Priorities and policy making for tobacco control in ASEAN Ulysses Dorotheo, MD, FPAO 29 August 2014 www.seatca.org

Southeast Asia Tobacco Control Alliance (SEATCA) Vision: Towards a healthy, tobacco-free ASEAN Mission: Working together to save lives by accelerating effective implementation of the FCTC in ASEAN Approach to mission: collaborative and strategic partnerships, capacity building, and evidence-based policy advocacy Partner countries: Cambodia, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, Vietnam, (Brunei and Singapore) www.seatca.org

Costs: TC makes sense Cost of inaction Cost of FCTC implementation Lives lost Healthcare costs Disability costs and productivity losses Environmental costs Cost of FCTC implementation USD 0.14 per person per year in China, USD 0.16 in India, and USD 0.49 in Russia seatca.org

Tobacco control policy Win – Win Win – Lose Lose – Lose seatca.org

How priorities are decided National health agenda Role of civil society Role of tobacco industry seatca.org

“Economically, there may be many alternatives available, but where health and life are concerned, do we have any alternative? The answer is clearly no. There are no alternatives as far as health and life are concerned, because health and life are all that we have. “Therefore, the issue before us is really quite obvious, whether we want to survive with smoking from the economic viewpoint, which has many alternatives, or do we choose one that totally has no alternative, that is to safeguard health and save lives?” His Majesty Sultan Haji Hassanal Bolkiah Mu'izzaddin Waddaulah, Brunei Darussalam, 11 July 2002

Policymaking considerations Lack of capacity: human, technical, financial Government conflict of interest: state-owned TI Politicians’ personal COI TI interference Misinformation, corruption, front groups Litigation Legal and illicit trade seatca.org

Evidence is not enough Capacity building Monitoring and countering TI interference Media advocacy seatca.org

179 Parties as of August 2014

Art. 2(1) - Introduction In order to better protect human health, Parties are encouraged to implement measures beyond those required by this Convention and its protocols, and nothing in these instruments shall prevent a Party from imposing stricter requirements that are consistent with their provisions and are in accordance with international law.

Tobacco harms The objective of this Convention and its protocols is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke. (FCTC Article 3)

”What gets measured gets done.” Dr. Margaret Chan WHO Director-General

Article 5.3 Art. 5(3) – General Obligations to “protect these [public health] policies from commercial and other vested interests of the tobacco industry”

Demand reduction measures Art. 6 – Price and tax measures Art. 7 – (Non-price measures) Art. 8 – Protection from exposure to tobacco smoke Art. 9 – Regulation of the contents of tobacco products Art. 10 – Regulation of tobacco product disclosures Art. 11 – Packaging and labeling of tobacco products Art. 12 – Education, communication, training and public awareness Art. 13 – Tobacco advertising, promotion and sponsorship (TAPS) Art. 14 – Demand reduction measures concerning tobacco dependence and cessation IN bold are pop based measures. 9 and 10 – is a growing field. There are no complete evidence based guidelines on HOW tob products should be manufactured, regulated.

Supply reduction measures Art. 15 – Illicit trade in tobacco products Art. 16 – Sales to and by minors Art. 17 – Provision of support for economically viable alternative activities Protection of the environment Art. 18 – Protection of the environment and the health of persons Questions pertaining to liability Art. 19 – Liability Scientific and technical cooperation and communication of information Art. 20 – Research, surveillance and exchange of information Art. 21 – Reporting and exchange of information Art. 22 – Cooperation in the scientific, technical, and legal fields and provision of related expertise Protocol on illicit trade. It’s a policy but not enfored. Only one country ratified it.

Monitor tobacco use & 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, & sponsorship Raise taxes on tobacco

Conference of Parties, 1 to 5 Guidelines for implementation Art 5.3: TI interference Art 6: tax and price (draft) Art 8: smoke-free Art 9&10: product regulation and disclosure (partial) Art 11: packaging and labeling Art 12: Education and awareness Art 13: TAPS ban Art 14: cessation Protocol Art 15: illicit trade

Are we really winning? 195 seatca.org WHO, 2013 Global Tobacco Control Report

Cambodia Passage of the TC Law Enforcement and monitoring of sub-decrees Increasing tobacco tax Partial SFE Partial TAPS ban seatca.org

Indonesia FCTC accession Rejecting the proposed Tobacco Bill (that will weaken PHW articles to text warnings only) Enforcement of PHWs Effective tax increases Implementation of earmarked local tax Only 20% of indon tbc has no pictoral wanring even though it is passed the deadline 2 months ago.. seatca.org

Lao PDR Collection of LAK 200/per pack for TC Fund International campaign to end the Investment License Agreement with TI Revision of TC Law seatca.org

Malaysia Good governance seminar (Art 5.3) Inclusion of trade agenda in COP 6 Amendment of TC regulations: SFE, POS Pioneering work.. To remove tobacco from trade agreements. COP 6 conference in Moscow. Conference of Parties. seatca.org

Philippines Utilisation of tobacco tax revenues Further tax increase in 2017 Implementation of the GHW law Expanding SFE Tobacco industry interference seatca.org

Thailand 85% PHW Tax increase for RYO Countering fake TI CSR (amend the law to push for total ban) seatca.org

Vietnam Tobacco tax increase TC Fund and TC Law implementation seatca.org

Thank you Email: ulysses@seatca.org www.seatca.org