Tobacco control in Indonesia Flashcards
Describe rates of smoking globally
Smoking Rate & NCD Death across the globe
- daily smoking rate very high in developing world
- non-communicable disease deaths increasing over time in developing regions
Consumption vs Number of smokers
While consumption per capita has declined across all regions, number of smokers has significantly increased in four out of six world regions. Largely in developing nations. Tobacco-attributable diseases correspond to a large percentage of DALYs.
Relative risk of disease and death is very high.
Describe smoking in Indonesia
- Between 2011 and 2021
- The overall prevalence slightly decreased from 34.5% to 33.5%
- The number of smokers increased from 59.9 to 68.9 million
- Electronic cigarette use increased by tenfold from 0.3% to 3%
- Average age of smoking initiation was 17.6 years
- 19.8% of ever smokers begin to smoke before 10 years old
Youth smoking:
- Australia: 1.4%
- Indonesia: 0.7%
Describe the epidemic of smoking using the epidemiological triad
Several agent, host and environmental factors influence tobacco use:
- agent: advertising and promotion, product packaging, retail environment and product design
- host: knowledge, attitudes and beliefs, biolofical factors and demographic characteristics
- environment factors: tobacco control policies or programs, including pack warnings taxes, limits on marketing, smoke-free rules, informational campaigns and access to cessation services
Describe some environmental causes of smoking
- High Exposure to tobacco advertising at PoS, TV
- High Access and availability to cigarette
- Online advertising
Describe how the tobacco industry has weaponised new media in Indonesia
- New media’ are the combination and convergence of computing and information technology, communications networks and digitised media and information content (Flew, 2008)
- Many to many communication- everyone can create and share content
- New media-online platform makin gencar disasar
- Less-regulated channel
- Bentuk: Tobacco industry website, Online Brand community site, Online advertisements (YouTube, news sites), Influencer, etc
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Describe Australian tobacco control policy addressing the triad
Addressing the triad:
- agent: comprehensive TAPS ban, plain packaging and pictorial warning, controlled retail environemnt
- host: educational campaigns, addressed socio-economic predictors of smoking e.g. poverty
- environmental: strengthen regulation, increase tax, smoke free lwas, cessation support, campaigns
Describe the WHO-FCTC
- Monitor: tobacco use and prevention policies
- Protect: people from smoke
- offer: help to quit
- warn: others about the dangers of tobacco
- enfroce: bans on advertising, promotion and sponsorship
- raise: taxes
- reduce access
Compare Australian and Indonesian regulation of tobacco
AUSTRALIA
- Advertising laws
- National: Limitation on tobacco advertising, promotion, and sponsorship, not a complete ban
- Age limits
- It is illegal to sell or supply tobacco products to young people under the age of 18 (Youth Law Australia website)
- Taxes
- The Australian Government taxes tobacco products to make them less affordable through excise on tobacco products
INDONESIA
- Advertising laws
- National: Limitation on tobacco advertising, promotion, and sponsorship, not a complete ban
- Subnational:
- Ban indoor ads under the Smoke-free law
- Some cities/districts ban outdoor advertisements and Point of Sale (PoS) display
- Age limits
- It is prohibited to sell tobacco products to young people under the age of 18 (No enforcement to date)
- Taxes
- Excise on cigarette in Indonesia is complex with multiple tiers
- Excise much lower in comparison to other countries, leading to high affordability
AUSTRALIA
- E-cigarette laws
- In Australia, it is illegal to sell or buy nicotine for use in e-cigarettes unless they are being supplied or accessed through a prescription.
- In most states and territories, it is also illegal to use e-cigarettes in places where smoking is illegal.
- Smoke-free laws
- State and territory governments are mainly responsible for smoke-free laws in Australia.
- Smoke-free laws protect people from second-hand smoke, encourage people to quit smoking, and help to de-normalize smoking in the community. It’s illegal to smoke in enclosed public places, and in some states, it is also illegal to smoke in a car when a minor (age below 16, 17, 18 depending on states) is inside.
INDONESIA
- E-cigarette laws
- No regulation on e-cigarettes, only tax on the e-liquid
- Smoke-free laws
- Prohibit smoking and Tobacco Advertising, Promotion, and Sponsorship (TAPS) at smoke-free areas (indoor or including areas inside the gate for education and healthcare facilities)
- Responsibility of subnational government
- Adoption is relatively high but enforcement is very weak
AUSTRALIA
- Duty-free tobacco
- There is a limit to the amount of tobacco you can bring into Australia. For details, see duty-free concessions on the Australian Border Force website.
INDONESIA
- Duty-free tobacco
- No similar regulation
- Smokeless tobacco products
- Regulated similarly to cigarettes or other tobacco products
- It is illegal to commercially import or sell smokeless tobacco products in Australia. This includes oral snuff, tobacco paste and powder, and chewing tobacco.
Describe tobacco regulation in Indonesia
- Government Regulation PP 109/2012
- Limitation on TAPS with many loopholes
- Prohibition of selling to minors and pregnant women – not implemented and enforced
- Adoption of smoke-free bylaw by each district
- Adoption of 40% pictorial health warning on cigarette packs
- No clear regulation on e-cigarettes and alternative tobacco products
- Compliance to Smoke-Free Laws (SFL) by city/district in Indonesia - 2020: 71.78%** – compliance widely varies
- not a best practice country
Why does tobacco control lag in Indonesia?
-
Institution
- political structure and type of policy: multistage delay
- government bureaucracy and corruption
- low bargaining position of MoH
- Ideas and transfer of ideas
-
Networks
- tobacco industry network: established and well-funded
- tobacco control network: resources and cohesion
-
Socio-economic
- social acceptability of tobacco: cigaretes are legal, and smoking is normal
- tobacco exception in the law
-
Agenda
- political economy framing of tobacco: need the money
- sovereignty framing: tobacco control is an ‘outsider’ project
What are ways that tobacco control can be strengthened in Indonesia?
- Coordinating Body for Tobacco Control
- Tobacco Control Focal Points at MoH
-
Intersectoral Approach
- CSR, clean, and good governance
- Framing of Tobacco Problems Beyond Health Perspective
- Gathering Evidence to Counter the Economic Arguments
- Limit Tobacco Industry
- Involvement in Policy Making
- Promotion and Marketing
- Adoption of Code of Conduct by All Public Organizations, Including Political Candidates
- Prompt Response to the Increasing Use of Alternative Tobacco Products
Describe some opportunities for control
- Commitment to SDGs
-
Child Friendly Cities
- Smoke-free and TAPS ban included as indicators - Sub-national Government (Mayor Alliance)
- Civil Society
- Regional and International Support
- Youth Movement
- Covid-19 Pandemic
-
Adoption of Health Bill 17/2023
- Ongoing development of government regulation
