Post C: Pedicabs of Prawirotaman

“The becak (pedicab) is as much a motif and symbol of Indonesia as the silhouette of a wayang kulit puppet, or the smell of a clove cigarette.”

(Admintih, 2016).

The pedicab is an integral part of Yogyakarta’s traditional culture. Stemming from the tourism boom pre 1980s, it is “employed as an important marketing tool for cultural tourism in Yogyakarta” and is in fact banned from major Javanese cities – but there it is “tolerated by the authorities” (Smithies in Dahles, H. & Prabawa, T.S. 2013, p. 242). Most of these men live in villages outside of the city, often travelling back to their hometown via motorbike (the pedicab is parked in location) or even sleeping overnight in their pedicabs to provide late service to tourists. More than any other participants in the informal tourism sector of Yogyakarta, pedicab men remain strongly embedded in their village community, with their earnings flowing back to the community they come from (Dahles, H. & Prabawa, T.S. 2013). However, given my recent visit to Yogyakarta, it was clear that the pedicab has lost its prevalence and the interests of many.

Pedicabs with Money Changer Sponsorship (Tan, 2019).

I had the blessing of speaking to one of these pedicab drivers in Prawirotaman, an area that is rich with the integration of traditional culture and modern design. Adi Tama, a 38-year old pedicab driver, points the cause of this fall towards people’s preference for convenience. With apps such as Gojek and Grab, tourists are less inclined to choose the pedicab, even when the bicycle of the pedicab had been swapped out for a motorcycle. With this decline in customers, I inquired what Adi and his fellow drivers do to cope, to which he answered “we find sponsors… we have other work.” Adi himself has 3 other jobs, 2 of them in the tourism industry, and 1 as a mobile handyman in his hometown, and is sponsored by Money Changer (they receive monthly funds for bike repair and are given packs of cigarettes, and also meat every religious holiday). The sponsorship of cigarettes is what was concerning, as “tobacco is responsible for 4.2 million deaths every year, a figure that… is estimated to reach 8.4 million by 2020” (Minh, H.V., Ng, N., Wall, S. et. al 2005, p.1) with “most smokers [coming from] lower education and economy levels” (Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014, p.2). With the stresses of a declining job market, the sponsorship tips of cigarettes and the busy lifestyle of a pedicab driver, it is no surprise that these men are at risk of a low chance of cessation.

On this note, Adi details his choice to be a pedicab driver was due to the fact that he and many others his age couldn’t afford further education. He’s had to learn English, German and Dutch from tourists. He’s grateful that with the new government established 5 years ago that his children can afford tertiary education, as “education is an important predictor of being a regular smoker. Men with less education tended to smoke regularly and cease less.” (Minh, H.V., Ng, N. Wall, S. et. al, 2005, p.6).

Although the pedicab is becoming scarcer on the roads of Yogyakarta, the gentlemen behind the cab are here to stay. When asked what his plans for the future is, Adi replied “I’m saving up, I’m saving up for something else, something better.”

References

Admintih, 2016, Becaks, the traditional transportation in Indonesia, topindonesiaholidays, viewed 20 December 2019, <http://blog.topindonesiaholidays.com/?p=4191&gt>.

Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014, ‘ Smoking behavior and attitude towards cigarette warning labels among informal workers in Surabaya city – East Java, Indonesia’, Advances in Life Science and Technology, vol. 21, pp.1-2.

Dahles, H. & Prabawa, T.S. 2013, ‘The case of the pedicab drivers of Yogyakarta, Indonesia’, Journal of Small Business & Entrepreneurship, vol. 26, no.3, p.242.

Minh, H.V., Ng, N., Wall, S. et. al 2005, ‘Smoking epidemics and socio-economic predictors of regular use and cessation: Findings Ffom WHO STEPS risk factor surveys in Vietnam and Indonesia’, The Internet Journal of Epidemiology, vol. 3, no. 1.

