Football is the most popular sport in Indonesia. Everywhere you look, children are wearing football jerseys, and teenagers are playing football. Many cigarette brands sponsor professional teams, and game coverage. For example, Djarum, an Indonesian Kretek manufacturer sponsored the top football league from 2005-2011, to the tune of over 6.5 million dollars in 2011. (AFF, 2010).
Ega, 24, is in his last semester of college, where he studies economic management majoring in human resources. While he admitted to trying cigarettes as a teenager, he never pursued tobacco because his father does not smoke. “I follow my dad.” Ega is a keen football player and a die-hard Cristiano Ronaldo fan. “He is big, strong and compact, he can jump very high!” I asked him how he would react if Ronaldo took up smoking, and interestingly, unlike most of the young men that football sponsors target, Ega claimed that he would not be impressed. “Even if my idol smoked, I would not think cigarettes were cool.”
Ega, 24, from Yogyakarta.
Although his friends encourage him to smoke, Ega chooses not to because he knows about the health detriments and “I know I can save a lot of my money if I don’t”. Ega dreams of visiting Times Square when he graduates, and it’s clear that his strong self-efficacy influenced by his parents, and high level of education, is what gives him the strength over his friends to not take up tobacco use. “An individual’s evaluation that they have the physical capacity (to avoid tobacco) will enhance evasion” (Elshatarat, 2016).
Ega believes that due to tobacco’s strong relationship with the football scene, the sport is not as healthy and beneficial as it should be. About half of his team smoke, and spectators are allowed to smoke, even on the indoor courts. “They (the football association) know it’s bad, but want the profit. It’s evil in a way.” I expressed how different sponsorship is in western countries, and how our sportspeople encourage the youth not to smoke, until Ega reminded me that we might not be so different after all. “It’s just like Liverpool though, they promoted Carlsberg, that’s a beer!” Talking to Ega made me realise that tobacco isn’t the only problem, it’s the media and the way sponsorships and advertisements prioritise profit, no matter where they are in the world. He gave me hope though; his intelligence and personal strength is admirable and I can soon see people like Ega inspiring the younger generation.
Spot the difference: An Indonesian Football team’s jerseys, with tobacco company Dunhill printed across the front, vs English Premier League team Liverpool’s jerseys with sponsor Carlsberg Beer.
Elshatarat, R., Yacoub, M., Khraim, F., Saleh, Z., & Afaneh, T. (2016). Self-efficacy in treating tobacco use: A review article. Proceedings of Singapore Healthcare, 25(4), 243–248.
In 2040, Malioboro street is a nation-wide success story in the wicked fight against tobacco. It is an eco-friendly, vibrant public space created through its socially diverse landscape of music, art and bicycle initiatives. The entire area is a complete smoke free zone as well as motor free zone thanks to the campaign #SuaraTanpaRokok and #TransportasiTanpaBensin.
complete vision for Malioboro 2040
The campaign’s highly recognised, interactive mural of coloured and personalised stickers has reached an audience of 20,000 people who have contributed either messages of encouragement or personal achievement through their commitment to give up smoking completely.
Under Vital Strategie’s #TransportasiTanpaBensin movement and their collaboration with Jogja Bikes, the street is covered with 280 bicycles with 40 of these being eco-friendly Spedagi Bamboo Bikes. In 5 years’ time, Spedagi Bamboo Bikes will replace the standard metal frames as a means of promoting and contributing to sustainable future.
Due to the popularity of smoke free bicycle riding, an all inclusive bicycle subculture has emerged with equal number of female and male riders, who take advantage of the #WatchJogjaBikes movement every Sunday to improve and beat their timed ventures from the previous week. For those who love a more leisurely and sight-seeing experience, there are currently three designated bike tours fit for both locals and tourists.
Annually, Indonesians eagerly anticipate the national Malioboro Sprint event, which is made up of 240 elite men and women from across the country and is broadcasted internationally to a large viewing audience. It is a charitable event, with all proceeds funding anti-smoking initiatives such as Vital Strategies and MTCC to further their clinical research. This year’s aim is 500 million rp, after raising 430 million rp last year.
