After years of doing nothing to regulate one of the international tobacco industry’s most profitable adventure playgrounds, and only passing legislation that it seemed to have no intention of enforcing, the government of Pakistan has at last been ordered by the highest court in the land to take tobacco control, and its own laws, more seriously.

The country’s Supreme Court has the power to take up any issues it considers to be a matter of public importance, and will sometimes act simply on the basis of press reports. More usually, it considers specific requests for justice, as in this case. Pakistan’s leading tobacco control advocate, respiratory physician Professor Javaid Khan of the Aga Khan University in Karachi, wrote to the court in March - it cost only his time and knowledge to present the case for action - detailing Pakistan’s appalling tobacco problem, and the catalogue of inaction by the government, despite having passed laws such as a ban on smoking in public places.

In September, to the delight of Professor Khan and many frustrated colleagues throughout the country, the court issued its findings. It formally requested the government to be more stringent about enforcing its tobacco control laws, and specifically to delegate punitive powers to provincial governments for the enforcement of the law passed in 2002 which is supposed to ban smoking in offices, hospitals, educational institutions and public transport.

The court’s response gained widespread media coverage, and understandably, threw the health ministry into turmoil, knowing it had to report back to the court within three weeks. A flurry of activity was seen, including the removal of some long-banned tobacco billboards. The health ministry is right to be worried, even if it is for the wrong reason. It has to make up for years of inaction, albeit years of what must have seemed like a perpetual blizzard of cigarette promotion aimed at young people. If recourse to the court action was comparatively simple—even simpler than the provision for legal redress afforded to non-governmental organisations in France, reported above—the solution will be complex and difficult. The deeply ingrained problem has been strenuously fuelled by transnational tobacco companies who will no doubt be just as strenuous in resisting effective action. The health ministry has its work cut out for many years to come.

Pakistan: the Supreme Court Pakistan in Islamabad.