Download - The End-game of Tobacco*
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The End-game of Tobacco*
Diberikan oleh:Yayi Suryo PrabandariProdi S2 IKM FK UGM , Yogyakarta
* Slide diambilkan dari Reddy (2013) “Tobacco control: The End Game”
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United States Surgeon United States Surgeon
General’s ReporGeneral’s Reportsts1964: Merokok berbahaya untuk
kesehatan
1986: Dampak rokok terhadap perokok pasif
1988: Rokok bersifat adiktif
2004: Rokok menyebabkan penyakit pada hampir SEMUA ORGAN TUBUH
1826 : ROKOK DIKETAHUI BERACUN1950 : MEROKOK BERHUBUNGAN DENGAN KANKER PARU DAN TUMOR LAINNYA1965 : IKLAN ROKOK DILARANG DI INGGRIS1971 : IKLAN ROKOK DILARANG DITAYANGKAN DI TELEVISI DI AMERIKA
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Sejarah dan Fakta tentang rokok di
Indonesia
The end-game of tobacco di Indonesia?
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Sejarah tembakau dan rokok
6000 SM
1492
1596
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Sejarah rokok
6000 sm
1492
1760, Pierre Lorillard
1847 Philip Morris
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Sejarah Industri Rokok di Indonesia
1840-1940
1891
1820
1904 > 1000 industri rokok
Tempat ditemukannya cengkeh bahan rokokKretek > Halmahera
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Evidence based medicine
Dicari penyebab di luar tubuh manusia: gambar rumah, lingkungan kumum
Dicari penyebab di luar tubuh organisme: gambar cacing, virus dsb
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Evidence based public health
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Proporsi Perokok di Indonesia
*Kosen, Aryastami, Usman, Karyana, Konas Presentation IAKMI XI, 2010 ** Ministry of Health, Basic Health Research, 2007 ( prevalence of > 10 years old)*** Ministry of Health, Basic Health Research, 2010 (prevalence of > 15 years old)
Tahun Laki-laki Perempuan
Total
1995* 53.9 1.7 27.2
2001* 62.9 1.4 31.8
2004* 63.0 5.0 35.0
2007** 65.3 5.1 35.4
2010*** 65.9 4.2 34.7
Indonesia adalah negara terbanyak ke 3 jumlah perokoknya di Indonesia
146.860.000 population is smoker
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Tahun Produksi rokok (Milyar batang)
Target (Trilyun rupiah)
Realitas pajak(Trilyun rupiah)
Pencapaian Target (%)
2000 241,92 10,16 12,46 110,792001 224,97 17,60 17,60 99,382002 207,62 22,30 23,30 103,882003 190,00 27,70 27,03 101,082004 203,80 26,20 27,70 102,572005 221,10 28,90 29,30 103,142006 220,00 38,50 38,40 43,512007 226,00 42,50 44,00 106,292008 235,00 48,20 50,20 2009 - 54,00 2010 - 55,90
Pajak yang diberikan oleh industri rokok di Indonesia*
*Dirjen bea cukai
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FCTC/Framework convention on tobacco control
Belum dilaksanakan diIndonesia
Akses mudah untuk beli rokok (belum ada aturan) dan murah
Setiap orang bisa beli rokok (tidak ada batasan umur) Iklan rokok dimana-mana (termasuk di media
elektronik Kebijakan pengendalian rokok belum
diimplementasikan secara luas dan kurang penguatan hukum
Sebagai sarana pertemanan, dianggap “budaya” Belum ada aturan untuk membatasi industri atau
pertanian Ada tiupan rumor bahwa kegiatan pengendalian
tembakau “dikendalikan” oleh kekuatan farmasi
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Basic Health Survey 2007 - 2010
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Demographic Characteristics Current smoker
2007 2010
Age group 10-14 2.0
15-24 24.6 26.6
25-34 35 37.2
35-44 36 37
45-54 38 38.2
55-64 37.5 37.1
65-74 34.7 33.6
75* 33.1 32.2
