Policy incoherence and tobacco control in Indonesia: an analysis of the national tobacco-related policy mix

Abstract

IntroductionIndonesia has a high smoking prevalence that has not diminished significantly since 1990. Considering this, we aim to summarise the existing national tobacco-related policy mix and explore markers of policy incoherence in tobacco control between 2014 and 2020.MethodsWe conducted (1) a review and synthesis of Indonesian tobacco-related legislation and regulations; (2) a systematic search and synthesis of related literature and news reporting; and (3) interviews with tobacco control activists and academics to understand political will towards tobacco control regulations and the tobacco industry.ResultsIndonesia’s existing tobacco-related policy mix lies across the president’s office, six national ministries and one independent agency. However, current responsibility lies primarily with four government ministries: Ministries of Health, Finance, Communication and Information, and Trade and Industry, with the Ministry of Finance most active. Evidence demonstrates that official interministerial collaboration was lacking from 2014 to 2020 and suggests that institutional will to introduce more effective tobacco control varies considerably between different arms of government.DiscussionPolitical will differs according to ministerial mandates and priorities, fostering a fragmented policy approach and undermining the development of a coherent response. Without political will from the president or national parliament to create an overarching framework for tobacco control, either via ratification of the Framework Convention on Tobacco Control or another mechanism, there remains no formal impetus for intragovernmental cooperation. Nonetheless, this analysis reveals some government progress and ‘pressure points’ that advocates can focus on to promote tobacco control policies within the current policy mix.

Tobacco industry influence in low- and middle-income countries in the ASEAN region: Qualitative interviews with tobacco control experts during the COVID-19 pandemic

“…The findings also revealed how political factors hinder tobacco control in LMICs in the region, including lack of enforcement of TAPS restrictions, insufficient fines to deter violations, and lack of government leadership to institutionalize tobacco control. While these results align with what has been revealed in Indonesia 22,23 , the current study suggests that these challenges occur more broadly throughout LMICs in the ASEAN region.…”

“…According to one study, policy adoption in Indonesia had been constrained by the industry’s lobbying practices, a complex bureaucratic process, political corruption, and the relatively low bargaining power and resources of the Ministry of Health and tobacco control advocates 22 . Further work utilizing document analysis and interviews with tobacco control experts demonstrated that Indonesia’s tobacco-related policy mix was fragmented across various ministries, which lacked the political will, institutional processes, and an overarching national framework to implement an effective policy response 23 . While these findings illustrate some of the factors influencing tobacco control in Indonesia, the only ASEAN country yet to ratify the FCTC, to the authors’ knowledge, no studies have explored experts’ insights on tobacco industry interference in ASEAN LMICs that have adopted the FCTC convention and are pursuing policies in line with its articles.…”

Political Economy Analysis of Health Taxes (Tobacco, Alcohol Drink, and Sugar Sweteened Beverage): Case Study of Three Provinces in Indonesia

“…The rationale for choosing these diverse commodities as the focus of the study is to investigate the political economy in light of their distinct attributes and characteristics. Furthermore, our focus is exclusively on the sub-national level, as there is an abundance of evidence regarding the political economy of health taxation in Indonesia at the national level (20,21,23,(36)(37)(38)(39). The next section will describe the methodology and analytical approach used in this study, followed by results, and finally discussion and future recommendation.…”

How Do National Laws Filter Down to the Local? Tobacco Control Regulations and Smoke Free Areas in a Decentralised Indonesia

“…Local governments have emerged as important sites for tobacco regulation around the world (Ackerman et al, 2016; Enrich and Davidson, 1998). In Indonesia, since national laws pertaining to health require local legislatures to issue implementing regulations, local governments are, essentially, required to play a role in tobacco control (Kramer et al, 2021). This particular responsibility applies to the implementation of Government Regulation (Peraturan Pemerintah, PP) No.…”