POST D: Is the Indonesian tobacco industry killing or giving?

I remember watching ABC News’ ‘Children smoking in Indonesia’ (ABC, 2012) in high school years back. The video depicted Indonesian toddlers in which majority were boys as young as two year olds smoking, sparking high controversy.

‘Children smoking in Indonesia (2012)’ by ABC News
Youtube, 2012, Children smoking in Indonesia, ABC, viewed 26 November 2019, https://www.youtube.com/watch?v=qcsdt468C_0.

Local tobacco company, Gudang Garam’s ‘GG Mild brand’ is rumoured to be notorious for targeting the youth in their trendy smoking advertisements (refer to video). They’ve used this to their advantage as cigarettes are accessible to the underage as there are no laws of restriction in buying (GYTYS). Further, tobacco is also sold cheaply at around $1.55USD for a Malboro 20 pack.

‘Iklan GG Mild 2017’
Youtube, 2017, Iklan GG Mild 2017 style of new generation, viewed 26 November 2019, https://www.youtube.com/watch?time_continue=7&v=_ulaZYgXzdM&feature=emb_title.

In 2012, Indonesia was said to have the most male smokers in the world according to the ‘Global Adult Tobacco Survey’ (GATS, 2012). Almost 72% of Indonesian men over the age of 15 years have smoked and more than half (54.2%) of their male population are daily smokers (WHO, 2019). Tobacco has been intentionally developed to integrate with Indonesian culture through ‘kretek’. Kretek is a clove scented cigarette which is inspired by Indonesian natural herbs and is said to be smoother but more toxic than the average commercial cigarette. Cigarette companies were aware of how Kretek played on Indonesian culture and thus, saw further opportunities with it. These companies invested greatly into marketing strategies, sponsoring national sporting events and even educational scholarships (Muhammad Zulfikar Rakhmat, University of Manchester, 2018). They were successful with using mainstream marketing as a strategy because unlike Australia, Indonesia does not have a cigarette advertising ban. In a GATS survey, 82.5% Indonesians reported seeing a cigarette promotion (GATS, 2012).

Indonesian boys smoking.
Muhammad Zulfikar Rakhmat and Dikanaya Tarahita, 2018, As the Rest of the World Quits, Indonesia’s Smokers Increase, asia sentinel, viewed 26 November 2019, https://www.asiasentinel.com/econ-business/indonesia-smokers-increase/.

Cheap and easy access to cigarettes go hand in hand with Indonesia’s poverty rate. Over ‘30 million’ Indonesians live in poverty and ’43.4 million’ youths are unemployed, West Java having the highest unemployment rate of 60%. When there is no employment, education is neglected which results in the population being un-educated to the consequence of smoking. This can be particularly dangerous in a place like Java as more than half of the nation’s tobacco is produced in East Java (Santi Martíni and Muji Sulistyowati, 2005). Perhaps, Java’s cultural hub Yogyakarta could also play a factoring role in the tobacco market there too as it is known for its island culture. Similarly, Surabaya, a city in East Java known for its organised youth gangs and homelessness could also add to the popularity of tobacco usage.

Hand drawn map of Indonesia highlighting Java island cities by Brandon Siow, 2019.

With tobacco having such a big part of their culture and high unemployment rates, it is no surprise the government sees no interest in promoting tobacco use less as it is profiting for them and employment in the tobacco industry.

References:

Matteo Carlo Alcano, 2014, Youth Gangs and Streets in Surabaya, East Java: Growth, Movement and Places in the Context of Urban Transformations, viewed 25 November 2019, https://www.researchgate.net/publication/307744782_Youth_Gangs_and_Streets_in_Surabaya_East_Java_Growth_Movement_and_Places_in_the_Context_of_Urban_Transformations.


Muhammad Zulfikar Rakhmat and Dikanaya Tarahita, 2018, As the Rest of the World Quits, Indonesia’s Smokers Increase, asia sentinel, viewed 26 November 2019, https://www.asiasentinel.com/econ-business/indonesia-smokers-increase/.

