To encounter the challenges of tobacco industry: concerted community effort to advocate for policy change

Background and challenges to implementation The Hong Kong Government proposed to enhance pictorial health warnings (PHW), prominently increasing the size to 85%, since May 2015. Opposition and interference of tobacco industry (TI) was fierce. They formed a strong opposition force by mobilizing front groups and stakeholders to lobby legislators and delayed the legislation for 2 years. TI' intimidations on policy change were resolved with concerted community effort. Intervention or response Tailor-made smoke-free promotion programmes were introduced by Hong Kong Council on Smoking and Health (COSH), targeting at all perspectives of society. Every year, education and community involvement programmes for specific target group, e.g. students, elderly, middle aged, women, medical and health, and business sector, etc were organized to build up smoke-free concept in the community and engage them as persistent working partners in tobacco control. Results and lessons learnt Since July 2015 to May 2017, over 220 organizations' representatives/individuals took part to support the 85% PHW. Apart from health advocates, medical professionals and scholars, participants also included ex-smokers, students, teachers, social workers, community leaders, businessman, etc. It demonstrated to legislators that tobacco control is the whole community's concern and should be superior to TI's commercial interests. The 85% PHW was finally passed in June 2017. Lobbying of TI is ferocious and always with pseudo-science. It should note that TI also mobilized over 110 representatives, including smokers, marketing experts, lawyers, politicians, social activists and scholars. Challenges for advancing smoke-free legislation could be huger as we expected. Wider support and collaborations with the community should be solicited. Conclusions and key recommendations Nearly 90% of Hong Kong population are non-smokers and public support to tobacco control measures is generally high. It is critical to identify and engage these supportive but silent forces in the legislative process. Smoke-free seeds should be sowed broadly, deeply and sustainably in all sectors of community for the policy change