ISSUES AND FUTURE DIRECTIONS Presented By: Indonesian Public Health Association at Donor Meeting in Mariott Hotel, Oct 17, 2011

INDONESIAN PUBLIC HEALTH ASSOCIATION (WHO, Report on Global Tobacco Epidemic,2008) Est 62 millions smokers

ASEAN: 46% Smokers in INDONESIA Est No.deaths related to tobacco*): -427,948/yr -1,172/day *)Kosen, An Economic Analysis on Tobacco Use in Indonesia

INCREASING TREND IN INDONESIA Sourse: Susenas 1995, 2001,2004 dan Riskesdas 2007 Smoker Prevalences among adults Indonesia, 1995, 2001, 2004, dan 2007 Men Women

INDONESIAN PUBLIC HEALTH ASSOCIATION Trend among age group 5-9 yrs old Case from a village: “Aldi (5yrs old) is addicted,” his mother said. “..if he could not get cigarette and smoke, he will cry so hard and bang his head to the wall.. “ Source Dr Widaystuti Soerojo, 26 Juli 2010

INDONESIAN PUBLIC HEALTH ASSOCIATION Source: Susenas tahun (1995, 2001, 2004) dan Riskesdas 2007 Indonesia, 1995, 2001, 2004, 2007 SAME PATTERNS AMONG YRS OLD Men Women

2005:  Expenditure for tobacco (2005): 23Mi packs = Rp 103.5T = US$ 11,5Bi  Est Health care costs: 11 diseases (Cancers, CVD, etc)= Rp 1.99T = US$ 221M  Est. economic loss (Macro) Rp 61.6T = US$ 6,8Bi  Est. Death rates: 399,000  Productivity loss related to deaths: US$ 4.9B  Productivity loss related illness: US$ 1.9B  Total economic loss related to tobacco consumption  Rp 167.1T = US$ 18,5B  5.1 times greater than state income from tobacco tax Kosen,2007 unpublished data presented in IPHA National Congress 2007 ECONOMIC LOSS

IN INDONESIA: Tobacco is un-controlled and un-regulated consumption good

INDONESIAN PUBLIC HEALTH ASSOCIATION  Increase Tobacco taxes and price  Graphic Health Warnings  Total ban for promoting smoking  Non-smoking areas

INDONESIAN PUBLIC HEALTH ASSOCIATION  NATIONAL REGULATIONS (!)  Approval of the Implementation Regulation draft (PP draft) by the President, with provision of 100% smoke-free indoor environment and at least 50% pictorial health warnings  Absence (up and down process) of a comprehensive Tobacco Control bill  Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC)

Strengthening all component including civil society to focus in achieving 3 “burning issues”

INDONESIAN PUBLIC HEALTH ASSOCIATION 4 Strategic roles: Advocacy and communication Knowledge holder Strengthening health system thru its members Network expansion among health professional organizations and NGOs

INDONESIAN PUBLIC HEALTH ASSOCIATION Future short-term activities Strengthening awareness among key stakeholders Social pressures of those 3 “burning issues”

INDONESIAN PUBLIC HEALTH ASSOCIATION Future short-term activities Expanding data exchanges and warehouse Seminars, workshops, roundtables

INDONESIAN PUBLIC HEALTH ASSOCIATION Future short-term activities Assisting government in programming and health policies

INDONESIAN PUBLIC HEALTH ASSOCIATION Future short-term activities Reposition IPHA as rainbow coalition for health development Strengthening TCSC for coalition

INDONESIAN PUBLIC HEALTH ASSOCIATION Strengthening the health promotion efforts Leadership on anti smoking habit Among bureacrats as a part of fit and proper test for career development Strengthening advocacy efforts to presidential office and “javanese advocacy” approaches to the closest within president circle Strengthening advocacy efforts to parliament for Tobacco Control Bill Strengthening the health professions in politics and health policy of tobacco control

INDONESIAN PUBLIC HEALTH ASSOCIATION Aggressive advocacy to parliament and government (i.e., president) to ratify the FCTC Carefully “touch” tobacco tax, not only as tobacco control instrument but as a part of state revenue (for development) Strengthening MoH structures and function for TC/NCD