Tobacco control: Best practices Tara Singh Bam The Union Asia Pacific, Singapore tsbam@theunion.org
http://www.worldtobacco.co.uk/asia/ Indonesia is a recognized tobaccofriendly market with no smoking bans or other restrictions and regulations in contrast to neighboring ASEAN countries.
Tobacco emergency About 800 million adult men worldwide smoke cigarette (20% in high income and 80% in low income countries) Nearly 200 million adult women worldwide smoke cigarette Each year Tobacco kills more than 5 million worldwide and > 200,000 people in Indonesia World cigarette consumption (5.9 trillion) by region, 2009 Source: World Health Organization
Global Deaths per Year (millions) Tobacco Is Now the World s Leading Single Agent of Death 6 5 4 3 5.0 3.9 3.0 2 1 1.8 1.7 1.2 1.0 0.6 0 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 Source: World Health Organization
Interventions are needed prevent youth from starting to use tobacco encourage and help users to quit
180 parties The International Responses
MPOWER- A key strategy monitor tobacco use and prevention policies protect people from tobacco smoke offer help to quit tobacco use warn about the dangers of tobacco enforce bans on tobacco advertising, promotion and sponsorship raise taxes on tobacco Source: World Health Organization
Effective policy reduces smoking-related deaths The evidence from 41 countries Deaths averted by 2050 8 million 7 million Warnings on packages Offer cessation Enforce marketing bans 6 million Protect air 5 million 4 million Raise tobacco taxes 3 million 2 million 1 million 0 million Source: Levy et al "Smoking-related deaths averted due to three years of policy progress", Bulletin, WHO 2013, 91:509 518
Best Practices Pictorial Health Warnings
Pictorial Health Warnings are effective Educate people on danger of tobacco use Motivate smokers/tobacco users to quit Convince youth not to start smoking/tobacco use Re-convince ex-tobacco users to remain quitter
120 Countries requiring picture warnings on cigarette packages- 2016 100 102 105 80 60 55 63 70 77 40 20 0 40 34 26 18 11 12 1 2 2 3 5 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society Global Tobacco Epidemic 2015. World Health Organization
50%+ Countries/jurisdictions requiring warnings of at least 50% of package (on average) 100 90 80 70 60 50 40 30 20 10 0 94 66 46 32 24 2008 2010 2012 2014 2016 Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society Global Tobacco Epidemic 2015. World Health Organization
Pictorial Health Warning in South and South East Asian Countries 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 90% 85% 85% 85% 80% 75% 75% 75% 55% 55% 50% 50% 50% 50% 40% Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society Global Tobacco Epidemic 2015. World Health Organization
Larger Pictorial Health Warning Nepal 90% Thailand 85% India 85% Sri Lanka 80% Myanmar 75% Brunei 75% Lao PDR Malaysia 55%
Indonesian Tobacco Industries fully comply other countries laws Nepal 90% Brunei 75% Plain Packaging Australia
Cigarettes produced in Indonesia carry a 90% pictorial health warning on packaging for Nepal, 75% PHW for Brunei and plain packaging for Australia Nepal 90% Brunei 75% Plain Packaging Australia
Myanmar- Comparison between text and pictorial health warning in building public awareness on danger of tobacco use Not scary Scary Not scary Scary 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 34.1% 85.9% 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 37.6% 88.1% Text warning Pictorial Warning Text warning Pictorial warning Adult population Youth population Source- Ministry of Health, Myanmar 2014
Evidences proved that PHWs are effective In Thailand, nine out of 10 current smokers noticed a pictorial health warning on cigarette packs, and six in 10 current smokers intended quitting because of PHW (GATS 2011) In Australia, PHW and plain packaging was found effective. Number of adolescents currently smoking reduced by more than 70 per cent, from 23.5% in 1996 to 6.7% in 2014 (Dessaix A et al Public Health Res Pract. 2016).
Larger pictorial health warnings are effective PHW made the smokers to reduce cigarettes smoked/day Indonesia Nepal 16 14 12 10 8 6 4 2 0 15 Cigarettes smoked (text warnings) 27% 11 Cigarettes smoked (PHW) 16 14 12 10 8 6 4 2 0 11 Cigarettes smoked (text warnings) 55% 5 Cigarettes smoked (PHW) Source: Indonesian Public Health Association, 2015 (N=5355, current smokers 1901) Action Nepal and Nepal Health Research Council, 2015 ( N = 2250, current smokers - 670)
Retailers support Pictorial health warnings policies and implementation Indonesia (N = 1425) Nepal (N = 270) 84.6% of the retailers support government policy on pictorial health warnings 90% of the retailers were found selling cigarettes with pictorial health warning 92.6% of the retailers support government policy on pictorial health warnings 99.3% of the retailers were found selling cigarettes with pictorial health warnings Source: Tobacco Control Support Centre, Indonesian Public Health Association, 2015 Action Nepal and Nepal Health Research Council, 2015
Indonesia: RI farmers support tougher tobacco control, study says - 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 62.5% Current tobacco farmers 83.3% Ex-tobacco farmers 70.4% All Don't know Not support Support Source: http://www.thejakartapost.com/news/2015/10/28/ri-farmerssupport-tougher-tobacco-control-study-says.html#sthash.gybfj6fj.dpuf Muhammadiyah University Yogyakarta, October 2015
Public Health WINS UK- Tobacco companies have lost a High Court challenge over government standardised packaging 19 May 2016 European Union (EU)- Tobacco companies have lost a legal challenge against EU rules that force them to put graphic images on cigarette packages warning people of the dangers of smoking 4 May 2016 India Supreme Court ruling to require 85% pictorial health warning 4 May 2016 India - The Supreme Court issued notice to the Health Ministry on a PIL which sought immediate implementation of plain packaging rules for cigarette and other tobacco products 8 March 2016
Summary Larger PHWs are more effective All segments of community support PHW; public, youth, retailers and tobacco farmers PHW is the most cost effective strategy No cost to government, easy to implement and monitor Government commitments
Indonesia: Let s join hands together to increase a size pictorial health warning to at least 90% Text warning 40% PHW 90% PHW Plain packaging Indonesia- ready for larger pictorial health warning and plain packaging