The Framework Convention on Tobacco Control (FCTC) and implementation of tobacco control policies: Lessons learned from Indonesia and Thailand

• Published date: 01 December 2022
• Author: Faizal Rahmanto Moeis,Renny Nurhasana,Fandy Rahardi,Danty Novitasari,Ni Made Shellasih, Inayati, Murwendah,Paibul Suriyawongpaisal,Roengrudee Patanavanich,Suci Puspita Ratih
• Date: 01 December 2022
• DOI: http://doi.org/10.1002/wmh3.534

Received: 12 August 2021

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Revised: 26 January 2022

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Accepted: 1 February 2022

DOI: 10.1002/wmh3.534

ORIGINAL ARTICLE

The Framework Convention on Tobacco

Control (FCTC) and implementation of

tobacco control policies: Lessons learned

from Indonesia and Thailand

Faizal Rahmanto Moeis

1

|Renny Nurhasana

2,3

|

Fandy Rahardi

1

|Danty Novitasari

2

|Ni Made Shellasih

2

|

Inayati

4

|Murwendah

4

|Paibul Suriyawongpaisal

5

|

Roengrudee Patanavanich

5

|Suci Puspita Ratih

6

1

Institute for Economic and Social Research,

Faculty of Economics and Business,

Universitas Indonesia, Depok City,

West Java, Indonesia

2

Urban Studies Program, School of Strategic

and Global Studies, Universitas Indonesia,

Central Jakarta, DKI Jakarta, Indonesia

3

Center for Social Security Studies, School of

Strategic and Global Studies, Universitas

Indonesia, Central Jakarta, DKI Jakarta,

Indonesia

4

Department of Fiscal Administrative

Science, Universitas Indonesia, Depok City,

West Java, Indonesia

5

Department of Community Medicine, Faculty

of Medicine Ramathibodi Hospital, Mahidol

University, Bangkok, Thailand

6

Department of Public Health, Faculty of

Sports Science, Universitas Negeri Malang,

Malang, East Java, Indonesia

Correspondence

Renny Nurhasana, Urban Studies Program,

School of Strategic and Global Studies,

Universitas Indonesia, Central Jakarta, DKI

Jakarta, Indonesia.

Email: rennynurhasana@ui.ac.id

Funding information

Campaign for Tobacco‐Free Kids (CTFK)

Abstract

The threat that the tobacco epidemic poses to public

health underscores the importance of comprehensive

tobacco‐related regulation. Despite aiming to reduce the

prevalence of smoking, Indonesia still falls short of this

goal. In contrast, within the same region, Thailand's

achievement in controlling tobacco serves as a potential

role model for Indonesia. To understand the issue, we

conducted a literature review of the current regulatory

framework as well as the implementation of the World

Health Organization's Framework Convention on

Tobacco Control (FCTC) and MPOWER framework in

both countries. The review was supplemented with a

Focus Group Discussion and an in‐depth interview with

stakeholders in Thailand and Indonesia. This study finds

that: (1) Indonesia currently lacks a strong tobacco

control policy champion, whereas Thailand has several

authorities that focus on the issue; (2) Thailand's

tobacco product advertising and promotion and smoking

bans are more restrictive compared to Indonesia's

policies; and (3) Thailand's policies on tobacco pictorial

health warnings, pharmacotherapy, and excise taxes are

more extensive than Indonesia's. We recommend that

Indonesia ratify the FCTC as the foundation of tobacco

control policies while also strengthening and coordinat-

ing organizations working on tobacco control, encoura-

ging subnational governments to introduce regulations,

and enforce control, as well as improving excise policies

to reduce the affordability of tobacco products.

World Med. & Health Policy. 2022;14:750–772.wileyonlinelibrary.com/journal/wmh3750

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© 2022 Policy Studies Organization.

KEYWORDS

Framework Convention on Tobacco Control, MPOWER, tobacco

control

Key Points

•Indonesia has yet to make significant progress in

reducing smoking prevalence.

•Comprehensive tobacco control regulations are needed.

•Indonesia currently does not have a strong tobacco

control policy, while Thailand has several authorities

that focus on this issue.

•Indonesia needs to ratify the FCTC as a cornerstone

of tobacco control policies and strengthen regulations

on tobacco control.

INTRODUCTION

Considering the significant and global threat of the tobacco epidemic to public health, there

have been many attempts to persuade governments to implement tobacco control policies.

However, tobacco control regulations have not been effective in controlling the prevalence

of smoking in Indonesia. The WHO (2021) estimated that the daily prevalence of smoking in

Indonesia's adult population (aged 15 years or higher) stands at 31%, which remained

relatively unchanged from 2008. The trend of smoking prevalence in Indonesia's youth

(aged 10–18 years) was even worse; the number increased to 9.1% in 2018 from 7.2% in

2013 (Ministry of Health of the Republic of Indonesia, 2018), indicating that smoking

behavior has begun to increase in the last few years. Smoking has been known to lead to

direct health consequences, such as lung cancer and cardiovascular diseases (Kondo

et al., 2019; Lee, 2018), as well as indirect adverse effects, such as stunting and poverty

(Dartanto et al., 2018; Semba et al., 2008,2011). Therefore, it is crucial for Indonesia to

make a serious attempt to tackle the issue of tobacco control. Fortunately, it can learn useful

strategies from its neighbor to combat the tobacco problem.

One nation that has been making tremendous efforts in implementing tobacco control

policies is Thailand. As one of the first countries in Southeast Asia to sign the WHO's

Framework Convention on Tobacco Control (FCTC), the government of Thailand has taken

drastic measures over the course of several years to reduce tobacco prevalence in the

country. While Thailand does not have the lowest smoking prevalence among Southeast

Asian countries (see Figure 1; WHO, 2021), the number comes close to the region's average

and is far lower than Indonesia's. As such, Thailand's achievement in taking measures to

implement tobacco control serves as an interesting comparison and potential role model for

Indonesia.

The difference between Thailand's and Indonesia's tobacco control policies may initially

be attributed to the FCTC, which Thailand has ratified but Indonesia has not. Craig et al.

(2019) showed that the FCTC was reported to have benefited the whole process of

establishing tobacco policies and regulations in 12 countries. Therefore, a government's

stance on the FCTC may eventually be reflected in the implementation of tobacco control

policies. In line with the FCTC, the WHO introduced MPOWER in 2008. Aiming to assist

countries in reducing the demand for tobacco, MPOWER is a package comprising six

tobacco control measures: (1) monitor tobacco use and prevention policies (M), (2) protect

people from tobacco smoke (P), (3) offer help to quit tobacco use (O), (4) warn about the

FCTC AND MPOWER IN TOBACCO CONTROL

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