Gender Male 55.7 65.9
Female 4.4 4.2
Smoking prevalence based on demographic characteristics in Indonesia
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Demographic Characteristics Current Smoker
2007 2010
Education None 30.9 31.8
Drop out from elementary 25.3 37.8
Elementary 28.3 36.6
Junior high school 30.6 33.1
Senior high school 34 35.5
University 27 25.5
Residence Urban 26.6 32.3
Rural 30.9 37.4
House hold expenditure
Quintile 1 29 35
Quintile 2 29.6 36
Quintile 3 29.5 36
Quintile 4 29.5 34.4
Quintile 5 28.7 32
Smoking prevalence based on demographic characteristics in Indonesia
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5-9 10-14 15-19 20-24 > 25
2007 2010 2007 2010 2007 2010 2007 2010 2007 2010
Age 10-14 1.4 19.0 0.0 0.0 0.0
15-24 0.1 2.2 17.8 29.3 57.3 56.5 7.1 5.7 0.0
25-34 0.1 1.4 9.8 18.6 44.6 51.5 18.6 14.5 3.9 4.0
35-44 0.2 1.5 7.7 15.4 34.7 43.6 19.5 17.5 8.9 8.9
45=54 0.1 1.5 7.1 14.1 28.3 37.7 18.8 17.7 11.9 12.4
55-64 0.1 2.0 7.3 12.8 22.9 30.4 17.3 17.0 13.3 15.9
65-74 0.1 2.4 6.9 11.7 19.2 25.4 14.0 14.7 13.1 15.6
75+ 0.1 2.1 6.7 10.2 15.9 20.4 10.3 12.2 11.7 12.9
Sex Male 0.1 1.7 10.1 18.3 38.2 45.0 16.8 14.6 6.9 6.8
Female 0.3 1.5 4.7 7.6 14.0 20.6 10.2 14.3 15.5 27.6
Married status
Single 2.0 26.0 55.1 8.1 1.5
Married 1.7 15.4 40.9 16.4 9.6
Widow 1.5 11.9 25.1 16.4 17.3
Age Initiation to Smoke
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Age Initiation to Smoke
5-9 10-14 15-19 20-24 > 252007 2010 2007 2010 2007 2010 2007 2010 2007 2010
Educa-tion
None 0.2 1.8 7.7 12.6 21.3 25.4 12.0 11.6 10.4 12.0
DO fr Elem 0.2 2.5 10.1 16.9 29,1 35.6 14.5 14.0 9.1 10.6
Elementary 0.1 1.8 11.2 17.9 35.0 40.2 16.0 15.2 7.6 9.1
Junior high 0.1 1.6 11.1 21.4 43.0 47.7 15.6 12.9 4.9 6.1
Senior high 0.1 1.3 7.6 16.6 45.1 52.5 19.3 14.9 6.4 6.1
University 0.1 1.2 5.6 13.5 38.4 47.4 24.6 19.9 10.2 8.9
Occu-pation
None 1.8 18.5 39.7 11.0 10.1
Student 2.6 36.8 51.5 2.9 0.1
Official 1.4 15.1 47.0 19.2 8.6
Enterpreuner 1.6 16.7 47.4 15.5 7.7
Farmer/labor 1.7 16.8 40.7 14.6 8.4
Other 1.7 16.9 39.8 16.9 11.4
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Age Initiation to Smoke
5-9 10-14 15-19 20-24 252007 2010 2007 2010 2007 2010 2007 2010 2007 2010
Resi-dence
Urban 0.1 1.8 9.2 18.0 40.7 46.0 18.4 15.1 7.5 7.9
Rural 0.2 1.6 9.9 17.0 34.1 40.5 15.3 14.0 7.6 8.6
Economic status
Quintile 1 0.1 1.6 10.6 17.2 34.9 40.1 14.6 12.9 6.9 9.3
Quintile 2 0.1 1.8 10.4 17.3 35.9 42.0 15.5 14.1 7.1 7.9
Quintile 3 0.1 1.6 9.6 17.7 36.8 44.5 16.1 14.5 7.5 8.1
Quintile 4 0.1 1.8 9.4 17.4 37.0 44.6 16.6 15.7 7.8 8.6
Quintile 5 0.2 1.8 8.4 17.9 36.9 45.8 18.6 15.8 8.4 9.6
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------------------------------------------------------------------------------ | Robust smoker | Odds Ratio Std. Err. z P>|z| [95% Conf. Interval]-------------+---------------------------------------------------------------- 1.sex Male | 48.83015 1.585416 119.76 0.000 45.8196 52.03851 | educstion | none | 2.65454 .2219741 11.68 0.000 2.25326 3.127283 d.o. elemtr | 3.225809 .1937587 19.50 0.000 2.867551 3.628826 elementary | 2.678008 .1399927 18.84 0.000 2.417216 2.966938 juior high | 1.686555 .0905743 9.73 0.000 1.518056 1.873757 senior high | 1.68288 .0858376 10.20 0.000 1.522777 1.859815 Economic sta | 1 | 1.06613 .0447782 1.52 0.127 .9818817 1.157607 2 | 1.007685 .0423369 0.18 0.855 .9280307 1.094176 3 | 1.046219 .0443829 1.07 0.287 .9627486 1.136927 4 | 1.062706 .0448195 1.44 0.149 .9783939 1.154283 | _cons | .0214726 .0012472 -66.13 0.000 .0191622 .0240615------------------------------------------------------------------------------
