM
BECAUSE THEY SIMPLY DO NOT WORK.
FAMILY HISTORY, AT LEAST FAMILY
--
THE FAMILY HISTORY OF SMOKING AS
AN EXAMPLE IS REALLY IMPORTANT.
IF YOUR PARENTS SMOKE, YOU'RE
TWICE AS LIKELY TO SMOKE.
AND THAT'S PRETTY MUCH AROUND
THE WORLD.
SO THERE IS AN EXAMPLEULAR ROLE
THERE.
SO NO, I MEAN, IN PART OF HEALTH
EDUCATION AND HEALTH PROMOTION,
I THINK YOU NEED HEALTH
EDUCATION ITSELF IS NOT ENOUGH.
YOU NEED MORE TOUGHER MEASURES
IN TERMS OF ACTUALLY BANNING
THINGS AND THIS IS WHERE THE
WHOLE NAN ESTATE ARGUMENT COME
IN.
IF YOU LOOK FORWARD INTO THE
FUTURE AND THAT'S WHAT THIS TALK
IS TRYING TO DO, I THINK IN
ANOTHER --
BEFORE 50 YEARS, SAY 30 YEARS,
PEOPLE WILL LOOK BACK AND THEY
WILL NOT ASK US WHY WERE WE SO
TOUGH ON TOBACCO?
WE WERE BANNING THIS AND THAT
AND NOT ALLOWING ADVERTISING
MAKING SMOKE-FREE AREAS AND
THAT.
THAT'S NOT THE QUESTION.
THE QUESTION IS WHY DID IT TAKE
US SO LONG?
WE HAVE KNOWN FOR 60 YEARS THAT
TOBACCO KILLS PEOPLE.
WE UNDERSTAND INCREASINGLY THE
RISKS OF ALL THE OTHER RISK
FACTORS AND YET, WE ARE SLOW IN
TERMS OF TAKING PUBLIC HEALTH
ACTION.
AND I THINK IT IS ONLY RECENTLY
THAT FOR EXAMPLE IN TOBACCO
CONTROL, FOR RIGHT THROUGH THE
80s AND MUCH INTO THE 90s,
IT WAS A RAGGED BAND OF
ACTIVISTS GOING ON THIS
BILLBOARD, DEFACING THEM AND
CAUSING ALL SORTS OF DEMOS AND
TROUBLE.
IT'S BECOME MUCH MORE MAINSTREAM
PUBLIC HEALTH NOW.
YOU SEE THAT AS AN EXAMPLE.
WE SEE U.N. MEETING COMING UP.
IT'S MOVED INTO MAINSTREAM
PUBLIC HEALTH.
BUT WE DO KNOW WHAT TO DO.
AND I THINK WE JUST NEED TO DO
MORE OF IT AND GET THAT ROLE
FROM GOVERNMENT TO IMPLEMENT IT.
I DON'T THINK THERE IS GOING TO
BE ANY SURPRISES IN TOBACCO
SAYING THIS IS SOMETHING WE
NEVER THOUGHT OF.
THIS IS WHAT WE SHOULD DO.
I DON'T THINK THAT WILL HAPPEN.
>> [OFF MIC]
>> I'M NOT FAMILIAR ENOUGH.
MAYBE SOMEBODY FROM THE U.S.
COULD ANSWER THAT QUESTION.
I'M NOT FAMILIAR ENOUGH WITH HOW
THAT MONEY WAS USED.
BUT CERTAINLY IT IS GOING BACK
TO WHAT I SAID EARLIER, IT'S NOT
SO MUCH THE HEALTH EDUCATION AND
THE HEALTH PROMOTION THROUGH
SCHOOLS THAT SEEM TO HAVE
BROUGHT RATES DOWN.
WHAT BROUGHT RATES DOWN HAS MORE
TO DO WITH THE TOUGH TAXATION
POLICY HAVING TAX OF 60-75% OF
THE RESALE PRICE OF CIGARETTES,
BANNING ALL PROMOTIONS AND ALSO
CREATING SMOKE-FREE AREAS TO
CHANGE THE SOCIAL NORM.
THESE ARE THE THINGS THAT WORK.