Nathalia Tjandra, 2018, Indonesia’s lax smoking laws are helping next generation to get hooked, viewed 26 November 2019, https://www.thejakartapost.com/academia/2018/06/04/indonesias-lax-smoking-laws-are-helping-next-generation-to-get-hooked.html.

Tobacco free kids, 2012, Survey: Indonesia Has Highest Male Smoking Rate in the World, viewed 23 November 2019, https://www.tobaccofreekids.org/blog/2012_09_12_indonesia.

Santi Martini and Muji Sulistyowati, 2005, The Determinants of Smoking Behavior among Teenagers in East Java Province, Indonesia, viewed 24 November 2019, https://openknowledge.worldbank.org/bitstream/handle/10986/13781/347660IND0YouthSmoking0HNP0Tobacco032.pdf;sequence=1

WHO, 2019, WHO report on the global tobacco epidemic, viewed 24 November 2019, https://www.who.int/tobacco/surveillance/policy/country_profile/idn.pdf.

Youth Hub Indonesia, 2019, Challenge, Emotive, viewed 26 November 2019, https://www.emotiveprogram.org/challenge/rural-hub/youth-hub-indonesia/

Youtube, 2012, Children smoking in Indonesia, ABC, viewed 26 November 2019, https://www.youtube.com/watch?v=qcsdt468C_0.

Youtube, 2017, Iklan GG Mild 2017 style of new generation, viewed 26 November 2019, https://www.youtube.com/watch?time_continue=7&v=_ulaZYgXzdM&feature=emb_title.

Post D: Targeting the youth – Tobacco culture in Indonesia

It was a few years ago now when a video of an Indonesian toddler, smoking up to 40 cigarettes a day, went viral. The video showed a young boy from Sumatra, puffing away on a cigarette, a habit which he took up at only 18 months old. Although this is an extreme case, it is not uncommon for children to begin smoking from a young age in Indonesia. 

‘Indonesian baby smokes 40 cigarettes a day’, (On Demand News, 2019)

Around 66.6% of men and 2.1% of women, are daily smokers in Indonesia. While nearly 4% of children between the ages of 10 – 14 years old use tobacco daily. (The Tobacco Atlas, 2015). Click for more information.

Without looking too far, it is easy to see why tobacco culture is rife in Indonesia. “Tobacco advertising in Indonesia is among the most aggressive and innovative in the world, and tobacco advertisements saturate the environment” (Danardono, Ng, Nichter, Padmawati, Prabandari, 2009). Click for full article. After conducting my own research, several key factors seem to be playing a contributing role to the issues surrounding smoking in Indonesia. These include, persistent and widespread advertising with few restrictions, tobacco companies as a large source of government revenue, a lack of cessation strategies being put into place, a societal pressure for men to smoke, and a lack of health care providers being at the forefront of tobacco reduction efforts. 

A photograph taken by me during my visit to Central Java. In the photo there are 4 signs in a row for cigarette companies and ‘Pro Never Quit’ slogans.

A survey carried out in East Java, studied the smoking behaviours of teenagers in the City of Surabaya and found that the “prevalence rate among youth in Indonesia is much higher than in neighbouring countries” (Martini, Sulistyowati, 2005). Part of this is a result of youth having easy access to tobacco in stores and from street vendors. Further results showed that the youth in Surabaya usually begin smoking between the ages of 10 and 17 years old. Shockingly, some begin as early as 3 years old. As East Java is one of the major raw tobacco, cigarette and kretek producing provinces in Indonesia, it is no surprise that such a high proportion of youths take up smoking. 

Hand drawn map of a section of Indonesia, showing key areas discussed in this blog post

A sad reality of the smoking epidemic are the health problems that come with it. “Indonesia is a significant contributor to the global burden of disease from tobacco-related illnesses” (Hidayat, Thabrany, 2010). Click for more. Cardiovascular diseases are one of the major causes of death in Indonesia, with over 26% being directly caused by tobacco. “Tobacco control is essential for preventing and controlling deaths…caused by CVDs” (World Health Organization, 2018). Further information.

