With Southeast Asia to be one community in 2015, anti-smoking campaigners are joining forces to turn the fast-growing region into a healthy area by trying to make life difficult for smokers.
Statistics from the Tobacco Atlas convinced them to make a serious move. Tobacco killed almost six million people last year, with Southeast Asia accounting for about 20% of global smoking deaths. The Asean region, comprising 10 member states of Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Singapore, the Philippines, Thailand and Vietnam, houses about 125 million smokers, or about one-third of its total population.
Realising that this growing health crisis needs tremendous attention and cooperation among all members and partners, a work plan on tobacco control was drafted based on the Asean strategic framework on health development between 2010 and 2015.
Its seven key strategies are protection from exposure to tobacco smoke, protection of tobacco control policy from industry interference, sustainable funding for tobacco control and health promotion, price and tax measures to reduce demand, stricter measures on packaging and labelling of tobacco products, advertising promotion and sponsorship, and strengthening networking and coordinating mechanisms on tobacco control among members.
The move was engineered by the Asean Focal Points on Tobacco Control, comprising a network of regional experts and representatives from each country.
It was organised to ensure that effective measures would be set in place in line with Asean health policy and the Framework Convention on Tobacco Control (FCTC), a landmark international treaty of the World Health Organisation (WHO) adopted by 168 member countries. The aim is to bring about a smoke-free Asean with clean air for future generations.
The campaign has received backing from Asean secretary-general Surin Pitsuwan, who pledged cooperation among all members to act as "one community" in enforcing effective and sustainable tobacco control measures.
"Though free trade has been seen as a key agenda of Asean, we believe it is not enough to focus only on free trade and fair trade. Safe trade should be a primary consideration," Mr Surin told the World Conference on Tobacco or Health last month in Singapore.
It is no secret that some Asean countries still depend on the lucrative revenue from tobacco and ignore the expense caused by smoking. But Mr Surin said more political dedication towards integrated anti-smoking policies was not unachievable.
Bungon Rittipakdee, the Southeast Asian Tobacco Control Alliance director, was positive that a smoke-free environment would be a crucial strategy to start denormalising tobacco use in the region, where the smoking rate, particularly among males, is still as high as 60% in some countries.
"Smoke-free is the simplest movement in terms of cooperation among member states since it has the least conflicts in politics, economics and international relationships. Therefore, it could be the first step to strengthen the Asean partnership in a bid to tackle more difficult tasks such as taxation and tobacco smuggling in the long run," she said.
The network banks on civil society to promote a smoke-free movement. It could start by promoting smoke-free status as a first step in such places as Laos' old capital of Luang Prabang, Malacca in Malaysia, Halong Bay and Hoi An in Vietnam and Borobudur in Indonesia.
A smoke-free environment is in accordance with the FCTC, which requires all member countries to protect citizens from second-hand smoke in all public and workplaces as well as public transport. Ms Bungon said it should cover all indoor areas including airports, schools and restaurants. A strict version of regulation could also cover protection from second-hand smoke at workplaces and public places.
However, a process of translating the term "smoke-free" into law could be tricky in different countries. Singapore and Brunei already have very advanced anti-smoking policies. Singapore is the first country in the world to impose duty-paid marking on cigarettes to counter illicit trade and the first in Asia to make graphic health warnings mandatory in line with the policy of the Singapore Health Promotion Board.
But comprehensive regulations have not yet been put in place in other states. Even Indonesia and Thailand have problems. Indonesia, listed among the world's leading tobacco producers, has not even ratified the FCTC. Thailand also still has problems in putting smoke-free regulations into practice.
"Despite having the stringent Tobacco Control Act since 1992, failure to continuously exercise the law, let alone the issue of a smoke-free environment, has led to the widespread use of low-cost imported and domestic cigarette brands upcountry and has contributed to as many as 600 new smokers every day in Thailand. Most of them are teenagers," said Prakit Vathesatogkit, secretary-general of the Action on Smoking and Health Foundation.
Some locally made and imported cigarettes cost as little as 25 baht, enabling teens to afford smoking, he added.
Dr Prakit is also concerned about an indirect public relations strategy through corporate social responsibility campaigns and activities by the Thai Tobacco Monopoly, which spread from schools to universities and cinemas, although the campaigns are against national health policy and the FCTC, which Thailand has already adopted.
Ang Hak Seng, chief executive of the Singapore Health Promotion Board, said the city state could help share its best practices in tobacco control with its Asean counterparts. He was optimistic that the region could achieve a smoke-free environment despite the tobacco industry's attempts to derail the effort.
The industry has already shifted its strategy to highly visible attacks on governments to avoid fully implementing the FCTC, including threats and intimidation through legal action and campaigns against political leaders.
Tobacco giant Philip Morris last year launched legal action against Australia's government after its parliament passed legislation that bans all logos from cigarette packages. Norway, Turkey and Uruguay also faced similar legal action due to tough tobacco control measure.
Such lawsuits are deliberately designed to scare countries wishing to introduce tough anti-smoking measures because poorer countries have difficulty in bearing the financial burden of prolonged litigation, according to WHO director-general Margaret Chan.
She said strong action against smoking was still needed in spite of the aggressive tobacco industry move to undermine national policies on smoking by filing lawsuits against governments enforcing strict tobacco control measures.
"What kind of world are we living in? Why do we allow governments to be intimidated by such inappropriate action?" she told the opening of the Singapore conference attended by 2,600 delegates from 124 countries.
Anti-smoking campaigners in Asean are fully backed by the WHO, which has pledged to support member countries in reducing tobacco consumption contributing to non-communicable diseases such as heart and respiratory disease, cancer and diabetes.
"We've come a long way, bullies. We will not be fazed by your harassment," she said, referring to tobacco firms.
Apiradee Treerutkuarkul reports on health affairs for the Bangkok Post.