Tobacco Control Efforts in Indonesia

8/8/2019 Tobacco Control Efforts in Indonesia

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Tobacco Control

Efforts in Indonesia

WHO Country OfficeNovember 2008


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Tobacco


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Tobacco


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Leaves that are chewed orburnt producing smoke to beinhaled.

Processed leaves contain2550 chemical substances. Some of the chemical

substances cause healthproblems: lung damages and

reducing fitness.

Tobacco

Manual on Tobacco Control in School, WHO SEARO, 2006


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Tobacco Deaths

Tobacco causes 1 of 10 adult deathsIt kills half of its users.(500M out of 1 billion users will die of it).

1 deaths every 6 seconds5,4M in 2005, 100M in 20th century

Without control measures ....8M deaths in 2030, 1 billion in 21th century

80% deaths occur in developng countries.


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Almost 2/3 of smokers reside in 10 countries.

Indonesia ranks the third.

Countries with HighBurden of Tobacco Use

(by cigarette sticks)


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EPIDEMIC

Tobaccomorbidity,mortality >HIV/AIDS +

Tbc+Malaria

Increased UseTobacco Epidemic


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Curbing Tobacco

EpidemicMonitoring

Protect people fromtobacco smoke

Offer help to stopsmoking

Warn about the dangerof tobacco.

Enforce bans of ads,promotion andsponsorship

Raise tobacco taxation


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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 tobaccoconsumption namely MPOWER,February 2008


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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.


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MPOWER Indonesia

Tobacco Control


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Monitoring

Tobacco Use

With high prevalence and increasing trend in tobacco use,Indonesia ranks the third world highest tobacco burden

country after China and India.

Adult (>15 yrs old) Young Adult (15-19)

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


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MonitoringTobacco Industry

4000 tobacco companies,4 largest in market share(July 2006): Gudang

Garam (32%), HMSampoerna/ Philip Morris(26%), Djarum (17%),Bentoel (3%).

Contribution of tobaccoindustry at nationaleconomy is diminishing.

Sumber: Ahsan A, LDUI, 2008


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Monitoring Tobacco

Import and Export

Imported tobacco > exported Source: Ministry of Agriculture

InMillionUSD


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Monthly household expenditure fortobacco by income level, 1995-2005

Source: Socio-economic Surveys

Monitoring Tobaccoand Poverty


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Cost of Smoking

Year Tobaccorelateddeaths

Cost(and source of data)

2001 427.948 IDR 127 Trillion (USD 13 billion)7.5 x tobacco tax revenue(Kosen, Health and EconomicImpact of Tobacco Use, MOH 2004)

2005 399.800 IDR 167 Trillion (USD 18 bilion)

5 x tobacco tax revenue(Kosen,MOH. Presented at IPHACongress, 2007)


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Monitoring

LegislationIndonesia 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 ownsmoke-free regulations in line with national law.


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FCTC

No cigarette selling to children < 18 years

Ban smoking at health facilities

Ban smoking indoor workplaces

Ban smoking in restaurant

Ban smoking at shopping malls

Ban smoking at bus/train stations

Second Hand Smoke is hazardous

Government policy is not firmConsumer/workers' rights is more important

than the rights to smoke in public places

Monitoring Public Opinion,Indonesia, June 2008

84

69

68

75

75

81

93

99

97

91

17

31

32

25

25

19

7

1

3

9

0 20 40 60 80 100

Source: IFPPD, 2008. % agree % disagree

1200 respondents over 18 years selected randomly


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Protect People

from Tobacco SmokeRegulation:PP 19/2003

2007 Implementation

Smoke Free Areasinclude

public places,health facilities,

work places,educational and

child playground,places of worship,public transport.

Health facilities Yes

Non-universityeducational institutions

Yes

Universities Some

Government office No

Indoor workplace No

Restaurants No

Bar and Pub No


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Article 13 in Jakarta clean air act No.2/ 2005,further elaborated in Governor Order 75/2005on smoking ban.

Article 14, 15, 16 of Bogor peoples order onpublic security, 2007

Cirebon City Executive/Mayor order, 2007.No designated room.

Surabaya peoples order, 2008.

SmokeFree Policy Develoment template forsub-national advocacy (IPHA)

Training Workshop by Govt-IUATLD-WHO-IPHAfor 8 provinces

Protect People

fromTobacco Smoke


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Initiative at Gajah Mada University.

Training Symposium for 750 SouthSulawesi physicians, July 2008.

Management of addict cases andsmoking cessation and tobaccocontrol recommendation in FamilyPhysician Annual Scientific Meeting.

Initiative of Indonesian NursingAssociation in tob-cessation services.

Offer Help

to Quit Tobacco Use


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PP 19/2003:

Health warning to beplaced on (the back of)cigarette packs, 1 mm

border. At least 15% sizeof space on billboard ads.

One authorized textualhealth warning: smokingcan cause cancer, heartattack, impotence and

harms pregnancy and fetaldevelopment.

Warn the Dangerof Tobacco

Space for

promotion


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Warn the Danger

of TobaccoResult of PH-Faculty Study, 2007: Preference: 76% 15% 9%

text+graphic graphic text

78% agreed that health warning should cover50% of cigarette pack surface.

