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Indonesian teachers group declares anti-tobacco stance

Ahead of World No Tobacco Day on May 31, Indonesia’s largest teachers group signed on Wednesday a declaration to underline the role of educators in supporting measures for tobacco control.

http://www.thejakartapost.com/news/2017/05/24/indonesian-teachers-group-declares-anti-tobacco-stance.html

Created by the Indonesian Teachers Association (PGRI), the declaration consists of six points, which include teachers’ commitment to “protect students from the dangers of smoking” and “oppose CSR [Corporate Social Responsibility] campaigns from the tobacco industry.”

Teachers also called on the government to create a comprehensive tobacco control regulations to curb cigarette consumption.

“Teachers have to be role models for their pupils by not smoking […] Exemplary acts by teachers are very strategic in the [anti-tobacco] campaign,” PGRI chairwoman Unifah Rosyidi said at the declaration’s signing event in Kuningan, South Jakarta, on Wednesday.

The event was organized by the National Commission on Tobacco Control (Komnas PT), a coalition of organizations that has been staunchly campaigning for tobacco related issues in Indonesia, one of the world’s biggest tobacco consumers.

Komnas PT chairman Prijo Sidipratomo welcomed the declaration, saying that it was in line with one of PGRI’s missions to support the country’s development.

“Some 25 percent of students’ daily time is spent at school, which highlights the role of teachers in shaping their way of life,” Prijo said. (rin)

What’s keeping Indonesia, China addicted to smoking?

A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”

Is tobacco bill really necessary?

Last week we learned that President Joko “Jokowi” Widodo verbally rejected a proposal from lawmakers for a new tobacco bill that would increase protection of the industry and production of cigarettes. However, he finally gave written agreement for discussion by government and the legislature about the proposed law.

http://www.thejakartapost.com/academia/2017/03/24/is-tobacco-bill-really-necessary.html

Smoking and the tobacco industry have long been big business here with well documented impacts on national, family and individual economies, health and welfare. Today I call on activists concerned for the people of Indonesia to reject the proposed tobacco law, which threatens the health and well-being of our people. It is in conflict with prevailing laws on health and other fields.

We must also raise our voices to point to positive action that the government can take to address some key concerns of the President — an increase in revenues and the welfare of tobacco farmers and workers in the cigarette industry.

A review of some basic facts about smoking and tobacco in Indonesia makes clear the importance of acting promptly.

Among the country’s 255 million people, an estimated 65 percent of adult males are regular smokers, making Indonesia the second-largest cigarette market in Asia after China. Furthermore, in Indonesia the rate of smoking among women has increased rapidly in recent years. This threatens not only the health of these women, but that of their babies and children. Smoking while pregnant increases the risk of miscarriage, low birth weight and respiratory problems in children after birth.

A child growing up with a mother or father or both smoking is at risk in multiple ways. Children’s health may be permanently affected by second-hand smoke in the house. Furthermore children may associate smoking with “being adult” and rush to start smoking themselves leading to early, long-term addiction.

Finally, the households of smokers, particularly low-income families, live with cruel competition for family funds between expenditure on cigarettes and expenditure on good nutrition, clothing, school books and basic medical care. Research shows that it is often the basic needs that lose out — a punishment for the whole family that falls particularly hard on children who are building bones, brains and muscles.

As a pediatrician I would like all parents to be disciplined, caring and active in promoting the best possible life chances for each of their children. Yet science and global experience make clear that the addictive nature of cigarette smoking, peer-group pressure among young people and alluring cigarette advertising makes it easy to start lighting up. Later, smokers find it difficult or impossible to shake the habit.

Therefore I argue not only against the proposed bill.

I also suggest four important actions that could eventually help reduce the threat of smoking to people’s health, thus reducing individual and health expenditure, increase revenue, improve the situation of tobacco farmers and help cigarette factory workers.

First, accede to the Framework Convention on Tobacco Control (FCTC). This global public health treaty aims to reduce tobacco-related causes of ill health and death through cutting legal and illegal supply and demand for tobacco, and protection of health and the environment from tobacco-related damage. Having been adopted by 180 of the 193 UN member states, Indonesia is one of only 13 which is not yet a party to the convention.

Second, increase revenues from tobacco and smoking. The expansion of cigarette production and sales in the proposed bill is presented in terms of expansion of employment opportunities and income for the government.

