Judith Mackay

Based in Hong Kong since the late sixties, committed feminist Professor Judith Mackay is a leading advocate of tobacco control, a role that comes with powerful industry adversaries.

Your time at the University

From Yorkshire to Edinburgh to beyond…

I was only aged 16 when I completed my A levels and, in those days, you could only enter English universities’ medical schools at age 17. The Scottish Universities would take you younger so, rather than a gap year (not common in those days), I decided to get started on the six-year course.

Edinburgh Medical Faculty had (and still has) an excellent reputation, so the choice was easy. I later learned from genetic profiling that I am predominantly Celtic, with a touch of East Coast Viking, so I felt I was coming home.

I have three reasons for being grateful for that decision. I had a great time during my years as a student in Edinburgh; I obtained a degree that launched me on a really interesting career; and I met my husband in Edinburgh.

I utilised every summer break to travel to distant parts – Russia and Eastern Europe in 1961 during the building of the Berlin Wall; the USA in 1962; and then I worked in hospitals in South Africa and Australia before graduating. 

After graduation, I spent my residency year in the then City Hospital and the Royal Hospital for Sick Children. My expected career path in Edinburgh was overturned by meeting postgraduate Dr John Mackay in the City Hospital, on six months leave from his group practice in Hong Kong to study for his Membership of the Royal Colleges of Physicians (MRCP). He was doubly successful in that he passed his exam AND found a wife. The interesting thing is that the second I first met John, I knew he was the man I would marry and, being also Rhesus negative sealed the matter. In fact, my Ipse Dixit in the 1966 Graduation Year Book was a humorous ‘I am looking for a Rhesus negative man!’ This taught me to trust my instinctive decisions.

My proudest accolade is to have been identified by the tobacco industry as one of the three most dangerous people in the world.

Tell us about your experiences since leaving the University

I arrived in Hong Kong in 1967, when China's Cultural Revolution had spilled over into Hong Kong, with Red Guards brandishing Mao's 'little red book' and shouting anti-British slogans (“Imperialists go home”) on the streets. Bomb scares occurred daily, and the Communist banks and schools were barricaded with barbed wire as they manufactured bombs. But, resilient as ever, Hong Kong emerged to establish itself as an international financial and business centre.

My first job in Hong Kong politicised and radicalised me in a totally unexpected way. I answered a job advertisement to discover that the advertised salary was for a male doctor. In conformity with Hong Kong government practice, the salary for a female doctor was 75% of the advertised 'male' salary. This was my first recognition of sexual discrimination, and I was outraged. Gritting my teeth, I took the job, but worked from that moment on for equal terms and conditions for women. I remain a committed feminist to this day.

In 1969 and 1970 I gave birth to our two sons Andrew and Richard, and spent the next few years on part‑time research on growth and development of Chinese babies with the Paediatric Department of Hong Kong University. This showed that when milk feeding ceased at 12 months there was no alternative source of replacement protein. This was remedied, and now I am dwarfed by the younger generation of Chinese in Hong Kong.

I then decided to train for the MRCP, and subsequently worked for many years in hospital medicine.

But three reasons caused a major career shift from curative to preventive medicine: I realised the majority of our medical hospital admissions were both preventable and often untreatable at the time of diagnosis, such as lung cancer, emphysema and heart disease – predominantly caused by tobacco. I thus came to understand that, while necessary, hospital medicine was a bit like Band-Aid, and I felt a need to prevent rather than attempt to cure.

Concurrently, my ongoing involvement with feminist issues led me to an interest in womens' health, which was defined gynaecologically in those days. Yet I realised that more women die from smoking than from all methods of birth control combined. In addition, girls and women were being both exploited and aggressively recruited by the tobacco companies, whose advertisements feature attractive, slim, successful, liberated women. Cigarette ads promised emancipation, whereas in reality smoking was yet another form of bondage for women.

The final factor was when British American Tobacco published a booklet claiming that the ‘anti-smoking lobby in Hong Kong (effectively only myself at the time) is largely anonymous, unidentifiable, entirely unrepresentative and unaccountable.’  In contrast, the self-promotional booklet claimed, ‘the tobacco industry comprises identifiable, legal, accountable, commercial organizations.’ This booklet, denying the health evidence (‘it has not been proven that these illnesses are actually caused by smoking’) so enraged me, that from that moment on I worked on tobacco control, abandoning curative hospital medicine in 1984. 

Since then, my job has been both working with national governments in low and middle-income countries to help get tobacco control policies, laws and tax systems in place, and also fighting Big Tobacco. Because of my location in Asia – seen by the industry as its future – I have been vilified, threatened with law suits, likened to Hitler, received death threats, and offered 24-hour police protection from the Hong Kong government. There have been so many other experiences – ranging from being held at gunpoint by Palace guards in Mongolia, testifying in a smuggling court case where witnesses were murdered or disappeared, or visiting and working in countries way ahead of the average tourist. For example, I have been three times to North Korea recently, working with the Ministry of Health on tobacco control. I have learned that, around the world, it is the same product, same health effects, same obstacles and same action needed.

I am a working person, and I will be working when I am 100. Work makes me happy, challenged and involved. I balance this with a profound thankfulness for my family and friends, golf (although the length of time I have been playing is not reflected in my handicap), and taiji (especially the sword programmes). My proudest accolade is to have been identified by the tobacco industry as one of the three most dangerous people in the world.

Alumni wisdom

Be thankful.                         

Related Links

Judith Mackay's entry in The 2007 TIME 100 (external link)

Judith Mackay's blog for the Dangerous Women Project (an initiative of the Institute for Advanced Studies in the Humanities at the University of Edinburgh)