JAKARTA, KOMPAS -The number of smokers and passive smokers continues to grow. Health costs to treat smoking-related diseases also continue to swell each year. However, policies regarding smoking control are considered still ambiguous and half-hearted.
Mustamin, 51, a resident of Depok, West Java, had a heart attack while driving a car on Jl. HR Rasuna Said, Jakarta, in April last year, an incident he cannot forget. He suffered a pain on the left side of his chest, was sweating and found it difficult to breathe. He stopped his car and asked for help.
With the help of an office security guard, he was taken to a clinic. The doctor who examined Mustamin suspected a heart attack and referred him to a nearby private hospital.
The hospital doctors found a blockage in Mustamin’s coronary arteries that required the installation of a ring to widen the blood vessels. "At that time, it cost Rp 170 million," Mustamin said in Jakarta, Sunday.
Mustamin is a civil servant and registered as a participant of the national health insurance (JKN) program. Because the hospital did not have any cooperation agreement with the Healthcare and Social Security Agency (BPJS Kesehatan), he was referred to Cipto Mangunkusumo hospital for the ring to be installed.
"All my health indicators at that time were good, including my cholesterol levels. The doctors suspected the heart attack was triggered by my smoking habit," he said. Mustamin smokes at least one pack of cigarettes a day.
Mustamin is only one of the 70 million smokers over 15 years of age in Indonesia in 2017. This number is based on the assumption that the prevalence of smokers in 2013 was 36.3 percent. In fact, since 1995, the prevalence of smokers has increased every year.
The average age that people start smoking is also falling as the ban on selling cigarettes to children under 18 years of age is not fully implemented. It is also caused by the fact that there is no prohibition on buying individual cigarettes, as well as the habit of adults smoking in front of children.
Basic health research in 2013 suggested that there were 48.4 million people smoking an average of 12 cigarettes per day. They spent a total of Rp 605 billion buying cigarettes every day. So, in 2013, the Indonesian people spent Rp 221 trillion just on smoking.
Health impact
General secretary of the Association of Indonesian Pulmonary Specialists, Agus Dwi Susanto said smoking not only affected the respiratory tract and lungs. From the lungs, the chemicals and toxic substances entered the blood vessels to the heart and spread to all the body’s organs. "Nicotine causes thickening of the blood vessel walls so they become narrow," he said.
Consequently, the narrowing of small blood vessels in the brain can trigger a stroke, while narrowing in the coronary arteries can cause coronary heart disease, in the genital area it can cause impotence, while in the umbilical cord it can cause fetal defects.
In addition, carbon monoxide from the cigarettes binds to blood hemoglobin 300 times more strongly than hemoglobin’s bond with oxygen. This results in a lack of oxygen in the blood, which also triggers cardiovascular disease.
Meanwhile, cigarette tar contains more than 60 carcinogenic substances that can cause cancers in the mouth, on the tongue and in the nasopharynx (upper throat) area. Non-oxidative free radicals also trigger inflammation of the glands in the nasal cavity and cause bronchitis.
Costs
Smoking has a negative impact on all the body’s organs, making cigarette a strong risk factor for catastrophic diseases and high-cost and high-risk diseases. "Cigarettes are a risk factor that contributes to the onset of catastrophic diseases," said head of BPJS primary care Fachrurazi.
In 2014-2016, about 20-25 percent of JKN’s total health care costs were used to treat eight catastrophic illnesses, including heart disease, kidney failure, cancer and stroke.
In 2016, the total cost of treatment for these eight catastrophic illnesses totaled Rp 14.58 trillion, or 22 percent of JKN’s total health care funds of Rp 67 trillion. Heart disease and strokes accounted for 13 percent of total costs.
However, the complexity of the body’s systems and uniqueness of each individual means the cause of catastrophic disease is not only from smoking. Research on global health conducted decades ago demonstrates that smoking control is also key to reducing catastrophic cases of degenerative diseases.
Therefore, BPJS external relations and public health department head Irfan Humaidi said that there should be a new policy to reduce the number of smokers. The policy must be changed to reduce the cost of tobacco-related illnesses.
Tobacco bill
Amid the rising impact of smoking on the quality of life for Indonesia’s population and JKN’s rising health care costs, the House of Representatives has proposed a draft tobacco law. The bill has however been accused of accommodating the interests of tobacco farmers and the tobacco industry.
Chair of the national commission on tobacco control, Prijo Sidipratomo, considered the tobacco bill as a threat to public health.
"Although it is claimed to accommodate public health interests, the contents of the bill will boost cigarette production," he said. The health clauses in the bill were weaker than those in existing regulations. He pointed out the tobacco bill proposed the elimination of pictorial health warnings on cigarette packages and for written warnings to be restored.
Health Ministry Director General of Disease Prevention and Control Mohamad Subuh said from the beginning the Health Ministry had rejected the tobacco bill because it was against the National Medium Term Development Plan, which targeted a reduction in smokers under 18 years old. (ADH/MZW)
