A new breakthrough on tobacco control

A new breakthrough on tobacco control Tommy Dharmawan ;  A General Physician Who Lives in Jakarta

JAKARTA POST, 26 Januari 2013

Ahmad, 53, is a fisherman with lung cancer. He used to smoke a pack of cigarettes a day from the age of 17. He earned only Rp 100,000 (less than US$10) fishing out on the sea for three days to support his three children, including a baby who has been diagnosed with malnutrition.  Ati, 50, a mother of four, is a passive smoker and also has lung cancer. Her husband smokes half a pack of cigarettes a day, a habit he has maintained since they married many years ago.  They are just two of the many victims of mild tobacco regulations in Indonesia. About 30 percent of the country’s population comprises smokers. Indonesia is the third-largest market in the world for the tobacco industry.  Despite intensifying campaigns promoting the hazards of smoking, the population of male smokers in Indonesia has increased from 30 percent in 1995 to almost 70 percent in 2011. Female smokers increased by five times, from 1 percent to 5 percent during the same period. In addition, there are 100 million passive smokers in this country.  Although a pack of cigarettes is not cheap, according to a survey from the University of Indonesia in 2009, cigarettes are only second to rice in terms of priority spending among poor families. Almost 60 percent of poor families allocate a budget for cigarettes.  On Dec. 24, 2012, President Susilo Bambang Yudhoyono signed Government Regulation No. 109/2012 on tobacco product monitoring. Although it came more than three years late, lagging behind our Southeast Asian neighbors, the regulation has been deemed as a breakthrough in the country’s tobacco control program. The regulation aims to protect Indonesians from the health risks of smoking cigarettes. A politician criticized the regulation, which he said was not pro-job, pro-poor and pro-growth. His argument, however, is completely wrong as through the regulation, the government intends on helping poor families restrict cigarette spending . The National Economy Survey conducted by the Central Statistics Agency (BPS) in 2011 revealed a disturbing fact, which stated that more than 220 billion cigarettes are consumed by people of the lower economic bracket.  The government has been very loose on tobacco control partly because of its addiction to easy-to-get revenue from the cigarette tax excise, which in 2010 reached Rp 55 trillion ($5.72 billion). But, the government should push for tobacco control because, according to the health minister, health expenditures on smoking-associated diseases hit Rp 231 trillion in 2010 alone. The government could use these health expenditures to create jobs or improve infrastructure to stimulate economic growth.  Under the new regulation, warnings on the health-related effects of smoking should comprise 40 percent of cigarette box packaging. Words such as “light” and “mild” can no longer be printed on packaging as they suggest that those products are less harmful. Packs should contain at least 20 cigarettes, thereby increasing its price. Under the regulation, smoking is banned in buildings and public facilities in an aim to further protect people. The regulation also requires cigarette producers to warn children below 18-years-old and pregnant women on the hazards of smoking via packaging. A national survey in 2007 revealed that the number of child smokers had multiplied by six times since 1995. With the new regulation, parents are also not allowed to ask their children to purchase cigarettes on their behalf. Arist Merdeka Sirait from the National Commission for Child Protection said the regulation should also ban children below 18 from selling cigarettes on the street. The regulation prohibits tobacco companies from sponsoring sports and music programs. Nowadays, the tobacco industry has developed a strategy to increase sales by encouraging the younger generation to smoke through the sponsorship of music concerts and sporting events. The industry knows that its sponsorships help create a positive among the young, thereby multiplying its sales.  What the regulation lacks is that it does not stipulate any sanction or fine for people or cigarette companies who fail to heed the regulation, reducing it to a paper tiger. The health minister, therefore, needs to strengthen the regulation with ministerial regulation that can impose penalties on offenders. The Food and Drug Agency and the police should be mandated to monitor the implementation of the regulation. Indonesia needs a strong government to control tobacco distribution due to its adverse impacts on the health of citizens and the well-being of the nation as a whole. The regulation, however, is just a start to a long and winding road to changing Indonesia’s reputation as a haven for smokers and the tobacco industry. ●