You are on page 1of 41

Tobacco Control

Efforts in Indonesia

WHO Country Office


November 2008
Tobacco
Tobacco
Tobacco
• Leaves that are chewed or
burnt producing smoke to be
inhaled.
• Processed leaves contain
2550 chemical substances.
• Some of the chemical
substances cause health
problems: lung damages and
reducing fitness.

Manual on Tobacco Control in School, WHO SEARO, 2006


Tobacco Deaths

Tobacco causes 1 of 10 adult deaths


It kills half of its users.
(500M out of 1 billion users will die of it).
1 deaths every 6 seconds
5,4M in 2005, 100M in 20th century
Without control measures ....
8M deaths in 2030, 1 billion in 21th century
80% deaths occur in developng countries.
Countries with High
Burden of Tobacco Use
(by cigarette sticks)
Almost 2/3 of smokers reside in 10 countries.
Indonesia ranks the third.
Increased Use
Tobacco Epidemic

EPIDEMIC
Tobacco
morbidity,
mortality >
HIV/AIDS +
Tbc+Malaria
Curbing Tobacco
Epidemic
Monitoring
Protect people from
tobacco smoke
Offer help to stop
smoking
Warn about the danger
of tobacco.
Enforce bans of ads,
promotion and
sponsorship
Raise tobacco taxation
Global Strategy to
curb the Epidemic
• Framework Convention of Tobacco
Control (FCTC), approved by all
member countries at WHA May 2003
• WHO collects experiences from its
member countries and formulate
strategy to control tobacco
consumption namely MPOWER,
February 2008
MPOWER
Six policies to address tobacco epidemic:
M onitor tobacco use/prevention policies.
P rotect people from tobacco smoke.
O ffer help to quit tobacco use.
W arn about the danger of tobacco.
E nforce bans on tobacco advertising,
promotion and sponsorship.
R aise taxes on tobacco.
Tobacco Control

MPOWER Indonesia
Monitoring
Tobacco Use
Adult (>15 yrs old) Young Adult (15-19)

Source: National Socio-economic surveys 1995, 2001, 2004

With high prevalence and increasing trend in tobacco use,


Indonesia ranks the third world highest tobacco burden
country after China and India.
Monitoring
Tobacco Industry
• 4000 tobacco companies,
4 largest in market share
(July 2006): Gudang
Garam (32%), HM
Sampoerna/ Philip Morris
(26%), Djarum (17%),
Bentoel (3%).
• Contribution of tobacco
industry at national
economy is diminishing.
Sumber: Ahsan A, LDUI, 2008
Monitoring Tobacco
Import and Export
In Million USD

Imported tobacco > exported Source: Ministry of Agriculture


Monitoring Tobacco
and Poverty
Monthly household expenditure for
tobacco by income level, 1995-2005

Source: Socio-economic Surveys


Cost of Smoking
Year Tobacco Cost
related (and source of data)
deaths
2001 427.948 IDR 127 Trillion (USD 13 billion)
7.5 x tobacco tax revenue
(Kosen, Health and Economic
Impact of Tobacco Use, MOH 2004)
2005 399.800 IDR 167 Trillion (USD 18 bilion)
5 x tobacco tax revenue
(Kosen,MOH. Presented at IPHA
Congress, 2007)
Monitoring
Legislation
Indonesia has not signed or ratified FCTC
Submitted Draft TC Law has got Legislative Body
approval to be discussed at Parliament in 2009.
Three related National Government Regulations:
PP 81/1999, PP 38/ 2000, PP 19/2003.
Local governments are required to enact their own
smoke-free regulations in line with national law.
Monitoring Public Opinion,
Indonesia, June 2008
FCTC 91 9
No cigarette selling to children < 18 years 97 3
Ban smoking at health facilities 99 1
Ban smoking indoor workplaces 93 7
Ban smoking in restaurant 81 19
Ban smoking at shopping malls 75 25
Ban smoking at bus/train stations 75 25
Second Hand Smoke is hazardous 68 32
Government policy is not firm 69 31
Consumer/workers' rights is more important 84 17
than the rights to smoke in public places
1200 respondents over 18 years selected randomly
0 20 40 60 80 100 120
Source: IFPPD, 2008. % agree % disagree
Protect People
from Tobacco Smoke
2007 Implementation
Regulation:
PP 19/2003 Health facilities Yes