Post A: SYTC Yogyakarta

Upon visiting Yogyakarta – Indonesia’s “cradle of Javanese culture” (Dahles, H. & Prabawa, T.S. 2013, p.245), it’s clear to see the city’s pride through the design that’s found in every aspect of the environment. From the colourfully painted pedicabs to the bold walls coated with murals by the youth, it’s evident that “design plays a role in forming and communicating national identity in Indonesia” (Crosby, A. 2019, p. 53). However, within this rich city lies a poison rotting away at the heart of the culture. With its bright colours and encouraging messages you wouldn’t think harm of it, but let’s take a look at these examples.

Show Your Colours by Phillip Morris (Vital Strategies, 2017)

With its striking reds, blues, yellows and whites under the slogan “Show Your Colours”, these houses along Kali Code River in Yogyakarta “didn’t just catch the attention of local people – the stunt gained national and international notoriety” (Vital Strategies, 2017). Unknown to the residents, the village had in fact been transformed with the brand colours of Phillip Morris International (Indonesia’s largest tobacco company) to essentially be one giant advertisement (Emont, 2016) at an estimated exposure worth at US$220,000 a month (Vital Strategies, 2017). In response, the campaigns “Show Your True Colours” and #SuaraTanpaRokok (or “Voices Without Cigarettes”) was released in collaboration with Muhammadiyah Tobacco Control Centre and several organisations and activists in Yogyakarta “as a symbol of resistance towards the exploitation of the community by the tobacco industry” (Vital Strategies, 2017). Led by renowned local graffiti artist Koma, giant anti-tobacco murals painted onto these houses were unveiled on World Cancer Day. Although the tobacco industry has a tough grip on the community as the Indonesian government relies on the industry for “around 10% of state tax revenue” (Emont, 2016), the examples of activists working with the community shows that change can be made through the people.

Show Your True Colours (Vital Strategies, 2017)
Java Rockin’ Land Poster 2011 (Cranberries World, 2011)

Another example is the poster for Java Rockin’ Land 2011 posted around Indonesia, it boasts a line-up of bands like Thirty Seconds to Mars and Neon Trees. However, another name displayed alongside these artists is Indonesia’s second largest tobacco company, Gudang Garam (Hefler, M., Chapman, B. & Chapman, S. 2013). It’s not unusual for the tobacco industry to sponsor arts and cultural events such as these, but this sponsorship received a backlash due to the band’s high level of teen appeal and activity in philanthropic efforts in UNICEF and cancer charities. In response, a campaign by Tobacco Control was held through Facebook, tobacco control organisations, and Twitter to target the band’s management and press agents. In response to fan’s petitions, Neon Trees (a band with a history of antitobacco advocacy) announced that at the end of their set they would donate their earnings to an Indonesian cancer charity (Hefler, M., Chapman, B. & Chapman, S. 2013), and posters for Rockin’ Land post 2011 no longer feature sponsors by tobacco companies.

The examples of these two campaigns show the complex relationship between designers, culture-makers, artists, customers, and the tobacco industry. Each group is the source for cause and effect in the preservation of Yogyakarta’s culture.

References

Cranberries World, 2011, Java Rockin’ Land, CranberriesWorld.com, viewed 20 December 2019 <http://cranberriesworld.com/live/concerts/java-rockinland-festival-2011-2011-07-23/>.

Crosby, A. 2019, ‘Design activism in an Indonesian village’, MIT Press Journals, vol. 35, no.3

Hefler, M., Chapman, B. & Chapman, S. 2013, ‘Tobacco control advocacy in the age of social media: using Facebook, Twitter and Change’, Tobacco Control, vol.22, no.3.

Dahles, H. & Prabawa, T.S. 2013, ‘The case of the pedicab drivers of Yogyakarta, Indonesia’, Journal of Small Business & Entrepreneurship, vol. 26, no.3, p.245.

