The Commitment of Government in Tobacco Control: Content-
Comparison Analysis on Policy Documents
Ryan Rachmad Nugraha
1
, Jaifred Christian Lopez
2
and Don Eliseo Lucero Prisno III
3
1
Center for Health Economics and Policy Studies, Universitas Indonesia, Depok, West Java, Indonesia
2
Office of Research and Innovation, San Beda College, 638 Mendiola St. San Miguel, Manila, Philippines
3
School of Public Health, Xian Jiaotong - Liverpool University, Suzhou, China
Keywords: Government commitment, Tobacco control, Comparison analysis, Indonesia, Philippines.
Abstract: Tobacco is a threat to Indonesian Health Coverage. In 2013, up to IDR 5 trillion has been spent due to
treating tobacco-related diseases, with approximately IDR 234.5 trillion potential loss on income due
reduced productivity. Framework Convention on Tobacco control (FCTC) came as an answer to tackle this
problem globally. Unfortunately, Indonesia hasn’t signed its FCTC yet, unlike its peers from South-east
Asia. Philippine, as a country with same geographical and custom as Indonesia, has already signed and
benefit from it. In order to gain insight on the commitment and its after-effects, we conducted comparative
content analysis on 37 legal documents from both countries related to tobacco control. The result is quite
shocking. From 16 category of public spaces identified, Philippine bans 69% of them from cigarette smoke,
while Indonesia only restrict it. On the advertising sector, while Philippine has banned domestic media (TV
and radio) from tobacco adv., Indonesia only restrict its permit. Commitment from regulator is needed
especially for aforementioned sectors to ensure better tobacco control. While in the other hand, such
findings can also be a strong reason for Indonesia to sign FCTC as soon as possible.
1 INTRODUCTION
Tobacco has been the highlight of Indonesian fight
against premature death. Tobacco has killed
approximately 521 people each day globally, while
caused up to 962.403 deaths in 2013 alone. (Assunta
& Dorotheo, 2015; Murray et al, 2015) Most of the
death caused by tobacco consumption is not only
due to non-communicable diseases, but also
infectious diseases. Stroke, tuberculosis, cancer, and
ischemic heart, and respiratory infection build up to
21% cases directly linked to tobacco death; all of
which stands in top 10 cause of mortality in
Indonesia. Based on recent studies, smokers are
more likely to get coronary heart diseases up to 2 to
4 times, stroke up to 2 to 4 times, and 25 times also
more likely to develop lung cancer (WHO, 2008)).
Not only death, tobacco consumption in the long run
might also cause loss of productivity. On average,
smokers may lose up to a decade life-span as
compared to non-smoker (Murray et al, 2015).
Despite the awareness of danger that has been
elicited in tobacco consumption, the demand of
smoking is still rising. Globally, the number of daily
smokers has increased from 721 million in 1980 to
967 million in 2012 (Murray et al, 2015). In
Indonesia, smokers results in amount of 29.3% of
total population (Badan Penelitian dan
Pengembangan Kesehatan, 2013). This number of
increasing demand needs to be controlled, and it is
the duty of government to serve this purpose.
There is a strong willing and commitment of
stakeholder all over the world in order to tackle the
poor regulation of tobacco, in response to increasing
number of cigarette smoking. WHO Framework on
Tobacco Control (FCTC) is an example of a world-
wide commitment of such `efforts. Up until now,
there has been 168 countries have signed the treaty,
with several is still in ratification progress; of which
displays the commitment being taken in control of
tobacco on behalf of the country. Not only it
displays commitment, but ratification of FCTC has
improved the health status of each country directly.
In Africa, 43 countries have signed the FCTC up to
date. Now almost all countries in the region have
national tobacco control focal points, and 41 of them
currently have national tobacco control as their
national program (WHO Regional Office for Africa,
2015).
228
Nugraha, R., Lopez, J. and Prisno III, D.
The Commitment of Government in Tobacco Control: Content-Comparison Analysis on Policy Documents.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 228-233
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

FCTC ratification as reflection of commitment
by nations to regulate tobacco use is not without
impact. Its measure have been projected anywhere
around the world. Health warning in cigarette
package, for example, as projected as tobacco
demand control by FCTC, has gained positive
impacts. After being implemented, pictorial health
warning has influence interests from people to quit
smoking, particularly in developing countries (Baška
et al, 2009).