Smokers agreed to use horror (34%) andpicture (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, WLFtraining).


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Enforce Ban onTobacco Ads


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Enforce ban on tobacco ads, promotion,sponsorship

National TV and radio NoInternational TV and radio NoNational magazines/newspaper No

International magazines/newspaper NoBillboard, outdoor ads NoPoint of sales NoInternet NoFree distribution of cigarettes YesDiscounted promotion NoNon tobacco products named tobacco NoNontobacco brand for tobaco products NoProduct image in TV and movies NoSponsored event NoScore of law enforcement 2/10(Cumulative score from 5 experts requested to value:minimal 0, moderate 1, maximal 2).

Enforce Ban on

Tobacco AdsStatus of Indonesia Ads Ban


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Enforce Ban onTobacco Ads

GYTS 2006:>90% students 13-15: exposed to tob-ads, 14% wereoffered cigarettes bytobacco companies.

Violation by tobaccocompanies in directand indirect ads

(sponsorship innational and religiousevents, CSR etc).

Actions:- Litigation- Draft law to comprehensiveban of tobacco ads,promotion and sponsorship


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Raise Tobacco Tax


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Raise Tobacco Tax

3 types of tobacco taxes:(MOF Order No. 118/2006, and No.406/2000)

VAT

8.4% ofERP flat

Ad Valorem Tax

4-40% ( 31%)

26-40% formachine kretekswhite cigarettes.

4-22% for handmade kreteks

Specific Tax, July 2007

Only for cigarettes

Varies by industry size

IDR 3/stick for industry2 B sticks

Complex system needs simplification


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Raise Tobacco Tax

Draft Law on Fiscal Decentralization provideopportunity for district governments to collect

tobacco surcharge up to 25% of cigarette prize.

7.45

10.11

16.49

22.88

25.93

28.67

32.65

0

5

10

15

20

25

30

35

IDRT

ril

lion

Tobacco Tax Revenue, 1999-2005

1999 2000 2001 2002 20032004 2005


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2008 TobaccoControl Players

>14 government organizations:MOH, FDA, MOF, MOE, MOI, MOCI, SMWE, SMOYS, SMOE, City Government ofJakarta, Bogor, Palembang, Cirebon, Surabaya, Makassar etc.

>26 active non-governmental organizations:NCTC, NCCP, IFPPD, TCSC-IPHA, Indonesian Cancer Foundation, IndonesianHeart Foundation, WITT, Scout Movement, Consumer Foundation, FAKTA, MedicalStudent Council, PH Student Council, IPPA, Smoking Control Foundation,Demographic Institute UI, Health Research Centre PH Faculty UI, Quit TobaccoIndonesia Medical Faculty UGM, PH Department Univ. Sriwijaya, Bogor AgriculuralInstitute, 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


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Summary

Monitor INO high burden tobacco use.Not signing/ratify FCTC.

Protect PP 19/2003 to drive subnationalgovernment in smoke-free policy.Law enforcement in some cities.Amendment on designated room.

Offer helpto quit

Initiatives from medical and nursingassociations, also cancer and heartfoundations, WHO.

Warning Draft order on health warning isbeing processed in the MOH.

Enforceads ban

Advocacy, litigation and draftamendment initiated by NCCP

Raise taxes Will be enhanced at sub-nationallevel through tobacco surcharge indraft law on fiscal decentralization


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Challenges

Tobacco industry.

Fragmented and ineffective societypressure.

Low public awareness.

Lack of advocating capacity of TCactivists.


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2008-09 Action Plan

Monitor GYTS 2009, GATS 2009 preparation.

Protect Continue advocacy for smoke free citiesand regencies, training in smoke freepolicies (IUATLD, WHO, GOI, IPHA 24-27 Nov).

Offer help to quit Technical support to medical andnursing associations.

Warning Continue process in MOH for MinisterOrder. Public education and antitobacco 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.


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Apapun Jenis dan Merknya

Semua rokok berbahaya!

Jauhi Konsumsi Rokok

Terima Kasih


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Thank You


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Indonesia

223 m population.4th wrld populous country.

Adult>15 yrs: 72%

1.3% growth rate.48% urban.

Largest archipelagowith 17.000 islands.

Republic, a decentralizingunion of 33 provinces,

>440 districts/cities.

7.5% poorest,middle income country

IntD 3720 per capita.

Source: Statistical Year Book of Indonesia, CBS, 2007


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Kematian

Akibat TembakauTembakau penyebab 1 dr 10 kematianorang dewasa. Ia membunuh separuhpenggunanya (500 juta dari 1 milyarpengguna akan mati karena tembakau).

1 kematian tiap 6 detik5,4 jutajiwa pada tahun 2005100 jutajiwa pada abad 20

Jika Dibiarkan8 juta jiwa pada tahun 20301 milyarjiwa pada abad 21

80% kematian akibat tembakau terjadidi Negara Sedang Berkembang


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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 reachedthe age of 10.

3.2% addicted (first thing theyconsumed in the morning).


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Cigarette Production

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


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INO within SEARO

Source: Global Tobacco Report, WHO, 2008

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Tobacco Control Efforts in Indonesia

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