POST A: Designing for the next generation

Design is a complex system often difficult to define. Design activism in particular gives shape to a cause in a way that’s easy to understand and embrace, acting as a sustained platform for change.(Miles, 2019) However, not all design can resolve issues, but instead unknowingly or purposefully contribute to them. In terms of Indonesia’s smoking epidemic, design is a vital tool effectively used to promote tobacco use, whether this be through the use of public space (billboards, banners outside shop fronts), social media and television campaigns, packaging or sponsorships and endorsements of major events. The tobacco industry has and continues to connect with designers and creative culture makers successfully, with the industry increasing their economic gain through their strategic and appealing advertising schemes targeting the youth; the next generation smokers.

In Indonesia, particularly Yogyakarta the presence of smoking advertisements are everywhere. It is surprising when there is a lack of. In Reynolds ‘Tobacco Control’ she shares “…visiting the country in early 1997, I was appalled by the enormous amount of billboard and point-of-sale advertising, indigenous and multinational, so prolific it almost became a “natural” part of the Indonesian landscape.” (Reynolds, 1997)

Smoking Campaign, Borobudur, 2019 (own photo)

Fast forward 22 years later, I share in Reynolds experiences in the sense not much has changed. The lack of advertising control has enabled the tobacco industry to continue to thrive, with it living proof of how impactful design really is. With the rise of a technological era, the exposure of such design is more far-reaching than ever before, from streets to television screens, to the sponsoring of public events, social media and Youtube – media outlets that are more commonly used by Indonesia’s youth.

Gudang Garam’s GG Mild brand Youtube advertisement (2017) clearly advocates the ‘new generation’ as their audience, promoting creativity along side tobacco. Smoking continues to be promoted as a ‘social activity’ or something that is considered ‘cool’, using works by designers as an engaging technique.

Gudang Guram GG Mild Advertisement, 2017

In 2016, Global Health Action conducted a survey with high-school students to investigate how youth perceived cigarette advertising. This study revealed that cigarette ads were perceived as encouraging youths to smoke and that smoking status was consistently associated with perception of cigarette ads. (Global Health Action, 2016)

Not only is the imagery a key aspect of design, but so is placement. Banner design in particular is placed on store fronts in close proximity to schools as a subtle yet strategic method to appeal to youth. (Lamb, 2018)

L.A Bold Cigarette Billboard on Yogyakarta street, 2019, (own photo)
Clas Mild Silver cigarette advertisement on vehicle down Yogyakarta street, 2019, (own photo)

Across Indonesia, more design activism for anti-smoking initiatives is needed. Design is both the problem and the solution, and it effects everything. (Crosby, 2016)

Crosby, A. 2019, ‘Design Activism in an Indonesian Village’, MIT Design Issues, vol. 35, no. 3, pp. 50-63, viewed 19 December 2019, < https://www.mitpressjournals.org/doi/pdf/10.1162/desi_a_00549>.

Medicine Man, How does design affect our lives?, marketing agency, London, viewed 20th December 2019, <https://medicine-man.net/2017/11/07/how-does-design-effect-our-lives/>.

Nichter, M., Padmawati, S., Prabandari, Y., Ng, N., Danardono, M. & Nichter, M. 2009, ‘Reading culture from tobacco advertisements in Indonesia,’ Tobacco Control, vol. 18, no. 2, viewed 20th December 2019, < https://tobaccocontrol.bmj.com/content/18/2/98 >.

Reynolds, C. 1999, Tobacco advertising in Indonesia: “the defining characteristics for success”, viewed 20th December 2019, <https://tobaccocontrol.bmj.com/content/8/1/85.short&gt;.

Yayi P., Arika, D 2016, US National Library of Medicine, How do Indonesian youth perceive cigarette advertising? A cross-sectional study among Indonesian high school students viewed on 20th Dec 2019,<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5005365/>

POST C: Sitting down with Dhohri

After months of research, I finally witnessed Indonesia’s tobacco culture first-hand, after recently returning from a two week adventure to Java, Indonesia. From vivid billboards and consistent banner displays of tobacco advertising to the tourist attraction of Malioboro Street, covered with smokers who continue to contribute to the existing second-hand smoke within the area. The problem of tobacco in Indonesia is certainly one that is wicked and complex. I sat down with Dhohri, a Yogyakarta local and staff member at the hotel Jogja Village Inn to gain more insight on the issue and a supposed “way of life.”

