1. Tobacco control: Best practices
Tara Singh Bam
The Union Asia Pacific, Singapore

2.
Indonesia is a recognized tobacco-friendly market with no smoking bans or other restrictions and regulations in contrast to neighboring ASEAN countries.

3. 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

4. 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

5. Interventions are needed
prevent youth from starting to use tobacco
encourage and help users to quit

6. 180 parties
The International Responses

7. 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

8. 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

9. Best Practices Pictorial Health Warnings

10. 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

11. Countries requiring picture warnings on cigarette packages- 2016
Source: Cigarette packaging health warnings. International Status Report 2016, Canadian Cancer Society
Global Tobacco Epidemic World Health Organization

12. 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 World Health Organization

13. 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 World Health Organization

14. Larger Pictorial Health Warning
Nepal 90%
Thailand 85%
India 85%
Sri Lanka 80%
Brunei 75%
Myanmar 75%
Lao PDR
Malaysia 55%

15. Indonesian Tobacco Industries fully comply other countries laws
Plain Packaging
Australia
Nepal 90%
Brunei 75%

16. 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

17. 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

18. 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 (Dessaix A et al Public Health Res Pract. 2016).

19. 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)

20. 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

21. Indonesia: RI farmers support tougher tobacco control, study says -
Source:
Muhammadiyah University Yogyakarta, October 2015

22. 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

23. 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

24. 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