International Women’s Day 8 March 2021

Judith Mackay

GGTC Knowledge Hub

I remember the hour I became a feminist, a path that took me to work in tobacco control.  It was in 1970, at a hairdresser’s in Hong Kong, reading Germaine Greer’s just-released feminist classic ‘The Female Eunuch.’ It instantly changed my life, and I remain a committed feminist to this day.

Why is this relevant to tobacco? Being a medical doctor, my early focus in the feminist movement was women’s health. In those days, women’s health was defined as gynaecological, but I realised that tobacco was killing more women than every method of contraception combined.

Girls and women were being exploited and aggressively recruited by tobacco companies, whose advertisements featured attractive, slim, successful women. Cigarette ads promised emancipation, whereas in reality smoking was yet another form of bondage for women. Tobacco was an issue for women themselves, not just on behalf of their children. And at that time, women were strikingly absent from public health policy and decision-making processes, conferences and committees on tobacco control. There were very few female role models or mentors, with rare exceptions such as Dr Eileen Crofton in Scotland, Professor Ruth Roemer in Los Angeles, and Professor Li Wan Xian in Shanghai. Thus, I identified with women, but worked with men.  All that had to change.

I wrote a weekly series on a whole range of women’s health topics in the South China Morning Post. The first two, on the health harm of tobacco, passed without comment. But the later ones covered tobacco control action – advertising bans, smoke-free areas and taxation. The tobacco industry cranked into gear, denouncing me as “entirely unrepresentative and unaccountable.”

Through my involvement with the women’s movement, I learned political advocacy, and the importance of legislation and economics, so crucial in tobacco control.

I learned that if women are not represented at policy-making level, the issue of women and smoking only too easily slips off the radar screen. I agreed to help organise the 1997 World Conference on Tobacco or Health in Beijing, China on one condition: gender equity. This meant equal numbers of women as men on planning committees, as chairs, as plenary speakers. In spite of being told from all sides it was an impossible task, we did it, and it was lauded as the best conference ever. Gender equity has become an enshrined principle in all subsequent world conferences. And many strong, capable women have now emerged working in tobacco control –around the world.

Today, women comprise about one-fifth of the world’s 1.3 billion tobacco users.[1] Women are as vulnerable as men to the dangers of tobacco, if not more so. Both men and women who smoke are prone to cancer, heart disease and respiratory disease. Tobacco also causes additional female-specific cancers and compromises pregnancy and reproductive health.[2], [3]

In spite of this knowledge, the industry continues to advertise, promote, and sponsor women’s organisations and events, as highlighted in the 2020 Global and Asian Tobacco Industry Interference Indices.[4], [5]

In 2018, 16% of all Philip Morris International’s (PMI) monetary charitable contributions were spent on ‘Empowering Women’ in Hong Kong, Indonesia, Japan, Malaysia, Pakistan, Philippines, Thailand, Vietnam; Israel, Jordan, Morocco, South Africa, Turkey, Ukraine; Austria, Czech Republic, Estonia, Germany, Greece, Italy, Slovakia, Switzerland; Argentina, Brazil, El Salvador, Panama, Canada, Colombia, Dominican Republic, Mexico. The industry spends very little (less than USD 5 Million in total worldwide), yet gains immense goodwill and recognition.[6]

While tobacco companies boast about their equity programmes, these whitewash over the harsh reality faced by millions of women in tobacco growing in low and middle-income countries – undertaking hazardous work, becoming impoverished and far from empowered. The companies benefit immensely by purchasing leaves from poor countries at low prices, take almost no responsibility for the problems of child labour and leave the sick behind.[7], [8]

Strong criticism of these activities came in 2020 from the British Medical Journal: “A bold new entry into the ‘beyond-satire’ stakes is an online gender equality conference held by the Financial Times in partnership with, of all people, Philip Morris International (PMI).” The report concludes “Philip Morris International is one of the world’s most prolific killers of women—participation in their bogus corporate social responsibility activities is a moral outrage.” [9]

[1] World Health Organization. 2019. WHO launches new report on global tobacco use trends. Available from: (accessed 5 March 2021).

[2] Haglund M. August 2010. Women and tobacco: a fatal attraction. Bulletin of the World Health Organization. 2010;88(8):563. doi: 10.2471/BLT.10.080747. Available from: (accessed 5 March 2021).

[3] Mackay J, Amos A. June 2003. Women and tobacco. Respirology 2003;8:123-130. doi: 10.1046/j.1440-1843.2003.00464.x. PMID: 12753525. Available from: and (accessed 5 March 2021)

[4] Assunta M. November 2020. Global Tobacco Industry Interference Index 2020. Bangkok, Thailand: Global Center for Good Governance in Tobacco Control (GGTC); 2020. Available from: (accessed 5 March 2021).

[5] Reyes JL. November 2020. SEATCA Tobacco Industry Interference Index: Implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control in Asian Countries, 2020. Bangkok, Thailand: Southeast Asia Tobacco Control Alliance (SEATCA); 2020. Available from: (accessed 5 March 2021).

[6] Philip Morris International. 2018. Charitable contributions. Available from: (accessed 5 March 2021).

[7] Unfairtobacco. 2021. (accessed 5 March 2021).

[8] Hu TW, Lee AH. October 2016. Women in Tobacco Farming: Health, Equality, and Empowerment. A study conducted in China, Tanzania and Kenya. Oakland, California: Center for International Tobacco Control, Public Health Institute; 2016. Available from: (accessed 15 February 2021).

[9] Hopkinson N. 13 November 2020. Nick Hopkinson: Tobacco industry collaborators sending equality up in smoke. The BMJ Opinion. Available from: (accessed 15 February 2021).

International Women’s Day 8 March 2021, Judith Mackay; reposted from GGTC;

Factsheet: Women and the tobacco industry, STOP, March 8, 2021

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