Indonesia is currently fighting for its own
regulation freedom for tobacco. The constituent law,
reflected by legislatives decision, has accommodated
the tobacco control program in the nation, either to
control the supply of tobacco products or to control
the demands from arising. However, In Indonesia,
there has also been challenge and barrier in
implementing this regulation. For example, in
national level, back in 2001, there has been a
petition addressed by Indonesian domestic tobacco
industry association that argued articles 113, 114,
and 199 health law of 36 in 2009 will cause decrease
in production. In the regional level, for example,
Jakarta as capital has been strong in enforcing law
regarding protection tobacco second-hand smoker.
In 2012, a case was handled enforcing smoke-free
rom law to be applied in all mall in Jakarta.
Despite the efforts, globally, Indonesia is still
lacking if compared with other nations. Indonesia is
currently the only country yet to sign Framework
Convention on Tobacco Control (FCTC) among
countries within the ASEAN, which contribute to
the delay of speeding control policy of tobacco.
Smoke free room, for example, although it is not
prohibited in national level, it is already enforce in
subnational level. In addition, the taxation structure
of tobacco, which is not uniform across tobacco
products, hinder taxation process and contribute to
low income from tobacco tax.
Indonesia and Philippines, given the same
geographical landmark (archipelagic) and population
density, share almost the same struggles regarding
tobacco control. Whilst being densely populated
(Indonesia 3rd most populous and Philippines 12th
most in the world), Indonesia has same trend with
Philippines in terms of tobacco cigarette
consumption. Philippine is regarded as one of the
nation with highest level of cigarette consumption
among ASEAN, same with Indonesia. Indonesia has
36% of total adult population who is currently
smoking; while Philippine adult population shares
total prevalent of 28.3% (MOH, 2013; Bellew et al,
2015). Although, the ratification by in Philippine in
2005 made difference between both countries in
terms of political commitment.
Policy papers published by the government will
provide insight on government’s commitment
towards the issue. Based on the differences on the
current status on FCTC, it is expected that
Philippines has been taking several steps ahead in
terms of implementing tobacco strict regulation.
Moreover, it is expected from the study that
legislative papers by both countries may give
landmarks of political decision regarding tobacco
control between two countries. In addition, by
looking at the content of both, insight of the
governments as well as its directions can be
assessed.
2 METHOD
We examine 36 circulating legislative articles
regarding tobacco regulation and conduct content
comparative analysis throughout documents. The
content of the paper was analysed, and compared in
descriptive manner in given matrix. There are
aspects assessed based on content on both papers,
referring to requirements that is stated in FCTC, of
which divided into regulating both demand and
supply side, as well as protection of health (World
Health Organization, 2005). The beginning analyse
aspects such as characteristic of the paper and target
population the document is aimed to. The main
content of papers from both countries was analysed
and compared referring to Article 6 to 14 in the
FCTC. There are two distinct variables, such as: 1)
smoke free are status, and 2) tobacco advertisement,
promo and sponsor rule of conduct in both countries.
Main contents were distinguished in qualitative
manner, and compared in matrix for highlighting
differences which accounts to the discussion.
Secondary data backup were also considered
upon creating the study. Data was gathered from
Campaign for Tobacco-Free Kids (CTFK) database
which enables extraction on policy content regarding
tobacco regulation across Asia. Permission was
granted from the officials to use such data for the
sake of study completion.
The ethical consideration was taken upon
completion of study. All data was described and
compared using Microsoft Excel®.
3 RESULT
Generally, as seen in Figure 1, documents observed
from both two countries are mostly composed of
legislative papers. Meanwhile, Philippine has one
recommendation guideline that is established as part
The Commitment of Government in Tobacco Control: Content-Comparison Analysis on Policy Documents
229

of policy paper regarding tobacco control, mainly in
safeguarding negotiation with tobacco control.
Meanwhile, Indonesia has regulated a standard of
procedure that is currently circulating mainly in
regulating nicotine containment test.
Figure 1: Characteristics of analysed papers
Figure 2: Target group of policy documents
Figure 2 shows the target population of each rule
of conduct is aimed to. Policies regarding tobacco
regulation are mostly directed towards general
population as a whole. However, there is a slight
variation on target of policy based on legislative
documents between two countries. While exceeding
in amount, Philippines published regulations
towards tobacco industries not only towards
protection of public and, but also to tobacco
industries and stakeholders.
