When the World Health Organisation (WHO) opens its large conference in Delhi, India next week about tobacco and smoking, the whole conference site will certainly be tobacco-free, nothing less, of course, in the midst of the many puffing and tobacco-chewing poor Indians.

The WHO conference goes under the name COP7, which in full stands for, “Seventh Session of the Conference of the Parties to the WHO Convention on Tobacco Control”. It will gather ‘all parties’, notably governmental departments and non-governmental organisations, who work from the perspective of medical and social health, trying to reduce and even eradicate the tobacco addiction and use.

On the other side, there is the tobacco industry, worried about the future of their lucrative business, under increasing fire for more than a generation by now.

The tobacco farmers may not have a loud voice, and it is said that in Pakistan alone, there are some 70,000 of them, and that means when we include their families, that in the range of one million people depend on the income from tobacco growing, as farmers, labourers, local shops, and so on. The farmers have little say unless they join hands with powerful interest organisations and indeed the government.

The industry still has some power, notably the large, mostly multinational companies which purchase tobacco, make it into products that people buy, plus those who market and trade in tobacco products. Advertising and marketing companies that engage in marketing, targeting specific subgroups, indeed in developing countries where two thirds of the smokers live, are criticised when the engage in aggressive marketing. Well, not all marketers are bad, of course, but some are, certainly those who target children and youth. But then, they also want to sell, so it is only through regulations and restrictions that they will restrain their practices.

Sometimes tobacco smoking and chewing is combined with other substance abuse, notably alcohol and drugs. The tobacco industry will probably deny that smoking is part of a negative substance abuse culture; on the contrary, they may argue that smoking keeps people away from other addictions, and there may be some merit to that.

In Pakistan, a recent WHO survey from 2012, and a student’s dissertation from the same year, carried out in cooperation with Gallup Pakistan, show that about a third of all men are smokers and the majority are older men; just some five-six percent of the women smoke. For smoking of shisha, and chewing nazwar (snuff), men are by far the main users. Sometimes, though, women also chew since it may be socially more acceptable for women chew than to smoke.

WHO says that smoking is one of the leading causes of preventable morbidity and mortality, and with about 1 billion smokers in the world, smoking kills six million every year, and some 600,000 die from hazards from second-hand smoke. Smoking leads to premature death and is a huge burden on the health systems and on families of smokers. In order to limit smoking, WHO recommends that countries monitor the use of tobacco products and advertising, that awareness campaigns are implemented to show the adverse effects of smoking, that people are protected from tobacco smoke, that help is offered to smokers to quit, that advertising is banned and that taxes are increased on tobacco products. All of us who smoke, or have smoked (like me), have a responsibility for how we behave socially when we smoke, indeed when we are around children and young people who are easily influenced. In Pakistan, most smokers are middle-aged and older.

When I quit smoking twenty years ago, after a twenty-five-year span of heavy smoking, I managed to end it thanks to the use of a nicotine patch and some advice from a doctor, who was not a specialist in the field, however. It is interesting that there is hardly any really professional medical help available to help smokers quit.

I stopped smoking because I was ‘forced’ to do so; I had taken up a post in an organisation in USA where smoking had been banned just as I joined it. Although about a third of my colleagues smoked, it was socially difficult to be a smoker; few would allow smoking in their homes, and most restaurants were non-smoking, and we could no longer sit at office meetings puffing. If the e-cigarette had been there, I think I would have used that, and through that gradually quitting (or stayed with it for long).

Generally, I am sceptical to absolute bans, in any field. That also goes for alcohol and other stimuli. In most cultures and countries, people use some stimuli for feasts or in other connections, even daily. True, they may be directly or indirectly harmful for some or all, and most create dependency. Tobacco smoking is also like that, even light cigarettes, and certainly alcohol and drugs. But we human beings still use such things. Besides, we also do a lot of other things that is harmful to our health and well-being; we eat too much and exercise too little; obesity and related deceases have become common, also in developing countries. Many people have to work in hazardous environments. We allow pollution of cities and the air everywhere, although now we are getting more aware of – and willing to – invest in clean environments. The anti-tobacco campaign of WHO is part of how we look at health and environment in our time. But as recent as in the 1950s, it was ‘in’ to smoke; it was part of being seen as modern and successful, with some religious and other groups being against it, and more so against alcohol and other drugs.

In Pakistan, I hope the government develops a clearer anti-smoking and tobacco control policy, with higher taxation, very limited advertising, and awareness campaigns. I also hope that the tobacco growers and others who depend on income from the industry are given assistance so that they can move to other livelihoods, although it will not be easy. Furthermore, why cannot the tobacco industry, too, move to healthier products and help the tobacco growers find sustainable crops? We need alternative foods and beverages that are good for us, and make us happy and comfortable, so we don’t have to worry about all the risks of tobacco. Finally, let us not become fanatically against smoking of cigarettes and chewing of Naswar – not quite yet. Social and economic change always takes time and is best enforced gradually.