Background Summary
Tobacco use is the leading cause of disease and premature death in Indonesia.
Public health experts estimate that every year, there are nearly two million cases of tobacco related illnesses and that smoking kills over 225,000 Indonesians, making up over 21% of annual deaths. The total economic costs of smoking in Indonesia, including direct and indirect costs, is estimated to be nearly 639 million rupiah. Smoking is largely unregulated and more than 64 million (66.6% of men, 2.1% of women) currently use combustible tobacco products, 4.3% of adults use smokeless products and over 3.5% of children under the age of 15 use tobacco products(1).
Policies in Focus
Indonesia has yet to sign or ratify the WHO Framework Convention on Tobacco Control (FCTC). Despite not being party the WHO FCTC, the Ministry of Health is working towards protecting the public from the dangers of tobacco use and has passed national and subnational tobacco control policy measures.
Vital Strategies tobacco control enforcement work in Indonesia focuses on strengthening implementation of local smoke-free laws in each city. Yogyakarta’s smoke-free focus is regulation No.2 Year 2017 that bans smoking in all indoor venues of public places and workplaces and Depok City regulation No. 3 Year 2014 that includes the ban of advertising and display of tobacco products at the point-of-sale.
Achievements in Indonesia
In 2007, The International Union Against Tuberculosis and Lung Disease, began working in Indonesia, supporting the national and subnational government with implementing effective tobacco control measures.
In 2009, the Mayor of Bogor city made the commitment to enforce smoke-free policies and formed a mobile court system as an enforcement mechanism to issue policy violations. The mobile court system increased community involvement and public awareness of the laws and resulted in increased compliance rates. Following the success in Bogor City, many other Indonesian cities have followed suit and implemented their own smoke-free policies.
The rapid expansion of smoke-free policies and the support from program teams has resulted in smoke-free legislations in over 300 cities and districts; tobacco advertisement, promotion and sponsorship (TAPS) bans in 25 cities; and point-of-sale tobacco product display bans in five cities and districts. However, policy implementation remains a challenge and compliance rates are low despite the expansion, highlighting the need for effective implementation and enforcement measures(2).
Under The Union, the program began working in collaboration with the city governments of Yogyakarta and Depok City to provide technical assistance and improve compliance of smoke-free policies in each city. The program has since transitioned to Vital Strategies Tobacco Control Division, who is carrying forward this important work in Indonesia.
An external study carried out by Johns Hopkins University in 2019 demonstrated a need for improved compliance in smoke-free public places in the two cities, and with the TAPS ban in retail settings in Depok City.
See the results here:
Compliance with Smoke-free Public Places, Yogyakarta, Indonesia, 2019
This study from Yogyakarta City, Indonesia, assessed compliance with smokefree in different settings from February to March 2019.
Compliance with Smoke-free Public Places, Depok, Indonesia, 2019
This study from Depok City, Indonesia, assessed compliance with smokefree in different settings from February to March 2019.
Compliance with Tobacco Product Display and Point-of-Sale TAPS, Depok, Indonesia 2019
This study from Depok City, Indonesia, assessed compliance with the tobacco product display and point-of-sale advertising and promotion ban in different retail settings from February to March 2019.
By working with local governments in each city to build strategies and carry out activities to build capacity of local enforcement agencies, previously inadequate enforcement efforts continue to be strengthened and ownership of compliance among the local stakeholders is increasing.
In Depok City, the smoke-free local regulation was amended in 2020 with the provisions to ban outdoor tobacco advertising as well as to ban use of e-cigarettes, shisha and other tobacco products.
These amendments, along with the program activities, resulted in the establishment of a smoke-free taskforce, integration of enforcement and random inspections within the COVID-19 response plans, sustained execution of enforcement activities during the pandemic, and successful counteractivity against tobacco industry interference.
In Yogyakarta City, the Mayor has shown support for the enforcement of smoke-free policies by consolidating each and every government department’s role and ownership in enforcing the law and expanding partnerships with civil society and community-based organizations.
Additionally, an online app was launched that allows the public to report violations with the aim to build public support and engagement. Monthly inspections are taking place, led by the local health office and local civil police. Enforcement activities have been decentralized at the sub-district level for a wider engagement of the local authorities who have committed to achieve over 85% compliance with smoke-free policies.
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Sources
1) Tobacco Atlas. (n.d.). Indonesia. Retrieved December 09, 2020, from https://tobaccoatlas.org/country/indonesia/
2) The Union. (2020, October 02). Tobacco Control in Indonesia. Retrieved December 10, 2020, from https://theunion.org/our-work/tobacco-control/bloomberg-initiative-to-reduce-tobacco-use-grants-program/tobacco-control-in-indonesia
Images: First two photos credit Vital Strategies #SuaraTanpaRokok