Interview with Yang Mao

Anti-smoking Pioneer – Interview with Yang Yang, an outstanding Chinese-Canadian

May is Asian Heritage Month in Canada; a time to introduce the culture, art and history of Canadians of Asian descent. The theme for Asian Heritage Month 2021 is: “Recognition, Resilience and Resolve”. Bardish Chagger, Minister of Diversity and Inclusion and Youth mentioned in her speech, “it’s about recognizing the contributions that communities of Asian descent in Canada have made, and continue to make, in building a more prosperous and equitable country—past, present, and future. It’s about celebrating the resilience of communities of Asian descent who have faced racism and discrimination for generations. It is our honour to have this opportunity to have Mr. Yang Mao attend our interview. Mr. Yang Mao is an outstanding representative of Asian Canadians.”

Yang Mao received his PhD in Epidemiology and Biostatistics from the University of Western Ontario’s Faculty of Medicine in 1968. He joined Health Canada in 1975 and retired in 2016. During his 40 years of service, he held the position of Director for 20 years. He has been appointed Professor Emeritus by five universities and was President of the Canadian Epidemiological Association for 8 years. He has received the Health Canada Award for Outstanding Achievement, the Canadian Public Health Science Award, and the Queen’s Award for Outstanding Achievement.

Thanks to the tireless advocacy of Mr. Yang Mao’s anti-tobacco team to “reduce smoking for all,” Canada’s tobacco control history has seen several great moments and firsts, such as:

  • Canada set a global precedent by becoming the first country to require graphic warnings on tobacco packaging. Legislation was passed in 2000 and came into effect in 2001.
  • The Federal Tobacco Act of 2003 banned tobacco sponsorship at sporting and artistic events.
  • Canada became the first country in the world to ban smoking in restaurant and bar patios in 2005 and banned smoking from all restaurants and bars in 2006. More than 115 countries and territories now follow the Canadian model.

In this interview, we honour Mr. Mao as an “anti-smoking hero,” but when Mr. Mao talks about the anti-smoking protest movement that has lasted throughout his 40-year career, he says modestly, “Anyone who has contributed to this struggle is a hero. So, who is the hero? It’s you. You’re the hero if you’re the one who has quit smoking. “

The times may have changed, but we still believe that in good times and bad, open-mindedness, spontaneity and an optimistic spirit are the qualities of Canadians of Asian descent which ensures infinite possibilities for the future for all Asian-Canadians.

Listen to the interview below:

Interview with Yang Mao and Ottawa Chinese Radio host, Yi Jiang

Transcript:

Interviewer: Ottawa Chinese Radio Host – Yi Jiang

Interviewee: Professor Yang Mao

Good evening, welcome to Ottawa Chinese Radio, organized by the Ottawa Chinese Community Service Centre. I am Yi Jiang. Tonight, I have an important guest of honour, Professor Yang Mao, who worked for Health Canada for 40 years, from 1975 to 2016. He is also an anti-smoking hero, so let’s hear his story tonight.

Host:                     First of all, we welcome Professor Mao. How are you, Professor?

Prof. Mao:           Hello.

Host:                     Could you first introduce yourself briefly? When did you come to Canada?

Prof. Mao:           I came to Canada in 1968 to study. Canada treated me pretty well: provided for my tuition fees and family expenses until I finished my PhD in epidemiology at the University of Western Ontario Faculty of Medicine. I was told that hard work in Canada would lead to a secure life: five years to stability, ten years to prosperity. After observing the people and things around me, I applied for immigration as well.

Host:                     Then you wanted to work for the government, right?

Prof. Mao:           Yes, I joined Health Canada in 1975 and retired in 2016. During my 40 years of service, I held the position of Director for 20 years. I have received the Health Canada Award for Outstanding Achievement, the Canadian Public Health Science Award, the Queen’s Award for Outstanding Achievement, and so on. I am grateful that Canada recognizes the achievements of hard-working people. In addition, I have been an Honorary Visiting Professor at five prestigious universities (McGill, Toronto, Western Ontario, Queen, Ottawa U) and was President of the Canadian Epidemiological Society for eight years (4 years as Vice-President and other 4 years as President. I have 217 Publications in leading national and international journals. During my tenure, I did not achieve any great success, but I did do something practical, something meaningful for Canadians. It is a way to repay the Canadian government for the kindness they have given me.