Logistic Regression of Gender, Education and economic status with smoking behavior
All together, gender, education and
economic status contribute to smoking
behavior
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Quit Tobacco Indonesia
Research Result
Please visit the website of Quit Tobacco International:
www.quittobaccointernational.org
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Assessment of Smoking Status*
Doctor’ report
• 72% of physicians reported that they do not routinely ask patients about their smoking status
• 34% (male) and 21(female) physicians reported that they did routinely ask patients Patient’ report
Of the 355 male patients interviewed, 41% of them were smoking in the last 30 days
Only 10% of all patients were asked by doctors about their smoking behavior during their clinical encounter
Patient Exit Interview•Objective: to examine patient reports of doctors’ asking and advising patients to quit smoking•Method: exit interview survey in four public health centers in Yogyakarta
Ng N, Prabandari YS, Padmawati RS, Okah F, Haddock CK, Nichter M, Nichter M, Muramoto M, Poston WSC, Pyle SA, Mahardinata N, Lando HA. Physician assessment of patient smoking in Indonesia: a public health priority. Tob Control. 2007 Jun;16(3):190-6
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Pengendalian Tembakau`
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FCTC (Framework Convention on Tobacco Control)
FCTC atau kerangka konvensi pengendalian tembakau adalah traktat dunia pengendalian tembakau yang dirancang WHO atau Badan Kesehatan Dunia
Dikembangkan sejak th 1995 dan secara resmi dibuka untuk ratifikasi dan tandatangan pada Juni 2003-Juni 2004. Sudah ditandatangani dan diratifikasi 160 negara
Indonesia adalah satu-satunya negara di Asia Pasifik yang belum atau tidak meratifikasi dan menandatangani traktat ini
Pasal 8 dan 18 berhubungan dengan perlindungan terhadap kesehatan lingkungan dan manusia
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FCTC:
Intervensi dari Segi Permintaan Intervensi dari Segi Penyediaan
• Harga dan pajak dinaikkan• Pelarangan dan pembatasan
iklan dan sponsor rokok secara komprehensif
• Proteksi dari paparan asap rokok
• Komunikasi edukasi, pelatihan dan peningkatan kesadaran publik
• Kemasan dan pemberian label• Intervensi untuk berhenti
merokok• Regulasi isi kandungan rokok
– Pelarangan– Pembatasan
penjualan rokok pada anak– Subtitusi pertanian– Pembatasan
perdaganan
– Memonitor rokok selundupan
Bukan
merupakan
intervensi
yang efektif
Pengecualian dan intervensi kunci
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Intervensi multi level untuk pengendalian tembakau
Increased levels of tobacco dependency
Taxation, workplace bans, restricted access, health warnings
TV campaigns
Brief intervention• Pharmacotherapies• non-prescibed
Pharmocotherapies• prescribed• non-prescribed
Intensive interventions
Specialistclinics
GPs
Allied health Media campaign
Legislation
Support quit lines
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Intervensi Efektif untuk Pengendalian Penggunaan
Tembakau (Seatca, 2007)
• Menaikkan pajak (65% dari harga eceran)
• Melarang semua bentuk iklan rokok• Mengimplementasikan 100% Kawasan
Tanpa Rokok (KTR) di tempat umum, tempat kerja, tempat pendidikan
• Memperbesar peringatan merokok di bungkus rokok dan menambahkan gambar akibat kebiasaan merokok pada bungkus rokok
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MENGAPA PAJAK ROKOK MENGAPA PAJAK ROKOK PERLU DINAIKKAN?PERLU DINAIKKAN?
