Tobacco OR Health. Tara Singh Bam, PhD, MPH

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1 Tobacco OR Health Tara Singh Bam, PhD, MPH

2 More than 7000 chemicals have been identified in tobacco smoke, 250 toxins or known carcinogens

3 Health Impact: Smoking and Second-Hand Smoke Damage Every Part of the Body Second-Hand Smoke Smoking

4 Global Deaths per Year (millions) Tobacco Is Now the World s Leading Single Agent of Death Tobacco Lower Resp Infect AIDS Diarrheal Disease TB Traffic Injuries Malaria Measles Unless urgent action is taken, tobacco will soon kill twice as many people and could kill 1 billion people this century

5 Deaths caused by tobacco 2015

6 Tobacco epidemic in Indonesia Tobacco use prevalence: 67.4 % in males and 4.5% in females >61 million smokers live in Indonesia 97 million Indonesian non-smokers are regularly exposed to secondhand smoke 43 million Indonesian children are regularly exposed to secondhand smoke >235,000 people die every year due to tobacco smoke Source: GATS 2011 Indonesia, Ministry of Health, RI

7 Tobacco smoke is main source of indoor air pollution Mean Concentrations of PM 2.5 in Buildings in Bogor (2009) Mean Concentrations of PM 2.5?

8 Noncommunicable Diseases 4 Diseases, 4 Modifiable Shared Risk Factors Tobacco Use Unhealthy diets Physical Inactivity Harmful Use of Alcohol Cardiovascular Diabetes Cancer Chronic Respiratory

9 Tobacco epidemic (~ other NCD) Smoking prevalence Tobacco consumption Number smokers 1.4 b -> 1.6 b By 2030 Tobacco deaths 6m->8m p.a. by 2030

10 Tobacco use is highest among the poor In 2005, Indonesian poor households with smokers spent 11.5% of their household income on tobacco products In China, in 2002, poor rural households spent 11.3% of their total expenditures In Mexico, the poorest 20% of households spent nearly 11% of their household income on tobacco Income spent by category in households with smokers in Indonesia (2005) Others, 72% Tobacco products, 11.5% Fish, milk, meat, and eggs, 11% Education, 3.2% Health, 2.3% National Institute for Health Research and Development, MOH RI

11 Noncommunicable Diseases Tobacco: The poorest people smoke the most Smoking prevalence prevalence in Bangladesh

12 Avg. Monthly Exp in INR Noncommunicable Diseases Tobacco: Behaviours associated with risk factors are costly Monthly household expenditure of tobacco vs. nutritious food among street children in Mumbai (India) Source: Path Canada 2003 Items Consumed

13 Global Action

14 Noncommunicable Diseases The Global Response

15 WHO Framework Convention on Tobacco Control FCTC FCTC is the first global public health treaty. The ratification of the FCTC legally binds nations to implement its provisions, including effective measures to protect people from exposure to tobacco smoke. FCTC was adopted in May 2003, went into effect in February 2005, and has been ratified by 177 nations (status June 2013).

16 Tobacco Control: WHO FCTC Parties ratified: 177/ 192 Indonesia neither signed nor ratified yet

17 Tobacco Control: FCTC Main Provisions

18 Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about the dangers of tobacco use Enforce bans on tobacco advertising, promotion and sponsorship Raise taxes on tobacco

19 Protect people from tobacco smoke Smoke-free Laws reduce indoor air pollution Mean Concentrations of PM 2.5 in Buildings in Bogor Mean Concentrations of PM 2.5 Reducing indoor air pollution due to tobacco smoke by banning tobacco smoke in all indoor public places and work places? The use of ventilation, filtration, and designated smoking areas do not protect the public from the harms of secondhand smoke

20 19:57 20:02 20:07 20:12 20:17 20:22 20:27 20:32 20:37 20:42 20:47 20:52 20:57 21:02 21:07 21:12 11:08 11:13 11:18 11:23 11:28 11:33 11:38 11:43 11:48 11:53 11:58 12:03 12:08 12:13 PM2.5 (micrograms/m 3 ) PM2.5 (micrograms/m 3 ) Measuring indoor air (PM2.5) in smoking and non-smoking restaurants in Mandalay Café City Mandalay- smoking 500 Café Corner Mandalay Complete ban of smoking in indoor Average level Average level 21.7 WHO Guidance 25 mg/m WHO Guidance 25 mg/m Time Time

21 Offer help to quit smoking Brief advice Results of smoking cessation among TB patient in Bogor (n=582) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 49.3% 26.6% 16.5% 10.7% 8.8% 7.7% 41.1% 56.5% 62.9% 66.7% Curernt smoker 69.8% 12.2% 10.7% 66.8% Month 0 Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Died Lost to follow up Relapsed Quitter Two third (66.8%) of smokers have successfully quit smoking at the end of 6 month

22 Tobacco Control: Pack Warnings More than half changed opinions Pack warnings are effective, especially if they have pictures covering half of pack 2/3 want to quit 3/4 approve of warnings

23 Enforce Bans on Tobacco Advertising, Promotion and Sponsorship

24 Total tobacco taxes as a percentage of retail price and the inflation adjusted tobacco tax revenues in Poland, Zloty 2010.

25 Figure 2 Cigarette consumption goes down as tobacco taxes go up in Israel from Real (inflation adjusted) price of a pack of cigarettes in 1990 Shekels (NIS) in Israel. Increases in cigarette prices were driven by tax increase.

26 Tobacco use is the leading preventable cause of death in the world CHALLENGES..

27 Indonesia is a recognized tobacco-friendly market with no smoking bans or other restrictions and regulations in contrast to neighboring ASEAN countries.

28 Prof. Paul

29 Hon ble Health Minister, RI

30 Tobacco control is the best buy for public health The Challenge is for us to Just do it Lets do it Lets ask Indonesian Government to ratify WHO FCTC Lets ban World Tobacco Asia 2014 Bali Indonesia

31 The future of the children is in our hands!