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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