The district of Malioboro hopes to be an example of what the rest of Yogyakarta could be as well as inspire a whole Indonesian culture that prevents the existence of the smoking epidemic.
In the context of 2019, Malioboro St has a proposed non-smoking law under the Governments Decree No.2, beginning in 2017, with 4 proposed smoking areas along the street. Visiting Malioboro St in 2019, there are visually no signs or clear directions for smokers to group in segmented areas across Malioboro, or are any authoritative enforcing the decree. Men dominate the communal population at night time, often seen socially smoking along Malioboro St, around children, at restaurants and at stalls. Young groups of teenage boys are seen hanging out with little to do, smoking and chatting as their predecessors did. Women are scarce in this environment, and teenage girls are virtually extinct. During the day the side walk isn’t as busy as night, however more women are noticeable at this time. Second hand smoke is a huge issue. Street vendors sell cigarettes with ease of access at cheap prices and seem un-phased by the buyers age.
In 2020, the launch of Malioboro St campaign #TransportasiTanpaBensi , translated to ‘Transportation Without Fuel’, and Vital Strategies already popular 2015 hashtag #SuaraTanpaRokok, (Voices Without Cigarettes) are implemented through public engagement in social media, activating the beginning of a street art movement that will engulf Malioboro. ‘#VoicesWithoutCigarettes’ is implemented as a public art hashtag for individuals to engage in both conversationally and through social media. Car free Sunday has been implemented as a pollution prevention scheme under the umbrella of ‘Transportation Without Fuel’ program, allowing community members to engage in casual bike riding and walking as a form of physical exercise.
In 2021, partnership with existing Malioboro St share bikes ‘Jogja Bikes’ is implemented with a small but powerful rebranding of the bikes with an inclusion of a new ‘Smoke Free Jogja Bikes’ logo, and both #TransportationWithoutFuel and #VoicesWithoutCigarettes printed on either side of the bike to reinforce the health-conscious message. The launch of ‘Watch Jogja Bike’ Sunday event will coincide with Car Free Sunday as an all-inclusive fitness event where participants will scan their personalised barcode through the existing ‘inabike’ app to enter, and then cycle there chosen 2K, 5K, 10K so on… track set up via digital GPS. Each Race is time scored so individuals compete with themselves to improve their fitness at their own pace, making it easier for individuals to become involved in more social aspects. A street mural has been started under there #VoicesWithoutCigarettes campaign, beginning on the corner of a laneway where a lot of Jogja’s street art thrives. Individuals will be given a blank coloured sticker with space to write something encouraging or personal about their journey towards quitting smoking, making their own mark on the landscape. Local artists will be employed on one Wage Tuesday to reinvent the vibrancy of Malioboro St, turning ash tray bins into plant boxes with no smoking signs, while also adding their own artwork to the outside. The unused Jogja Bikes information panels will be turned into motivational messages for healthy living without smoking, for example, “After 2-12 weeks of no smoking, your blood circulation and lung function begin to improve. More stamina to ride your bike!”
In 2022, due to the popularity and success of Vital Strategies ‘Watch Jogja Bike’ weekly event, Malioboro has seen a significant increase in the amount of ‘Smoke Free Jogja Bikes’ and personal bikes used weekly, with its bike subculture growing in scale. The yearly charitable event ‘Malioboro Sprint’ has begun as a way of creating national attention towards both #VoicesWithoutCigarettes and #TransportationWithoutFuel movement. The event will begin as a local competition, engaging equal percentage of both women, girls, men and boys in a more elitist performance focus, making for a great viewing experience. Entrants will race in their specified category in groups of 4 and will be time ranked until the final race, building the anticipation for the crowd to stay around all day to watch the event. Through the competitor’s fee, sponsorships and public donations, money will be raised for smoke free organisations such as the MTCC. With the popular increase in Sunday’s ‘Watch Jogja Bike’ event, volunteers from organisations such as Kota Kita (an Indonesian grass roots organisation that promotes informed and empowered citizens) will be present under there ‘Women On Wheels’ project, encouraging empowerment for women and girls to fully and equally participate in socioeconomic attainment, while promoting the values of a sustainable smoke free and liveable city. Volunteers from Jogja Bikes will also be present running mental health talks, encouraging positivity and understanding in an age where mental health is apparent.