Smoke Free Areas


Non-university Yes
include educational institutions
public places,
health facilities, Universities Some
work places,
educational and Government office No
child playground,
places of worship, Indoor workplace No
public transport.
Restaurants No

Bar and Pub No


Protect People
fromTobacco Smoke
• Article 13 in Jakarta clean air act No.2/ 2005,
further elaborated in Governor Order 75/2005
on smoking ban.
• Article 14, 15, 16 of Bogor people’s order on
public security, 2007
• Cirebon City Executive/Mayor order, 2007.
No designated room.
• Surabaya people’s order, 2008.
• Smoke–Free Policy Develoment template for
sub-national advocacy (IPHA)
• Training Workshop by Govt-IUATLD-WHO-IPHA
for 8 provinces
Offer Help
to Quit Tobacco Use
• Initiative at Gajah Mada University.
• Training Symposium for 750 South
Sulawesi physicians, July 2008.
• Management of addict cases and
smoking cessation and tobacco
control recommendation in Family
Physician Annual Scientific Meeting.
• Initiative of Indonesian Nursing
Association in tob-cessation services.
Warn the Danger
of Tobacco
PP 19/2003:

Health warning to be
placed on (the back of)
cigarette packs, 1 mm Space for
border. At least 15% size promotion
of space on billboard ads.

One authorized textual


health warning: ‘smoking
can cause cancer, heart
attack, impotence and
harms pregnancy and fetal
development’.
Warn the Danger
of Tobacco
Result of PH-Faculty Study, 2007:
• Preference: 76% 15% 9%
text+graphic graphic text
• 78% agreed that health warning should cover
50% of cigarette pack surface.
• Smokers agreed to use horror (34%) and
picture (32%) for health warning.
Draft MOH Decree on Graphic Health Warning is
being processed.
Anti tobacco media campaign is being developed
(WHO, TC network, Nat TC Commission, WLF
training).
Enforce Ban on
Tobacco Ads
<1990 1990 PP19/2003
All TV ads TV ads were permits
were prohibited tobacco
banned 5 am-9.30 pm importers &
manufactures
Images of to advertise in
cigarrette packs, all media, with
smoking figures, health warning
pictures/ words incorporated.
with children,
teenagers and
pregnant women
were banned
Enforce Ban on
Tobacco Ads
Status of Indonesia Ads Ban
Enforce ban on tobacco ads, promotion,sponsorship
National TV and radio No
International TV and radio No
National magazines/newspaper No
International magazines/newspaper No
Billboard, outdoor ads No
Point of sales No
Internet No
Free distribution of cigarettes Yes
Discounted promotion No
Non tobacco products named tobacco No
Nontobacco brand for tobaco products No
Product image in TV and movies No
Sponsored event No
Score of law enforcement 2/10
(Cumulative score from 5 experts requested to value:
minimal 0, moderate 1, maximal 2).
Enforce Ban on
Tobacco Ads
• GYTS 2006:
>90% students 13-
15: exposed to tob-
ads, 14% were
offered cigarettes by
tobacco companies.
• Violation by tobacco
companies in direct
and indirect ads Actions:
(sponsorship in - Litigation
national and religious - Draft law to comprehensive
events, CSR etc). ban of tobacco ads,
promotion and sponsorship
Raise Tobacco Tax
Raise Tobacco Tax
3 types of tobacco taxes:
(MOF Order No. 118/2006, and No.406/2000)

VAT Specific Tax, July 2007 Ad Valorem Tax


Only for cigarettes
8.4% of 4-40% ( 31%)
Varies by industry size
ERP flat
IDR 3/stick for industry 26-40% for
<500 M sticks machine kreteks
IDR 5/stick for industry white cigarettes.
500M-2B sticks
IDR 7/stick for industry 4-22% for hand
>2 B sticks made kreteks

Complex system needs simplification


Raise Tobacco Tax
Tobacco Tax Revenue, 1999-2005
35 32.65

30 28.67
25.93
25 22.88

IDR Trillion
20
16.49
15
10.11
10 7.45

0
1999 2000 2001 2002 2003
2004 2005
Draft Law on Fiscal Decentralization provide
opportunity for district governments to collect
tobacco surcharge up to 25% of cigarette prize.
2008 Tobacco
Control Players
• >14 government organizations:
MOH, FDA, MOF, MOE, MOI, MOCI, SMWE, SMOYS, SMOE, City Government of
Jakarta, Bogor, Palembang, Cirebon, Surabaya, Makassar etc.