Table 1: Smoke Free Status of Philippine and Indonesia
No Smoke Free Status
I
D
P
H
1 Indoor Work
p
lace R R
2 Indoor Public Places R R
3 Public Trans
p
ort
Taxis R SF
Bus & Trains R SF
Public Transport facilities (terminal,
Station)
R SF
4 Govt. Facilities R SF
5 Hospitals R SF
6 Healthcare Facilities
Public Areas R SF
Patient Rooms R SF
Non-residential R SF
9 Schools & Universities
Preschools R SF
Primary & Secondary R SF
Universities R SF
10 Dine Places
Restaurants R R
Bars/Pubs R R
Casinos R R
Abbreviations: SF = Smoke Free; R = Restricted; U =
Uncertain; ID = Indonesia, PH = Philippines
Table 1 depicts the undergoing regulation for
both countries in terms of smoke free area status.
Public protection from cigarette smoking is priority
decision in order to prevent afterward health effects.
Smoke free area is regarded as highlight of smoke
protection policy in regional level.
Between two countries, there is a significant
difference in terms of enforcement on smoking ban
in certain public places. Philippines has enforced
ban on certain public places, while Indonesia have
not banned cigarette in several area that is deemed
for public. Most of this area, according to FCTC Art
8, should be smoke free (World Health
Organization, 2005). While Philippine has made
public transport and government facilities totally
smoke free, Indonesia only restricts its use.
Indonesia also hasn’t made health facilities and
school totally smoke free, although prohibition is
already enforced to both facilities. Based on analysis
of both countries’ policy papers, we believe also
Indonesia, while has restricted tobacco use, has not
made vital public places to be 100% smoke free.
While some may see restriction as national
prohibition, some sub-national laws may not agree;
thus highlight the difference between terms
restricted and smoke-free. While smoke free allows
all level of law to prohibit and enforce law to
cigarette smoking, restrictions may vary especially
in sub-nationals, e.g. districts and regional law.
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230

Table 2: Comparison in Advertisement, Promotion, and
Sponsor
No Forms of APS ID PH
1 Domestic TV and radio R B
2 Domestic news
p
a
p
er and ma
g
azines R B
3 Printed domestic media R B
4 International tv and radio U U
5 International news and magazines U U
6 Internet communications R B
7 Internet tobacco
p
roduct sales R R
8 Outdoor advertising (e.g. Billboards,
p
osters
)
R B
9 Point of sale advertisin
g
/
p
romotion A A
10 Point of sale
p
roduct dis
p
la
y
AA
11 Vending machines B R
12 Conventional mail A R
13 Telephone and cellular mail A R
14 Brand markin
g
on
p
h
y
sical structure R R
15 Tobacco
p
acka
g
in
g
RA
16 Free distributions of tobacco products B R
17 Promotions with a tobacco product
p
urchase
B R
18 Competitions associated with tobacco
p
roducts
A R
19 Direct person to person targeting with
individuals
A R
20 Brand stretching/trademark
diversification
B R
21 Reverse brand stretching or brand
sharin
g
A A
22 Toys that resemble tobacco product R A
23 Candies that resemble tobacco
p
roduct
R A
24 Retailer incentive
p
ro
g
rams A A
25 Paid placement of tobacco products in
TV, film, or other media
B B
26 Unpaid depiction of tobacco use or
p
roducts in media
R R
27 Tobacco industry sponsorship of
events activities, individuals,
or
g
anizations or
g
overnments
R R
28 Publicity or financial sponsorship by
tobacco industry
R R
29 Promotion by any means that are
false, misleadin
g
, or dece
p
tive
R A
Abbreviations: SF = Smoke Free; R = Restricted; U =
Uncertain; ID = Indonesia, PH = Philippines
From the table 2, we can see some differences
between two nations mainly in terms of promotion
and advertisements. While Indonesia only restrict
domestic advertisements (TV, radio, magazines),
Philippines already banned domestic commercials
regarding to tobacco. In addition, Philippines also
banned internet use of tobacco promotion, as well as
outdoor advertising; while Indonesia limits it.
In several aspects, Indonesia has exceeded
Philippines regarding advertisements and sponsor.
