Indonesia: Ratification of the Framework Convention would help reduce tobacco prevalence

Tobacco control in Indonesia could advance with the implementation of the WHO Framework Convention on Tobacco Control (FCTC). The country is currently the only one in the Asia-Pacific region not to have ratified it due to strong tobacco industry lobbying. A recent study[1] presents empirical evidence countering industry arguments about the negative economic consequences of adopting the treaty.

Comparing Indonesia, which has not ratified the WHO FCTC, with other countries with similar economies (Bangladesh, Brazil, and Pakistan) that are parties to the treaty, a difference in smoking prevalence after the treaty's entry into force is observed. Bangladesh ratified the FCTC in 2004, while Pakistan and Brazil ratified it in 2005. Overall smoking rates have steadily declined in these three countries since 2007, whereas over the same period, smoking prevalence in Indonesia declined by only 1.4%. In Bangladesh, the overall prevalence decreased from 45.5% in 2007 to 39.1% in 2018, from 30.7% in 2007 to 20% in 2018 in Pakistan, and from 25.5% to 16.5% in Brazil.

The weight of smoking in Indonesia

Tobacco kills approximately 290,000 people a year in Indonesia, and more than 50,000 of these deaths are due to exposure to secondhand smoke. Among Indonesian adults (aged 15 and over), 33.8% use tobacco, including nearly two-thirds of men (62.9% of men).[2]There has been a worrying increase in the prevalence of smoking among women and a steady increase in the prevalence of smoking among minors aged 10 to 18. The prevalence of smoking among women has almost doubled, rising from 2.5 % in 2013 to 4.8 % in 2018, while the prevalence among 10-18 year olds has increased from 7.2 % in 2013 to 8.8 in 2019 and then 9.1 % in 2018.

Tobacco industry main opponent of adoption of Framework Convention in Indonesia

Tobacco control advocates in Indonesia have worked at the national and subnational levels with promising results, with several regional governments adopting smoke-free regulations. For example, the city of Bogor became the first Indonesian city to adopt a comprehensive tobacco control law in 2009, including smoke-free spaces and a ban on point-of-sale advertising. At the national level, with the notable exception of the adoption of a pictorial health warning covering 40 % of the packaging surface, no significant progress has been made. Indonesia remains one of the few countries to broadcast tobacco advertisements on television, and cigarette taxes are among the lowest in the world.

Although the tobacco industry interferes in public policies in almost all Southeast Asian (ASEAN) countries, the level of tobacco industry interference in policymaking in Indonesia is the highest in the region.[3]The tobacco industry and its supporters argue that ratification of the FCTC will have negative consequences for the country's economy due to the decline in tobacco production and associated economic activities. The industry claims this would lead to major macroeconomic problems, including increased poverty and unemployment rates and a decrease in GDP per capita.

The Framework Convention contributes to the reduction of tobacco consumption

The study also concludes that the extent of the tobacco industry's economic contribution to the national economy is overestimated, and that arguments that stricter measures would have disastrous economic consequences are not supported by the experiences of other countries that have ratified the FCTC. Conversely, reducing overall smoking prevalence is likely to lead to long-term benefits such as reduced health care spending and improved labor productivity. Strong fiscal policies simultaneously increase government tax revenues and reduce tobacco-related health expenditures.

Keywords: Indonesia, Framework Convention, FCTC, lobby, tobacco

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[1] Ahsan, A., Afin, R., Amalia, N. et al. FCTC ratification, smoking prevalence, and GDP per capita: lessons for Indonesia and the rest of the world. Global Health 18, 11 (2022). https://doi.org/10.1186/s12992-022-00810-y [2] The toll of tobacco in Indonesia, Campaign for Tobacco-Free Kids, last updated August 26, 2021, accessed February 8, 2022 [3] Mary Assunta. Global Tobacco Industry Interference Index 2021. Global Center for Good Governance in Tobacco Control (GGTC). Bangkok, Thailand. Nov 2021. National Committee Against Smoking |