Vital Strategies, 2016, Anti-tobacco advocates in Indonesia show their true colors, viewed 20 December 2019, <https://www.vitalstrategies.org/anti-tobacco-advocates-in-indonesia-show-their-true-colors/>.

Vital Strategies, 2017, Tunjukkan Warna Aslimu – Kali Code (1 menit), video, YouTube, viewed 20 December 2019, <https://www.youtube.com/watch?v=gi0ErxDxggY>.

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 A: Two parties using design to their advantage

As designers, we hold far more responsibility than ever in this digital world where technology is relied on. A designer has the power to control how a space can be more hospitable and the way the general population consumes context (Role of design in society, chapter 1).

In Indonesia, the tobacco industry has used design to their advantage in order to boost tobacco consumerism. A tobacco company giant that has been notorious in pushing their kretek products to men through heavy graphics is ‘PT Gudang Garam’. In their graphics, they depict masculine men and this notion of masculinity has been further supported by their infamous slogan ‘Kretekeknya lelaki’, meaning ‘man’s cigarette’. This has been successful as more than 62% of their men smoke and 90% of are kretek smokers (Tobacco control, 2009). This graphic design as a form of advertising to a large demographic is dangerous in a country like Indonesia as it has not signed with the ‘WHO-FCTC’ (WHO, 2015) which means mainstream tobacco advertising coverage is still prevalent. So why are the deaths of these men ignored? The tobacco industry is one of the largest source of government revenue (Tobacco control, 2009) and with the backing of the government, the industry thrives.

Masculine graphic advertisement by Gudang Garam. Catherine Reynolds, 1999, Tobacco advertising in Indonesia: “the defining characteristics for success”, viewed 20 December 2019, https://tobaccocontrol.bmj.com/content/8/1/85

The continuous use of political power and design, Gudang Garam held a rock competition in 2007 and a rock festival called Rockinland in 2011. These festivals were again targeted at males, as all of their graphic promotional materials depicted rock symbols which were masculine. Apart from that, Rockinland’s lineup were male rockstars to further portray this lifestyle of ruggedness. Similarly, the Jakarta open which was a male’s tennis event was also sponsored by the tobacco industry. Drawing considerations starting from as simple as masculine graphics to enlisting only male stars ultimately is clever design as each element is cohesively attractive to their male target market.

A graphic poster showcasing Rockin’land’s male dominated lineup. Cranberriesworld, 2011, ‘Rockinland festival lineup’, viewed 20 December 2019, http://cranberriesworld.com/live/concerts/java-rockinland-festival-2011-2011-07-23/.

A communal organisation however, has used this design formula to advocate for a more sustainable future. ‘Kartel Awul Yogyarkata’ holds events targeted at youths, predominately males with their primary focus on encouraging them to trade and sell used clothing. The events are generally held at the few skateparks alongside local punk bands in order to appeal to this demographic. Similarly, they advertise graphically through their cult online presence. Although these events do not have primary involvement with tobacco, they do have anti-smoking zones in the larger areas of these events such as the foodcourt and the thrift stalls which can discourage general smoking there.

A band playing at the Kartel Awul YG event I attended, 2019.
stakeholder map and chain to vaguely show the relationship both parties share with government and people of Indonesia, 2019.

Catherine Reynolds, 1999, Tobacco advertising in Indonesia: “the defining characteristics for success”, viewed 20 December 2019, https://tobaccocontrol.bmj.com/content/8/1/85

Cranberriesworld, 2011, ‘Rockinland festival lineup’, viewed 20 December 2019, http://cranberriesworld.com/live/concerts/java-rockinland-festival-2011-2011-07-23/.

Mimi Nitcher, 2009, ‘Reading culture from tobacco advertisements in Indonesia ‘, tobaccocontrol, viewed 20 December 2019, https://tobaccocontrol.bmj.com/content/18/2/98.

SEATCA, 2010, ‘International artists performing at Indonesian tobacco-sponsored rock festival despite protests’, viewed 20 December 2019, https://seatca.org/international-artists-performing-at-indonesian-tobacco-sponsored-rock-festival-despite-protests/.

