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Vol. LXIII, No. 18
September 2, 2011
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Health Advisor Mackay Tackles Tobacco Industry, Global Cancer Control

On the front page...

Dr. Judith Mackay discusses the future of cancer control.
Dr. Judith Mackay discusses the future of cancer control.
Identified as one of the “three most dangerous people in the world” by the tobacco industry, Dr. Judith Mackay spoke at NIH July 27 as part of NCI’s 12th annual Advances in Cancer Prevention Lecture Series. A senior advisor to the World Lung Foundation and the Bloomberg Initiative to Reduce Tobacco Use, she spoke on “Cancer Control: A Look at the Future.”

Mackay (pronounced “mc-EYE”) described cancer as a “global epidemic,” emphasizing that the future global cancer burden will only increase, for all cancer types and across all regions. The World Health Organization predicts a substantial increase in cancer and cancer-related deaths worldwide by 2030.

As an anti-tobacco advocate, Mackay pointed out the perils of the tobacco epidemic and drew parallels to overall cancer control. “Tobacco has been a sophisticated political issue for a longer time than some of the other cancer risk factors, such as obesity, alcohol and unhealthy diets, where there is also a need to deal with…the sugar and alcohol industries,” she said. “We’ve learned for the last 40 to 50 years that we’re dealing with a very dangerous opposition in the form of the tobacco industry. It has forced us to become political.”

Continued...

Mackay explained how fighting the tobacco industry has revealed that a medical approach isn’t enough for tobacco and cancer control. The number of smokers worldwide is increasing and tobacco deaths are expected to rise over the next two decades, from the approximately 5 million deaths now up to 8 million-10 million in 2035.

Cigarettes are smuggled on a massive scale and, according to WHO, by the tobacco companies themselves in order to evade restrictions and taxes. This allows companies to flood the markets with cheap cigarettes that reach even more young smokers.

A wide range of allies must be recruited in this fight, according to Mackay, including the World Bank, governments and environmental, women’s and other NGO (non-governmental organizations) groups. “The principal concern of governments is their misconception that without tobacco, their economies will suffer. This isn’t true. Tobacco is an overall debit to the economy, but governments just see the taxes coming in. Having partners who can look at the tax structure, for example, is very vital,” Mackay said.

Fighting the tobacco industry has also revealed that some prevention strategies do not have a substantial impact on public health. In one vivid example, Mackay said two of the most widely used prevention strategies—health education in schools and banning the sale of tobacco to minors—are the two with the strongest support from the tobacco industry: because they are the least effective.

“Thirty years from now, people won’t look back wondering why we were so tough on tobacco; they’ll look back and wonder why it took so long,” Mackay said.

Like the difficulties posed by the far-reaching tobacco industry, overall cancer control has its own obstacles. A key difference can be seen in low- and middle-income countries, which are a primary focus for Mackay. These countries bear a greater burden in cancer and cancer deaths, but preoccupation with other diseases that may cause far fewer deaths can take the focus away from cancer control.

Mackay said the tobacco industry favors health education in schools and bans on sales of tobacco to minors precisely because those two approaches are ineffective.

Mackay said the tobacco industry favors health education in schools and bans on sales of tobacco to minors precisely because those two approaches are ineffective.

Photos: Bill Branson

Still, some progress has been made. Mackay pointed to the increase in hepatitis B immunization worldwide as well as the presence of cancer organizations in most countries. She also remarked on the United Nations’ upcoming summit on non-communicable diseases, which are responsible for 60 percent of deaths worldwide. Mackay said the outcome of the summit will be critical, as it will have implications for funding, reporting, targets and more in the realm of non-communicable diseases, which include cancer.

Mackay emphasized the crucial role of government and the need for international laws in advancing public health. With opponents such as the tobacco industry, international efforts and even relationships with customs agencies are critical. Cigarettes are smuggled on a massive scale and, according to WHO, by the tobacco companies themselves in order to evade restrictions and taxes. This allows companies to flood the markets with cheap cigarettes that reach even more young smokers.

Mackay took time to highlight the impact of the United States and NIH on producing sound science and research that is used across the world. “Research done in the United States has a global reach,” Mackay said. “Most countries just don’t have the resources to do anything like what you’re doing here.”

But while there is much work to be done by governments, enacting taxation policies and legislation, Mackay underscored the need to draw on the power of the media, social media, effective advocacy targeting and even workplace policies such as establishing tobacco-free premises.

“The responsibility for the future cancer epidemic is across the whole world. There are tremendous inequalities and challenges that lie ahead for treatment, but any major reduction in cancer deaths will come from prevention, not cure,” Mackay said. “The fight for cancer control will continue.” NIHRecord Icon


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