TOBACCO CONTROL IN INDONESIAISSUES AND FUTURE DIRECTIONS

Presented By:Indonesian Public Health Association at Donor Meeting in Mariott Hotel, Oct 17, 2011

INDONESIAN PUBLIC HEALTH ASSOCIATION

INDONESIA RANK 3RD ►OF 1.3BILLIONS SMOKERS

(WHO, Report on Global Tobacco Epidemic,2008)

Est 62 millions smokers

ASEAN: 46% Smokers in INDONESIA

Malaysia2.90%

Indonesia46.16%

Myanmar8.73%

Philippines16.62%

Singapore0.39%

Thailand7.74%

Viet Nam14.11%

Lao PDR1.23%

Brunei 0.04%

Cambodia2.07%

Est No.deaths related to tobacco*):

-427,948/yr

-1,172/day

*)Kosen, 2004. An Economic Analysis on Tobacco Use in Indonesia

53.4

62.2 63.1 65.6

1.7 1.34.5 5.2

2731.5 34.4

34.2

0

10

20

30

40

50

60

70

1995 2001 2004 2007

Laki

Perempuan

Total

INCREASING TREND IN INDONESIA

Sourse: Susenas 1995, 2001,2004 dan Riskesdas 2007

Smoker Prevalences among adultsIndonesia, 1995, 2001, 2004, dan 2007

MenWomen

INDONESIAN PUBLIC HEALTH ASSOCIATION

SMOKERS ARE GETTING YOUNGER

0,60,4

1,8

0

0,5

1

1,5

2

%

1995 1998 2001 2004

5 - 9 yrs

Trend among age group 5-9 yrs old

Case from a village:“Aldi (5yrs old) is addicted,” his mother said. “..if he could not get cigarette and smoke, he will cry so hard and bang his head to the wall.. “

Source Dr Widaystuti Soerojo, 26 Juli 2010

INDONESIAN PUBLIC HEALTH ASSOCIATION

13.7

24.2

32.837.3

0.3 0.2 1.9 1.67.1

12.717.3 18.8

0

5

10

15

20

25

30

35

40

1995 2001 2004 2007

Laki

Perempuan

Total

Source: Susenas tahun (1995, 2001, 2004) dan Riskesdas 2007

Indonesia, 1995, 2001, 2004, 2007

SAME PATTERNS AMONG 15-19 YRS OLD

MenWomen

2005: Expenditure for tobacco (2005): 23Mi packs= Rp 103.5T = US$ 11,5Bi Est Health care costs: 11 diseases (Cancers, CVD, etc)= Rp 1.99T =

US$ 221M

Est. economic loss (Macro) Rp 61.6T = US$ 6,8Bi Est. Death rates: 399,000 Productivity loss related to deaths: US$ 4.9B Productivity loss related illness: US$ 1.9B Total economic loss related to tobacco consumption

Rp 167.1T = US$ 18,5B 5.1 times greater than state income from tobacco tax

Kosen,2007 unpublished data presented in IPHA National Congress 2007

ECONOMIC LOSS

CONCLUSION-1:IN INDONESIA:Tobacco is un-controlled and un-regulated consumption good

INDONESIAN PUBLIC HEALTH ASSOCIATION

CURRENT STRATEGIES Increase Tobacco taxes and price

Graphic Health Warnings

Total ban for promoting smoking

Non-smoking areas

INDONESIAN PUBLIC HEALTH ASSOCIATION

3 BURNING ISSUES NATIONAL REGULATIONS (!)

Approval of the Implementation Regulation draft (PP draft) by the President, with provision of 100% smoke-free indoor environment and at least 50% pictorial health warnings

Absence (up and down process) of a comprehensive Tobacco Control bill

Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC)

CONCLUSION-2:Strengthening all component including civil society to focus in achieving 3 “burning issues”

INDONESIAN PUBLIC HEALTH ASSOCIATION

ROLES OF IPHA4 Strategic roles:

Advocacy and communication

Knowledge holder

Strengthening health system thru its members

Network expansion among health professional organizations and NGOs

INDONESIAN PUBLIC HEALTH ASSOCIATION

ADVOCACY & COMMUNICATION Future short-term activities

Strengthening awareness among key stakeholders

Social pressures of those 3 “burning issues”

INDONESIAN PUBLIC HEALTH ASSOCIATION

KNOWLEDGE HOLDER Future short-term activities

Expanding data exchanges and warehouse

Seminars, workshops, roundtables

INDONESIAN PUBLIC HEALTH ASSOCIATION

HEALTH SYSTEM STRENGTHENING Future short-term activities

Assisting government in programming and health policies

INDONESIAN PUBLIC HEALTH ASSOCIATION

STRENGTHENING NETWORK Future short-term activities

Reposition IPHA as rainbow coalition for health development

Strengthening TCSC for coalition

INDONESIAN PUBLIC HEALTH ASSOCIATION

POINTS OF FUTURE DIRECTION AND STRATEGIES_1 (DISCUSSION RESULTS) Strengthening the health promotion efforts Leadership on anti smoking habit

Among bureacrats as a part of fit and proper test for career development

Strengthening advocacy efforts to presidential office and “javanese advocacy” approaches to the closest within president circle

Strengthening advocacy efforts to parliament for Tobacco Control Bill

Strengthening the health professions in politics and health policy of tobacco control

INDONESIAN PUBLIC HEALTH ASSOCIATION

Aggressive advocacy to parliament and government (i.e., president) to ratify the FCTC

Carefully “touch” tobacco tax, not only as tobacco control instrument but as a part of state revenue (for development)

Strengthening MoH structures and function for TC/NCD

POINTS OF FUTURE DIRECTION AND STRATEGIES_2 (DISCUSSION RESULTS)