World health organisation, 2015, ‘Tobacco control in Indonesia’, WHO, viewed 20 December 2019, https://www.who.int/tobacco/about/partners/bloomberg/idn/en/.

POST C: The involvement of tobacco within the subcultures of Jogja

During my visit to Jogja, I had crossed paths with youths at the local events I had attended. Having already known that Indonesia is recognised as the fastest growing cigarette consumer worldwide (Joy de Beyer and Ayda A. Yurekli, 2000), I was interested in the hierarchal value that tobacco had within these environments. I decided to follow up on two individuals whom I had met at these events after to gain a more in-depth understanding of how smoking is affecting youths behind these culture as a whole.

The first individual, is 20-year-old Zulfian. Zulfian has been smoking since high school which started at the first punk show he had attended and blamed both the high prevalence of smoking at these shows and also the social stigma that smoking is associated with amongst men. He considers himself a regretful smoker as he is aware of the dangers of smoking and thus, hopes for a future where tobacco is more considered in education. Although Zulfian is amongst the 70.5% of men who are current smokers (WHO, 2017), he does not completely blame punk for his tobacco consumerism but wishes there were other alternatives other than smoking when attending these shows.

Photographs I took of smoke clouds from smokers and attendees smoking at the punk show, 2019.

My other candidate Za however, is a member of a sculpture making society that do not condone smoking at their events. Being a foreign student from Portugal, she was aware of the Indonesian tobacco industry prior to her move. Initially, this did not phase her as she was originally a social smoker but her views on smoking shifted after joining the sculpture society through her Jogja university. Before her involvement within the society, Z stated that she continued to smoke socially despite fellow classmates advising her that female smokers are frowned upon in Indonesian society. This is no surprise as a study in 2007 showed that only as little as 3% of women smoked (Mimi Nitchter, 2007). The events organised by her society promotes sustainability through showcasing works made from organic and natural resources. She felt the need to quit as a whole because smoking did not align with her society’s motif for advocating a greener society as it causes pollution.

Photo of Za’s works at a event her society had which promotes sculptures and fabrics made from reusable and organic materials.

Ultimately, although the relationship that tobacco has within these two groups differ, I understand that this could be bias perspectives as these opinions derive from two minority sub cultures in which are highly niche.

Joy de Beyer, Ayda A. Yurekli, 2006, ‘Curbing the Tobacco Epidemic in
Indonesia’, viewed 20 December 2019, <http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.552.952&rep=rep1&type=pdf>.

Mimi Nichter, S Padmawati, M Danardono, N Ng, Y Prabandari, Mark Nichter, 2009, tobaccocontrol, viewed 19 December 2019, <https://tobaccocontrol.bmj.com/content/18/2/98.short>.

Nawi Ng, L. Weinehall, A. Öhman, 2007, ‘‘If I don’t smoke, I’m not a real man’—Indonesian teenage boys’ views about smoking ‘ pages 794-804, academic, viewed 19 December 2019, <https://academic.oup.com/her/article/22/6/794/640787>.

World health organisation, 2019, ‘‘WHO report on the global tobacco epidemic, 2019 ‘, WHO, viewed 19 December 2019, <https://www.who.int/tobacco/surveillance/policy/country_profile/idn.pdf>

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 C: Fitri – Gender and Smoking

