Indonesia is one of the five topmost producers and exporters of cigarettes in the world (WHO, 2012). It is also the fourth-largest cigarette consuming country. So in what ways have they attempted to enforce anti-smoking measures and how effective have these measures been? How have they actually influenced the smoking epidemic in Indonesia.
I interviewed my cousin, Andrew, 32, who has been smoking for the past 17 years. Initially influenced by friends at the young age of 12, he did not like the initial effects it gave him, such as coughing and dizziness. It was at 15 when the addiction started, it was seen as cool and he dangerously thought he could quit at anytime if he wanted to, and shortly learnt that wasn’t the case. Children and teenagers learn about the health effects of smoking in school, however with so many people in their daily environments smoking, it makes them curious and difficult to take the issue seriously. In Indonesia, 51.3% (14.6 million) adults are exposed to tobacco smoke in the workplace and 78.4% (133.3 million) are exposed to tobacco smoke at home (WHO, 2012).
I wanted to investigate the effectiveness of anti-smoking measures that have been made in Indonesia and what people think would actually be effective. Andrew mentioned that the change of plain packaging to graphic images was more of a nuisance than effective. When he first saw the graphic images it did make him think of wanting to quit but instead he would just look for a packet that was plain instead. This reveals that graphic packaging may inform people of the extreme effects of smoking but doesn’t necessarily make them want to quit.
When smoking in public places such as malls were banned, he did smoke less, but it didn’t stop him completely. Even with new laws people tend to ignore the consequences because they know that no-one will truly enforce it upon them, and if they do they will move on to another place where it is allowed. Anti-smoking measures are not likely to move forward in Indonesia until the government strengthens existing laws and develops protocols for enforcing these laws. (Aditama, 2008)
Rather than quitting, Andrew has started smoking a ‘lighter’ brand, Esse, that promotes with descriptive deceptors that since it is ‘light’ it is not as bad as normal cigarettes. In Indonesia, the labelling restriction has actually reduced the proportion of smokers who agree that ‘light cigarettes are less harmful’ (Henriksen, 2012). Indonesia is still a long way away from solving the tobacco epidemic and should strongly consider work with the World Health Organisation framework on Tobacco Control.
World Health Organization, Regional Office for South-East Asia. (2012). Global adult tobacco survey: Indonesia report 2011. WHO Regional Office for South-East Asia. 2012. http://www.who.int/iris/handle/10665/205137
Wilson, L, et al. “Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review,” Journal of Environmental and Public Health, vol. 2012, Article ID 961724, 36 pages, 2012. https://doi.org/10.1155/2012/961724.
Aditama, T, et al. Linking Global Youth Tobacco Survey (GYTS) Data to the WHO Framework Convention on Tobacco Control: The Case for Indonesia, Volume 47, Supplement 1, September 2008, Pages S11-S14
Henriksen L, Comprehensive tobacco marketing restrictions: promotion, packaging, price and place, Tobacco Control 2012; 21:147-153.
Designers have the ability to position products, services and experiences to gain maximum engagement for its audience. In the success of the tobacco industry, designers have played a large influential role upon the Indonesian population. Masculinity and individuality are predominant themes in cigarette advertisements (Reynolds, 1999). Figure 1 displays a PT Gudang Garam 1995 advertisement with the slogan ‘Kretekeknya lelekai’ which translates to ‘the man’s cigarette’ (PTGudangGaram, 1995). Even in today’s society, 2018 Surabaya, I saw numerous advertisements relaying the same masculinity and individuality message for Surya Pro with the slogan ‘never quit’. These two advertisements, 23 years apart, evidently reveal the large role designers play in the success of the tobacco industry in Indonesia, with 65.4% of men smoking tobacco and women at only 1.8% in comparison (WHO, 2017).
Surya Pro banner advertisement in the Warna Warni village, Malang (taken by Josepha Na 2018)
With the large influence designers have, it is not impossible for designs to impact the population in a positive way. This influence can effectively foster for change and activism. However, smoking in Indonesia is heavily embedded in the social, economic and political culture. Numerous tobacco companies are often the sponsors for national sporting events and events such as music festivals. (Achadi, 2005). The relevance of the tobacco industry in Indonesia presents numerous challenges for behaviour change.