In 2025, Jogja Bikes has implemented a further 50% increase in bikes available along Malioboro St and has increased access to pick up points by 20%. Jogja Bikes has now implemented a self-guided bike tour, with signage around the city to help guide both the tour. Due to the popular communal acceptance of both #VoicesWithoutCigarettes and #TransportationWithoutFuel schemes, Malioboro has now become a completely smoke free zone.
In 2030, the self-guided bicycle tour has now added an extra 2 routes for locals and tourists to engage with. The ‘Voices Without Cigarettes’ public mural has been a massive success, covering a 3rd of one side of Malioboro St. The yearly ‘Malioboro Sprint’ event has increased dramatically in participant engagement and has seen a total donation of 150million rp due to its national broadcast. Statistics gathered from #VoicesWithoutCigarette sign up forms reveal that 60% of participants have completely quit smoking, with others having reduced their smoking intake.
In 2035, the ‘Malioboro Sprint’ event has is now internationally broadcasted, hence raising 300million rp for smoke free organisations. The weekly ‘Watch Jogja Bike’ event has become a huge success within the city of Yogyakarta, engaging community from families to elite athletes in equal numbers women and men.
Lack of public acceptance towards the campaign will result in loss of much needed funding for Vital Strategies and MTCC, as well as reduced public health awareness that will further promote the social acceptance and advocacy of tobacco smoking. This will increase the already high 68% of male smokers to 80% and will break into the female market with invasive advertisement schemes. This will allow tobacco companies to further take advantage of the young impressionable minds that they already advertise towards. Due to the increase in social acceptance, the government will surpass the existing $62.2 billion Aus. spent annually on medical resources that fight the crisis, projecting to be $80 billion Aus. by 2030. This is 5.5 times the amount earned annually from the tobacco industry, pushing the government into high risk of economic failure and collapse. To fight this projected threat, the government needs to implement a public hashtag, mural and street art scheme with involvement from local Javanese artists to create communal, regional and national conversation around the tobacco epidemic. This will implement efficiently due to Malioboro’s already high occupancy of local and international groups. Currently, smoking for men in Indonesia is considered acceptable on a sociable and cultural scale. If we were to implement and enforce the smoke free zones along Malioboro Street now, communal backlash would occur towards government and health organisations which would deeply impact the implementation of a smoke free Malioboro, and decrease the efficiency at which our #WatchJogjaBike and ‘Malioboro Sprint’ events would be accepted by local Javanese people.
With the implication of engaging health activities, the future of Malioboro is one full of colour and community that we hope everyone will be able to experience.
While Indonesia’s recovery from the Asian Economic Crisis was commendable, 26.6% of Indonesians are still living in poverty (Hartati, 2018). The most disadvantaged Javanese per capita are those living in the Special Region of Yogyakarta, due to its extreme population density (1138 people/square kilometre) (World Bank 2010), as well as families in rural villages such as those in Central Java.
Despite Indonesia being in the bottom 50% of wealthiest countries in the world (IMF, 2019), tobacco consumption is on the rise, increasing almost 7 times between 1970 and 2000 (WHO, 2000). Globally, 84% of smokers live in developing and transitional economies reflecting the global epidemic of tobacco use in poorer regions. WHO states that tobacco kills 225720 Indonesians per year – that’s 14.7% of all deaths and the top cause of premature death. Furthermore, cardiovascular diseases in adolescents are more likely to be caused by tobacco use, reflecting the strengthening tobacco culture. For the 9% of the youth population who smoke (WHO, 2018), socio-economic factors can be largely attributed. Bigwanto (2015) reported that youths having mothers with a lower level of education or employment were more likely to smoke. This is due to the malleability of young minds and a child’s search for empowerment in a parental figure.
Poor Indonesian families place tobacco as a necessity, spending 12.4% of their incomes on it, only second to rice (19%) (National Socio-Economic Surveys, Indonesia, 2003-2005). Furthermore, populations in the most socioeconomically deprived groups have higher lung cancer risk than those in the most affluent groups (Singh, 2011). These healthcare costs of smoking reinforce Indonesia’s poverty, direct costs including medicine and hospital visits, and indirect costs referring to productivity and caregiving. The government is burdened with most of this cost, which in turn drains and represses the economy. (Ross, 2015).
