From Indian public health researchers Amit Yadav and Prashant Kumar Singh, a call to action for world leaders to take action at the UN General Assembly on the eve of Gandhi’s 150^th birthday. 

“A correspondent who is interested in a variety of reforms asks what the nation pays for her tobacco bill.  I find that we pay for unmanufactured tobacco and cigarettes 213 lakhs per year.  The cost is increasing every year,” said a concerned Gandhi. (*one lakh = 100,000)

Last century, in Gandhi’s time, the World Health Organization (WHO) estimates tobacco use killed 100 million people, a figure that will rise to 1 billion this century if tobacco use continues unabated. As India prepares to celebrate the 150^th birth anniversary of Mahatma Gandhi, one of the country’s greatest thinkers and enlightened political men, whose influence extended far beyond India and left a global legacy, the greatest tribute would be to pledge for a Tobacco-Free world and save one billion lives from perishing due to this fatal addiction.

Mahatma wrote in his autobiography, that at an early age, he and a friend were attracted to smoking. They started with left over cigarettes stubs and soon “began to steal coppers from the servant’s pocket money in order to purchase Indian cigarettes”. Unable to smoke freely, they thought that life was hardly worth living and decided to commit suicide by eating dhatura seeds. What if the seeds did not work and they did not die? The thought made them abort the idea of suicide, along with the idea of smoking. Gandhi’s experiment is a testimony to how addictive tobacco can be. The Mahatma never touched a cigarette or tobacco for the remainder of his life.

Long before the dangers of secondhand smoke became known through scientific research, Gandhi wrote about the discomfort it caused to others, and his own experiences of feeling choked when exposed to secondhand smoke on trains. He also wrote about the problems of oral tobacco, and the fouling of public transport and other public areas caused by the spitting which accompanies tobacco chewing. One hundred years later, these experiences from Gandhi’s life continue to be experienced by billions of people across the globe.

It is encouraging to see that in 2019, 15 years after the WHO Framework Convention on Tobacco Control (FCTC) entered into force, five billion people live in countries that have introduced smoking bans in public places, graphic warnings on packaging and other effective tobacco control measures. While this represents a four-fold increase since 2007, several countries are yet to effectively implement FCTC provisions, and only two countries – Brazil and Turkey – have implemented all the six WHO MPOWER strategies to the best practice level.

The largest number of world’s tobacco users come from five countries – China, India, Indonesia, Russia and the United States of America (USA). Unfortunately, two of these high burden countries are yet to ratify the FCTC, despite the fact that it is the most widely-ratified UN Treaty. If the USA and Indonesia ratified the FCTC and fully implemented it, the number of people protected by evidence-based, effective tobacco control measures would increase by about 600 million more people (8% of the global population).

There is global consensus about the threat tobacco poses to health and economic development, as tobacco is the single most preventable reason for the majority of non-communicable diseases (NCDs). This consensus is reflected in Goal 3 of the UN Sustainable Development Goals, 2030. Target 3.4 stipulates a one-third reduction in premature mortality from NCDs and 3.a recognizes the urgency to “Strengthen the implementation of the WHO FCTC in all countries, as appropriate.”

Einstein believed that Gandhi’s views were the most enlightened in his time, including his views about both the individual and social impacts of tobacco and benefits of quitting. However, it has taken the world almost a century to unambiguously call for stronger action against tobacco in all countries. The third Secretary General of the United Nations, U Thant said, “Many of his (Mahatma’s) principles have universal application and eternal validity.” His message on tobacco control is of universal importance. UN leaders should  pledge a Gandhian approach to meet the UNSDG target on tobacco and bequeath a Tobacco-Free World to future generations. A greater commitment to the FCTC and the UNSDG will be the greatest homage to the Gandhi on his 150^th birth anniversary on 2^nd October 2019, about whom Einstein once said, “Generations to come will scarce believe that such a one as this ever in flesh and blood walked upon this earth.”

Stepping stones to a Tobacco-Free World

1. The sixteen countries which are not yet Party to the WHO FCTC should ratify the Treaty.
2. Parties to the FCTC have adopted the only Protocol to the treaty, to eliminate illicit trade in tobacco products. However, only 56 Parties to the FCTC are Parties to the Protocol. The remaining 124 Parties should ratify the Protocol.
3. All countries should commit dedicated resources to ensure full implementation of the FCTC provisions, and beyond, and implement them at the best practice levels.
4. All countries should apply and implement all FCTC provisions on all kinds of tobacco products (smoking, smokeless other novel tobacco products) without any exemptions.
5. The tobacco industry continues to attempt to interfere in FCTC implementation at the global, national and sub-national level. Parties should remain cautious against any alternative or voluntary approach or agreements put forward by the tobacco industry with regard to implementation of the FCTC or its Protocol.
6. Article 19 of the FCTC has been the least utilised provision of the Treaty. For all the other provisions of the Treaty to be implemented effectively, Parties must consider fixing civil and criminal liability as appropriate against the industry and hold those accountable who are responsible to implement tobacco control within their jurisdictions.

Amit Yadav is a Postdoctoral Scholar at the Center for Tobacco Control Research and Education (CTCRE), University of California San Francisco. Prashant Kumar Singh is a Scientist ‘D’ at the ICMR National Institute of Cancer Prevention and Research, Preventive Oncology, Noida, Uttar Pradesh, India.