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Improving health
Previously NHS Health Scotland

Just before the start of the year I was invited to Hong Kong to talk to its government about Scotland's unanimous stance that vaping e-cigarettes is less harmful to health than smoking tobacco. It came about because of our close working relationship with ASH Scotland, the anti-smoking charity, and its CEO Sheila Duffy who recommended me.

I had always wanted to go Hong Kong. It is such an iconic city. There is something exciting about big cities; a feeling of limitless opportunities. Glasgow has it, London has it and Hong Kong has it.

I'm not sure if it was just the jetlag but getting a taxi downtown for dinner that first night felt like being on set in Blade Runner. The slick, perfectly smooth mixture of concrete, tarmac, metal and glass. Buildings lit up like a Christmas tree, unintelligible flashing neon signs, and endless traffic. Although it looked like Blade Runner, when I got out of the taxi the wall of heat, and smells of spices and street food, very much reminded me of growing up in rural Malawi. Even though the dirt roads, Tilly lamps and intermittent water supply of my childhood couldn't have been more different to hyper hi-tech Hong Kong.

Dividing opinion

Everyone knows what e-cigarettes are, but I'm not sure if people realise how divisive they are. They are pulling the tobacco control community apart. The round table discussion I attended had representation from the WHO, Hong Kong, Canada, USA, Japan, Australia, China and, of course, Scotland. I knew it was as important as ever to stick to the evidence base to protect the profile of NHS Health Scotland within a global political and academic community.

I quickly found out that the local view on e-cigarettes was totally different to ours. The person who talked before me at the round table discussion was a public health professor who said that e-cigarettes were dangerous and should be banned. My opposing view was that, based on current evidence, the consensus in Scotland is that e-cigarettes are definitely less harmful than smoking. Also, that dual use of tobacco and e-cigarettes has no health benefit and e-cigarettes are not products for non-smokers or children. Although the discussion was tense and we differed on many issues, it never became personal or unprofessional. I gave my view when asked and contributed where I felt it was useful.

Influencing policy

One of the things it really made me appreciate is how unique our situation is in Scotland. We are encouraged to build relationships with government civil servants to impart knowledge which means that the evidence we look at has a real bearing on policy. And Scotland's small size means we are well connected to international experts on a huge range of topics, and to local policy makers too. This is why working for an organisation that not only generates evidence to improve health, but works across all sectors to make best use of that knowledge, is appealing. It is not just about doing excellent science, it is about using it to make a difference to the population of Scotland. What I have learned from Hong Kong is that our impact can be even greater than that. We can help other countries tackle the same problems we have.

Having said that, what works in Scotland won't necessarily work in Hong Kong. But maybe the collaborative process which we use to influence government policy could be used by other countries. Indeed, on the eve of this year’s No Smoking Day (14 March) Jersey’s government, together with health professionals and partners in the public and third sectors, published its own consensus statement on e-cigarettes. Based on Scotland’s agreement, it delivered the message that e-cigarettes are less harmful to smokers’ health than continuing to smoke conventional cigarettes.

A good move for Jersey’s health. But, no matter where you live, opportunities, choices and change are all there for the taking. Relationships help things get done.

Relationships matter.

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