14 | <strong>Somerville</strong> 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 <strong>of</strong> the biggest tobacco company on the planet. Why don’t you pick a more achievable goal, like changing the orbit <strong>of</strong> Jupiter?” This is the kind <strong>of</strong> 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 <strong>Somerville</strong>. That was the day I passed my DPhil thesis defence and the day my father died <strong>of</strong> 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 <strong>of</strong> a lifelong addiction. So, though the task is daunting, the potential to save some <strong>of</strong> the millions <strong>of</strong> lives lost to tobacco every year is as big as the Jovian challenge. While a graduate student at <strong>Somerville</strong>, I studied human genetics under the guidance <strong>of</strong> Somervillian, Kay Davies (now Dame and Pr<strong>of</strong>essor), hoping to find a treatment for disease, or a way to prevent illness. In the place <strong>of</strong> 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 <strong>of</strong> the biggest tobacco company on the planet, run by the State Tobacco Monopoly Administration, and China is home to a third <strong>of</strong> 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 <strong>of</strong> 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 <strong>of</strong> the World Economic Forum identified chronic disease as the third and fourth greatest threat to the global economy in terms <strong>of</strong> likelihood and severity <strong>of</strong> risk, respectively. The risk level is in the hundreds <strong>of</strong> billions <strong>of</strong> US dollars. Tobacco is an important factor in many chronic diseases and is therefore a key component <strong>of</strong> 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 <strong>of</strong> technical support to China’s implementation <strong>of</strong> 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 <strong>of</strong> measures to be taken to address the global threat <strong>of</strong> 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 <strong>of</strong> the story, Bloomberg Philanthropies, the Gates Foundation and the sister organisations <strong>of</strong> a global partnership to fight tobacco. Mayor Michael Bloomberg together with his health commissioner Tom Frieden (now head <strong>of</strong> 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 <strong>of</strong> the Olympics is a Beijing directive banning smoking in many locations, a greater understanding <strong>of</strong> the harms <strong>of</strong> smoking among citizens, and a home-grown movement <strong>of</strong> tobacco control activists. The Olympic Games were pro<strong>of</strong> <strong>of</strong> 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. ■
Inset: Sarah at the Great Wall <strong>of</strong> China <strong>Somerville</strong> Magzine | 15
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