The International Conference on Public Health Priorities in the 21st Century: The Endgame for Tobacco was held in New Delhi, India from 10-12 September 2013. It was attended by 600 delegates from 52 countries The Conference built on the expanding global narrative of the tobacco endgame, which calls for reducing consumption and availability of tobacco in the society to minimal levels through full, effective and accelerated implementation of all policy measures recommended under WHO-FCTC and adopting new strategies.

The World Health Assembly (WHA), in May 2013, adopted a target of 30% relative reduction in tobacco use prevalence by 2025. Tobacco Control is also becoming integral to the agenda of sustainable development, adding urgency for attaining the WHA target and swiftly moving beyond that to eliminate tobacco use in all forms, by 2050, everywhere in the world. This Conference deliberated to identify strategies for ending tobacco related harm to health and development in the 21st Century and setting global and country-wise targets to protect present and future generations from the harms of tobacco use. The path towards achievement of a tobacco free world is delineated in the following declaration adopted by the Conference.

Conference Declaration

Towards a tobacco-free world

We, the participants of this conference:

Recognize the enormous adverse impact of the tobacco epidemic, globally and particularly in low-and middle income countries and the need to hasten tobacco control efforts across the world.

Observe that despite effective, evidence-based tobacco control policies, reduction in smoking prevalence in developed countries has started to slow down and use of smoked and smokeless tobacco continues to increase in many low-and middle income countries.

Identify the tobacco epidemic as a global threat to equitable social and economic development and recognize the need to integrate tobacco control into the global discourse on the post-2015 sustainable development goals.

Emphasize that multi-sectoral integration, inter-agency coordination and wide ranging partnerships remain central to fighting the tobacco epidemic and countering the tobacco industry interference.

Express concern about the debilitating nature of tobacco farming, production and manufacturing, associated human rights violations and call for policies to support transition from tobacco to other livelihoods.

Our Vision: To make the 21st Century the last period in history where any harm is caused to humans by tobacco.

Our view of The 'Endgame' A composite of strategies to reduce or contain the prevalence of tobacco use to less than 5%, which is a tipping point of de-normalisation, at which countries are enabled to further completely eliminate all forms of tobacco consumption.

To advance the world towards realization of our collective vision, we strongly recommend:

1. Adoption of national action plans for moving towards the 'Endgame' target.

2. Sustained government commitment, continuous goal-setting and amendments to legislation based on periodically updated nation-wide data on the magnitude, patterns, determinants and consequences of both smoking and smokeless tobacco use and exposure, with four yearly monitoring of indicators linked to the endgame target.

3. Ratification and full implementation of WHO FCTC by all countries, including setting of time bound targets to become tobacco-free in the national legislation of each country.

4. Raising tobacco taxes sharply on all products, as recommended by WHO, in accordance with global evidence which shows this to be a highly effective way of reducing tobacco consumption.

5. Utilization of tobacco derived tax revenues for strengthening the implementation of national tobacco control programmes, funding universal health coverage and supporting the transition of tobacco farmers and workers to alternate occupations.

6. Mandating plain packaging for all tobacco products, as exemplified by Australian regulations to enhance the impact of health warnings and prevent use of packaging for product promotion.

7. Development of national policies requiring licensing for cultivation, manufacture, distribution and all sales of tobacco products

8. Progressively reducing the land under tobacco cultivation through substitution with nutrient rich crops and shifting tobacco farmers and workers to economically viable alternate occupations.

9. Adoption of policies to prohibit the sale of tobacco to all persons born after 2000, to ensure tobacco free millennium generations (as proposed by Tasmania and Singapore).

10. Upholding child rights, to curb exposure to tobacco smoke at all places including homes and private transport.

11. Provision of a comprehensive set of tobacco cessation services to support current users to quit and avoid relapse.

12. De-normalisation of both tobacco use and tobacco industry through effective communication and strict adherence to Article 5.3 of FCTC.

13. Inclusion of targets related to control and accelerated elimination of tobacco within the post 2015 Sustainable Development Goals of the United Nations.

14. According priority to public health, particularly to tobacco control measures, while entering into multilateral and bilateral trade and investment agreements.

15. Establishment of global and national funding mechanisms for tobacco control, with particular focus on low-and middle income countries.

16. Strengthening of inter-governmental, inter-ministerial and multi sectoral coordination to prevent tobacco industry interference in the effective implementation of: the FCTC; regional directives (such as in the European Union) and national laws for tobacco control.

17. Positioning tobacco control in other health and development agendas at both national and global levels, with particular attention to reduction of poverty and health inequity.

18. Support from WHO, Bureau of FCTC's Conference of Parties, Secretariat and the UN Interagency Task Force on the Prevention and Control of NCDs, to all countries, for effective implementation of FCTC and the WHO Global NCD Action Plan 2013-2020.

19. Ratification and implementation, by all governments, of the first protocol under the WHO-FCTC to ensure elimination of illicit trade in tobacco products.

20. Mandatory training in health promotion and tobacco control as a part of education across sectors at the graduate and post-graduate levels and especially for health professionals, social workers and teachers.

21. All health care providers to be trained to seek information from patients and families on tobacco consuming habits, so as to minimize missed opportunities for initiating effective tobacco cessation interventions.

22. Advancing research to support stronger, innovative and evidence based tobacco control measures beyond FCTC.

23. Adoption of the "No More Tobacco in the 21st Century" (NMT21C) as the symbol of global movement for elimination of tobacco.

The Conference calls on Governments, WHO, other UN agencies and the Conference of Parties to take leadership position in advancing the actions under FCTC and its protocols as well as the Global Action Plan on NCDs 2013-2020, while linking them to the evolving UN Agenda for Sustainable Development, and support the recommendations contained in this declaration to realize the vision of a world free from tobacco, within this century.