Yet this increase can be achieved without the bill by increasing the price of a pack of cigarettes (20 sticks), now at US$ 1.40, among the world’s lowest. A significant increase in price will automatically increase revenues from taxes and excises, which benefits the national and regional levels.

Increasing the price would both raise revenue and reduce smoking among the young and the poor -meaning lower treatment costs of tobacco-related diseases.

Third, protect and develop tobacco farmers. Since independence, Indonesia has worked to improve its citizens’ productivity, health services and welfare. There is already a law for the protection and empowerment of farmers (Law No. 19/ 2013). Presidential or other government regulations with special focus could fully meet the needs of tobacco farmers.

Also urgent are special efforts to support farmers wanting to transit out of tobacco farming but without the resources for the startup investment, including training, equipment, seeds etc.

Fourth, protect and attend to the welfare of cigarette factory workers. Similar to farmers, there are laws and regulations that could be used to address their special needs as the industry evolves. And it is clear that even if the cigarette industry expands production in line with the proposed law, it would not expand employment, given the industry’s preference for the speed, efficiency and simplicity of mechanized production.

Layoffs of workers and the shift from hand-rolled cigarettes to mostly mechanized production is already well advanced – 75 percent of kretek (clove-based) cigarettes is now machine rolled. Thus the new law would unlikely provide any significant new employment or support for workers displaced by mechanization.

So is the proposed tobacco bill needed to raise revenues and protect agricultural and factory workers in the industry? No. If we are concerned about the people, their health and well-being, the proposed tobacco bill is clearly unnecessary!

***

The writer is presently leaders’ envoy and board chair for the Asia Pacific Leaders’ Malaria Alliance (APLMA). She served as health minister (2012-2014) and chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria (2013–2015)

Indonesia tobacco bill would fire up output despite health fears

Indonesia’s parliament has proposed a draft law that could lead to a sharp increase in tobacco output in a country that is already a top producer with one of the heaviest rates of smoking in the world.

http://uk.reuters.com/article/uk-indonesia-tobacco-idUKKBN16M1FK

Indonesia’s tobacco industry employs millions of workers and contributes almost 10 percent to government revenues through taxes, but has faced a backlash from the health ministry and anti-smoking organizations.

Health Minister Nila Moeloek said her ministry “definitely” opposes the tobacco bill as it has the responsibility to “safeguard the health of the people”.

The bill, which covers production, distribution and excise taxes, has to be approved by President Joko Widodo.

Indonesia’s industry minister, Airlangga Hartarto, said the government has to assess how the tobacco bill would affect existing regulations for the industry.

Firman Subagyo, the parliament member who initiated the bill, played down health concerns, saying tobacco is a “strategic” commodity that can increase the prosperity of Indonesian farmers and state revenues.

“Health should not be used as an excuse to destroy people’s livelihood,” Subagyo, who comes from Indonesia’s second-biggest political party, Golkar, said in an interview on Wednesday.

Under the draft law, manufacturers of tobacco products have to use locally sourced tobacco for at least 80 percent of their production, while imports of ready-to-use cigarettes may be subject to an excise tax of 200 percent.

‘RATIONAL PRICING’

Abdus Setiawan, a board member at the Indonesia Tobacco Growers’ Association, said he welcomed the draft law as it could help to protect farmers. But an increase in production should be balanced with “rational pricing”, he said.

Indonesia was the world’s fourth-biggest cigarette producer with an output of 269.2 billion sticks in 2015, according to the latest data from research firm Euromonitor International. The market was valued at 231.3 trillion rupiah (£14.20 billion).

Nearly two-thirds of men are smokers in Indonesia, where an average pack of cigarettes costs less than $2.

Major cigarette companies operating in the country include Phillip Morris-controlled PT Hanjaya Mandala Sampoerna Tbk, Djarum Group and PT Gudang Garam Tbk.

Sampoerna, through its tobacco suppliers, has partnered with about 27,000 tobacco farmers in Indonesia and gets almost three-quarters of its tobacco domestically, said Elvira Lianita, Sampoerna’s head of fiscal affairs and communications.

However, the industry’s total tobacco requirements have outpaced the domestic growth in tobacco output, Lianita said. Restricting access to raw materials through import regulations or taxes would disrupt the “overall economic stability”, she said.

“Partnership programs, not risky restrictions, would be the solution to bridging this gap and increasing farmer prosperity,” she added.

Gudang Garam and Djarum declined to comment.

