Judith Mackay: brandishing a sword for health

BMJ 2009; 338 doi: (Published 27 April 2009) Cite this as: BMJ 2009;338:b1689
  1. Jane Parry
  1. 1Hong Kong

    In the 25 years that Judith Mackay has been fighting the tobacco industry, she has been described as dogmatic, meddlesome, puritanical and “psychotic human garbage.” Jane Parry finds out the truth

    Judith Mackay typically starts her day with a session of t’ai chi. Her teacher is strict and demands high standards from her students, but the discipline suits Mackay, as does t’ai chi’s emphasis on harmony and balance.

    Mackay, originally from Yorkshire, has lived in Hong Kong for 42 years, and credits living in an Asian society with teaching her about the value of negotiation over confrontation. Despite her reputation as a terrier at the heels of the tobacco industry, she sees herself as an advocate for good rather than an adversary of harm. She sees herself as a promoter of public wellbeing, helping governments and individuals to make decisions that are in the interests of good health.

    The shift from activist to advocate happened in the 1980s, when she started working with governments in Asia, particularly China, as a World Health Organization consultant. Since then her name has long been synonymous with persuading governments in the region to adopt tobacco control.

    When Mackay turned her attention fully to tobacco control in 1984, she worked alone. “She impressed me as a totally committed advocate for tobacco control, the first person doing this in Hong Kong and Asia on a full time basis, with no pay and single handedly, as a pioneer,” recalled Tai-hing Lam, head of the University of Hong Kong’s department of community medicine.

    Since then almost all governments in Asia have ratified the WHO Framework Convention on Tobacco Control. In 2006 Mackay became project coordinator for the launch of the World Lung Foundation component of the Bloomberg Initiative and is now its senior adviser. The Bloomberg Initiative to reduce tobacco use in low and middle income countries, set up by the New York based Bloomberg Philanthropies, employs hundreds of people in tobacco control.

    She has many supporters, and her work has won her a slew of awards in recent years, including the BMJ Group’s first ever lifetime achievement award (BMJ 2009;338:b1428, doi:10.1136/bmj.b1428). Peter Baldini, chief executive officer of the World Lung Foundation, describes Mackay as “always passionate, articulate, and relentless in her pursuit of effective public health policy and education.”

    Like anyone in a position as high profile and controversial as hers, she has also been described as single minded, sometimes ruthlessly so, and egotistical. Whatever the views of her personality, however, it is her achievements that stand out.

    “She has exploited the platform she was given by WHO in an imaginative, professional, and extremely effective way, so much so that tobacco control will be defined in many countries for decades by what she achieved with [that organisation],” said Anthony Hedley, professor of community medicine at the University of Hong Kong. “She has undoubtedly been able to steer their thinking in a way that perhaps very few others could.”

    Mackay has often been publicly denounced by the tobacco industry and its supporters as, among other things, dogmatic, pontificating, meddlesome, puritanical, and hysterical.

    In 1993 a US smokers’ rights group described her as “psychotic human garbage.” Such insults bounce off Mackay, although the death threat that came from the same smokers’ rights group was rather more chilling, and if anything she wears such barbs as a badge of honour.

    Mackay was born Judith Longstaff in Yorkshire. She passed the entrance exams for university at the age of 16 and went to Edinburgh to study medicine, the first in her family to do so.

    It was during her intern year at City Hospital in Edinburgh that she met her future husband, John, back from Hong Kong to take the examination for membership of the Royal College of Physicians. After a courtship of just four months, he popped the question the day he passed his exam and a week before he was due to return to Hong Kong. In that week he must have had a glimpse of the human dynamo that he was about to marry as she pulled together a marriage ceremony and wedding reception while putting in overnight shifts every other night at the hospital.

    Mackay followed her husband to Hong Kong three months later, looking forward to a life of leisure lazing on the beach after seven gruelling years of medical training. “It lasted six weeks before I got bored and took a Cantonese course for the next nine months,” she said.

    After a stint as a part time GP in the British army, followed by a university research job she decided to retrain and in 1973 was accepted by Alex McFadzean as an honorary registrar in a training post for membership of the Royal College of Physicians (MRCP). “It was by far the most difficult career step I’ve ever made, and I was surprised by my lack of confidence at that time, how the prospect was quite scary,” Dr Mackay recalled.

    Thus began a stage of her life where she juggled her family and career with innovative proposals, such as during her MRCP training having: to have responsibility for 25 hospital beds but with no overnight or weekend duties, for no pay, in order to secure family friendly clinical hours.

    Later, when she took a post as deputy head of a hospital medical department, she extended her summer holiday leave to match that of her family’s by inviting a specialist from the UK over to live in her home and take her salary for a month a year. “The hospital was astonished at my suggestion but quickly saw the benefit of having a specialist from the UK to help train and prepare their MRCP candidates,” she said.

    Dr Mackay subsequently became active in the women’s movement, and the transition from working in a hospital to working in tobacco control came with the realisation that smoking was a bigger threat to women’s health than gynaecological problems.

    Her first role in tobacco control in 1984 was as founder and director of the Asian Consultancy on Tobacco Control. Then in 1987 to 1989 she was the founding director of the Council on Smoking and Health, subsidised by the Hong Kong government, after which, in 2001, she became a senior policy adviser for the WHO Tobacco-Free Initiative, a position that she still holds. In 2006 she began working with the World Lung Foundation on the Bloomberg Initiative.

    At 65, Mackay shows no signs of putting her career on the back burner, although she says that tobacco control has become so mainstream now that she could easily step away from it and spend more time on her t’ai chi. “I’ve really taken to it. My place in life is brandishing a sword, but t’ai chi has taught me you have to do that with humility.”


    Cite this as: BMJ 2009;338:b1689

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