AND I DON'T FINISH MONEY WAS PUT
INTO THOSE KIND OF THINGS OR IF
IT WAS MOSTLY PUT INTO PROGRAMS
FORç YOUNG PEOPLE.
>> I WAS TALKING ABOUT VITAMINS,
BETA CARE TEEN ANDç THAT KIND OF
THING.
>> I'M.
I DIDN'T CATCH THAT.
>> BETA CARE TEEN AND VARIOUS
VITAMIN TRIALS.
>> WE SPONSORED A NUMBER OF
TOBACCO-CONTROLLED TRIALS IN A
SERIES.
WHEN I FIRST CAME TO NCI IN
1991, THERE WERE MANY REDUNDANT
STUDIES OF THE CAUSES OF LUNG
CANCER AND NOTHING ON TA BOCK
ACK --
TOBACCO CONTROL.
AND THEN WE STARTED SMALL
STUDIES LIKE WOMEN, MINORITY
GROUPS, HOW IT AFFECTED THEM AND
THEN IT WENT INTO COMMUNITY
STUDIES, CONTROLLED COMMUNITIES
AND THEN INTO A LARGE --
I GUESS YOU CALL IT A
DEMONSTRATION TRIAL, WHICH
COVERED IF YOU COUNT THE
POPULATION OF THE STATE, 95
MILLION
MILLION PEOPLE.
BUT WHAT WE DID IN DOING THAT
WHILE IT WAS HARD TO MEASURE
BECAUSE THERE WAS A TREND OVER
TIME AND WHETHER YOU LOOK AT
CONTROLS, THE PEOPLE THAT WERE
RUNNING THOSE WERE THE ACTIVISTS
ALL ACROSS THE COUNTRY.
WE WERE FUNDING THEM TO DO THE
TRIALS AND NOT TALKING ABOUT THE
FACT THAT THEY WERE THE
ACTIVISTS THAT WERE GETTING
ACTION WITHIN THEIR STATE
GOVERNMENTS AND WITH THE LOCAL
COMMUNITIES AND CALIFORNIA,
MASSACHUSETTS, MINNESOTA AND SO
WE THINK THAT DID HAVE AN
AFFECT.
IT'S HARD TO MEASURE EXACTLY.
>> I WOULD JUST SAY THAT MUCH OF
THE WORLD, OF COURSE, IS MUCH
LESS SOPHISTICATED.
MOST COUNTRIES DON'T EVEN HAVE
IN THE WHOLE COUNTRY, AS MANY
PEOPLE IN THIS ROOM TODAY
WORKING ON TOBACCO CONTROL.
SO, I THINK WHAT WE ARE TENDING
TO SEE IT'S NOT THE MOST
SOPHISTICATED APPROACH OF
BEHAVIORAL CHANGE, FOR EXAMPLE,
OR LOOKING EVEN AT QUITTING.
QUITTING IS IN ITS INFANCY IN
THE LOWER AND MIDDLE-INCOME
COUNTRIES.
IT'S VERY, VERY FEW PLACES THAT
ARE DOING ALMOST ANYTHING ON
QUITTING.
THEY ARE JUST BEGINNING TO NOW.
SO I THINK THE LOWER AND MIDDLE
INCOME COUNTRIES THERE IS AT A
STAGE WHERE THEY ARE PUTTING
TAXATION IN PLACE, THAT'S THE
STAGE WE ARE AT MORE THAN REALLYñr
LOOKING AT SOME OF THE
BEHAVIORAL THINGS, ALMOST
VIRTUALLY NONEXISTENT AND A
GREAT MANY LOWER OR
MIDDLE-INCOME COUNTRIES.
I DON'T FINISH ANYONE IS HERE
THAT WOULD LIKE TO COMMENT ON
THAT, WHAT IS HAPPENING ABOUT
TOBACCO IN YOUR OWN COUNTRY AND
WHETHER THE RATES ARE SIMILAR.
WHETHER YOU TRIED TO RUN ANY
KIND OF BEHAVIORAL WORK?
I'D BE INTERESTED TO KNOW.
TOL WOULD LIKING TO SAY
SOMETHING.
TOM GLENN.
