Bali Declaration: Is it the clarion call to #endTobacco ?

Shobha Shukla / Bobby Ramakant *

7th Asia Pacific Summit of Mayors (7th APCAT Summit or #APCAT2022) in Bali, Indonesia

Tobacco use is among the unhealthy behaviours that result in preventable burden of cancers, strokes, and heart diseases, said Budi Gunadi Sadikin, Indonesia’s health minister. In Indonesia tobacco use is the second largest risk factor for untimely deaths, he added. World Health Organization had earlier underlined that without clamping tobacco use, we cannot deliver on the promises enshrined in the Sustainable Development Goals.

Indonesia has walked the talk on building a grounds-up movement against tobacco. In 2011, twelve Mayors had come together to forge a Mayors’ Alliance to advance tobacco control in their respective cities. Today in 2022, there are over 150 Mayors of different Indonesian cities that are part of this Alliance, who are adapting as well as enforcing local laws to reduce tobacco use, said Dr Bima Arya Sugiarto, Co-Chair of Asia Pacific Cities Alliance for Health and Development (APCAT) and Mayor of Bogor City in Indonesia. “Mayors’ Alliance has been the main driver for banning tobacco advertising and promotion, as well as preventing tobacco industry interference in public policy” he said.

Both were speaking at the opening ceremony of 7th Asia Pacific Summit of Mayors (7th APCAT Summit or #APCAT2022) being held in Bali, Indonesia.

Another sterling example of grounds-up tobacco control movement in Indonesia is the fact that “as of November 2022, over 300 cities have adopted the local smokefree laws,” said Dr Bima Arya.

That is why Indonesian health minister called for stronger partnerships “to reduce tobacco use” and “expand the on-the-ground effective programmes for tobacco control.”

“I would like to extend my gratitude to Mayors who have passed local smokefree laws. It is important for central government to collaborate with local governments to achieve tobacco control,” said the Indonesian health minister.

Despite alarming levels of tobacco industry interference, it is indeed commendable that Mayors and sub-national leaders of Indonesia have been able to advance tobacco control.

Agrees Kelly Larson of Bloomberg Philanthropies: “We acknowledge the role of sub-national leaders in Indonesia and commend the Mayors of over 300 cities who have passed local smokefree laws, that protect 75% of the country’s population from the hazards of tobacco smoke.” Kelly Larson shared that prioritising tobacco control and public health in New York resulted in increased life expectancy of 2 years for its citizens.

Not surprisingly, tobacco industry and its front groups are trying to create hurdles when local sub-national leaders try to advance tobacco control and health promotion. Effective enforcement of strong tobacco control laws hurt the industry profits. For instance, in 2017, Bogor City had become the first Indonesian city to implement a point-of-sale tobacco display ban as part of its smokefree law. But soon after a legal battle ensued. Finally, in February 2020, the city of Bogor won the court case when Supreme Court had upheld its ban on the display of tobacco products at point-of-sale.

While exposing how tobacco industry approaches election candidates to influence public policy, Mayor of Bogor City Dr Bima Arya said in 7th APCAT Summit opening session that “every candidate of local elections was approached by the tobacco industry…”

#APCAT2022 Declaration gives hope for a better tomorrow

"We, the delegates of the 7th Asia Pacific Summit of Mayors, recognize that APCAT is a vital platform to share experiences, shape local actions, and secure greater leadership as well as look for synergistic actions between specific health and development programmes.

We commit to accelerate progress towards eventually ending tobacco use, as well as preventing the avoidable burden of NCDs, eliminating Tuberculosis, and improving synergy between health and development programmes and promoting integrated responses where possible, thereby reducing disease burden and averting untimely deaths, by:

- Leading effective implementation of tobacco control programmes that include smokefree environments; a complete ban on tobacco advertising, promotion, and sponsorship; promotion of larger graphic health warnings with plain packaging on tobacco packs; smoking cessation programmes; and a ban on electronic cigarettes, heated tobacco products, shisha, and other similar products;

- Working with national government and policy makers to raise taxes and prices on unhealthy commodities (such as, but not limited to, tobacco products, alcohol, sugary and sweetened beverages);

- Ensuring accountability to prevent interferences and rejecting funding, logistics, donations, or grants from, and partnerships with, any entity related to any unhealthy commodity industries (such as, but not limited to, tobacco, alcohol, sugary and sweetened beverages);

- Investing in tobacco control for prevention of tuberculosis, non-communicable disease, and stunting. It includes smoking cessation in TB and NCD clinics, and family health programs; universal screening for TB and NCDs

- Adopting One Health approaches and processes to ensure that “a healthy city is a resilient city”.

Every tobacco-related death is preventable

The 7th Asia Pacific Summit of Mayors, which opened today in Bali, Indonesia, is jointly organised by the Asia Pacific Cities Alliance for Health and Development (APCAT), Ministry of Health, Republic of Indonesia; Ministry of Home Affairs, Republic of Indonesia; National Centre for Health Promotion, Ministry of Health, Cambodia; Bloomberg Philanthropies; Cities of Bogor, Denpasar and Klungkung of Indonesia; Balanga City, Philippines; Association of All Health Offices Indonesia (ADINKES), Indonesia Mayor and Regent Alliance, Indonesian Public Health Association; Udayana Central; Campaign for Tobacco Free Kids, Vital Strategies; Tobacco Free Generation International, The International Union Against Tuberculosis and Lung Disease (The Union); APCAT Parliamentarians and Asia Pacific Media Alliance for Health and Development (APCAT Media).

Over 1000 national and sub-national leaders, public health experts are attending the 7th APCAT Summit in Bali, Indonesia in person and virtually. Participants include mayors, governors, ministers, members of parliament, tobacco control advocates, and media from across the Asia Pacific region.

Over 8.67 million people die of tobacco use every year (out of which one million die due to second and third-hand tobacco smoke). Despite the crippling onslaught of COVID-19 public health emergency and humanitarian crises, tobacco industry has heightened its deceptive strategies to protect and expand its markets. In addition to the mountainous death toll and avoidable disease burden, tobacco use has also resulted in an annual economic loss of nearly USD 2 trillion to the global economy.