April 06, 2012
A staggering 100 million people died from smoking-related diseases in the 20th century, but the projected death toll by the end of this century could blow that figure out of the water.
If the current smoking trends continue, 10 times as many people could die as a result of smoking during the 21st century, according to the fourth edition of the Tobacco Atlas, recently launched by the American Cancer Society and World Lung Foundation.
By 2030, smoking-related diseases are expected to be the leading causes of death worldwide, with eight million people dying from them every year.
Ellen Feighery, the associate director for international research at the Campaign for Tobacco-Free Kids, says that about 80 percent of these deaths will occur in developing countries, including Indonesia.
The Indonesian case
Around 200,000 people die from tobacco-related illnesses each year in Indonesia — the only country in Asia that has not ratified the United Nations Framework Convention on Tobacco Control.
And because it has the third-highest number of tobacco consumers in the world after China and India, a substantial number of smoking-related deaths over the next century will happen here, says Hasbullah Thabrany, a public health professor at the University of Indonesia.
The lax smoking regulations — including no graphic warnings on cigarette packs, limited regulations on tobacco advertisements, easy access to cigarettes for children — and the prominent increase in young people taking up the habit will only put more Indonesians at risk of preventable diseases, Hasbullah says.
“My forecast, with reference to the one billion deaths [from the Tobacco Atlas], is that at least 10 million of them will be Indonesians,” he said.
He added this should serve as a serious warning to the government, which has a responsibility to protect its people. The state, he said, should act fast to prevent these deaths by pushing stronger regulations on tobacco and educating the public on the dangers of smoking.
“But if the government is still afraid of losing money [from the tobacco industry], and the [tobacco] industry lobby remains powerful, and the [political party] leaders still need money for their campaigns, then ...,” he says, shaking his head as he trails off.
Still lighting up
In just five years, Indonesia’s tobacco consumption is predicted to surpass the projections drawn up by the Trade Ministry of 260 billion sticks a year.
“By 2017, the tobacco consumption projection for Indonesia will be more than 270 billion sticks per year,” Nasruddin Djoko Surjono, from the UI School of Economics, said at the recent 15th World Conference on Tobacco or Health in Singapore.
Around 70 percent of adult males in Indonesia smoke. But the starting age, according to Hasbullah, has shifted younger.
According to the data compiled by the UI School of Economics’ Demographic Institute, more Indonesians aged 15 to 19 are smoking now than previously. And they keep getting younger: In 1995, around 71,000 children aged 10 to 14 were smokers, while in 2010 that figure increased to more than 426,000.
Lisda Sundari, from the National Commission for Child Protection (Komnas Anak), says the real figure is probably double that, with even younger kids taking up the habit.
Starting young
Last year, 2-year-old Aldi Rizal from Musi Banyuasin in South Sumatra became an international sensation because of his two-pack-a-day habit.
But Lisda says his case is only the tip of the iceberg.
Just last month, 8-year-old Aldi Ilham from Sukabumi, West Java, also made international headlines for his heavy smoking — a habit that he picked up at the age of four.
Umar, the boy’s father, said he believed that the sight of adult males, including himself, smoking in the neighborhood had influenced the child.
Although Lisda did not give a figure for the number of other children suffering from the same addiction, she said Komnas Anak was currently monitoring 20 children under the age of 10 who were heavy smokers.
“All those little boys have the same background. They come from low-income families, where the parents and other members of the community aren’t very well educated and not aware of the dangers of smoking,” she said.
“They see little kids smoking as something cute, even amazing. The government is responsible for all this — the lack of education, the lack of strict regulations — for failing to prevent this from happening.”
The 3B Girls
Children are not the only component of the growing number of smokers in the country, with more women also lighting up.
In 2007, there were 4.8 million female smokers in Indonesia, up from 1.1 million in 1995, according to the Demographic Institute.
“Tobacco companies market directly to women and create an association between smoking and gender equality,” said the Tobacco Atlas, which was launched at the WCTOH.
“This is happening today in many low- and middle-income countries where there are potential new smokers and sparse marketing restrictions.”
Andika Priyono, a Komnas Anak official who works with female smokers, says that in major cities such as Jakarta, women as young as their late teens now tend to smoke to look cool and independent.
“They have this title of 3Bs: BlackBerry, braces and black menthol,” he said, referring to the popular smartphone brand, a non-prescription dental accessory and a type of menthol cigarette.
Esthi Annafika, 23, a self-professed 3B girl, says she smokes because it is part of the modern lifestyle. Having taken up smoking at the age of 16, she says she now goes though a pack a day.
“I see more girls smoking today. I think we copy each other, because we think it’s cool to smoke,” Esthi said.
“I know it’s bad for our health, but I always think, ‘Let me just smoke while I’m young.’ ”
So how bad is smoking for women? The Tobacco Atlas says it decreases fertility, affects the development of fetuses, and combined with oral contraceptives, can increase the risk of heart attack and stroke.
“If women begin smoking at rates equivalent to men, the world will face a public health disaster of enormous proportions,” the atlas said.
Is the price the solution?
In 2010, Indonesia paid more than Rp 1.8 trillion ($198 million) to treat smoking-related diseases, according to UI’s Nasruddin. Not a single rupiah came from tobacco excise, he adds.
The solution to Indonesia’s tobacco problem, he says, is to push both price and non-price measures to control smoking, including adjusting the tobacco excise every year.
Tobacco prices in the country are among the cheapest in the world, according to the Tobacco Atlas. “The median employed person has to work for only four minutes to buy a pack of the cheapest cigarettes,” it said.
Abdillah Ahsan, from the Demographic Institute, said the government should increase the excise, setting it at around 70 percent of the price of a cigarette.
The current excise is around 52 percent, despite the excise law stipulates it should be at a minimum of 57 percent.
Non-price measures, meanwhile, include more restrictions on tobacco advertising, a ban on sales to minors, the designation of smoke-free areas, a requirement for graphic health warnings on cigarette packs, and an intensified campaign on the dangers of smoking.
In principle, the government must also ratify the FCTC, “but if that’s too hard [for now], just finish the government regulation on tobacco use,” Abdillah says.
The regulation, mandated in Article 116 of the 2009 Health Law, should have been passed by October 2010. But a draft of the regulation is still lingering with the Coordinating Ministry for People’s Welfare.
“The government, the president, should be ashamed. We are the only country [in Asia] that has yet to ratify the FCTC. But it seems like [the government has] no shame,” Abdillah says.
A question of will
Surin Pitsuwan, the secretary general of the Association of Southeast Asian Nations, recently launched a campaign for a smoke-free Asean with a call for all countries in the region to commit to a healthier community.
But the goal seems in doubt with Indonesia, the biggest nation in the bloc, yet to ratify the FCTC.
“One hundred and seventy-four countries signed on to the Framework Convention on Tobacco Control,” he said at the opening of the WCTOH. “All [in Asean] ratified, except one.”
To be ratified, the FCTC must be signed by the president and passed into law by the House of Representatives.
Last September, President Susilo Bambang Yudhoyono stressed the importance of protecting the people from the dangers of tobacco.
He told the National Commission on Tobacco Control: “Our goal is the same. The spirit is also the same. The Indonesian people must be safe and healthy. Otherwise, what will happen with the country in the next five or 10 years?”
( this article x the JG)
vr 6 apr 2012 - 20:05