Govt (still) has no commitment to tobacco, smoking control

The Jakarta Post , Jakarta | Wed, 05/30/2007 8:45 AM | Life

Tommy Dharmawan, Contributor, Leiden, The Netherlands

In May 2003, member countries of the World Health Organization (WHO) adopted an historic tobacco control treaty, the Framework Convention on Tobacco Control (FCTC), which has the potential to reduce the terrible health toll of smoking.

To date, Indonesia -- which ranks among the five major consumers of cigarettes in the world and has a booming tobacco industry -- has not yet ratified the FCTC. This means the government does not have any regulation on tobacco control and smoking to educate their citizens on the dangers of smoking.

In comparison, almost all developing countries in Asia now have strict tobacco/smoking regulations about tobacco control and smoking.

This condition could be interpreted to mean that the government has no commitment to protecting and ensuring the health of the Indonesian people.

Analysts have pointed to a few reasons why the government has not yet ratified the FCTC: One, a strict tobacco/smoking regulation might incur a loss in tax revenue from the tobacco industry; two, such a regulation might cause massive lay-offs in the industry and add to national unemployment; and three, it could negatively impact tobacco farmers, particularly small-medium producers, who depend on the industry to make their living.

Are the analysts correct?

It is true that the cigarette industry plays important role in the country's economy. More than 600,000 workers are employed directly by 3,000 cigarette producers and related businesses across Indonesia, and about 10 million indirectly work in the industry.

On the other hand, in developing countries the tobacco industry contributes only a small percentage to the job market. In terms of the living standards of workers, no significant increase has been seen, even though the industry makes a huge annual profit from cigarette sales.

The majority of industry workers are hired on a contract basis, even if they have worked more than 10 years at a single company. The same holds true for tobacco farmers: A survey by a non-governmental organization in East Java shows that a majority of tobacco farmers still live below the poverty line.

In terms of tax, the tobacco/cigarette industry generates much in annual tax revenue for the government. In 2006, this figure reached almost Rp 38.53 trillion; for 2007, the government has estimated a revenue of almost Rp 42.03 from cigarette tax.

However, World Bank data in 1990 show that the health budget used for the curative treatment of diseases related to smoking is almost six times the cigarette tax income. The data shows annual revenues from cigarette tax at Rp 2.6 trillion and economic losses related to smoking at Rp 14.5 trillion.

The health budget is estimated at Rp 1.7 trillion, which means that the short fall must be borne by the public.

The government should tackle smoking because it is unprofitable in terms of both physical and economical health.

According to WHO data, tobacco kills almost five million people each year. If current trends continue, it is projected to kill 10 million people annually by 2020, with 70 percent of those deaths occurring in developing countries.

Tobacco also causes an enormous toll in health care costs, lost productivity and of course, the intangible costs of the pain and suffering born by smokers, passive smokers and their families.

According to the WHO's The Tobacco Atlas, smoking is the etiology for almost 90 percent of lung cancer cases, 75 percent for cases of chronic obstructive pulmonary disease (COPD), and 25 percent for heart attacks.

Nowadays, smoking is not restricted to men as more and more women are becoming active smokers. Consequently, cases of smoking-related cancers in women are also increasing.

Aside from lung cancer, smoking has been connected to many forms of cancer, including gynecologic cancers. Smoking can increase the risk of developing gynecologic cancers by fivefold.

Data from the 2001 National Economy Survey by the Central Statistics Agency (BPS) revealed a disturbing trend that people below the poverty line sacrificed their family budgets to buy cigarettes. From the hundreds of billions of cigarettes produced in a year, more than 220 billion cigarettes are consumed by those of the lower economic bracket.

These statistics indicate the declining quality of health among Indonesians -- but the same phenomena has also been recorded in other developing countries.

World No Tobacco Day, which falls on May 31, was established in 1987 by WHO member countries. In Indonesia, every year this day is commemorated with anti-tobacco campaigns and much newspaper and television coverage of the issue.

Nevertheless, no clear government regulations exist on tobacco control.

To minimize the negative health and economic impacts of smoking, the government must act by first ratifying and implementing the FCTC along with supporting tobacco/smoking control regulations.

In the economic sector, a progressive tax on cigarettes can be levied -- up to 50-70 percent as in developed countries. This way, national revenues from cigarette tax will remain high while the cigarette consumer rate will fall.

Another solution is to implement more stringent regulations on the media promotion of cigarettes, particularly in advertisement, could be put in place as part of a national anti-smoking campaign. Furthermore, the government can educate citizens about the dangers of smoking to both the economy and an individual's health by involving public participation.

But this is not just the government's responsibility. Citizens must also recognize the negative impacts of smoking and, instead of waiting passively for a regulation to be enacted and enforced, we should move to protect ourselves and our family.

With the death and disease that smoking causes, smokers will be the burden of the country, which is still combating infectious diseases.

This year, May 31 could be a new start for the Indonesian government to show the world that it cares for the health of its citizens.

The writer is a University of Indonesia medical student attending Leiden University on an exchange program sponsored by the Asia Link Female Cancer Programme Foundation. He is researching cancer prevention and treatment in developing countries with a focus on Indonesia.

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