(Reporting by Eveline Danubrata and Agustinus Beo Da Costa; Additional reporting by Cindy Silviana and Jakarta Newsroom; Editing by Ed Davies and Bill Tarrant)

Indonesia’s Child Tobacco Workers in Peril

In the next week, Indonesian President Joko (“Jokowi”) Widodo will decide whether to encourage parliament to move forward with a draft tobacco bill aimed at increasing domestic tobacco production. The bill would gut many important existing health regulations, like the requirement that companies include a health warning with a picture on the label of tobacco products.

Those are troubling proposals given that millions of children in Indonesia start smoking each year, and that 40 million more are “passive smokers” from secondhand smoke. The Indonesian Ministry of Health, 17 prominent health organizations, and many others have denounced the measure as an attempt to undermine Indonesia’s already weak tobacco control laws. Jokowi should reject the bill.

But the draft bill is not the only tobacco policy issue awaiting action by the Jokowi administration. Each year in Indonesia, thousands of children, some just 8 years old, work in hazardous conditions producing tobacco that ends up in products marketed and sold by huge Indonesian and multinational tobacco companies.

My colleagues and I published a Human Rights Watch report documenting hazardous child labor on Indonesian tobacco farms last May. Since then, another tobacco season has come and gone, but the child workers behind Indonesia’s tobacco industry remain unprotected.

We interviewed 132 children who worked on tobacco farms in four of Indonesia’s biggest tobacco-producing provinces. We found that child workers are exposed to nicotine and pesticides—toxins that can be especially harmful to children who are still growing and developing. Half the children we interviewed had experienced nausea, vomiting, headaches, or dizziness while they worked. Those symptoms are consistent with acute nicotine poisoning, which happens when workers handle tobacco plants and absorb nicotine through their skin. Many children said they also mixed and sprayed toxic chemicals on the plants with no protective equipment, and some became violently ill afterward.

The families we interviewed did not intentionally put their children in harm’s way. They were committed to helping their children get an education so they could have a better future.

Indeed, most of the children we interviewed attended school and worked in tobacco farming only outside of school hours.

But direct contact with tobacco in any form is hazardous work for children because of the nicotine in the leaves. Most of the families we spoke with had never received comprehensive information about the hazards for children of work on tobacco farms, so they did not know the risks to their children.

We urged the Jokowi government to take action to protect children from danger in tobacco fields. We called on the Health Ministry to work with other ministries to develop a public education campaign to raise awareness of the dangers to children of work on tobacco farms. In recent meetings with Human Rights Watch, government officials have said they need additional support and resources to get the campaign underway this year.

Indonesia already prohibits children under 18 from work “with harmful chemical substances.” The Ministry of Manpower and Transmigration should explicitly prohibit children from working in direct contact with tobacco in any form and increase labor enforcement efforts to make sure government inspectors check for workers’ safety, especially on small tobacco farms where children might be in danger.

In our meetings with government officials, we have heard many times that the tobacco industry is powerful in Indonesia, and that it is difficult to achieve policy changes the industry opposes. Surely eliminating child labor in tobacco farming is an issue tobacco companies also want to address.

The UN Guiding Principles on Business and Human Rights make clear that companies have responsibilities for addressing human rights abuses in their supply chains. We shared our findings with the largest tobacco companies operating in Indonesia—Djarum, Gudang Garam, Philip Morris International (which owns Sampoerna), British American Tobacco (which owns Bentoel), and others. The large multinational tobacco companies have policies to prevent children from doing the most dangerous tasks on tobacco farms, but their policies are not strong enough, and they should do more to monitor for child labor when they buy Indonesian tobacco on the open market through traders.

The largest Indonesian companies—Djarum and Gudang Garam—do not appear to be taking any steps to prevent or address child labor in their supply chains. They have never responded to our many requests for information and meetings, and they do not make any information publicly available about their child labor policies.

These companies should not be profiting off the backs of Indonesian child workers.

Two months from now, the next tobacco-growing season will be underway, and children will be heading to the fields again. The controversy around the draft tobacco bill likely will not be resolved by then. But with decisive action, the Jokowi administration and tobacco companies could take steps to protect children from dangerous work in tobacco fields. Their futures depend on it.

