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 tobacco-friendly 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

Tobacco Is Now the World’s Leading Single Agent of Death Tobacco use is the single greatest cause of preventable death in the world today, killing more than 5 million persons each year – more than TB, HIV/AIDS, and malaria combined. In the next two decades, the annual death toll from tobacco is expected to rise to over 8 million, with more than 80% of those deaths projected to occur in low and middle income countries. If effective measures are not urgently taken, tobacco could kill more than 1 billion people in the 21st centuary. 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 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

Countries requiring picture warnings on cigarette packages- 2016 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) 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 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% Brunei 75% Myanmar 75% Lao PDR Malaysia 55%

Indonesian Tobacco Industries fully comply other countries laws Plain Packaging Australia 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 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 27% 55% 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 - Source: http://www.thejakartapost.com/news/2015/10/28/ri-farmers-support-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% 40% PHW 90% PHW Text warning Plain packaging Indonesia- ready for larger pictorial health warning and plain packaging