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JAKARTA
POST, 31 Januari 2013
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Despite skepticism over the effectiveness of the recently passed
tobacco control regulation, often referred to as an initiative to protect
“women and children”, many have hailed the move a “breakthrough”.
However, at a time when health initiatives are shifting toward programs to reduce socioeconomic disparities, increasingly recognized as a determinant factor in health inequities, the government is apparently opting for a victim-blaming policy. Indeed, the bill was followed by the Minister of Health’s announcement that smokers will not be entitled to medical coverage under the national social health insurance scheme, effective in 2014. It seems peculiar that the minister of health appears to support a policy that is bound to create a new stigma among smokers while she has a track record of failed attempts to scale up HIV testing during her former tenure as secretary to the National AIDS Commission, on account of the strong stigma attached to HIV/AIDS. In Indonesia, according to the WHO, smoking prevalence among men is 53.4 percent, among women is 3.4 percent. Of all deaths caused by non-communicable diseases, cancer is estimated to account for 13 percent and respiratory diseases for 7 percent. The main cause of deaths, however, is communicable diseases. Around 250 people die each day from Tuberculosis. The tobacco control regulation may be a breakthrough, but one wonders what its objective actually is. Is the regulation designed to reduce the incidence of smoking-related diseases? In this case, how will success (or failure) be measured when reliable data regarding the actual number of lung cancer patients is missing? Data on cancer is mainly based on estimates as there is no national population-based cancer registry in Indonesia. One fears, therefore, that the objective of the regulation is superficial; only reduced smoking prevalence rates will be used to confirm its success. If this is indeed the regulation’s objective, stigmatizing smokers is certainly a logical move as many smokers will inevitably lie if asked whether they are indeed smokers. Furthermore, as cigarettes are mostly consumed by tax-paying citizens from the lower economic brackets, the policy appears to single out the country’s underprivileged who will be made to shoulder an even heavier burden because they will not be able to afford healthcare services. In other words, they will have to take their smoking-related illnesses to death, so to speak. Who will ensure the livelihood of their wives and children then? Furthermore, law enforcement in Indonesia is weak. If a city like New York City is unable to uphold the smoking ban in public places, particularly bars, one wonders how Jakarta will be able to enforce such a regulation. Besides, smoking ban in public places is meaningless if one continues to puff cigarettes at home and thereby exposing their wives and children to secondhand smoke. Lung cancer takes more lives than any other cancer. The sad truth is that our knowledge of lung cancer is limited because the stigma of smoking has led to a lack of funding research on the disease. While cigarette smoking remains the most common cause of lung cancer among both men and women, tobacco is responsible for about 30 percent of all cancer deaths in the United States, tobacco use does not explain all cases of lung cancer in women because about one in five women who develop lung cancer have never smoked (Kligerman & White, 2011). Indeed, among lifetime non-smokers in Western countries, many more women than men develop lung cancer, i.e. 22 percent vs 2.9 percent, while female non-smokers are more likely to develop lung cancer than non-smoker men. Many women non-smokers in developing countries also develop lung cancer. While secondhand smoke is a factor, studies are increasingly pointing out to genetic and molecular susceptibility, exposure to environmental factors that are associated with lung cancer, such as ionization radiation from radon, cooking fumes and indoor burning of coal or biomass, hormonal factors and infections. After long debates between the pro- and anti-smoking camps, the government has finally passed the tobacco control regulation. But soon enough everyone will realize that the regulation is hardly a panacea. Whether or not one is aware of the risks of smoking and regardless of any restrictive measures the government may take to reinforce the regulation, significant segments of the population will continue to smoke. Higher taxes on cigarettes will only lead many Indonesians, especially the underprivileged, to roll their own cigarettes while others will buy them in the black market. Indeed, if one can get marijuana easily, let us not kid ourselves about not being able to find illegal tobacco in this country. The way forward, therefore, is to make smoking itself a harmless behavior. Researchers at Brawijaya University have already identified free radicals as the main cause of smoking-related diseases. These free radicals are caused by toxic materials, particularly mercury, found in tobacco. The researchers were able to demonstrate that by preventing their formation through a nanotechnology called “Balur”, invented by Gretha Zahar, the harmful effects of smoking are turned into beneficial ones. And the technology doesn’t even cost much. But doctors are turning a blind eye to this controversial invention except those who had developed cancer or heart diseases and have been cured by this process. While clinical studies on “Balur” are still ongoing at Diponegoro University, anti-smoking campaigners are celebrating the tobacco control regulation. It seems obvious that to them, only the endorsement of the regulation matters — not whether it will actually lead to a reduced incidence of smoking-related diseases. In light of the numerous studies that have demonstrated the harmful effects of smoking, the question now is whether the government will dare to admit that there may be a more effective — though controversial — way to reduce the incidence of smoking-related diseases. We can already imagine the formidable fight the medical establishment will put up against a method that promises to prevent and cure cancer without the expensive cost or harmful effects of chemotherapy or radiation. ● |
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