On a regional scale, a direct correlation between poverty and tobacco use can be seen on the island of Java, where regions with the highest Purchasing Power Parity experience the lowest rates of smoking. Exceptions are made for Jakarta, where income levels are high enough to purchase tobacco as a luxury and for Jogjakarta where residents may be too poor to afford tobacco. From these trends it can be seen that smoking and poverty are interrelated and self-reinforcing.
The solution to reducing consumption, especially in the youth and poor demographics, is price and taxation intervention (Barber, 2008). This would additionally generate government revenue, offsetting the debt caused by medical bills and premature mortality, and stabilise Indonesia’s economy as the nation grows and emerges.
References
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Aditama 2002, ‘Smoking Problem in Indonesia’, vol 11, no. 1, pp. 56-65.
The disabling challenges of mental illness are enhanced by the stigma associated with these health conditions, which may lead to a host of adverse consequences such as hopelessness, reduced self-esteem, delayed help-seeking, and diminished quality of life—just to name a few. (Schomerus, 2009).
The In One Voice campaign was a brief anti-stigma social media intervention that was rolled out from January to March 2012 in British Colombia, Canada. Funded by Foundry (https://foundrybc.ca/), a non-for-profit network of community-based health and social services, the campaign targeted young people ages 12-24 in the peak time where attitudes start to form, and mental health issues may begin to emerge. (Reavley, 2011).
Home page of the Foundry website.
The urgent priority (Collins, 2011) for the initiative was to eliminate the stigma behind mental health through public education, aided by the Foundry website, which is full of resources and references to nearby health centres.
In a top-down approach, the campaign was transdisciplinary and multi channel; advertised traditionally at several hockey games including the National Hockey League’s All Stars game, as well as on television, radio, and in print. Being specifically designed to reach the youth however, the campaign was also rolled out via social media including Facebook, Twitter, and Youtube.
Vancouver Canucks defenceman Kevin Bieksa shares his experience in a video about close friend and teammate, Rick Rypien, who suffered from depression.
Results of the campaign were measured by BC Mental Health and Addiction Services, with a survey study of approximately 400 people from the targeted group. Results showed 24.8% of respondents having remembered the campaign two months after its airing, 36% of these having recalled discussing or sharing the campaign with others, as well as an 11% increase in awareness of the Mindcheck website. (Livingston, 2012). This success can be largely attributed to the appearance of well-liked sportsman Kevin Bieksa in the film, authors concluding that a key approach in reducing stigma among young people is to involve individuals directly affected by the issue – a method with potential to be applied universally (Yamaguci, 2011).
The challenge of engaging those without mental health issues was addressed by encouraging the community to “add your voice” on the website in support of friends and family affected. As a result, a 16% increase in awareness of the website was experienced by respondents without mental illness.
There was no significant difference however, in respondents ability to assist others with mental health issues nor an improvement in stigma. This suggests that social media campaigns may be more successful in achieving improvements in health literacy outcomes and are less effective for reducing the personal stigma and social distance associated with mental health issues.
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References
Collins PY, Patel V, Joestle SS (2011) Grand challenges in global mental health. Nature 475(7354):27–30.
Livingston D (2012) Evaluation of a campaign to improve awareness and attitudes of young people towards mental health issues. Social Psychiatry and Psychiatric Epidemiology 48(6):965-973.
Reavley N, Jorm A (2011) Young people’s stigmatizing attitudes towards people with mental disorders: findings from an Australian national survey. Aust N Z J Psychiatry 45(12):1033–1039.
Schomerus G, Matschinger H, Angermeyer MC (2009) The stigma of psychiatric treatment and help-seeking intentions for depression. Eur Arch Psychiatry Clin Neurosci 259(5):298–306.
Yamaguchi S, Mino Y, Uddin S (2011) Strategies and future attempts to reduce stigmatization and increase awareness of mental health problems among young people: a narrative review of educational interventions. Psychiatry Clin Neurosci 65(5):405–415.
Indonesia Global Design Studio 