Commitment To End Tobacco Must Translate To Bold Actions On The Ground

Commitment to end tobacco must translate to bold actions on the ground, said Dr Tara Singh Bam. He exhorted the new government of Indonesia to sign and ratify the global tobacco treaty (formally called the World Health Organization Framework Convention on Tobacco Control or WHO FCTC) in the interest of the health and wellbeing of its people.

FCTC is the first international legally binding corporate accountability and public health treaty of the WHO to protect people from the devastating tobacco use. It was adopted by the World Health Assembly of the WHO on 21 May 2003 and entered into force on 27 February 2005. Currently, among the countries that are part of the United Nations, except 14, all of them have ratified the FCTC. Among the 14 countries that have not yet become a part of the global tobacco treaty, 6 have signed but not ratified it, and 8 have not even signed it - including Indonesia.

Dr Tara Singh Bam was addressing the delegates of 10th Indonesian Conference on Tobacco Control (ICTOH 2025) including Vice President of Indonesia, Minister of Health of Indonesia, and other dignitaries. Dr Bam is the Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT) and serves as Asia Pacific Director (Tobacco Control), Vital Strategies. Indonesian conference was held just few days before the World No Tobacco Day 2025 and few weeks before the World Conference on Tobacco Control opens in Ireland next month.

With highest male smoking rates globally in Indonesia, ratifying FCTC is an urgent priority

With an Adult Smoking rate of 39%, Indonesia ranks among the top 5 countries with highest smoking rates. It also holds the dubious distinction of having 74.5% male smokers - highest in the world.

It is also the only country in the Asia Pacific region that has not signed the FCTC. Dr Bam blames it on the intense influence of tobacco industry on the government. It lobbies with the government, including giving donations to political parties for their political campaigns.

According to Dr Bam, in the absence of FCTC, the tobacco industry interference is all pervasive in Indonesia- at the central level, provincial level and local level. So, the first urgent thing to do is for the government to sign the FCTC in the interest of public health. Once the government ratifies the treaty, it will become mandatory for it to implement all the provisions of the treaty comprehensively, including FCTC Article 5.3, that mandates protection of public health policies from commercial and other vested interests of the tobacco industry, and take steps to ensure that tobacco industry interference does not undermine the implementation of tobacco control measures and public policy.

“Signing FCTC is all about political leadership, commitment and action. What I have seen in Indonesia is commitment, but there is not enough action on the ground. Action also means that the government has to sign and ratify the treaty. The government has to be honest to its people. We now have a new government and hopefully it will take this issue seriously and ratify the treaty," he hoped.

Bright tobacco products, dark deadly intentions

The theme of World No Tobacco day 2025 theme is ‘Bright Products. Dark Intentions. Unmasking the Appeal: Exposing industry tactics on tobacco and nicotine products’.

Dark intentions indeed! Throughout its lifecycle, tobacco pollutes the planet and damages the health of all people. Globally, about 35 lakh hectares of farm land are destroyed to grow tobacco every year. Deforestation caused by tobacco farming is estimated at 2 lakh hectares annually. Sustainable food production in poor and middle-income nations is jeopardised where tobacco is grown as a commercial crop.

Tobacco use is one of the biggest (and yet entirely preventable) risk factors for major non-communicable diseases (NCDs) such as type-2 diabetes, cardiovascular diseases (such as heart diseases and stroke), cancers, chronic obstructive pulmonary disease (COPD), and arthritis, as well as for communicable diseases like TB and COVID-19.

One in six NCD deaths and 27% of TB deaths globally are attributed to tobacco use.

The economic losses are staggering too. The global economic cost of tobacco use is estimated at USD 1.85 trillion annually, equivalent to approximately 1.8% of the world's GDP. These are funds that could be used by governments for education, healthcare, and social benefit schemes for the good of the common public, especially the disadvantaged communities.

Burden and Impact of tobacco use in Indonesia

In Indonesia too, tobacco is the leading cause of preventable deaths, claiming over 270,000 lives annually, which is about 23.3% of the total deaths. It deepens poverty and hits the most vulnerable the hardest. Tobacco use is also the biggest risk factor for TB in Indonesia which has the 2nd highest burden of TB globally. Smoking is responsible for up to 30% of Indonesia’s TB burden, or 319,000 TB cases each year. All this drains the country’s exchequer by over IDR 450 trillion or approximately USD 29 billion annually.

And yet, the tobacco industry continues to find new ways to dole out this poison in various forms to lure youngsters and children - by way of new nicotine products like e-cigarettes and flavoured tobacco products- that are rapidly gaining ground. It is high time to focus on challenging the misleading techniques employed by the tobacco industry to make their unsafe products appealing to their victims.

Silver lining

Although Indonesia is yet to sign the WHO FCTC, Indonesia’s Ministry of Health supports the Asia Pacific Cities Alliance for Health and Development (APCAT),which is a unique alliance of mayors and sub-national leaders from 122 cities of 12 countries. APCAT is dedicated to advance tobacco control, prevention and control of NCDs and TB in the region, among addressing other compelling health and development priorities.

Several Indonesian cities are members of APCAT, including Bogor, Denpasar, Klungkung, Bandar Lampung, East Jakarta, Pekalongan, Malang, and Balikpapan. Local governments of these cities have been doing inspiring work on the ground for tobacco control since several years now which has demonstrated commendable public health impact. This includes implementing 100% smoke-free policy in all public and work places; banning tobacco advertising, promotion and sponsorship; building policy advocacy to raise taxes and prices on tobacco, alcohol and other harmful products; safeguarding peoples’ health from tobacco industry tactics; incorporating NCD prevention programmes into primary healthcare services, among others.

The way forward to #endTobacco

But this is not enough. Dr Bam rightly calls upon all levels of government, parliamentarians, and stakeholders to act decisively to align the local tobacco control efforts with global standards by committing to the ratification of the WHO FCTC. He acknowledges the Presidential Regulation No. 28 of 2024 (that covers a wide range of healthcare issues, including regulations on tobacco products and steps against electronic cigarettes) as a step forward in the right direction, but thinks it is not enough for the scale of the crisis the country is facing.

“It is our shared responsibility to protect public health policies from the vested interests of the tobacco companies. Both national and local governments must ensure that all tobacco control policies are developed and implemented, free from tobacco industry influence. The tools, the science, and the evidence are in our hands. What we need now is political will and courageous leadership," he said.

Shobha Shukla – CNS (Citizen News Service)

(Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)

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