Saloni Khanna is an Educationist, Economist and Interviewer
New Delhi [India], November 12: When the world gathers for COP11 of the WHO Framework Convention on Tobacco Control (FCTC) in 2025, countries will debate how to curb the world’s leading cause of preventable death—a question that carries special weight for India, home to 27 crore tobacco users and over 1.35 million deaths annually. It is a chance to question whether the world’s tobacco control treaty, drafted two decades ago for very different economies and health systems, can still serve its purpose.
India must decide whether to keep following a universal model designed for high-income nations—or to lead a redesign that reflects its unique social, economic, and public health realities. This is not a call to reject the WHO, but to reform a framework that no longer matches the world’s second-largest tobacco-consuming country.
To truly protect its citizens, India must examine why the global template doesn’t fit its realities
A Treaty That Misses the Indian Context
The WHO’s tobacco control model was built on assumptions that fit high-income nations far better than India. It imagines a world where tobacco use is an individual lifestyle choice, quitting is supported by health systems, and farmers can easily shift to alternative crops. But in India, tobacco addiction is often born from poverty and stress, not choice; cessation infrastructure is sparse, with fewer than 500 centres serving 27 crore users; and nearly 4 crore livelihoods still depend on tobacco cultivation and trade. When these ground realities collide with a one-size-fits-all global template, policy compliance becomes impossible, and progress becomes performative.
Two Sides of the Same Tobacco Trap
In India’s cancer wards—from Tata Memorial in Mumbai to AIIMS in Delhi—young oral cancer patients wait months for treatment, often after selling land or jewellery to pay hospital bills. Their suffering is mirrored in India’s tobacco heartlands. In Andhra Pradesh’s Prakasam and Karnataka’s Mysuru districts, farmers who grow flue-cured Virginia (FCV) tobacco are struggling with auction prices that have fallen from ₹210/kg to ₹150/kg, even as fertiliser and labour costs soar. Many now sell below cost, trapped between falling incomes and uncertain futures.
What links these two ends of the crisis is not just tobacco—it’s the absence of alternatives. Patients lack affordable cessation and screening; farmers lack viable replacement crops and market support. Treating one without addressing the other leaves India’s tobacco epidemic half-solved.
These contrasting crises—on hospital wards and in the fields—highlight where global tobacco policy fails to align with India’s needs.
Why the Global Template Breaks Down for India
The WHO’s tobacco control framework is based on assumptions that do not match India’s social and economic landscape.
It treats a ₹1 bidi and a regulated nicotine alternative alike, even though science clearly shows that smoke and combustion, not nicotine itself, cause most harm. The treaty also presumes the presence of robust health systems, capable of providing counselling, treatment, and support—a standard far from India’s reality.
In countries like Japan and Sweden, harm reduction strategies, including regulated nicotine alternatives, have led to dramatic declines in smoking rates; India bans such alternatives entirely, leaving millions dependent on bidis, gutka, and khaini—the most harmful forms of use.
The framework also overlooks that tobacco is not merely a product but an entire economic ecosystem. Around 4 crore Indians depend on it directly or indirectly. Policies that aim to cut consumption and cultivation simultaneously, without offering transition support, risk not just public health failure but widespread economic distress.
Forward-Looking & Reformist
India faces a choice: follow a global template or help redefine it for the modern world. The WHO treaty was written for a different era, when the economics, health infrastructure, and harm-reduction tools we have today did not exist. India has the credibility, scale, and experience to push for a framework that is grounded in science, equity, and economic reality. By differentiating between combustible and non-combustible products, embedding cessation and screening into public health, and supporting farmers through transition policies, India can demonstrate that effective tobacco control does not have to come at the cost of livelihoods or access.
From Compliance to Global Leadership
India has never achieved progress by blindly following global models. From affordable vaccines to generic medicines, solar diplomacy to public health innovations, India has repeatedly reshaped global systems on its own terms.
At COP 11, it can do so again—turning tobacco control from a compliance exercise into a model of pragmatic, science-driven reform.
The message is clear: not rejection, but redesign; not slogans, but solutions.
Disclaimer: Views expressed above are the author’s own and do not reflect the publication’s views.