Recently tobacco control representatives from 6 countries-- Indonesia, Timor-Leste, Myanmar, Cambodia, Vietnam and Nepal - met in Bali, Indonesia, to take part in a workshop on 'Enforcement and Monitoring of Pictorial Health Warnings' organized by International Union Against Tuberculosis and Lung Disease (The Union), in collaboration with School of Public Health, Udayana University. The two day meet exposed the participants to a rich, cross-functional environment for sharing experiences with others working in tobacco control, with a view to improve approaches to planning, implementation, monitoring and evaluation of pictorial health warnings (PHW).
The significance of holding this meet in Bali in Indonesia should not be lost upon us. In 2014, the Governor of Bali declined to host the Inter-Tabac Asia, the largest international tobacco trade fair of the tobacco industry, for boosting tobacco sales in Asia, despite the central government of Indonesia having granted permission for it. Another similar 'Expo' planned for Bali was also cancelled by him. This commitment of the local authorities for standing up against the tobacco industry has shown Bali’s determination to defeat the tobacco giants and conveys a very strong positive message to the country and to the region. Bali is much more than being a top tourist destination—despite huge pressures from the tobacco industry, it has taken a firm stand against it, keeping people’s lives above profits. Dr Tara Singh Bam, Regional Advisor (Tobacco Control), at The Union, calls Bali a role model for Indonesia and also for the whole region.
Indonesia has not ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), and with around 600 tobacco factories and 3000 brands of cigarettes produced in the country, Big Tobacco perceives it as a ‘booming tobacco market in Asia’. Cigarette advertisements are not banned and it is not surprising that 41% of Indonesia’s young males are smokers. Indonesia is seeing an increase of smoking prevalence, especially in teenagers. Smoking prevalence among > 15 years old rose from 27% in 1995 to 36.3% in 2013 and among 15-19 years it rose from 7.1% in 1995 to 19.5% in 2007. But teachers, doctors, NGOs and activists are all trying to endorse the provisions of FCTC even without the government having ratified it. They have managed to implement 40% PHW since 2014, despite the very strong tobacco industry interference that tries to delay and/or weaken legislation. Alfan from the Union office Jakarta informed that the Tobacco Control Bill is being debated in the Parliament and there is a talk about removing PHW altogether.
On the other hand, at the provincial level Bali has very strong tobacco control laws. Dr Ayu Swandewi Astuti, from Udayana University, Bali who is closely associated with the Bali Tobacco Control Initiative (BTCI), told CNS (Citizen News Service) that in Indonesia local/provincial governments have the autonomy to promulgate their own laws and regulations. Bali was the first Indonesian province that passed the 1st provincial smokefree law in Indonesia in 2011. Currently all its 8 districts have enacted the smokefree law. Other than Bali, only Jakarta has passed this law in Indonesia. Some districts of Bali now want to have a complete ban on tobacco advertising, promotion and sponsorship (TAPS).
Dr Ayu explained that Bali’s antismoking law not only imposes a ban on smoking in public places, but also bans promotion and production of cigarettes in these areas, (except in hotels where cigarettes can be sold but not smoked). Public places include hospitals, hotels, restaurants, workplaces, super markets, schools, public transport, children’s playgrounds, etc.
Dr Ayu lamented that while overseas tourists in Bali respect the antismoking law, it is basically the domestic tourists who flout it. She shared some interesting results of a survey-- “We did a case study of hotels and restaurants in Bali, before and after the enforcement of smoke free law. We found that while there was no change in the number of hotels’ customers, the maintenance costs had decreased. So the law actually benefits the hotel industry even from financial point of view. Hotels have thus seen the benefit of having smoke free rooms in terms of not only promoting health but also reducing their cost of maintenance—for linen, curtain, upkeep, etc”.
Advertisements and peer pressure are the two key influences responsible for increasing smoking rates in the Indonesian youth, while decreasing the age of initiation of smoking, feels Dr Ayu. The emerging trend of e-cigarettes is another big concern. Youngsters are curious to know about e-cigarettes and they are getting wrong messages from the tobacco industry that e-cigarettes are less harmful. So there is need for more orientation programmes on these issues at school level, through greater involvement of teachers.
Dr Ayu informed that BTCI has established a smoke free team in every district that includes members from the health office, police department, civil society, and teacher associations. This team monitors smokefree law once every six months and presents the survey results at the district level.
Dr Tara Singh Bam’s optimism, as well as enthusiasm, is infectious. “We are winning the battle. Tobacco Industry is going to die—choking on its own smoke. There is lot of commitment from various stakeholders in the South Asia Region, and civil society, governments, media, health professionals are all working closely for the cause. We do not have big resources but we have lifesaving agenda. I am hopeful that in ten years’ time the ASEAN region and SE Asia will be tobacco free. We just have to enhance our synergy and work together and engage with media more and more to share and disseminate correct information to gain public support. It is all about collaboration and cooperation”.