magazine - Somerville College - University of Oxford

14 | Somerville Magzine
Fighting China’s
Grim Reaper
A Somervillian is leading the World Health Organization’s battle
against tobacco in China. But it is also a personal crusade…
DR SARAH ENGLAND
(1986, Medicine)
The government
is the sole
shareholder
of the biggest
tobacco company
on the planet.
Why don’t you pick a more achievable goal,
like changing the orbit of Jupiter?” This is
the kind of incredulous response I get when
I tell people that my job at the World Health Organization
is tobacco control in China. I never tell them about my
saddest day at Somerville. That was the day I passed
my DPhil thesis defence and the day my father died of
heart disease. He had his first heart attack at 47. He was
a smoker who tried over and over to quit and ultimately
suffered the tragic consequences of a lifelong addiction.
So, though the task is daunting, the potential to save
some of the millions of lives lost to tobacco every year is
as big as the Jovian challenge.
While a graduate student at Somerville, I studied human
genetics under the guidance of Somervillian, Kay Davies
(now Dame and Professor), hoping to find a treatment
for disease, or a way to prevent illness. In the place of
genetic change, my work now is aiming at using policy
change to do the same thing. Through population-based
approaches, we can stretch public health funding to its
greatest efficiency – prevent suffering and premature
death, increase productivity and save money.
In China, the scale is massive and so the tobacco stakes
are huge. The government is the sole shareholder of the
biggest tobacco company on the planet, run by the State
Tobacco Monopoly Administration, and China is home to
a third of the world’s smokers. China has more smokers
than there are people in the United States, and the death
toll attributable to tobacco is a million a year and rising.
The World Health Organization Global Tobacco Control
Report 2008 stated that tobacco, the biggest agent of
death on earth, will claim a billion deaths this century
if trends continue, mostly in middle- and low-income
countries, where the epidemic continues to grow.
What policy makers are just beginning to realise is that
tobacco is not only a public health issue. The 2009
Global Risk Report of the World Economic Forum
identified chronic disease as the third and fourth greatest
threat to the global economy in terms of likelihood
and severity of risk, respectively. The risk level is in
the hundreds of billions of US dollars. Tobacco is an
important factor in many chronic diseases and is
therefore a key component of this important threat to the
global economy.
Luckily, as UK residents know, there are proven
interventions that can stop the tobacco epidemic, and
my job is to advocate with the Chinese national and
municipal governments for such measures as smokefree
environments, graphic warning labels on cigarettes,
higher taxes and prices, smoking cessation services,
hard-hitting public education campaigns, and bans
on tobacco advertising promotion and sponsorship.
This is in the context of technical support to China’s
implementation of the World Health Organization
Framework Convention on Tobacco Control. Similar
in concept to the Climate Change Convention, this
international public health treaty has been ratified by
more than 165 parties including China. It calls for a
number of measures to be taken to address the global
threat of tobacco. In China, however, despite the fact
that the Convention is binding law, the tobacco industry
has openly published its counter-strategy and it is a
formidable opponent.
Enter the heroes of the story, Bloomberg Philanthropies,
the Gates Foundation and the sister organisations of
a global partnership to fight tobacco. Mayor Michael
Bloomberg together with his health commissioner Tom
Frieden (now head of the USA Centers for Disease
Control and Prevention) made New York smoke free.
No one thought they could ban smoking in New York
bars, but they did, and New Yorkers approved. The city
raised tobacco taxes – people liked the way the tax funds
were used. It was a popular tax! The city implemented
an emotional anti-smoking campaign, gave out nicotine
patches and New Yorkers quit smoking. The Mayor put
his personal philanthropy behind spreading the New
York experience around the globe and we have amazing
success stories as a result – even in China.
Last year’s Beijing Olympics were tobacco-free, with
no smoking in the stands or competition areas – even
outdoors – and no tobacco advertising in host cities.
The legacy of the Olympics is a Beijing directive banning
smoking in many locations, a greater understanding of
the harms of smoking among citizens, and a home-grown
movement of tobacco control activists. The Olympic Games
were proof of concept that smoke-free environments can
work in China. Other cities are starting to follow suit and the
Guangzhou 2010 Asia Games have been declared smoke
free. There is a global tobacco control movement and it is
coming to China. I think my father would approve. ■