Indonesia has already fully-banned free distribution
of tobacco products, especially for promotional
purpose; while Philippines only restrict it. In terms
the availability of tobacco product vending machine,
while Philippines still limits its availability,
Indonesia has already erased its practice. Moreover,
compared to Philippines, Indonesia has been firm in
restricting the packaging of tobacco products, while
there is no such regulations act on Philippines.
In terms of pictorial health warnings, there are
only slight differences. Both countries have
committed mainly in giving warnings in packaging
as well as advertisements. In general, Philippines
allow larger picture in their package (50%
proportions of package) rather than Indonesia (40%
proportions of package).
4 DISCUSSION
FCTC lays a perspective of policy commitment
towards tobacco control, and usually is shown
effective after it has been ratified. While Indonesia
hasn’t agreed on the matter, evidence shows that
Indonesia has been catching up its national law in
implementing such measure. The differences need to
be seen directly from policy of both countries. In
addition, although the variables of control in FCTC
use measures of MPOWER as their indicator of
control, it is not valid in Indonesia since it is not yet
able to stand in positive side of FCTC.
Several differences arise when Indonesia is
being compared to countries with similar
background. Take example, Philippines. Given the
matching background of population, also the
prevalence of the smoker to the number of
population, the country gives as great example.
Moreover, the Philippines’ archipelagic nature
makes the nation also fights the same setback as
Indonesia does.
One of the examples is regarding the differences
of enforcement in smoke free-area. It is evident from
the study observation that Indonesia has lower
commitment in enforcing law in smoke-free area.
This has been contradictory in every developing
country. Nepal, for example, has been providing this
law since 2007 (Sussman et al, 2007). Philippines, as
a comparison in the study, also have implemented
the same measure.
Enforcing smoke-free law area, while it has been
effective, it also correlates with good
implementation measures within one country. The
The Commitment of Government in Tobacco Control: Content-Comparison Analysis on Policy Documents
231

implementation strategy is up to the country, such as
by collaborating with local ask forces and other
related bodies in enforcing punishment to those who
disobey (Goel et al, 2014) . The implementation of
such policy is proven to decrease comorbidities
caused cigarette in a long period (Lee et al, 2011).
This can be an evident for Indonesia to implement
total smoke-free law. Although the national
commitment is absent, the subnational law is
currently underway. One of the examples is the
Jakarta provincial decree of smoke-free law.
Subnational and local regulation can be strengthened
in spite of the absence of national consensus.
Meanwhile, pictorial health warnings shows
almost no differences. This shows both countries
had taken similar efforts despite the difference in
FCTC ratification status. However, there are one
difference, that is the size of warning in cigarette
pack. It is evident that pictorial health warning can
modify the behavior of the smoker, and that pictorial
warning lays more effective result in terms of
making smokers think about quitting (Fathelrahman
et al, 2010; Hammond, 2011; White et al, 2008).
Therefore, Indonesia may benefit from adopting
same regulation in pictorial health warnings.
In terms of advertisement of tobacco related
product, being compared to Philippines, Indonesia
still is permitting advertisements both in aired and
printed media. This has a strong correlation to
increased consumption especially in youth
(Edwards, 2017). In addition, if we let it, this can
harm the country and banning it is proven to lay
benefit in the long run (Levy et al, 2008). Strong
willing in the body of government, with or without
the boost from ratification, is undeniably required.
On the other hand, promotion of tobacco
products that is currently allowed in Philippines also
needs to be straightened out. This also includes
promotions with a tobacco product purchase, and
granted availability of tobacco-product vending
machines in the countries. This is dangerous
especially if directed to high-risk target, such as kids
and adolescents. In the other hand, USA and
Indonesia, while haven’t ratified FCTC and being
largest market of tobacco, has banned such
promotions (Deyton et al, 2010; Henriksen, 2012).
5 CONCLUSION
Considering the efforts made between two countries
in terms of tobacco control, several aspects need to
be considered. While FCTC ratification has boosted
progress in several aspects in tobacco control,
several aspects has progressed especially when
nations have its own national tobacco control unit. In
terms of tobacco control, being compared to
Philippines, generally Indonesia has a lot to catch up
on. In addition, while national consensus awaits,
other efforts such as local and subnational law
should be undertaken, specifically regarding the
smoke free area.
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