Promoting women’s leadership in tobacco control

24-GBPatti White
National Institute for Health and Care Excellence
24-flag United Kingdom
17 May 2014

How did you get started with tobacco control?

I had been living in London for a couple of years and had decided to do another university course (mainly because that is what I had been doing since I was a teenager and I clearly lacked imagination). It was September and I was due to start a course in philosophy in October of the following year, so I needed to get a job.  I applied for a very junior position at ASH (Action on Smoking and Health)[MH3]  just to pay the rent. At the time I thought ASH was a good idea because 1) I would not be doing harm; 2) it involved both science and politics, both of which interested me. It transpired that I became very interested in the work, despite the rather shocking misogyny of most of the men involved!  This was in the early 1980s, and coming from a university environment in the United States, it was all a bit of culture shock.

You are a founding member of the International Network of Women against Tobacco (INWAT). How did that organization come about? What was the motivation?

INWAT began at the 1990 World Conference on Tobacco or Health held in Perth, Australia.  There was a series of pre-conference seminars, one of which was on women and tobacco. So there was a bunch of bolshie, awkward women already on hand.  What really galvanized us was the realization that there were so few women speaking in the plenary sessions. If memory serves, I remember two!

A number of us had been working on issues of gender and tobacco for a few years and were used to the topic being overlooked, but there was a general feeling that this was too much and future conference organizers should recognize the importance of the subject and the contribution women were making to public health.

What are the goals of INWAT?

The goals of INWAT are to provide contacts between individuals and organisations working in tobacco control, particularly those interested in gender issues. We have set up a website (inwat.org) and publish newsletters and reports on different topics around women and tobacco to support sharing information.  An extremely important goal is to promote women’s leadership in tobacco control.

What are some of the things INWAT is currently working on?

We have just completed an issue of our newsletter, The Net, with Global Bridges on the topic of preventing tobacco use among girls and helping women to stop. This looks both at women who are trying to quit and at how professionals can best support them.

In 2010, our European Region published a report with WHO Europe, Empower Women, that looked at tobacco industry targeting women in Europe with its marketing. That report highlighted a lot of the work that governmental authorities and women’s organizations were undertaking to fight back.

The new report, which we hope to launch at the European conference on tobacco or health in Istanbul in March 2014, takes a more analytical look at the actions of the tobacco industry in attracting new female smokers in the very large European region of WHO, which stretches from Scandinavia and the Atlantic isles all the way to Central Asia. Europe has changed radically in the last 25 years — politically, socially and culturally — and tobacco companies are taking advantage of this.

Please tell us about your work as a policy analyst at the National Institute for Health and Care Excellence (NICE).

NICE is an organization that gives guidance on different topics in several domains — clinical, health and social care, public health —  based on a process that uses the best available evidence as considered by an independent panel of experts. Our methods are transparent and all the committees are accountable, so it is clear how they have come to make their recommendations.

Now, due to policy changes, local government is to become much more engaged in public health in England, so we are looking at new ways to engage people working on a local level, although this has always been part of our work.

What development or success are you most proud of?

I have done a few things in my career that I believe have made a contribution to public health and tobacco control, but one of which I am most proud was working with a very small team at WHO Europe in Copenhagen to set up the Smokefree Europe project.

The Regional Committee had decided they should take action against tobacco and asked the regional office to write an ‘Action Plan’ for tobacco control in Europe. This was in the late 1980s, long before the FCTC.  WHO had been strongly criticized about its general failure to engage with tobacco, which was such a massive cause of illness and premature death in Europe as well as the rest of the world.

From the rather wooly brief for an ‘Action Plan’ we set up a project which focused on giving Member States the best available guidance on tobacco policy, aimed at making them believe that they really could do something about the rise of tobacco use and very high levels of disease and early death that it causes.

We considered that one of the key messages that we had to send was that a tobacco control policy had to be comprehensive and it was useless to rely on one aspect or element. Many countries wanted to stop tobacco use by “educating children” that it was unhealthy. That kind of naivety was laughable to some of us then, as it is for many people now. But in those days, it was frightening how many people thought children’s’ education was the key to ending tobacco use. You’d have thought that they might have noticed that it had not worked!

A key element of our programme was a five-day European conference held in Madrid, Spain, which was attended by invited delegates from all the European Member States. The conference was a creative mix of plenary sessions, panel discussions chaired by Peter Taylor, a BBC journalist, and discussion groups.

We assigned people to discussion groups to achieve a good balance and the group stayed together for the duration of the conference.  Each group had appointed a chair who reported back to a drafting group every evening. It was hard work, but each morning the two conference rapporteurs would report back in plenary on discussions of the previous day. My impression was that people were very engaged because they thought they were being listened to.

I see some of that same kind of enthusiasm in the people now working on the FCTC and it is so gratifying to see the real progress being made, not by the high-income rich world, but by low- and middle-income countries.

What do you ultimately hope for with your work in tobacco control?

I hope that one day very few people will use tobacco.  I don’t think that is entirely unrealistic, but equally I certainly do not underestimate the difficulty of the task to make this come about.

It may be that technological advances will make it possible for people to remain addicted to nicotine without using tobacco.  Developments like the e-cigarette point that way.  But, to my mind, there is a huge risk around the regulation of nicotine containing products (NCPs).  We have already seen them advertised as cigarettes were advertised 50 years ago – and now we have the internet as an additional medium. We have no mechanisms in place to limit children’s and young peoples’ exposure to promotion of e-cigs or age limits for purchase. There are not clear guidelines about how they should be used in public places.  We do not know about their effect on the ‘denormalisation’ of tobacco that so much of tobacco control has been aiming at in recent years.

We don’t think it is a good idea to leave them unregulated, but we are also frightened of over regulation — many people argue convincingly that regulation will accelerate the existing trend of the tobacco companies to take over the NCP market.  And we know how trustworthy the tobacco industry has shown itself to be! So I think this new area will pose all sorts of problems for tobacco control along with the possibility for a solution to smoking.