>> [OFF MIC]
>> I THINK YOU NEED A MICROPHONE
BECAUSE THEY ARE RECORDING IT.
>> AMONG YOUR MANY SKILLS IS, AS
A PROGNOSTICATOR, AND I WONDER
IF YOU MIGHT SPECULATE A BIT ON
YOU WHAT THINK THE OUTCOME OF
THE U.N. SUMMIT MIGHT BE.
I KNOW YOU TALKED ABOUT THE
OUTCOME DOCUMENT.
BUT 2-5 YEARS DOWN THE LINE,
WHAT IS THE AFFECT OF THE SUMMIT
GOING TO BE?
IT'S A UNIQUE OPPORTUNITY NETIME
AND HERE WE ARE A FEW MONTHS
OUT.
>> HERE WE ARE.
I THINK IT WILL GO THROUGH.
I THINK IT WILL GO THROUGH
PRETTY MUCH WITHOUT DECENT.
SURPRISINGLY THE BIGGEST
DIFFICULTY AND THE BIGGEST
OPPOSITION TO IT IS FROM THE
WEALTHY COUNTRIES.
BECAUSE AS I SAID, IT DOES CARRY
WITH IT OBLIGATIONS FOR ACTION
AND THEREFORE FOR FUNDING.
AND IF THE LOW-INCOME COUNTRIES
CAN'T FUND IT THEN IT WILL
SOMEWHAT COME BACK TO THE
WEALTHY COUNTRIES IN TERMS OF
THEIR DEVELOPMENT AID TO
ACTUALLY PUT MONEY INTO IT.
AND A LOT OF COUNTRIES WHO ARE
TRADITIONALLY FIRST CLASSyM IN
TERMS OF DOING PUBLIC HEALTH
MEASURES LIKE NORWAY, THERE ARE
SOME0COUNTRIES WHO ARE REALLY
BACHING AT THE IDEA OF,
ESPECIALLY THE ECONOMIC CLIMATE,
HAVING TO FUND YET ANOTHER KIND
OF FAIRLY MASSIVE KIND OF
PROGRAM.
SO I THINK IF THERE IS ANY
TWEAKING TO BE DONE, I THINK IT
MIGHT BE ALONG THE LINES OF
FUNDING WHICH WILL BE A GREAT
PITY.
I THINK IF IT FALLS ANY WHERE,
THAT MIGHT BE WHERE IT FALLS.
THE SECOND THING I WOULD PREDICT
IS THAT THEY ARE NOT GOING TO
SET UP A BIG NEW ORGANIZATION
LIKE WE DID FOR AIDS.
I THINK THAT IT WILL COME UNDER
W.H.O.
IT'S EASIER, IT'S SIMPLER AND
MUCH LESS EXPENSIVE TO HAVE IT
SHEPHERDED, TO HAVE THE
SECRETARY WITHIN THE W.H.O. WARN
ANYWHERE ELSE.
I THINK THERE IS SAY AGREEMENT
AMONG THE GOVERNMENTS AND THE
NGOs THAT THAT IS PROBABLY THE
BEST WAY FORWARD.
THIRDLY, THE NGOs INVOLVED
WITH HEART AND CANCER, THEY WILL
BECOME AND HAVE BECOME, MUCH
MORE POLITICAL IN TERMS OF
UNDERSTANDING US.
LOBBYING GOVERNMENT'S AND
ECONOMIC ARGUMENTS AND LOOKING
AT TAXATION, LOOKING AT THE
INDUSTRY, FOR EXAMPLE.
I THINK THAT WOULD ONLY INCREASE
QUITE SUBSTANTIALLY AND QUICKLY
IN THE FUTURE.
IT'S BEEN ADVISED THAT
EVALUATION SHOULD BE ONLY EVERY
FIVE YEARS BECAUSE EVALUATION AS
SOMETHING AS COMPLEX AS THIS
WILL BE DIFFICULT TO START WITH.
TRYING TO WORK OUT HOW IT IS
WORKING AND W.H.O. HAS
CIRCULATED SOME TARGETS.
WE NEVER HAD TARGETS.
HAS THERE EVER BEEN A GLOBAL
TARGET IN TOBACCO?