Host:                     Although you have just described your journey from school to work in just a few minutes, from the awards you have just mentioned and the positions you have held, we know that you have done a lot of important work. And that’s what we want to introduce to our audiences today: when did you start focusing on lung cancer surveillance and anti-smoking work?

Prof. Mao:           It was in 1975 that I joined in Public Health Agency of Canada. I was a health researcher. I met a young, talented, determined and persistent Canadian doctor in 1977 during a lunch hour. We noticed that the Canadian government only had surveillance for infectious diseases and did not pay enough attention to chronic diseases. We were two young men with a vision to guide the government with a message: we wanted to give them what they wanted and more than they wanted so we proposed to our top director at the time that we may need to work on chronic disease control in the future. With the director’s approval, we organized the Canadian Chronic Disease Control Group: a two-person group that we had no idea would later grow to its current size of 250 people.

Host:                     You two were very committed and had such a sense of innovation.

Prof. Mao:           Yes, we were young and energetic at that time. The main component of the work was monitoring the disease: starting with time, place and population and then moving onto crisis assessment. We analyzed the information on chronic diseases nationwide: which chronic diseases are increasing or have abnormally high values. When and where did they start? From which group? Hopefully, we can conclude why the data is abnormal and then we can control it to the maximum extent.

With the limited number of people in the research group, we narrowed down the scope and chose to start with cancer surveillance. At that time, there was collected a classification of 54 types of cancer. We conducted data surveillance for each type. Lung cancer was the focus of our surveillance at that time.

Host:                     What was the trend of lung cancer at that time?

Prof. Mao:           Canada had the highest lung cancer mortality rate among men in the early 1980s. The dramatic increase in lung cancer in women seemed to follow the pattern of the increase in lung cancer in men. We predicted that lung cancer in women would increase at a rate of 8-9 times faster in 1986 and would overtake breast cancer as the highest number of cancers in females. Lung cancer surveillance and prevention officially became the focus of our team’s work in 1986, and our confidence was strengthened by the fact that the actual value was only 0.5% inaccurate from the predicted value.

Host:                     When I hear this, I’d like to ask in particular what the causes were in the increase of lung cancer? First of all, air pollution in Canada is not so serious and why was there a dramatic increase in the rate of growth in women?

Prof. Mao:           That was one of the feelings we had at the time; even though we saw the data, we couldn’t believe it. In the 80’s the information technology was not as advanced as it is now, and although we were confused, we could not find much information about it. The only thing we could do was to analyze and research lung cancer-related information from academic articles to discover the causes of the disease and the distribution groups in regions. Statistically, the causes are roughly divided: radium radiation, pesticide use, water pollution, laboratory work environment, improper dietary habits, pollution from heavy industry and partly due to smoking. The assessment concluded that only smoking was nationwide and that there was a significant increase over time. It is also interesting to note that from the 1960s onwards, as women gradually entered the workplace, perhaps because of stress, the number of women smoking began to increase.

Host:                     Based on your assessment at the time, what kind of damage does smoking do to men or women, other than to the respiratory tract?

Prof. Mao:           Yes, that’s what we found out later, that smoking has an effect not only on lung cancer, but also on other cancers such as laryngeal, oesophageal, bladder, kidney, breast, and uterine cancers. Some chronic diseases such as cardiac atherosclerosis, heart disease, stroke, bronchitis and bronchiectasis are also aggravated by smoking. We also proposed a scenario of the dangers of second-hand smoke, for example, if a person smokes, does his wife also suffer from the effects? At that time, we could only collect available documents from various countries, translate them and then analyze it. We provided information to government policymakers and pointed out the need for Canada to reduce the level of the smoking population.

Host:                     Did you encounter any difficulties when you were working on these projects? Because at that time there wasn’t any information and all the decisions and initiatives needed to be proposed by your team, right?