I first met Dhohri when going out for lunch to Jogja Village Inn’s ‘Secang Bistro’ with a bunch of other individuals also on the university studio. His welcoming and friendly nature created an inviting presence and was a reflection of the kind-spirited and hospitable Indonesian folk I had already met across my travels. Shocked by the number of young tourists in front of him, he was interested in knowing about our visit to Yogyakarta. When I responded with “a project on tobacco” he looked in confusion and asked “why would you come to Indonesia to study tobacco?” After explaining how tobacco is a huge issue in Indonesia and our motive was to create design ideas that implement anti-smoking, he agreed that the majority of Indonesians are smokers and continued to add that “smoking pollutes the air”, highlighting smoking’s affect on others. To date, there are about 66 million active smokers and approximately 90 million passive smokers. (Afifa, 2019) Vital Strategies powerful campaign #SuaraTanpaRokok (Voices without Cigarettes) included a video of the recently deceased spokesman Pak Topo, who targeted smokers stating “I’m not a smoker. There are no smokers in my family. I also lead a healthy lifestyle… Maybe one of the causes [of my lung cancer] was that I’m a passive smoker…” (Topo, 2018)

In my conversation with Dhohri, I continued to ask him about his personal lifestyle. I learnt that he was a non-smoker and had a wife and two children. His 15 year old son also does not smoke because he attends an “educated and international school,” further implying that ones education and socioeconomic status correlates to the odds of smoking. A 2018 study has shown that adolescents in the poorest quintile had more than twice the odds of smoking compared with adolescents from the richest quintile (Global Health Action, 2018) When questioned as to why he doesn’t smoke he responded that “it is not healthy” and mentioned that Indonesians are ill informed of the health impacts. However, he went on to add that “smoking is a tradition…it is a way of life…many do it socially.” Laughing in response to my question of what could we could do to change the smoking scene, he said “it is too difficult to change…”

Dhohri in his element at Jogja Village Inn, 2019

Afifa, N., 2019, ‘Secondhand Smoke Is Much More Than Just a Smelly Nuisance’, Jakarta Globe, Jakarta, viewed 19th December 2019, <https://jakartaglobe.id/context/secondhand-smoke-is-much-more-than-just-a-smelly-nuisance>.

Cahya, G., 2019, ”I’m a passive smoker’: Sutopo leaves powerful warning against smoking before death’, The Jakarta Post, viewed 19th December 2019, <https://www.thejakartapost.com/news/2019/07/09/im-a-passive-smoker-sutopo-leaves-powerful-warning-against-smoking-before-death.html>.

Kusumawardani,N., Tarigan, I., Schlotheuber, A., 2018, ‘Socio-economic, demographic and geographic correlates of cigarette smoking among Indonesian adolescents: results from the 2013 Indonesian Basic Health Research (RISKESDAS) survey’, Global Health Action, vol.11, viewed 19th December 2019,<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990951/>.

POST D: The male strive to become a “smoking warrior”

Tobacco kills more than 8 million people each year, with there being dramatically more male users than female users worldwide. Around 80% of the world’s 1.1 billion smokers live in low-middle income countries. (World Health Organisation, 2019) Amongst these countries, Indonesia is the world’s second largest tobacco market after China, with the population of active smokers being 67.4% male and 4.5% female.(World Health Organisation, 2018) These figures demonstrate how cultural, social and gender normalities surrounding tobacco usage have provoked this nature of toxic masculinity as well as how the act of smoking is associated with ‘fitting in.’

Top Ten Cigarette Markets by Volume, 2018

A society’s cultural norms and values help mould the way gender is perceived and expressed. (Marrow, 2010) In Indonesia, the presence of tobacco has been evident since the 16th century, adapting to what is now an accepted and social necessity. (Swandewi Astuti, 2018) Due to the normalisation of smoking culture, the tobacco industry is hugely influential, therefore continuing to target the male population aggressively. It is further encouraged by the positive connotations, with smoking promoted as a ‘pleasurable’ and ‘beneficial’. Social denormalisation of smoking can provide an environment that helps smokers to quit, (Schoenaker, 2018) which is what Indonesia’s cultural demographic lacks.