NO NOT UNTIL NOW.
PEOPLE ARE LOOKING AT SHOULD IT
BE 4% BI2040 OR WHAT SHOULD THE
TARGET BE FOR CANCER?
SHOULD IT BE A PROCESS TARGET?
SO MANY PEOPLE GET TREATMENT
WHEN THEY ARE DYING.
SO MANY PEOPLE GET PAIN RELIEF.
A HUGE DEBATE ABOUT TARGETS THAT
THERE NEVER WAS BEFORE.
FROM THAT POINT OF VIEW IT'S
USEFUL AND I THINK THAT WILL GO
FORWARD AND REALLY GO FORWARD
FROM NOW ON.
BECAUSE WE NEED TARGETS.
WE NEED TO BE FOCUSED ON WHERE
WE WANT TO GO AND THE TIME WE
HAVE TO DO IT.
IT CONCENTRATES THE MIND MOST
WONDERFUL TOW HAVE A TARGET.
SO I THINK --
I CAN'T REALLY SEE ANY TERRIBLE
DOWNSIDE IN THIS.
BECAUSE IT IS A U.N., IT'S NOT
JUST W.H.O. CRON SENSION.
IT'S A U.N. MEETING AND AS I
SAID EARLIER, IT'S NOT JUST THE
MINISTERS, IT'S THE HEAD OF THE
STATE LIKE PUTIN AND PEOPLE LIKE
THAT FROM RUSSIA WHO WILL HAVE
TO COME AND SIGN THIS.
I THINK IT'S ELEVATION A BIT OF
INSURANCE POLICY FOR IT.
MIND YOU, I'M OPTIMISTIC.
SO IN LIFE IN GENERAL, SO I'M
ALWAYS, A REALISTIC AND
OPTIMISTIC.
I THINK YOU HAVE TO BE TO BE A
TOBACCO CONTROL ACTIVIST.
AND PRETTY ROBUST AS WELL.
SO I'M SORT OF QUITE OPTIMISTIC
THAT THIS WILL CERTAINLY MOVE
THE NCDSHS --
ISSUES FORWARD BECAUSE NCD IN
THE WORLD WILL INCREASE.
HAVE YOU ANY VIEWS ON THAT AS
WELL, TOM?
>> I AGREE ON THE SPECIFIC
TARGETS.
THAT'S BEEN DEBATED AND YOU HAVE
BEEN INVOLVED IN THE LEAD UP TO
THIS BUT I THINK THAT IS
SOMETHING THAT ALL OF US NEED TO
PUSH FOR NOT JUST IN THE U.N.
SUMMIT BUT JUST IN GENERAL IN
THESE HEALTH ISSUES THAT WE DEAL
WITH GLOBALLY IS TO SET SPECIFIC
TARGETS BECAUSE OTHERWISE IT'S
FAR TOO EASY AS WE SAW IN THE
FREE MARKET CONVENTION AND
TOBACCO CONTROL, IF YOU DON'T
SET TARGETS, IT'S EASY TO JUST
SLIP AWAY.
>> I HAVE A QUESTION.
THIS QUESTION IS REALLY ABOUT
WHETHER WE SHOULD LOOK BEYOND
TOBACCO.
WE ALL KNOW AS WE ARE HERE, THATç
TOBACCO IS A SERIOUS PROBLEM FOR
CAUSING CANCER.
BUT YOU MENTIONED IN YOURç
PRESENTATION THAT IN SHANGHAI,
IN 16 YEARS, THE NUMBER OF
CANCER CASES TRIPLED.
NOW, I DON'T HAVE THE STATISTICS
WHETHER THE SMOKERS IN SHANGHAI
TRIPLED BUT THE IMPRESSION IS
NOT.
SO, WHAT IS REALLY CAUSED THIS
HUGE INCREASE OF CANCER CASES IN
THE 16 YEARS?
SOME SAY OF COURSE THE GENERAL
INDUSTRIALIZATION BUT THERE MUST
BE SOMETHING ELSE.
>> I THINK REPORTING MIGHT BE AN
ISSUE HERE.
THIGH MIGHT HAVE GOT BETTER AT
REPORTING.