Looking to the future, it is clear that there needs to be some changes made, knowing where to begin and how to go about making these changes are the first steps towards tackling the tobacco industry in Indonesia.  

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References

Achadi, A., Croghan, I., Ebbert, J. & Hurt, R. 2012, Roadmap to a tobacco epidemic: transnational tobacco companies invade Indonesia, BMJ Journals, vol. 21, no. 3, viewed 21 November 2019,

https://tobaccocontrol.bmj.com/content/21/3/306.short

Broadhurst, C. 2019, Dihan, 6, has cut down to just four cigarettes a day from his usual two packs a day. And his parents are proud, PRI, viewed 25 November 2019,

https://www.pri.org/stories/number-children-smoking-indonesia-getting-out-control

Danardono, M., Ng, N., Nichter, M., Padmawati, S. & Prabandari, Y. 2009, Reading culture from tobacco advertisements in Indonesia, BMJ Journals, vol. 18, no. 2, viewed 24 November 2019,

https://tobaccocontrol.bmj.com/content/18/2/98.short

Dhumieres, M. 2019, The number of children smoking in Indonesia is getting out of control, Public Radio International, unknown date, viewed 23 November 2019,  

https://www.pri.org/stories/number-children-smoking-indonesia-getting-out-control

Hidayat, B. & Thabrany, H. 2010, Cigarette Smoking in Indonesia: Examination of a Myopic Model of Addictive Behaviour, International Journal of Environmental Research and Public Health, vol. 7, no. 6, viewed 22 November 2019,

https://www.mdpi.com/1660-4601/7/6/2473/htm

Hull, T., McDonald, P., Reimondos, A., Suparno, H., Utomo, A. & Utomo, I. 2012, Smoking and young adults in Indonesia, Australian Demographic and Social Research Institute, vol. 1, no. 2, viewed 25 November 2019,

https://chr.ui.ac.id/wp-content/uploads/downloads/2013/06/policy_background_2_smoking.pdf

Lando, H. 2016, Promoting tobacco cessation in low- and middle-income countries, Cambridge Core, vol. 11, no. 2, viewed 22 November 2019,

https://www.cambridge.org/core/journals/journal-of-smoking-cessation/article/promoting-tobacco-cessation-in-low-and-middleincome-countries/841A7ADD6DB9A77EA7BD3BE8DB871F46/core-reader

Martini, S. & Sulistyowati, M. 2005, The determinants of smoking behaviour among teenagers in East Java Province, Indonesia, Economics of Tobacco Control Paper No. 32, vol. 1, no. 1, viewed 25 November 2019,

https://openknowledge.worldbank.org/bitstream/handle/10986/13781/347660IND0YouthSmoking0HNP0Tobacco032.pdf;sequence=1

McCall, C. 2014, Tobacco advertising still rife in southeast Asia, The Lancet, vol. 384, no. 9951, viewed 20 November 2019,

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61804-3/fulltext

Ng, N., Ohman, A. & Weinehall, L. 2007, ‘If I don’t smoke, I’m not a real man’—Indonesian teenage boys’ views about smoking, Health Education Research, vol. 22, no. 6, viewed 22 November 2019,

https://academic.oup.com/her/article/22/6/794/640787

The Tobacco Atlas, 2015, Indonesia, American Cancer Society, viewed 26 November 2019,

https://tobaccoatlas.org/country/indonesia/

World Health Organization, 2018, Factsheet 2018 Indonesia, Regional Office for South-East Asia, viewed 24 November 2019,

https://apps.who.int/iris/bitstream/handle/10665/272673/wntd_2018_indonesia_fs.pdf?sequence=1

Post B: Success in Plain Packaging

On 29 April 2010, the Australian Government made an important decision to introduce mandatory plain packaging of all tobacco products by 2012. I was only 15 at the time, but I welcomed this change. I had lost my grandmother 6 months prior to complications brought about by emphysema. For years, I watched her suffer as she continued to puff away on her packs of ‘Peter Stuyvesant’s’. With each inhale, the false promise of glamour and beauty once paraded about by the ads on television, scattered away into the distance. Instead, I watched the damaging effects of cigarettes as they slowly took the life of my grandmother.