Metro TV welcomes plan to ban cigarette ads

http://www.thejakartapost.com/news/2017/01/14/metro-tv-welcomes-plan-to-ban-cigarette-ads.html

Metro TV news director Suryapratomo said Friday that the private TV station welcomed lawmakers’ plan to ban cigarette advertisements on television and radio, saying that a ban would not significantly affect its revenue.

“Lawmakers have the right to make any regulation. But I hope the House of Representatives carries out comprehensive discussion before making a final decision,” Suryapratomo told The Jakarta Post on Friday.

He added that a ban would have minimal impact on Metro TV, as cigarette ads contributed only a small portion to the company’s revenues.

“So please do ban [cigarette ads on TV] if you want. Metro TV does not make much from cigarette ads. We also don’t air cigarette ads frequently on our TV station,” Suryapratomo emphasized.

TV stations are currently allowed to air cigarette ads only after 10 p.m. However, the government may issue a total ban on cigarette ads on TV and radio, with a draft bill comprising stipulations of a ban awaiting deliberation at the House.

The House is expected to start deliberations this month and has assured that it will include various stakeholders in the discussion to gain comprehensive insight.

Cigarette ad ban aims to protect children, lawmaker says

The House of Representatives’ plan to ban tobacco companies from advertising their products on television and radio aims to protect young audiences, says a lawmaker.

http://www.thejakartapost.com/news/2017/01/13/cigarette-ad-banaims-to-protect-children-lawmaker-says.html

Lawmaker Elnino M. Husein Mohi argued that cigarette advertisements could be easily viewed by children.

“Broadcasting companies run the industry using state-owned frequency, which is supposedly used to help build good character,” Elnino told The Jakarta Post on Friday, adding that smoking did not help build positive character. “The plan to ban cigarette advertisements is basically meant to protect youngsters from the campaign”.

The politician from the Gerindra Party explained the House had included stipulations to ban such advertisements in a draft bill on broadcasting to amend a prevailing law passed in 2002. The current draft was initiated by the House.

Elnino, a member of House Commission I overseeing defense, foreign affairs and information, however, ensured that Commission I would open the deliberation process to the public to include relevant stakeholders in the discussion.

“We are aware of the complexity of the issue. Therefore, deliberations will later invite insights from various stakeholders, including the broadcasting industry, so that we can obtain a comprehensive understanding before passing the bill into law,” he emphasized. (dmr)

Indonesia may ban cigarette advertisements from TV, radio

The government may completely ban tobacco companies from advertising their products on television and radio in the future, according to a tobacco watchdog.

http://www.thejakartapost.com/news/2017/01/12/indonesia-may-ban-cigarette-advertisements-from-tv-radio.html

The National Commission on Tobacco Control (Komnas PT) said on Thursday that the latest draft of the broadcasting bill stipulated that the content of a broadcast advertisement was prohibited from promoting alcohol, cigarettes, and other addictive products. The bill is a revision of Law No. 32/2002 on broadcasting.

“The banning of [tobacco] advertisements, promotion and sponsorship in the bill is a policy by the House of Representative that is progressive and conforms to the Health Law and several Constitutional Court rulings,” Komnas PT law and advocate department member Muhamad Joni said.

Joni pointed out that the latest draft of the bill indicated the country was showing progress in tobacco control efforts as previous drafts did not contain such stipulations.

“The House has proven to be in favor of tobacco control and the public’s protection. Therefore, the bill must be secured in its deliberation process until it is passed,” Joni said. (dan)

Hiking tobacco excise alone won’t reduce smoking: Finance Ministry

The Finance Ministry doubts that the increase in tobacco excise can reduce the prevalence of smoking in the country, arguing that the regulation needs to be combined with non-fiscal policy to make it more effective.

http://www.thejakartapost.com/news/2016/12/20/hiking-tobacco-excise-alone-wont-reduce-smoking-finance-ministry.html

Suahasil Nazara, the ministry’s fiscal policy office (BKF) head, said besides gradually increasing excise tax, educating people about the negative impact of smoking and preventing youths from purchasing tobacco products also were equally important.

“I don’t believe that increasing excise tax will reduce the prevalence of smoking. We need to use a combination of fiscal and non-fiscal policies,” he said in a discussion on cigarettes at Hotel Borobudur in Central Jakarta.

In eight years, the number of tobacco factories had gone down from 4,669 in 2007 to 714 in 2015, which reflected the recent decline in cigarette production. The fact implied that production had decreased in line with market forces, he said.

