Indonesia Is Enforcing Stronger Anti-Tobacco Measures Despite Industry Interference – OpEd

There is plenty of scientific evidence to show that tobacco kills one out of every two of its users (as per the WHO). Tobacco use devastates lives and fractures families killing over 8 million people every year – year after year. While governments are enforcing stronger evidence-based tobacco control measures, the tobacco industry is conniving to lure children and young people into addiction traps and reap bigger profits by selling its deadly products.

Akin to the oft-quoted proverb "When the going gets tough, the tough get going", Dr Tara Singh Bam has painstakingly advanced tobacco control in Indonesia and other countries in Asia and the Pacific for over almost two decades now – despite mammoth tobacco industry interference in public health policy.

Indonesian Ministry of Health awards Dr Tara Singh Bam

Indonesian Ministry of Health awarded him on 4th June 2024 to shine a spotlight on his stellar contributions to advance tobacco control and public health in Indonesia over the past 17 years. Dr Tara Singh Bam received the award certificate from Indonesian Health Minister Budi Gunadi Sadikin, who appealed to the children and young people to make the smart choice of choosing life, and not tobacco.

Global Goals, Local Actions

Although Indonesia is not among the 183 countries that have ratified the global tobacco treaty (formally called the World Health Organization Framework Convention on Tobacco Control – WHO FCTC), Dr Tara Singh Bam has played a phenomenal role in mobilizing sub-national leaders in Indonesia and several other countries to adapt and enforce WHO-recommended evidence-backed tobacco control policies – grounds up!

He has worked closely with Mayors, Governors, Commissioners and other sub-national leaders to adopt stronger policies and improve its implementation to advance tobacco control, TB control, prevention and control of non-communicable diseases (NCDs), rabies control, address antimicrobial resistance with One Health approach, among others.

Nearly 300,000 people die of tobacco use in Indonesia every year. Almost US$ 15 billion is the annual economic loss due to tobacco use in Indonesia – this includes direct costs related to healthcare expenditures and indirect costs related to lost productivity caused by illness and premature deaths.

Dr Mrunal Shetye, Deputy Representative of UNICEF in Indonesia said in the award ceremony organised by the Ministry of Health of Indonesia: "Each year hundreds and thousands of children are drawn into the web of tobacco addiction through cunning marketing strategies of tobacco industry, and the lure of flavoured tobacco products especially crafted to lure them, including e-cigarettes. Today, approximately 3 million children are exposed to tobacco use in Indonesia. Every child has an inherent right to a life untouched by the shadow of tobacco – but this right is perpetually violated by tobacco industry's relentless pursuit to attract new users."

WHO Indonesia's head Dr Navaratnasamy Paranietharan congratulated Dr Tara Singh Bam and all other award recipients. He said: "As WHO representative in Indonesia, it is a bit tricky for me to speak on tobacco control as feelings are mixed. On one side, Indonesia is ranked 87th out of 90 countries on global tobacco industry interference index and is also one of the six countries globally where tobacco use is projected to increase in the world (these 6 countries are: Congo, Egypt, Indonesia, Jordan, Oman, and Moldova). On the other hand, emergence of grassroots campaigns and sustained efforts for implementing WHO-recommended tobacco control policies and commitment of local and sub-national leaders to enforce these, is commendable."

Dr Paranietharan added: "The Global Youth Tobacco Survey data shows that tobacco use has increased among the young people to 23%. One out of every five youth is addicted to tobacco. We must ban every form of tobacco use – including so-called (and misleading) 'novel' or 'innovative' or 'electronic' or 'e-cigarettes' or 'vaping' along with ban on online promotion or sale of these deadly products."

Dr Paranietharan called for a complete blackout or a ban on all forms of tobacco advertising, promotion and sponsorship. "We have to make tobacco products less appealing and less affordable to our children. We must ban all flavouring of tobacco products as well as increase the excise tax on them."

Connecting the dots: tobacco use and TB, NCDs, and local actions

Dr Tara Singh Bam currently serves as Asia Pacific Director for Tobacco Control at Vital Strategies and Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT). He has earlier served as Asia Pacific Director of International Union Against Tuberculosis and Lung Disease (The Union).

WHO Global TB Report 2023 clearly outlines 5 top-risk factors for TB worldwide: these include malnutrition, tobacco, alcohol, HIV and diabetes. Over 70% of untimely deaths occur due to one of the non-communicable diseases (NCDs) – a lot of them are preventable. Tobacco use is a major and common risk factor for several NCDs and infectious diseases like TB. Tobacco also jolts the global economy by a loss of over US$ 1.4 trillion every year. Tobacco harms our environment too.

That is why local and other sub-national leaders are working with Dr Bam to advance progress towards ending tobacco, ending TB, preventing NCDs and promoting public health for the people – especially those most-in-need.

According to The Union, "In the remote Nepali village where Tara Singh Bam was raised, people grew their own tobacco. They claimed smoking helped them overcome the stress of struggling to survive, but his father died from asthma and the results of heavy smoking, and other relatives died too".

"Even though I did not know the full effects, I saw tobacco was a problem," says Dr Bam, and he became determined to work in public health.

Dr Tara Singh Bam has been a force for change for forging and strengthening national-level Mayors' alliances in Indonesia, Bangladesh and other countries. He has also been a formidable force to bring mayors, and other sub-national leaders from several countries in Asia Pacific region to unite for public health – Asia Pacific Cities Alliance for Health and Development (APCAT) is one of the pioneering initiatives that is translating Global Goals into Local Actions on the ground.

• About the authors: Shobha Shukla and Bobby Ramakant co-lead the editorial of CNS (Citizen News Service) and are on the governing board of Global Antimicrobial Resistance Media Alliance (GAMA www.amrmedia.org) and Asia Pacific Media Alliance for Health and Development (APCAT Media). Follow them on Twitter: @shobha1shukla, @bobbyramakant