Forewords

The 5th edition of the Atlas updates tobacco issues in ASEAN during a time like no other.

The COVID pandemic has dominated the health agenda during the last two years. The tobacco industry has exploited every moment to use COVID to attempt to shift its image from a vilified business to a trusted health partner, and to make and maximize contact with policy-makers and health professionals, contravening WHO FCTC Article 5.3. It has distributed free masks bearing industry logos, ventilators and protective equipment amid a flurry of publicity. The tobacco companies are in the process of producing COVID vaccines, with headlines such as 'Tobacco to the rescue.'

Throughout the pandemic, the industry has interfered with government tobacco control policies at many levels, continuing to sell cigarettes and make profits while stepping-up sales and marketing of vape and heated tobacco products. These tactics are rightly exposed by the STOP campaign, the Tobacco Industry Interference Indexes, and also now in the ASEAN Atlas.

The silver lining of COVID is that it has given the health sector an unprecedented opportunity for communicable and non-communicable diseases to find a common cause - with non-communicable disease risk factors of smoking, obesity and chronic illness contributing to the COVID epidemic. Smokers, vapers and waterpipe users are all at increased risk of catching COVID and/or increased risk of severe COVID and death.

With the publication of this 5th edition, the series of Tobacco Control ASEAN Region Atlases is now established as a valuable source of information on the 10 ASEAN countries. The stunningly simple, colourful, graphic format - based on sound data - is immediately understandable. The series of atlases also documents progress (and obstacles) over a time framework since the first edition in 2013.

There is bad news and there is good news between the pages: the bad news is that ASEAN countries continue to be a target for tobacco and e-cigarette market growth. Tobacco industry interference remains the biggest barrier to developing, implementing, and enforcing strong and effective tobacco control policies in most ASEAN countries.

The good news is that all countries are implementing measures to reduce the epidemic, slowly but surely. There is no quick fix, but the Atlas calls on countries in the region to step up action - now - to reduce the economic and health harm of tobacco.

Professor Dr. Judith Mackay

Director
Asian Consultancy on Tobacco Control

As the COVID-19 pandemic and response enters its third year, we must also continue our work on the many other health challenges our Region faces - one of the most urgent of which is the tobacco epidemic, which claims 8 million lives globally and 1.4 trillion US dollars in health expenditures and lost productivity every year.

In the 16 years since the WHO Framework Convention on Tobacco Control (WHO FCTC) entered into force in 2005, great strides have been made. Globally, the prevalence of tobacco use among adults aged 15 years and older has been on a steady decline. A similar trend has been observed in the ASEAN region, as countries continue to adopt stronger tobacco control policies. For example, several countries have adopted standardized packaging, and all ten ASEAN countries have now implemented pictorial health warnings. Most ASEAN countries have also taken steps to protect their public health policies from tobacco industry interference.

However, we still have a very long way to go. Close to a quarter (22.5%) of adults in this region are regular smokers; and a staggering 546 billion cigarettes were sold to children and adults last year in the 10 ASEAN countries. The fight against tobacco is far from over. It is imperative that countries continue to take more decisive, innovative, and strategic action to accelerate progress in tobacco control.

We must also stay vigilant in combating the tactics of the tobacco industry, which never ceases to market death and disease, even during the pandemic. The tobacco industry has long attempted to circumvent tobacco laws and regulations, and will continue to do so, as well as using the cover of “corporate social responsibilities” to improve its image. Right now, the tobacco industry is spreading misunderstanding about novel and emerging tobacco and nicotine products, in order to attract new generations of users to its products and renormalize tobacco use.

To protect the gains we have made in tobacco control and further accelerate progress in the future, now more than ever, countries need to make implementation of the WHO FCTC front and centre of their sustainable development policies and strategies. The WHO FCTC is the most powerful and effective tool we have in the fight against the tobacco epidemic, and tobacco control is an investment in sustainable development.

To support these efforts, the Tobacco Control Atlas: ASEAN Region tracks the progress of tobacco control efforts - and closely monitors the activities of the tobacco industry - in ASEAN countries. The Atlas is an important reference for policymakers, researchers, and advocates to identify gaps, formulate strategies to advance tobacco control.

Congratulations to SEATCA on the launch of the 5th Edition of the Tobacco Control Atlas for the ASEAN Region. The Atlas is a much needed, timely, renewed call to action, urging all of us in the health and non-health sectors, as well as civil society and academia to act now to integrate tobacco control into pandemic recovery and broader health, social and economic development efforts.

Dr. Takeshi Kasai

Regional Director
WHO Regional Office for the Western Pacific

In the South-East Asia Region and across the world, tobacco use is a major health and development threat. The world has nearly 1.3 billion tobacco users. This leads to more than 8 million deaths annually, including around 1.2 million from exposure to second-hand smoke. Most tobacco-related deaths occur in low- and middle-income countries, which are often targets of intensive tobacco industry interference and marketing. The WHO South-East Asia Region is home to an estimated 432 million adult tobacco users and accounts for 1.6 million tobacco-related deaths annually. The Region is among the top tobacco consuming and tobacco producing regions in the world.

WHO continues to support countries of the Region to take evidence-based action to reduce tobacco use among all demographic groups, in line with the Region's Flagship Priority on preventing and controlling noncommunicable diseases (NCDs). As highlighted in the fourth edition of the WHO global report on trends in prevalence of tobacco use 2000 - 2025, between 2000 and 2015, estimated tobacco prevalence in the Region declined from 46.6% to 31.2% - the fastest rate of decline among all WHO regions.