The heavy drinking culture of Australia, can be seen as a suitable comparison to the prominent smoking culture in Indonesia. In the Australian media, daily articles can be found relating to alcohol abuse, from glassing attacks to teenage binge drinking (Fitzgerald, 2017). Prime Minister Kevin Rudd, announced a $53 million program to address the binge-drinking epidemic in teenage Australians, whilst threatening the raise of taxes on popular drinks. Having a strong Muslim majority, Indonesia is not found to have a large drinking culture however the cultural comparison of the substance-abuse epidemic is relatively evident within these two countries. Effective designers have the power to be agents of change, through design activism, in assisting their country to tackle social challenges that affect their culture. Through the outlet of involving new laws, designing new programs or positive advertisements for the public, can design become ethically influential.
Surabaya is the second most populous city in Indonesia. It has one of the most busiest seaports and is an important financial hub. It has a particular importance in the trading of coffee, sugar and tobacco. “The tobacco industry here is very strong. Unlike in most other countries now, they’re still perceived simply as a normal business and treated that way.” says Dr. Widyastuti Soerojo, head of the Tobacco Control Unit in the Indonesian Public Health Association. Due to this, there is an extreme lack in the necessary control measures. Tobacco plays a huge role in the Indonesian culture and walking around Surabaya proved very evidently of how tobacco is integrated into the lifestyles of majority of the population.
Upon observation, through walking through different parts of Surabaya, from the Europe quarter, Chinese quarter and Arab quarter, and through the different places we walked through, I noticed that it was more common to see men smoking rather than the women. According to WHO, they state that 65.4% of men smoked tobacco, where women were only at 1.8% (WHO, 2017). Research reveals that Indonesian women are known for the growing and processing of tobacco, (evident in witnessing the cigarette production floor of House of Sampoerna) yet their smoking rates are low in comparison to males. This may be due to commonly attibuted cultural values, stigmatising women smokers as morally flawed (Barraclough, 1999)
One observation from walking through the fruit market, where it was predominantly female vendors, in comparison to walking through the wet market, where it was predominantly male vendors, was that there was a significantly noticeable difference in who was smoking. I found that it was more common to see men smoking in the stalls. Another observation was through the ‘bawang’ market, as it was also predominantly female vendors with little to no smoking. Whereas, in visiting the public bathroom and ‘warung’s’, it was most common to find men resting and smoking.
Indonesia is the only country in the Asia-Pacific region that has yet to ratify the World Health Organization’s Framework Convention on Tobacco Control. According to Mark Hurley, former Indonesia director for Tobacco-freekids, “The big companies have convinced the government they are important for local [tobacco] farmers and for tax revenues,” However in reality, the costs of treating diseases caused by tobacco outweigh any economic benefits. (Bevins, 2017)
Singapore is one of the first countries in the world that has adopted a tobacco control initiative on a nationwide scale. The challenge was that smoke environments expose the public to secondhand smoke. Removing this exposure would effectively minimise the health effects caused by tobacco smoke. 2012 Design initiative, Blue Ribbon, is a symbol of the anti-tobacco movement by the Health Promotion Board (HPB). Its effectiveness on minimising the exposure of secondhand smoke upon the public, through smoke-free areas, has been acknowledged and recognised by the World Health Organisation (WHO) in 2012.
This initiative contains a bottom-up approach. Through de-normalising smoking, with smoke-free environments, it sends the message that this is a default lifestyle. Citizens themselves have to promote this lifestyle “to build such smoke-free environments,” said Dr Amy Khor, Minister of State for Health. Evidently, Singapore has always had one of the lowest prevalence of smoking in the world, with men at 24.2% and women at 3.5%. (Shafey, 2003).
Through this timeline we can see that it was not a simple and quick process. In 1986 the government launched a long term, comprehensive national programme with the theme: “Towards a Nation of Non-Smokers.”(Assunta, 2004) and even till today new initiatives have been created to combat new challenges and enforce further control on tobacco.
Singapore has taken numerous progressive steps in Tobacco Control. Largely the government has impacted this movement through accepting it as legislation across the nation (Barraclough, 2003). This is also largely a part of its success. Being recognised by WHO, for Blue Ribbon, is a huge indicator that this legislation has been successful. HPB’s health ambassadors play a large role in advocating for these smoke free environments. They go door to door distributing blue ribbons and quit kits. This involvement is a positive enforcement upon the community. The peer support given by the higher ups is definitely a positive act that will impact citizens.
In being recognised by the World Health Organisation and evidently having one of the world’s lowest prevalence rates of smoking, Singapore’s government has made effective and successful measures from the past 4 decades to ensure tobacco in the country is under control.