Tobacco consumption in Southeast Asia has dropped dramatically over the past two decades, at least in per capita terms, according to a new report from the World Health Organization (WHO).
Between 2000 and 2020, smoking prevalence in the region fell from 54% to 23%, an achievement that demonstrates “strong political commitment, comprehensive policies and community engagement,” said Catharina Boehme, officer-in-charge of WHO Southeast Asia, in a statement earlier this month.
Experts say the decline shows the success of long-term public health initiatives.
Most Southeast Asian countries have strengthened their policies on taxation, packaging, advertising bans and public smoking restrictions, said Yvette Van Der Eijk, assistant professor at the National University of Singapore’s Saw Swee Hock School of Public Health.
“These measures have made tobacco products less accessible and less socially acceptable,” she told DW.
However, while the WHO has hailed the region’s progress as a major public health success, some researchers have questioned the logic behind its definition of the Southeast Asian region.
The organization includes India within its Southeast Asia category, while placing Indonesia, the region’s largest country, in the Western Pacific region. Most other international bodies classify India as South Asia and Indonesia as part of Southeast Asia.
This inconsistency makes it difficult to compare the WHO’s figures with other datasets. A Lancet study published in June found smoking rates declined significantly in most Southeast Asian countries between 1990 and 2021, but the absolute number of smokers has risen by around 63%.
This is largely due to population growth, from roughly 440 million people in 1990 to more than 700 million today.
Tougher laws, higher taxes
Despite these statistical caveats, experts say the region has made undeniable progress. Singapore was one of the first countries in the world to ban tobacco advertising and smoking in public places in the 1970s.
Thailand became the first country in Asia, and the first low- or middle-income nation globally, to adopt plain packaging for tobacco products in 2018.
The introduction of large health warnings on cigarette packs, the creation of smoke-free environments in most public places and comprehensive bans on nearly all forms of direct and indirect advertising have played a major role in reducing consumption, Nuntavarn Vichit-Vadakan, the founding dean of the Faculty of Public Health at Thammasat University in Thailand, told DW.
Southeast Asian countries have also followed best-practice measures set out in the WHO Framework Convention on Tobacco Control (FCTC).
Across the region, governments have raised excise taxes to deter smokers. In the Philippines, the average price of a pack of 20 cigarettes rose by 263% between 2009 and 2021 due to additional levies, according to government data.
Economic cost of smoking
The politics of anti-smoking legislation make financial sense for most governments. Smoking-related illnesses are estimated to cost Southeast Asian economies between 1% and 2% of GDP each year in lost productivity and health care expenses, a major concern for a region that must maintain high growth rates to sustain development.
In Malaysia, for instance, tobacco-related health care and productivity losses amount to roughly 1.7% of GDP, while tobacco tax revenues contribute less than 0.9%.
Indonesia scraps a planned tobacco tax hike
One notable exception is Indonesia, where an estimated 72% of men use tobacco, one of the highest rates in the world. The country remains the only one in Southeast Asia that has not ratified the WHO’s FCTC framework.
According to official estimates, smoking-related costs amount to around $25 billion (€21.4 billion) annually, or 2.6% of GDP.
The Global Tobacco Industry Interference Index ranks Indonesia as the third-worst country globally in terms of tobacco industry influence over government policy. Most other Southeast Asian states rank around the middle of the index.
Earlier this month, Indonesia’s new finance minister, Purbaya Yudhi Sadewa, announced that he would scrap a planned increase in tobacco excise taxes for next year.
He argued that annual tax hikes since 2014 have merely pushed most smokers toward illegal cigarettes, which he intends to crack down on.
Critics noted that his decision came just hours after a meeting with the Indonesian Cigarette Manufacturers Association, which has lobbied aggressively against further tax hikes.
Vaping dilemma
Meanwhile, Southeast Asia also faces a new challenge: the rapid rise of e-cigarettes.
Brunei, Cambodia, Laos, Singapore and Thailand have banned vaping outright, while Vietnam this year prohibited the sale and possession of e-cigarettes.
The WHO has warned that vaping is becoming increasingly popular among adolescents aged 13 to 15, with around 7.2% using e-cigarettes globally.
Data on vaping in Southeast Asia remains limited, but researchers are increasingly concerned about “dual use,” when smokers take up vaping but continue to smoke cigarettes.
Moreover, the vaping bans are primarily aimed at preventing youth vaping, as young people are the main target of the vaping industry, said Van Der Eijk. “The goal is to avoid creating a new generation of nicotine users while existing smokers continue to receive support through proven cessation programs,” she added.
Other Southeast Asian states, however, remain hesitant to crack down on vaping. In Malaysia, efforts to outlaw e-cigarettes have repeatedly run into political resistance.
A 2015 attempt to ban vape products was dropped after politicians argued that doing so would hurt small Malay-Muslim business owners.
The vaping industry is now estimated to be worth around $830 million in Malaysia, with about 10,000 retailers nationwide. Most of them are owned by members of the Malay-Muslim community — the same group that is increasingly turning its political support away from the ruling coalition.
With Prime Minister Anwar Ibrahim’s government struggling to keep Muslim-Malay voters in their camp, analysts say the tobacco industry is exploiting political sensitivities to block tighter regulation.
Edited by: Srinivas Mazumdaru
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