Each year, May 31 is observed as World No Tobacco Day. The harmful effects of smoking are clear, which is why countries are implementing various strategies to reduce tobacco consumption.

While the goal is noble and the number of smokers in some countries is indeed falling, we still face significant sociocultural, economic and political barriers to control one of the biggest preventable causes of death.

Reaching that ultimate goal requires making incremental progress on many fronts in the fight against tobacco.

There is one that may serve as a crucial stepping stone: preventing exposure to secondhand smoke (SHS), especially in children.

Babies born from mothers exposed to SHS are at a higher risk of premature birth and low birth weight, both of which are risk factors for numerous other health issues. SHS in infants and children is linked to sudden infant death syndrome, respiratory infections and middle ear infections. Children with asthma may experience more frequent and severe attacks.

Later in life, SHS is a risk factor for heart disease and lung cancer. The young are more vulnerable to these consequences because they have relatively little control over their environment.

Several regencies and cities have tried to curb SHS exposure by enacting a ban on cigarette smoking in some public places. Yet, there is still much space uncovered by such bans, which are often weakly enforced.

It is not uncommon to see children dining with parents in the “smoking area” of a restaurant or breathing in air full of cigarette smoke while eating at a road side stall.

Indonesian children are exposed to toxic SHS in what should be the safest and healthiest place for a child: at home. An analysis of the Global Adult Tobacco Survey (GATS) from 21 countries discovered that 79 percent of Indonesian children are exposed to SHS at home, with a higher percentage in rural (89 percent) than urban (68 percent) areas.

That percentage is correlated to the prevalence of adult smokers in the country.

Hence, the number is not surprising given that, in 2011, 35 percent, or almost 60 million Indonesian adults, are smokers.

Furthermore, a systematic review found that children, whose parents are smokers of low socioeconomic status with less education, are more likely to be exposed to SHS at home.

As with other public health issues, tackling this requires multiple approaches, by all players in the field. With regard to how smoking parents increase the risk of a child’s exposure to SHS, an obvious solution is for parents to quit smoking.

Strengthening policies to reduce the number of smokers must continue, including educating smokers of the dangers of SHS. If parents refuse to quit smoking, they must not smoke in the presence of children and in places where children spend considerable amount of time such as home, school and cars.

The government should put in place laws designed to protect everyone, including children, from SHS exposure and enforce them consistently. Arguably, the law tends to take its time catching up with scientific evidence, and even more so when the evidence calls for “unpopular” policies.

Nevertheless, other stakeholders can take the lead. For example, restaurants, shopping centers and office building management can restrict smoking on their premises.

Next, we need to engage diverse communities to raise awareness and change attitudes about the dangers of SHS. If we cannot stop people from smoking, at least we can help parents shield their children from SHS.

Smoking cessation programs should be expanded and made available to as many smokers as possible. Additionally, these efforts must be tailored to the characteristics of each community otherwise disadvantaged communities may not enjoy the full benefit of health programs.

If the current situation continues, Indonesia is putting its future generations at risk of health problems that are largely preventable, and the cost is simply too great for us to bear. Failing to rectify this situation is utterly unacceptable. In fact, an article in Annals of Family Medicine argued that “purposefully and recurrently exposing children to secondhand smoke, despite repeated warnings, is child abuse”.

We firmly believe that we must protect children from all kinds of abuse; therefore, we need to protect them from the harms of secondhand smoke.
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The writer is a doctor living in Jakarta.

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