Prof. Mao:           Yes, our proposal did correspond to the priorities of the policy-making department. The implementation of the decision had to meet the following criteria: it must be based on accurate data; it must have an impact on the majority of Canadians; it must be derived from the needs of the majority of people; it must be practicable and it must have a positive impact on the long-term program of the government. But at that time, the government believed that with the small number of heavy smokers and the long cycle of lung cancer, smoking did not have a significant impact on the health of the nation’s population. We also didn’t have enough data to convince them at that point of making the smoking ban a priority.

Host:                     So, what’s next? What were some of the stronger actions you’ve taken?

Prof. Mao:           We decided to fight to provide evidence and we sought help from academic professionals to increase the completeness and credibility of the information through academic prestige and thorough research. We developed a method that is recognized by the health community: we quantified the impact of smoking on mortality, morbidity, hospitalization, work years, life expectancy and economic burden among the Canadian population.  We worked with communities to inform, educate and appeal to the public about the negative health effects of smoking. We helped policymakers to develop programs that can reduce smoking, such as banning smoking in certain areas, increasing cigarette taxes, limiting cigarette advertising and increasing smoking cessation advertising.

Host:                     You just mentioned the smoking reduction programs; these programs are based on and rooted in your teams’ research, so that people can better accept the facts, such as the dangers of second-hand smoke and smoking-related cancers.

Prof. Mao:           Yes, although at first, the government did not draw attention to our proposal, after researching some relevant data, the government also began to set up a Tobacco Control Union to conduct various researches on cigarettes.

Host:                     Is the work of reducing smoking across Canada now complete?

Prof. Mao:           The number of smokers has been reduced, but is it low enough? No, not enough, but it’s not likely to get any lower.

Host:                     Why?

Prof. Mao:           I think two main reasons: the curiosity of young people and their tendency to get addicted after trying along with the fact that many people have a deep-rooted habit of smoking and they can’t quit. Policies and education can only help smokers understand that they should quit but cannot make them quit.

Host:                     These days there are a lot of tobacco alternatives like E-cigarettes with different flavours. Will this will drive young people to try more?

Prof. Mao:           Yes. There are always new gimmicks and they will continue to exist. That’s why the government needs to continue increasing smoking cessation ads and educating the public.

Host:                     In terms of recent medical research, there is no medical solution for smoking addiction, so if you want to quit smoking, you still have to rely on your determination and perseverance, right?

Prof. Mao:           Yes, although various countries and institutions are working on effective ways to quit smoking, it is still up to the individual to take action.

Host:                     Who do you think plays the most important role in this long invisible war against smoking?

Prof. Mao:           All those who have contributed to this struggle are the heroes’ sidekicks. So, who is the hero? It is you: if you are a person who has quit smoking, you are the hero. The biggest enemy in life is yourself; you are a hero if you can overcome yourself, and you are a hero if you have successfully quit smoking. Let’s help the people around us to be heroes and quit smoking as much as possible.

Host:                    I hope that, as you said, everyone who is smoking will, one day, become heroes. Each person has a role to play in the process of fighting the smoking movement. We are grateful to Professor Mao Yang for being an outstanding Asian-Canadian representative who spoke to us today about his 40-year career in lung cancer research and the anti-smoking battle. I hope that after listening to him today, we can all become heroes in our own lives and work together to do what we can in the battle against tobacco.

Click the link to watch the interview video at https://youtu.be/zwXpavwm2H8

References

Wigle, D., Collishaw, N., Kirkbride, J., & Mao, Y. (1987 May 1). Deaths in Canada from lung cancer due to involuntary smoking. PubMed Central PMCsite.

Johnson, K., Hu, J., & Mao, Y. (2001 Sep). Lifetime residential and workplace exposure to environmental tobacco smoke and lung cancer in never-smoking women, Canada 1994-97. Int J Cancer.

Mao Y, M. H. (1988 Sep-Oct). The health consequences of smoking among smokers in Canada. . Can J Public Health.

Mao, Y., Gibbons, L., & Wong, T. (1992 Nov-Dec). The impact of the decreased prevalence of smoking in Canada. Canadian Journal of Public Health.

Villeneuve , P., & Mao , Y. (1994 Nov-Dec). Lifetime probability of developing lung cancer, by smoking status, Canada. Can J Public Health.