ES20.05 Tobacco Control in Indonesia

Abstract

Indonesia is the largest archipelago country of more than 17,000 islands over 5,200 km width, with population over 260 million makes it fourth most populated country in the world. As the largest economy in South East Asia, and member of G20 country, Indonesia’s economy growth is second fastest growing economy after China. A changing in socioeconomic profile of Indonesia is in paralel with increase prevalence of tobacco smoking. Current data showed prevalence of current adult male tobacco smoking is 64.9% which predicted to increase to 79% in the year of 2030, while youth male prevalence of current tobacco use is 23.0% and current cigarette smoking is 21.4%. This number is highest for daily smoking rate in male, and two third Indonesian women are regularly exposed to second-hand tobacco smoke. Indonesia’s life expectancy increased between 1990 and 2016 at 8 years to 71.7 years (7.4 years for male and 8.7 years for female). Double health burden due to mix of communicable and noncommunicable diseases. Of all proportional mortality, 35% are cardiovascular diseases, 12% cancer, 6% chronic respiratory diseases, 21% communicable, maternal, perinatal and nutritional conditions, 6% injuries, 6% diabetes. Noncommunicable disease are estimated to responsible for 73% of all death in Indonesia. The increasing leading causes of DALYs in 2017 as compared to 1990 are ischaemic heart disease, cerebrovascular diseases, diabetes, COPD, lung cancer. Tobacco listed as fourth risk factor of cause of death after high systolic blood pressure, dietary risks, high fasting plasma glucose. Tobacco control remains contradictory within the country, despite strong national tobacco control program and government law implementation, Indonesia has yet to sign the WHO Framework Convention on Tobacco Control. National tobacco control program in Indonesia were transformed into specific national government objectives in tobacco control, such as national agency of technical unit for tobacco control, through MPOWER activities. Monitor tobacco use and prevention policies were implemented in Indonesian Law Article 26/2009 for Health and translated in Government Ordinate Article 109/2012 for the Security and Restriction of Addictive Substance of Tobacco and other several Presidential Decrees and Ministerial Decrees. Protect people from tobacco smoke were implemented in Ministerial Decree, and Provincial Decree for Tobacco Smoke Free policy. Offer help to quit tobacco use were included in Ministerial of Health Decree and implemented in National Smoking Cessation Program. Warn about the dangers of tobacco were translated in Ministerial Decrees Article 56/2017 for tobacco health effect warning in tobacco products and pictorial warning of tobacco smoke. Enforce bans on tobacco advertising, promotion and sponsorship were implemented through Indonesian Broadcasting Law Article 46 Clause 3B prohibits promotion of addictive substances and Raise taxes on tobacco were implemented in Ministry of Finance Decree article 222/2017 regarding using, monitoring and evaluation of tobacco tax income. Moreover, Presidential Decree article 44/2016 and Ministry of Industry Decree Article 64/2014 for Regulation and Control of tobacco industry. Tobacco and related industries argued against tobacco control policy by mentioning largescale effects of tobacco industry for Indonesian economy, and controlling tobacco industry will create massive unemployment, and economic crisis. Ministry of Industry of Republic Indonesia mentioned that tobacco industry creates 5.98 million employments, in which 4.28 million in manufacture and distribution, and 1.7 million people working in tobacco farming. In 2018, export rate of tobacco as cigarettes and cigar were 931.6 million USD, increasing 2.98% as compared to 2017. Tobacco company links closely to small medium enterprises as the tobacco company’s social responsibility (CSR) program. One CSR program as retail community, was founded in 34 provinces, 408 cities which included 60,000 small business retail. Other tobacco related industry's CSR are including sports, youth and creative activities nationwide. Since 1968, Indonesia National Health insurance system was only implemented for formal sector, individual, civil servants, police and military member, but, since 2014, Indonesian Government launched Universal Health System called Jaminan Kesehatan Nasional (JKN) for all Indonesian. In 2017 approximately 180.7 million people are insured through JKN, 70% of total population and planned to reach 95% target in 2019. While tobacco industry tax income were IDR 153 trillion (approximately USD 10.9 billion) in the year of 2018, tobacco related lost due to early death and disease were IDR 4,200 trillion (one third of national GDP), and economy related lost due to tobacco consumption were approximately IDR 596 trillion. This should be bear in mind, that amount of tax income from tobacco company is incomparable to high burden loss due to tobacco related morbidity and mortality.