A 2006 study titled ‘If I don’t smoke, I’m not a real man’ by Nawi Ng, highlighted the pressures of smoking and its engraved link to masculinity. It focused on 50 teenage boys in four schools in Purworejo District, Central Java purposely examining rural regions to collect understandings. Results found that the boys had not only emphasised that “man has always smoked”, but that smoking as an activity, increased social status amongst friends. If they smoked a ‘good’, expensive and popular cigarette brand, they felt more confident and superior to their peers. (Health Education Research, 2007)

“If we don’t follow our peers and smoke, they will call us feminine” (Health Education Research, 2007, p.798) This idea of achieving manhood is also promoted through smoking, as “A real man should be daring, courageous, confident…[and] able to prove his manliness.” (Courtenay, 2000,p. 73).
The masculine norms discourage ‘feminine’ behaviours and instead aim to express the ‘male identity.’

Project Quit Tobacco International also conducted their own research between 2001-2007 on how smoking appeals to men. After interviewing a sample of urban male smokers from Yogyakarta, results emphasised that masculinity was the main motivation.

In a particular interview, a young man who was a non-smoker, recalled how his uncle expressed concern that neither he nor his brother smoked; “There is nothing bad that will happen to you…It’s a shame for our family line that you and your brother are not smoking—all the men in our family smoke—your father, your grandfather. You are breaking the chain of our family’s smoking history”. (Nichter, 2009)

Population of female and male smokers amongst the whole and targeted regions of Indonesia, based off statistics from the World Health Organisation, 2017

Barber,S., Ahsan, A., Adioetomo, S., Setyonalur, D., 2008, ‘Tobacco Economics in Indonesia’, International Union Against Tuberculosis and Lung Disease, France, viewed 25th November 2019, <https://www.tobaccofreekids.org/assets/global/pdfs/en/Indonesia_tobacco_taxes_report_en.pdf>

Morrow, M., Barraclough, S., 2010, ‘Gender equity and tobacco control: bringing masculinity into focus’, Sage Publications, viewed 25th November 2019, <https://journals.sagepub.com/doi/pdf/10.1177/1757975909358349>

Nawi, Ng., Weinehall, L., 2006, ‘If I don’t smoke, I’m not a real man’—Indonesian teenage boys’ views about smoking’, Health Education Research, Vol 22, no. 11, viewed 25th November 2019, <https://academic.oup.com/her/article/22/6/794/640787>

Nichter, M., Padmawati, S., Danardono, M., 2008, ‘Reading culture from tobacco advertisements in Indonesia’, BMJ Journals, Arizona, USA, viewed 25th November 2019, <https://tobaccocontrol.bmj.com/content/18/2/98.info>

Schewe, E., 2017, Why Do So Many Indonesian Men Smoke?, Jstor, viewed 25 November 2019, <https://daily.jstor.org/why-do-so-many-indonesian-men-smoke/>

Schoenaker, D., Brennan, E., Wakefield, M., Durkin, S., 2018, ‘Anti-smoking social norms are associated with increased cessation behaviours among lower and higher socioeconomic status smokers: A population-based cohort study’, Plos One, viewed 25th November 2019, <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0208950>

Swandewi Astuti, P., Freeman, B., 2018, Protecting Indonesian Youth from Tobacco, The Conversation, Sydney, viewed 25th November 2019, <https://thewire.in/health/protecting-indonesian-youth-from-tobacco>

World Health Organisation, 2010, ‘Brief Profile on Gender and Tobacco in South East Asia region’, New Dehli, India, viewed 25th November 2019, <http://apps.searo.who.int/PDS_DOCS/B4519.pdf>

POST B: Happy New Smear

Cervical cancer is one of the leading causes of cancer-related deaths amongst women globally, with approximately 530,000 new cases every year. (Centers for Disease Control and Prevention, 2016) In Australia, numerous cervical cancer initiatives have appeared over the past two decades via a diverse range of media, encouraging women to receive regular check ups and the often “uncomfortable” Pap test. In December 2017, the two-yearly Pap test was removed and reintroduced with the five-yearly National Cervical Screening Program; a more effective and accurate technology used to detect potentially problematic signs. (Medianet, 2018) As a result of the change, in 2018 The Aids Council of New South Wales introduced a ground-breaking campaign titled ‘The Inner Circle’, that aimed to not only educate the importance and increase participation in cervical screening, but build awareness amongst all members of the LGBTIQ+ community with a cervix. (JOY 94.9, 2018)