• >26 active non-governmental organizations:


NCTC, NCCP, IFPPD, TCSC-IPHA, Indonesian Cancer Foundation, Indonesian
Heart Foundation, WITT, Scout Movement, Consumer Foundation, FAKTA, Medical
Student Council, PH Student Council, IPPA, Smoking Control Foundation,
Demographic Institute UI, Health Research Centre PH Faculty UI, Quit Tobacco
Indonesia Medical Faculty UGM, PH Department Univ. Sriwijaya, Bogor Agriculural
Institute, PH Dept Univ. of Diponegoro, PH Dept Univ. of Hasannuddin, KUIS,
Yastroki, Pena Indonesia, National Journalist Assc, Teacher Assc, TB Assc, IMA,
Indonesian Assc for Family Physician, Nat. Nursing Association, etc.

• >8 international organizations:


WHO, BI Foundation, IUATLD, CTFK, WLF, JHBSPH, WB, SEATCA, FCA etc
Summary
Monitor INO high burden tobacco use.
Not signing/ratify FCTC.
Protect PP 19/2003 to drive subnational
government in smoke-free policy.
Law enforcement in some cities.
Amendment on designated room.
Offer help Initiatives from medical and nursing
to quit associations, also cancer and heart
foundations, WHO.
Warning Draft order on health warning is
being processed in the MOH.
Enforce Advocacy, litigation and draft
ads ban amendment initiated by NCCP
Raise taxes Will be enhanced at sub-national
level through tobacco surcharge in
draft law on fiscal decentralization
Challenges

• Tobacco industry.
• Fragmented and ineffective society
pressure.
• Low public awareness.
• Lack of advocating capacity of TC
activists.
2008-09 Action Plan
Monitor GYTS 2009, GATS 2009 preparation.
Protect Continue advocacy for smoke free cities
and regencies, training in smoke free
policies (IUATLD, WHO, GOI, IPHA 24-
27 Nov).
Offer help to quit Technical support to medical and
nursing associations.
Warning Continue process in MOH for Minister
Order. Public education and anti
tobacco media, training 11-13 Nov ‘08.
Enforce ads ban Continue litigation & amendment of PP
19/2003.
Raise taxes Continue with support to tobacco
surcharge in fiscal decentralization act.
Workshop 2-3 Dec 2008.
Apapun Jenis dan Merknya
Semua rokok berbahaya!

Jauhi Konsumsi Rokok


Terima Kasih
Thank You
Indonesia
223 m population.
4th wrld populous country.
Adult>15 yrs: 72%
1.3% growth rate.
48% urban.
Largest archipelago
with 17.000 islands.
Republic, a decentralizing
union of 33 provinces,
>440 districts/cities.
7.5% poorest,
middle income country
IntD 3720 per capita.
Source: Statistical Year Book of Indonesia, CBS, 2007
Kematian
Akibat Tembakau
Tembakau penyebab 1 dr 10 kematian
orang dewasa. Ia membunuh separuh
penggunanya (500 juta dari 1 milyar
pengguna akan mati karena tembakau).
1 kematian tiap 6 detik
5,4 juta jiwa pada tahun 2005
100 juta jiwa pada abad 20
Jika Dibiarkan………
8 juta jiwa pada tahun 2030
1 milyar jiwa pada abad 21
80% kematian akibat tembakau terjadi
di Negara Sedang Berkembang
GYTS 2006

• 13-15 years of age.


• 12.6% are current smokers.
(24.5% boys, 2.3% girls).
• 37% had ever smoked cigarettes.
• 31% initiated smoking before reached
the age of 10.
• 3.2% addicted (first thing they
consumed in the morning).
Cigarette Production

In million sticks. Source: Global Tobacco Report, WHO, 2008


INO within SEARO

Source: Global Tobacco Report, WHO, 2008