The government’s argument was slammed by Hasbullah Thabrany, a professor of public health at the University of Indonesia’s School of Public Health, who said the reason behind the declining number of tobacco companies was because many small companies—mostly hand-rolled cigarettes—were unable to compete with big firms.

The Finance Ministry announced in October that it had issued a regulation to increase excise taxes by an average of 10.54 percent next year for several types of cigarettes. The price increase was lower than the target set by the government this year of 11.33 percent. (win/evi)

WITH MIXED PROGRESS, NATIONS REVIEW WAR VS. TOBACCO INDUSTRY

http://macaudailytimes.com.mo/mixed-progress-nations-review-war-vs-tobacco-industry.html

In Nepal, health warnings cover 90 percent of cigarette packs, while Australia requires those packets be wrapped in drab, plain paper. Indonesia’s new ban on outdoor advertising brought down tobacco billboards depicting smiling, smoking youths. And India wants scary photos of rotting lungs and mouth tumors covering packets sold in the country.

Still, national drives to discourage smoking and cut back tobacco sales haven’t done enough, campaigners say. Smoking-related deaths are still rising worldwide, with 80 percent of them expected to occur in developing country populations by 2030.

“Most people in the United States think tobacco is over and done with, but it’s still the largest preventable cause of disease on the planet” killing 6 million people a year — or one person every six seconds, said John Stewart, deputy campaigns director at the Boston-based lobbying group Corporate Accountability International.

Starting Monday, representatives from at least 178 countries are meeting for five days in the Indian capital to discuss how they can further the fight against smoking and push back against tobacco company lobbyists.

Since they set down stiff regulations and guidelines in a landmark 2003 treaty called the Framework Convention on Tobacco Control — the first and only global treaty dealing with public health — most of the 180 signatories have ratified it and passed laws restricting tobacco advertising or sales.

Still, many governments remain entangled with powerful tobacco companies, while industry lobbyists continue attempts to stymie efforts to implement anti-smoking laws through bribery, misinformation and even suing national governments for lost profits, campaigners say.

“The tobacco industry is definitely feeling the heat,” Stewart said. “They’ve got their back against the wall.”

Indian courts are currently grappling with 62 lawsuits filed by tobacco companies or cigarette makers challenging laws requiring that 85 percent of all cigarette packets be covered with photos of medical horrors.

In Japan, a 10-percent hike in taxes on cigarettes has led to a 30-percent decline in smoking. But the country still has some of the lowest tax rates on cigarettes among industrialized nations, while its finance ministry owns 33 percent in Japan Tobacco.

The anti-tobacco campaign has had some success. It is widely accepted, at least among national leaders, that smoking causes cancer, cardiovascular and respiratory disease, along with a host of other harmful health impacts.

That awareness still has not trickled down to national populations, though. And campaigners say tobacco interests have shifted their focus to poorer, less educated populations in the developing world.

India — among the first to ratify the anti-tobacco treaty in 2004 — is still considered one of the biggest battlegrounds in the fight against the tobacco industry, public health specialists say.

Despite harsh laws passed more than a decade ago banning smoking in public and sales to children, smoking is still common across the country. A government survey in 2010 showed nearly 35 percent of adults were either smoking or chewing tobacco.

Meanwhile, more than 1 million Indians die each year from tobacco-related diseases that cost the country some $16 billion annually, according to the World Health Organization.

“The revenues that the government earns from tobacco taxes are far less than the billions that are spent on health care,” said Bhavna Mukhopadhyay of the Voluntary Health Association of India, a public health organization.

“Public health and the health of the tobacco industry cannot go hand in hand,” she said, noting that campaigners are now pushing for countries to make tobacco companies and their shareholders civilly and criminally liable for the harm done by tobacco.

Part of the trouble in India is “the Indian consumer is spoilt for choice,” she said, with cigarettes sold alongside chewing tobacco and cheap, hand-rolled smokes known as bidis.

The easy availability and wide choice means many smokers get hooked at a young age. Some are initiated early through the common, cultural practice of chewing something called gutka, which combines tobacco with spices, lime and betel nut and is widely sold as a mouth freshener.

Putting pictorial warnings on cigarette packets is an attempt to educate people about the risks.

“The idea was that even an illiterate person, or a child, would understand the message about the health risks from smoking,” said Monika Arora of the Public Health Foundation of India, who runs an anti-smoking campaign aimed at young Indians. Nirmala George, New Delhi, AP