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Kematian, penyakit, dan kecanduan semakin murah; dan dapat dibeli orang miskin
0.93
1.25
2.18
0.61
0.94
1.79
1.25
7.47
1.25
5.73
0.39
1.03
0.310.38
0.10
0.62
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
Cambodia Indonesia Lao PDR Malaysia Philippines Singapore Thailand Viet Nam
MarlboroMerk rokok termurah
Harga 1 bungkus rokok isi 20 batang(US$)
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MENGAPA IKLAN MENGAPA IKLAN HARUS DILARANG?HARUS DILARANG?
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Apa hubungan iklan rokok dan kebiasaan merokok?
• Pucci & Siegel (1999), melakukan penelitian antara paparan iklan dan kebiasaan merokok, hasilnya adalah adanya hubungan antara paparan iklan dan kebiasaan merokok semakin tinggi paparan iklan, semakin frekuen merokoknya
• Iklan rokok merupakan faktor potensial pencetus inisiasi merokok di kalangan remaja (Botvin, Botvin, Michela, & Filazzola, 1991)
• Prabandari, dkk (2007) mengadopsi penelitian Puccini dan hasilnya sama.
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Tobacco control in Indonesia
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PolicyGovernor Yogyakartaregulation no 39 7 SMOKE FREE setting
Regulation cannot be applied in the house hold private area SMOKE FREE HOUSE KAMPONG
Ministry of Education instruction no 4 1997: Smoke Free School
Campaign and disse-mination of Smoke free area
IndonesianGov Reg on Tobacco Control (GRTS)Number 109 2012 about substance protection that contain addictive substance, tobacco effect for health
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Pengendalian Kebiasaan Merokok di Yogyakarta
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Perjalanan Kebijakan di Yogyakarta
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Status Kebijakan KTR di DIY
Wilayah Status Keterangan
Kabupaten
Kulonprogo
Ditetapkan perbup KDM Perbup Nomor 61 Tahun
2009
Kabupaten
Gunungkidul
Ditetapkan perbup KDM Perbup Nomor 22 Tahun
2009
Kota Yogyakarta Penyusunan perwal Masih dalam pembahasan
Kabupaten Bantul Penyusunan perbup Masih dalam pembahasan
Kabupaten
Sleman
Penyusunan perbup Masih dalam pembahasan
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Workshop untuk penyusunan naskah akademik dan Raperda KTR
1. Inisiatif DPRD
2. Rekomendasi ekskutif
Workshop untuk penyusunan naskah akademik dan Raperda KTR
1. Inisiatif DPRD
2. Rekomendasi ekskutif
Pertemuan Badan Legislasi DPRD
Rapat paripurna DPRD
PROLEGDA 2012
Pansus PERDA
Rapat Paripurna Penetapan
Langkah untuk menetapkan regulasi KTR di Yogyakarta
QTI & Yogya Sehat Tanpa Tembakau
* Naskah akademik dikembangkan oleh QTI dan Yogya Sehat Tanpa Temkau didasarkan survei kolaborasi antara QTI dan Dinas Kesehatan Propinsi dan Kota Yogyakarta
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Wilayah Status Keterangan
DPRD Prov. DIY Prolegda 2012 Pendalaman materi antar
fraksi
DPRD Kota
Yogyakarta
Belum prolegda Proses pengajuan NA dan
Raperda
DPRD Kab. Bantul Prolegda 2012 Proses konsinyering
DPRD Kab. Sleman Prolegda 2012 Proses konsinyering
DPRD Kab.
Kulonprogo
Belum prolegda Proses audiensi DPRD
DPRD Kab.
Gunungkidul
Belum prolegda Proses audiensi DPRD
Perkembangan usulan KTR masing-masing wilayah
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Strategy for community: Implementation of Smoke Free House Kampong
Quit Tobacco Indonesia works with Provincial & District Health Office
Nichter, M., Nichter, M., Padmawati, RS., & Ng, N. Developing a smoke free household initiative: an Indonesian case study. Acta Obstetricia et Gynecologica. 2010; 89: 578–581
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Terima kasih atas perhatiannya
Telusuri website berikut untuk mendapatkan bahan presentasi dan sosialisasi tentang dampak rokok terhadap kesehatan, serta pengendalian tembakau secara umum:
www.quittobaccointernational.org