AS I SAID BEFORE, THE CANCER
REGISTRY ARE INADEQUATE.
AND SECONDLY, THE CANCER THAT
THEY MENTIONED IN PARTICULAR IS
NOT SMOKING RELATED, IT WAS
SURVIVAL CANCER AMONG YOUNG
PEOPLE.
I THINK THAT AGAINST GIVES THEM
THE DIRECTION FORWARD IN TERMS
OF GIVING IMMUNIZATION AND
LOOKING AT PREVENTION AND EARLY
DETECTION AND ALL OF THAT.
THAT IS PROBABLY A GOOD THING.
BUT IT WON'T BE SMOKINGÑi CANCER.
WHEN MALE SMOKING RATES IN CHINA
HAVE STUBBORNLY STUCK AT 60% FOR
ABOUT THE LAST 30 YEARS.
THE FEMALEIVATES GONE DOWN FROM
7% TO 3%, SURPRISEILY.
BUT I THINK IF I WAS TO GIVE
THIS LECTURE IN 20 YEARS, I
THINK SMOKING RATES WILL TURN
THE CORNER AS THEY HAVE IN SO
MANY OTHER COUNTRIES.
THAT WAS NOT A SMOKING SLIDE.
>> YOU FORGIVE ME IF A MAKE A
COMMENT.
TO ME, IT APPEARS THAT YOUR
PRESENTATION AND WHAT YOU
PRESENTED ARE REALLY
ORGANIZATION HEAVY.
IT'S MORE OF THINGS BEING DONE
BY BIG ORGANIZATION.
WHAT ABOUT AT THE LOCAL LEVEL,
AT THE COMMUNITY LEVEL, AT HIGH
SCHOOL LEVEL, AT THE LEVEL OF
RINSEITUTIONS.
HAVE THOSE EFFORTS BEEN MADE AND
FOUND TO BE NOT EFFECTIVE OR
HAVE NOT BEEN TRIED?
THEY ARE NOT PART OF THE MODEL
YOU'RE PRESENTING.
>> I'M SMOKING REALLY ABOUT
POPULATION PUBLIC HEAL --
I'M SPEAKING ABOUT POPULATION
PUBLIC HEALTH.
FOR EXAMPLE, I COULDN'T POSSIBLY
GO INTO VIETNAM AND WORK AS A
SMALL VILLAGE SCHOOL OR
SOMETHING LIKE THAT IN TERMS OF
LEVERAGE.
MY MAIN APPROACH IS USING VERY
COORDINATED DATA AND ALSO REALLY
LOOKING AT POPULATIONS AND
STUDIES.
I COULDN'T AGREE MORE.
THERE HAS GOT TO BE THAT
TOP-DOWN APPROACH FOR
GOVERNMENT.
GOVERNMENTS HAS THE
RESPONSIBILITY TO SET THE
TEMPLATE.
THEY HAVE TO SET THE TEMPLATE
FOR WHETHER IT'S SMOKE-FREE
WORKPLACES OR CANCER-FREE
WORKPLACES OR WHATEVER.
THEY HAVE TO SET FOOD STANDARDS
AND ALL THESE SORTS OF THINGS.
ONLY GOVERNMENT'S.
THERE IS A LOST THINGS THAT ONLY
GOVERNMENT'S CAN DO.
ONLY GOVERNMENT'S CAN ENGAGE IN
TAX POLICY.
ONLY GOVERNMENT'S CAN RELY
LEGISLATE.
AS I SAID BRIEFLY AT THE END
THAT THERE IS A RESPONSIBILITY,
MUCH FURTHER DOWN THE LINE WITH
EMPLOYERS AND WITH THE EDUCATION
SYSTEM AND SCHOOLS AND COMMUNITY
EVENTS.
BUT I THINK IT IS TRUE TO SAY
THAT IN IN GENERAL, WHAT
HAPPENED UP TO NOW IN THE LOWER
AND MIDDLE-INCOME COUNTRIES IS
THAT IT IS A TOP-DOWN AFFECT.
I THINK THAT YOU'RE BEYOND THAT
NOW.
