Ariesta Milanti, BSN, RN, MHC, Public communication committee, Indonesian Oncology Nurses Association
In the global map of the tobacco issue, Indonesia holds some prominent figures. According to the World Health Organisation data, Indonesia ranked first in the prevalence of tobacco smoking (76.2% among males aged 15 years) (WHO, 2015). This number is estimated to keep increasing by up to 82.5% by 2020 (WHO, 2015). More than 97 million Indonesian people are exposed to the tobacco smoke (Ministry of Health Republic of Indonesia, 2013). On the other hand, Indonesia is the 6th leading tobacco-producing country in the world (FAO, 2017), and in the top five countries with the highest level of tobacco industry interference (Assunta, 2019). Additionally, Indonesia is the only country in Southeast Asia that has not ratified the Framework Convention on Tobacco Control/FCTC (WHO FCTC, 2018).
In Indonesia, more than 230,000 tobacco-related deaths occur every year; in which lung cancer contributes as the highest cause of cancer death (Ministry of Health Republic of Indonesia, 2015). With the increasing trend of smoking in a younger population less than 15 years old, this figure is very likely to increase (National Development Bureau Indonesia, 2017). Most smokers in Indonesia are those with lower levels of education and socio-economics and live in the villages.
The above overview may give a hint on how severe the tobacco problem is and how arduous it can be for tobacco control advocacy in Indonesia. Despite the myriad challenges, Indonesian nurses through the Indonesian Oncology Nurses Association (IONA) are keen to contribute to it. That is why we take the ISNCC position statement on tobacco control very seriously. In our national meeting, we learned it and decided to translate its key points into our national agenda. We are compelled by the statement that nurses should take the lead in tobacco control activities.
Therefore, we organised a tobacco-control campaign in seven provinces throughout Indonesia (link to the article here). It was a major event to mark IONA’s anniversary. The cancer nurses conducted public education talks about tobacco control at the hospitals and community and called the attendees to write down their anti-tobacco commitment statements. It was both exciting and rewarding for us to be able to do more for the community, apart from our daily practices at the oncology wards or units.
But as the event was concluded, so was our tobacco control advocacy book. We had no idea on how to sustain the agenda or how to implement a more comprehensive intervention encompassing the educational and cessation programs – let alone advocating policy. We may be powerless – or even clueless – in public health advocacy.
Reflecting on our attempt to create an advocacy program for tobacco control which embarked on the ISNCC position statement, we come up with several questions. Which area of tobacco control advocacy should we start with and how? How can we build our capacity on this matter? How to mobilize resources? How can we build a base of support locally and internationally?
We have a strong hope for ISNCC to lead an orchestrated effort for the cancer nurses in Indonesia, as in other low- and middle-income countries, to carry out tobacco control advocacy. Despite having the main focus to strengthen our cancer nursing competency, in our national cancer nurse organization, we are aware of the importance to spare our energy for urgent public health issues such as tobacco problems in our country. We cannot wait until we are fully ‘enhanced’ as the cancer nurses, but around us, more Indonesians start smoking at a very young age and keep smoking until they are old, and more patients are suffering and dying from tobacco-related cancer. We need to do better.
Assunta, M. (2019). Global Tobacco Industry Interference Index. In Global Center for Good Governance in Tobacco Control (GGTC). Retrieved from https://exposetobacco.org/wp-content/uploads/2019/10/GlobalTIIIndex_Report_2019.pdf
FAO. (2017). Tobacco.
Ministry of Health Republic of Indonesia. (2013). Riset Kesehatan Dasar (RISKESDAS) 2013. Laporan Nasional 2013, 1–384. Retrieved from http://www.depkes.go.id/resources/download/general/Hasil Riskesdas 2013.pdf
Ministry of Health Republic of Indonesia. (2015). Data and information on cancer situation (Data dan Informasi Kesehatan Situasi Penyakit Kanker). Buletin Kanker, 1(1), 1–5. https://doi.org/10.1007/s13398-014-0173-7.2
National Development Bureau Indonesia. (2017). Modul sinkronisasi RPJMD-RPJMN bidang kesehatan dan gizi masyarakat (Module of development plan synchronisation in public health and nutrition).
WHO. (2015). Tobacco use data by country. Retrieved from http://apps.who.int/gho/data/node.main.65
WHO FCTC. (2018). Progress report on regulatory and market developments on electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS): Report by the Convention Secretariat. Retrieved from http://www.who.int/fctc/cop/sessions/cop8/FCTC_COP_8_10-EN.pdf