Packaging

‘Before and after photos of cigarette packs from Australia, where plain packaging was introduced in 2012’ (Hammond, 2016)

Since the introduction of plain packaging, all tobacco products now come with a confronting health warning in the form of a graphic image, as part of the campaign to reduce the rate of smoking within Australia. Funded by the government, the method behind the campaign is to ‘shock’ viewers. A study on the effectiveness of ‘shock tactics’ in advertisement, determined that the use of shocking imagery by organisations was “…deemed successful at capturing the audience’s attention”. (Jones, Parry, Robinson, Stern, 2013) Click for article.

Furthermore, the Australian Bureau of Statistics show the successful impact of plain packaging in Australia: “…Since 1995, the proportion of adults who are daily smokers has decreased from 23.8% to 13.8% in 2017-18.” (ABS, 2019)  Click to visit website.

Another study carried out, looked at links between the introduction of plain packaging in Australia and Quitline calls. Results showed that there was a “78% increase in the number of calls to the Quitline, associated with the introduction of plain packaging”. (Currow, Dessaix, Dobbins, Dunlop, Stacey, Young, 2014) Click for article.

In the early stages and still today, the government has been met with strong opposition, from Big Tobacco, members of the World Trade Organization and Australian retailers. Those opposed, were concerned that other countries would see the success of the plain packaging campaign, and would want to implement their own, thus industry profits would suffer. “Once even one country with a population of 23 million showed that plain packaging could be implemented, others would see it as something feasible”. (Chapman, Freeman, 2014)

The success of the plain packaging campaign in Australia shows a method that could be applied universally through a transdisciplinary approach.

Although my grandmother did not live long enough to see the changes brought about by the introduction of plain packaging, she would have been happy to see its success.

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References

Australian Bureau of Statistics 2019, National Health Survey: First Results, Australia, February 2019, cat. no. 4364.0.55.001, ABS, Canberra, viewed 16 November 2019,

https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Smoking~85

Australian Government Department of Health, 2019, Tobacco plain packaging, Canberra, viewed 16 November 2019,

https://www.health.gov.au/health-topics/smoking-and-tobacco/tobacco-control/tobacco-plain-packaging

Brenna, E., Coomber, K., Durkin, S., Scollo, M., Wakefielf, M. & Zacher, M. 2019, Tobacco Control, BMJ Journals, vol. 24, no. 2, viewed 17 November 2019,

https://tobaccocontrol.bmj.com/content/24/Suppl_2/ii17

Chapman, S. & Freeman, B. 2014, Removing the Emperors Clothes: Australia and tobacco plain packaging, 1stedn, Sydney University Press, Sydney.

Hammond, D. 2016, Before and after photos of cigarette packs from Australia, where plain packaging was introduced in 2012, Vox, viewed 18 November 2019,

https://www.vox.com/2016/6/2/11818692/plain-packaging-policy-us-australia

Jones, R., S., Robinson, M. & Stern, P. 2013, ‘Shockvertising’: An exploratory investigation into attitudinal variations and emotional reactions to shock advertising, Journal of Consumer Behaviour, vol. 12, no. 2, viewed 17 November 2019,

https://onlinelibrary.wiley.com/doi/abs/10.1002/cb.1430

Pursuit, 2018, Big tobacco vs Australia’s plain packaging, The University of Melbourne, Melbourne, viewed 15 November 2019,

https://pursuit.unimelb.edu.au/articles/big-tobacco-vs-australia-s-plain-packaging

WHO Framework Convention on Tobacco Control, 2019, Protocol, Geneva, viewed 16 November 2019,

https://www.who.int/fctc/en/

Young, J., Stacey, I., Dobbins, T., Dunlop, S., Dessaix, A. & Currow, D. 2014, Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis, The Medical Journal of Australia, vol. 200, no. 1, viewed 17 November 2019,

https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.11070