‘The Inner Circle’ campaign is one funded through a grant from the Cancer Institute NSW and is the first large-scale, multi-platform effort to introduce the changes to screening to any community across Australia. They incorporate digital, social and direct community engagement approaches, as well as public placements in key locations across Sydney (Medianet, 2018) to reduce stigma and promote the health service, specifically targeting the LGBTIQ+ community who are often left out of ‘mainstream’ conversation on the topic. President of ACON, Dr Justin Koonin states “it was crucial the campaign reached not just ‘lesbians’ but the full spectrum of LGBTIQ people with a cervix. It had to reflect the diversity and address the misconceptions faced by this group.” (Koonin, 2018)

Inner Circle- Happy New Smear, Aids Council of New South Wales, 2018

The Inner Circle launched on New Years Day, 2018 with a video posted to Facebook called ‘Happy New Smear’, which would be the first of many successful projects designed under the initiative. Its success is measured in numbers, with this video shared internationally and viewed more than 14,000 times. The following videos that recognised individual experiences generated close to 100,000 views while its website engaged with 2500 visitors per month. (Goodwork Agency, 2018)

“A 2014 survey found that 20 per cent of lesbian, bisexual and queer women in Sydney had never had a Pap test. People with trans experience face significant issues relating to cervical screening, such as trans men who report avoiding screening out of fear of discrimination.” (Price, 2018, para. 8) Partnering with Family Planning NSW, the campaign introduced the CheckOut clinic located in Surry Hills, Sydney, “delivering high quality services in a community-based setting.” (Bassil, 2018, para. 14)

In 2018, the initiative won the Australian Good Design Award in the Communication Design category, in recognition for outstanding design and innovation. The Inner Circle campaign continues to achieve their goals of raising awareness and interacting with LGBTIQ+ people, demonstrating a “progressive way of cervical screening.” (McGregor, 2018)

ACON Health 2018, Inner Circle – Happy New Smear, video recording, Youtube, viewed 18 November 2019, <https://www.youtube.com/watch?v=6lTBztS4IQs&feature=emb_title>

Aids Council of New South Wales 2018, Check OUT The Inner Circle: Promoting Regular Cervical Screening For LGBTIQ People, Science and Medical Media Release, Medianet, Australian Associated Press, NSW, viewed 18 November 2019, <https://www.medianet.com.au/releases/153308/>

Aids Council of New South Wales 2019, About ACON, viewed 18 November 2019, <https://www.acon.org.au/about-acon/>

Aids Council of New South Wales 2019, New Campaign To Answer Your Questions About LGBTIQ Cervical Screening, viewed 18 November 2019, <https://www.aconhealth.org.au/new_campaign_to_answer_your_questions_about_lgbtiq_cervical_screening>

Good Work 2018, don’t just make it look and sound good. Make it save lives., viewed 19 November 2019, <https://www.goodwork.agency/acon-theinnercircleau/>

Good Work 2018, goodwork wins 2018 Good Design Award® for The Inner Circle, viewed 19 November 2019, <https://www.goodwork.agency/goodwork-wins-2018-good-design-award-for-the-inner-circle/>

McGregor, V. 2018, ‘The Informer’, Community Broadcasting Association of Australia, radio broadcast, JOY 94.9, Melbourne, 6 February, viewed 19 November 2019, <https://joy.org.au/theinformer/2018/02/06/inner-circle-provide-care-support-anyone-nsws-lgbtiq-community-cervix/>

PHHA 2018, Top 10 public health successes over the last 20 years, PHAA Monograph Series no. 2, Canberra: Public Health Association of Australia, viewed 18 November 2019, <https://www.phaa.net.au/documents/item/3241>

The Inner Circle AU, About the Project, The Inner Circle, ACON, Sydney, viewed 18 November 2019, <https://www.theinnercircle.org.au/about-the-inner-circle>

William Small Jr, M.D., Monica, A., Linus, T., 2017, ‘Cervival Cancer: A Global Health Crisis’, Cancer, vol. 123, no. 13, viewed 19 November 2019, <https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.30667>