Question: The report says that global smoking rates dropped from 22.6 percent in 2007 to 19.6 percent in 2019. For Indonesia and other countries with a heavy smoking burden, the same drop in smoking rates is probably not happening. What is your opinion on this?

Answer: Indonesia has the third-highest number of smokers after China and India. With a smoking prevalence of over 33 percent of its 257 million population, an urgent and sustained effort is needed to aggressively regulate this harmful industry and its products to accelerate the end of cigarettes as a mass consumer product, save hundreds of millions of lives and spur economic growth.

For the first time on record, global smoking rates dropped, from 22.6 percent in 2007 to 19.6 percent in 2019. But uneven and anemic implementation of tobacco control measures means that richer countries are unlocking the economic and health benefits of strong tobacco control, while the industry is still preying on emerging economies in ways that will lock in harms for a generation or more.

Global tobacco users stand at 1.3 billion; smoking among young teens ages 13 to 15 has increased in 63 countries. Indeed, the data show that adult smoking prevalence increased between 1990 and 2019 in Indonesia.

Adult male smoking increased from 54.45 to 58.3 percent, and adult female smoking from 3.4 to 3.6 percent. Youth smoking trends were mostly upward, though appear to have leveled off somewhat in the last couple of years.

Read also: WHO says 'policy coherence' key to tobacco control in Indonesia

Many countries, including Indonesia, fail to regulate their tobacco industries effectively, often because these countries are politically or economically vulnerable, the report mentions. What is your take on this issue?

Tobacco control works, and every country can implement policies and programs to reduce the harms of tobacco use. In particular, tobacco taxes are a triple win for health, driving down smoking rates, deterring initiation among youth and generating revenue that can pay for other health interventions.

It is estimated that increasing the price of tobacco by 50 percent worldwide through higher taxes would save more than 27 million lives and generate US$3 trillion in extra tax revenue over the next 50 years.

Indonesia has two major challenges in terms of taxation. First, it has a tiered tax structure in which different types of cigarettes are taxed at different rates. This creates opportunities for smokers to switch to a cheaper product when taxes and prices go up.

The government needs to make this tax consistent across products. Tax rates are also too low, and they need to be raised. The goal is to make tobacco products less affordable, and there is a long way to go to making sure this is happening every year, particularly because incomes are growing among many in Indonesia.

What are other measures that can be taken to prevent people from smoking?

In addition to taxation, Indonesia and other countries should undertake proactive efforts to inform consumers about the harms of tobacco use. Graphic pack warnings have been implemented in Indonesia and are an important start, but the government should consider plain packaging of all tobacco products, which is another proven high-impact, low-cost intervention.

Plus, media campaigns can reshape social norms and drive millions to quit at extremely low cost. A smokeless tobacco control mass media campaign conducted in India, for example, yielded more than 17 million additional quit attempts at a cost of just $0.06 per attempt. Almost every country in the world is underinvested in media.

How can we counter the narratives that the tobacco industry benefits local tobacco farmers, provides jobs and spurs economic growth?

A rich literature demonstrates clearly that tobacco farmers in Indonesia would be better off growing other crops and/or pursuing other livelihoods. It is necessary for civil society and those in government who understand this reality to promote it vigorously and change the positive narrative about tobacco production that the tobacco industry is successfully pushing. It takes a concerted effort to do this because it is very easy simply to rely on what the tobacco industry has been telling officials and others with no evidence for many years.

With 1.1 billion smokers in the world and 200 million more who use other tobacco products, tobacco use remains a global epidemic. Global progress is threatened by growing smoking rates among children aged 13 to 15 years in many countries and by tobacco industry tactics such as targeting poorer countries with weak regulatory environments and pushing novel products in previously untapped markets.

Although more people overall are being protected by effective regulatory interventions including tobacco taxes, smoke-free public areas, access restrictions and education, these efforts must be much more robust to contend with this “dinosaur” industry whose gross profits climbed to at least $60 billion in 2020.

Globally, nearly 5 trillion cigarettes are consumed every year, contributing more than 8 million deaths and almost $2 trillion in economic damage.

The phenomena of industry covert advertising, for instance, using influencers on TikTok and Instagram, and aggressively lobbying governments is global – we see it in nearly every single country in the world. Governments need to more effectively regulate the social media companies, and they need to make communication between government officials and the tobacco industry much more transparent.

Read also: Jakarta moves to take down cigarette ads in latest tobacco control campaign

Based on the report and the situation on the ground in Indonesia, what should the government and people do to protect the health of citizens and to strengthen tobacco control measures?

The most effective way to strengthen tobacco control measures: raise taxes. Raising taxes enough to lead to significant price increases will lead to serious declines in consumption. It works particularly well with young people and those in lower socioeconomic groups.

Also, close the channels of communication: first, between the tobacco industry and potential customers by banning all marketing, especially on social media; second, between the tobacco industry and the government.

We must more strongly regulate the tobacco industry. To significantly minimize the industry’s size, influence and power, we need to invest more in pushing healthy narratives to dominate and quicken changing social norms.

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