Smoking is a major killer in Indonesia - Jimmy Walsh
‘Support Smoke Free Jakarta’ reads a sign posted at the front entrance of the Century Park Hotel, an international class hotel in Jakarta’s Senayan area. When I first stayed at this hotel a few years ago, it offered rooms on designated smoking and non-smoking floors. But now it is almost completely smoke free; the only part of the hotel where smoking is permitted is the outside bar area. By contrast, many other top hotels in Jakarta still have dedicated smoking floors.
The Century Park’s decision to go smoke-free and advocate a smoke free Jakarta doubtless reflects a commercial judgment by its owners and managers. But it also reflects increasing activism on the part of anti-smoking groups following the country’s transition to democracy. This activism has led to increasing concern about the popularity of smoking in Indonesia and its negative effects on people’s health and welfare.
A nation of smokers
More than one-third of Indonesians aged over 10 years smoke according to Ministry of Health figures. And the number is rising. Between 1995 and 2010 the proportion of men who smoke rose from 53 per cent to 66 per cent while the proportion of women rose from 1.7 per cent to 4.2 per cent. With such a large number of smokers, passive smoking – that is, the involuntary inhalation of smoke from other people’s cigarettes – is also extremely widespread. An extraordinary 78 per cent of adult Indonesians are exposed to passive smoke at home according to the 2011 Global Adult Tobacco Survey.
At the same time, smokers are getting hooked at ever younger ages. Between 2001 and 2010, Ministry of Health figures suggest that the number of people who started smoking between the ages of 10 and 14 rose by 80 per cent, while the number who started between five and nine years of age quadrupled. In 2010, two-year old toddler Ardi Rizal became an internet sensation when video footage of him puffing away on cigarettes went viral on YouTube. Severely obese, he was reportedly consuming 40 cigarettes a day until he did a deal with his parents to quit smoking in exchange for new toys. His case, the many similar ones that have since been reported in the mass media, and the widespread nature of passive smoking illustrate graphically that Indonesia’s smoking problem affects people of all ages.
The health and welfare effects of this epidemic are immense. According to one recent study published by the International Union Against Tuberculosis and Lung Disease, smoking kills at least 200,000 Indonesians each year while also contributing to lower economic productivity through reductions in physical functioning, lung capacity, and more frequent illness. It also reduces welfare – particularly in poor households – to the extent that cigarette purchases often displace spending on necessities such as food, clean water, health care and education.
Driven by concerns about these issues, anti-smoking organisations – the most prominent of which are the National Commission on Tobacco Control, the National Commission for Children’s Protection, the Anti-Corruption Coalition on the Tobacco Clause, and the Indonesian Women Without Tobacco Association – have lobbied actively in recent years to persuade Indonesia’s political leaders to introduce stronger controls on the advertising, sale and consumption of tobacco. And with the support of some figures in government, such as the late Health Minister Dr. Endang Rahayu Sedyaningsih (who ironically died from lung cancer in early 2012), they have had some success.
In 2009, Indonesia’s national parliament enacted a new Health Law that included tobacco in its list of addictive substances and provided for the establishment of dedicated Smoke Free Zones in public places. In August 2011, President Susilo Bambang Yudhoyono said that he would support a proposed government regulation on tobacco control that, among other things, requires cigarette producers to provide pictorial as well as written warnings on cigarette packets and prohibits children from buying, selling and consuming cigarettes (although this regulation has still not been issued). Finally, many regional governments have moved to implement the 2009 Health Law’s requirement for Smoke Free Zones in their respective regions: in December, Vice Minister for Health, Ali Ghufron Mukti, announced that 58 district-level governments and three provincial governments (Jakarta, Bali and West Sumatra) had passed regional regulations providing for such spaces.
Tobacco fights back
Anti-smoking groups have not had things all their own way, however. The country’s smoking lobby – the key elements of which are major cigarette producers such as Gudang Garam, Djarum, British American Tobacco, and Philip Morris; groups representing tobacco farmers; and smokers’ rights groups – has actively resisted efforts to impose controls on tobacco at virtually every stage. Cigarette barons have good political connections and enormous financial resources at their disposal – they are among Indonesia’s wealthiest people according to rankings published by magazines such as Forbes and GlobeAsia – and tobacco farmers are well organised and arrange effective public protests. Together they have had the capacity to frustrate, if not completely stop, anti-smoking groups’ efforts to promote reform.
For instance, it is widely believed that major cigarette companies persuaded President Yudhoyono against appointing Nila Djuwita Anfasa Moeloek, the wife of a well-known anti-smoking campaigner, as Health Minister in 2009. It is also believed that they successfully bribed legislators in the national parliament to remove articles in the 2009 Health Law referring to tobacco as an addictive substance before it was signed by the President (although, once the changes to the law were publically exposed, Yudhoyono subsequently insisted that the missing articles be reinserted into the law).
Members of the smoking lobby have also challenged parts of the Health Law through the Constitutional Court, winning a case last year that forced the Jakarta city administration to annul a 2010 regulation prohibiting smoking in workplaces and public places. The ruling makes it compulsory for government and privately-owned buildings to provide dedicated smoking areas.
Finally, over the past year tobacco farmer groups have actively lobbied against the proposed government regulation on tobacco control, threatening to vote informal at the next national elections if it is enacted. This political challenge has clearly swayed the views of some politicians and appears to be the main reason why the proposed government regulation on tobacco control has not been issued so far.
How this contest between pro and anti-smoking groups will play out in the future remains to be seen. But what is clear is that the issue is not as straightforward as perhaps it should be. The politics surrounding the issue means that there is a real prospect that the health of millions of Indonesians, including many children, will be sacrificed to serve the narrow interests of powerful cigarette companies and tobacco farmers. For politicians, the issue is, and will continue to be, a major test of political will.
Andrew Rosser (firstname.lastname@example.org) is associate professor of development studies and an Australian Research Council Future Fellow at Adelaide University.