YOU'RE LOOKING VERY MUCH AT
BEHAVIORAL CHANGE AND MUCH, MUCH
MORE DOWN AT THE COMMUNITY LEVEL
THAN I THINK HAS HAPPENED.
NO, I AGREE WITH YOU MORE AND
THAT WILL BE ANOTHER THING THAT
WILL COME IN THE FUTURE.
THERE WAS A LADY JUST BEHIND
THAT YOU HAD HER HAND UP BEFORE
WE FINISHED.
WE WERE JUST ABOUT TO FINISH.
>> THANK YOU FOR THE TALK.
I JUST WANTED TO ASK, THERE ARE
CERTAIN CULTURES THAT USE
TOBACCO, SNUFF, FOR --
[INDISCERNIBLE]
WANTED TO FIND OUTzV FROM YOU HOW
ONE APPROACH THISÑi KIND OF
POPULATIOOç IN TERMS OF CONTROL.
>> THERE IS NON-CIGARETTE
TOBACCO.
YOU HAVE TO THINK OF INDIA WHEN
YOU THINK OF THAT AND THE
CHEWING TOBACCO, PARTICULARLY
AMONG THE WOMEN.
AND THEN YOU HAVE GOT A COUPLE
OF COUNTRIES LIKE SWEDEN AND
PLACES LIKE THAT THAT HAVE GOT
THIS HISTORY OF CHEWING TOBACCO
AMONG THE GHERKAS AND SO ON.
IT'S GETTING RESURRECTED.
THE TOBACCO COMPANIES ARE TAKING
THIS STUFF AND ADDING FLAVORS TO
IT, VANILLA AND SWEET FLAVORS
AND ALL SORTS EVER THINGS.
THIS IS SOMETHING THAT --
AND THE ECIGARETTES.
ALWAYS CHALLENGES IN TOBACCO.
AND I THINK THE WHOLE QUESTION
OF HARM REDUCTION, THAT IS A
WHOLE OTHER LECTURE.
I HAVE TO SAY.
HARM REDUCTION AND THE USE OF
SMOKERS TOBACCO AND ALSO THE USE
OF E-CIGARETTES AND MANY
REGULATIONS AND I THINK IT'S
VERY GOOD THE FDA, IF I
UNDERSTAND IT CORRECTLY, SEEMS
TO HAVE STEPPED FORWARD IN THIS
COUNTRY IN A MORE OBVIOUS WAY TO
TRY AND LOOK AT SOME OF THESE
ISSUES.
IS THAT CORRECT?
THEY ARE NOW LOOKING AT
REGULATION?
AND I THINK THAT IF WE LOOK AT
THE FUTURE OF TOBACCO, WE HAVE
GOT TO LOOK AT A MUCH MORE
REGULATED PROCESS.
AFTER ALL, PHARMACEUTICAL DRUGS
ARE THERE TO HELP PEOPLE AND
IMPROVE HEALTH, REGULATE IT
1,000 TIMES MORE THAN TOBACCO IS
REGULATED FOR ALL SORTS OF
THINGS.
AND YET THERE HAS BEEN A
FREE-FOR-ALL AS FAR AS TOBACCO
GOES PARTLY BECAUSE OF ITS
HISTORY.
I THINK WE HAVE TO ESTABLISH
REGULATORY MECHANISMS AND THERE
HAS BEEN A COUPLE OF MODELS PUT
FORWARD AS TO HOW THEY SHOULD
OPERATE BUT REGULATING
MECHANISMS TO GET THIS INDUSTRY
IN CHECK AND TO REALLY LOOK AT
THESE ISSUES ON SMOKELESS
TOBACCO.
WHAT SHOULD WE BE DOING ABOUT
IT?
IT'S NOT AN EASY ANSWER.
NOT AN EASY ANSWER.
>> THANK YOU DR. JUDITH MACKAY.
AS A MEASURE OF OUR APPRECIATION
WE HAVE A PLAQUE FOR YOU.
THE HONOR OF HAVING YOU COME
PRESENT.
[APPLAUSE]
>> THANK YOU VERY MUCH.
>> PLEASE JOIN US FOR THE
RECEPTION IN THE MAIN HALL.
THANK YOU.