Amid the COVID-19 response, countries have continued to strengthen implementation of the WHO MPOWER package, drawing on considerable momentum. In 2018 Thailand became the first country in Asia to adopt standardized (plain) packaging. DPR Korea, Nepal, India, Thailand, Timor-Leste and Sri Lanka have banned the use of Electronic Nicotine Delivery Systems. The Region continues to contribute to global tobacco control, including through the FCTC Global Knowledge Hub on smokeless tobacco in India; the Knowledge Hub to track tobacco industry interference in public policymaking in Thailand; and the Centre for Combating Tobacco in Sri Lanka.

To build on these and other successes, I welcome this fifth edition of the Tobacco Control Atlas for the ASEAN region, produced by the South-East Asia Tobacco Control Alliance. As every edition, the Atlas provides the Region's three ASEAN countries - Indonesia, Myanmar and Thailand - an array of useful statistics, many in vivid graphic formats, which will enable them to review progress, identify opportunities, and accelerate progress towards our time-bound targets and goals. I urge stakeholders in policy, civil society and across sectors in ASEAN and beyond to make full use of this resource, as together we advance towards the tobacco endgame, a healthy, and tobacco-free South-East Asia Region for all.

Dr. Poonam Khetrapal Singh

Regional Director
WHO South-East Asia Region

ASEAN Member States have sustained efforts to reduce tobacco use and its impact to public health, economy, and society in line with the WHO Framework Convention on Tobacco Control (FCTC) and the United Nations 2030 Sustainable Development Goals. ASEAN countries carried out a wide range of programmes to address tobacco use, from raising awareness on the dangers of tobacco use, smoke-cessation to smoke-free campaigns, or banning tobacco advertisements, marketing, and sponsorships, to instituting hefty taxes on the sale of tobacco products.

However, tobacco use continues to be a major public health issue in the ASEAN region. In addition to the increasing negative impact on the health and lives of the people in the region, there persists a market which is so huge for the tobacco industry to let go. We see the tobacco industry employing various strategies and tactics - from philanthropy and corporate social responsibility, use of lobby groups, to confrontational legal challenges, among others - all of which are aimed to subvert, hinder or undermine national tobacco control efforts.

The ASEAN, guided by its vision and by the ASEAN Socio-Cultural Community Blueprint 2025, envisages a healthy, caring, and sustainable Community. The ASEAN addresses the challenges and risks associated with tobacco use through regional advocacy and awareness, guideline development and implementation, monitoring and reporting of tobacco control efforts led by the ASEAN Health Sector in cooperation with non-health sectors and various partners.

I take this opportunity to express our appreciation to valuable contributions of the Southeast Asia Tobacco Control Alliance (SEATCA), a strong technical partner of the ASEAN Health Sector since 2011 in its efforts to reduce tobacco consumption. We look forwarded to the continued and expanded cooperation with SEATCA as the ASEAN Health Sector, through the ASEAN Post-2015 Health Development Agenda and the ASEAN Health Cluster 1 on Promoting Healthy Lifestyle, determine the priority regional initiatives on tobacco control, which is one the sector's strategic health priorities.

I also welcome the publication of the fifth edition of the Tobacco Control Atlas: ASEAN Region. The Atlas will be a critical resource for policy makers, government agencies, civil society organisations and other partners of ASEAN Member States in crafting innovative and effective policies, programmes, interventions, and partnerships that will strengthen the implement of the WHO FCTC in ASEAN. The Atlas is also a crucial reference in further shaping regional cooperation in tobacco control as ASEAN Health Sector finalizes its work programme for the next five years.

I also congratulate SEATCA and all its partners for coming up with this brilliant work.

H.E. Ekkaphab Phanthavong

Deputy Secretary General of ASEAN for ASEAN Socio-cultural Community

This fifth edition of SEATCA's Tobacco Control Atlas continues to track national tobacco control progress across the ASEAN region in accordance with the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), which is the globally recognized minimum standard for all governments that are serious about reducing tobacco use, saving lives, and promoting public health.

All countries are making slow but progressive improvements in the implementation of WHO FCTC measures despite the COVID-19 pandemic. Certainly, one milestone to highlight since the 4th edition is that three ASEAN countries are the first in Asia to require standardized (plain) tobacco packaging: Thailand (2019), Singapore (2020), and Myanmar (full compliance in 2022).

Still, the ASEAN community continues to be a target of the tobacco industry, not only for its usual harmful products, but also for its newer electronic smoking products that are a growing threat to the sociopolitical gains made by countries in recent years. It is quite alarming that e-cigarette use is catching up with and, in some countries, even exceeded cigarette use among youths. The need to accelerate implementation of tobacco control measures in line with the WHO FCTC remains as urgent as ever, if countries are to significantly reduce tobacco use and achieve the UN 2030 Sustainable Development Goals.

SEATCA remains committed to stand with ASEAN countries in this protracted battle waged by the tobacco industry against public health and to support country efforts to fast-track implementation of tobacco control measures that protect and promote health and save lives.

We are deeply grateful to all of our country partners from all 10 ASEAN countries and TFI/WHO country offices for their ever-valuable contributions, as well as our SEATCA team, without which this new edition would not be possible.

We hope that, like past editions of the atlas, this fifth one will be as informative and useful to health advocates and partners in ASEAN countries and around the world, and we welcome all comments and suggestions for its further improvement.

Tan Yen Lian, M.A.

Knowledge and Information Manager
SEATCA

E. Ulysses Dorotheo, MD, FPAO

Executive Director
SEATCA