On 1-14thDecember of 2019, I visited Yogyakarta to participate in a global studio focusing on the wicked problem of tobacco. During my visit, I got a chance to interview one of the clothing street vendors in Malioboro street, Fitri. In Indonesia, it is estimated that around 65 percent of Indonesian men are smokers. While for Indonesian women, the figure is much lower – around 3 percent only (Indonesia Investment 2016). I asked her several questions about the current situation of smoking in Yogyakarta, precisely in Malioboro street. She claimed that most of the smokers situated there, are young men and usually they smoked as a group “they smoke just to socialize” she said. When I asked her about why we don’t really see young girls or women smoke in public she answered that in Indonesia it is still taboo for women to smoke moreover if they are wearing hijab. Tobacco kills 255 720 people each year around the world (WHO 2018) and Indonesia is the 6thranked country that smokes the most cigarettes around the world. Everywhere I walk along the Malioboro street I could see someone smoke while they are sitting, walking or even standing while chatting with their friends. Fitri also told me that her father and older brother smokes since young age because of the pressure from their community. After she said that it makes me think that young students smoke not because they want to in the first place but because of the pressure from their surroundings since early age that makes them hard to quit. Fitri claimed that she wishes that her father and brother will quit smoking as soon as possible since she is worried about their health condition. She claimed that her dad has a hard time breathing while her brother keeps on coughing occasionally. 

A person standing in front of a store

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One of the cigarettes seller selling ranges of cigarette brands in Malioboro street (Rokok Indonesia 2014).

From a research conducted by the University of Muhammadiyah Yogyakarta, most smokers are worried about the dangers of smoking that can affect their health if the cigarette packaging shows the picture of diseases that they can get if they continue to smoke printed on the packaging cover(University of Muhammadiyah Yogyakarta 2012). In my opinion, Indonesia needs to enforce the plain packaging law as soon as possible since when I go to the supermarket I can still see cigarette boxes with no big image of health warning printed on the cover.

Reference:

Indonesia Investments 2016, Tobacco & Cigarette Industry Indonesia, viewed 16 December 2019, <https://www.indonesia-investments.com/business/industries-sectors/tobacco/item6873&gt;.

Rokok Indonesia 2014, INDUSTRI ROKOK, Flickr, viewed 16 December 2019, <https://www.flickr.com/photos/130075348@N08/15751292613/in/photostream/>.

Saragih, M. 2012, THE EFFECT OF DISEASE PICTURE PRINTED-CIGARETTE PACKAGE TO ACTIVE SMOKERS OF HIGH SCHOOL STUDENT IN YOGYAKARTA, University of Muhammadiyah Yogyakarta, viewed 16 December 2019, <http://repository.umy.ac.id/handle/123456789/11769&gt;.

World Health Organization 2018, Factsheet 2018 Indonesia, viewed 16 December 2019, <https://apps.who.int/iris/bitstream/handle/10665/272673/wntd_2018_indonesia_fs.pdf?sequence=1&gt;.

Post D: Mental Health Implementation

Based on the results done in 2010, Java is the province with higher rates of an active smoker (Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014). A survey conducted in East Java’s Surabaya – Indonesia’s second largest city, found that there was a significantly higher prevalence of depression in women in comparison to other cities (Byles, J., Christiani, Y., Dugdale, P. & Tavener, M. 2015). Women have turned to smoking as a form of a quiet self-medication, with the odds of a depressed woman being a smoker being twice that of a depressed man (Liew, H.P. & Gardner, S. 2016). In the same research study, the results of Indonesia was compared to the results attained in USA, South Africa, and Glasgow (UK), and it was found that the common aspects to the co-morbidity of depression and smoking is due to lack of strong social support networks caused by stigmas with mental health.

Statistical analysis showed that with better knowledge about mental health, the lower the tendency to have negative attitudes towards mental disorders. This recommends psychoeducational programs through a variety of methods to improve the understanding of mental health and the resources available to treat it (Ariana, A.D., Fardana, N.A., Hartini, N. & Wardana, N.D. 2018). In Surabaya, the highest concentration of Puskesmas (Community Health Centres) are greatly concentrated in the city centre. However, it is found that “current smoking behaviour was more frequent among the poor.” (Byles, J., Christiani, Y., Dugdale, P. & Tavener, M. 2015). 

The support needed for these women and the community as a whole is greatly lacking. Indonesia possesses a Mental Health Law established in 2014, but its implementation is not yet optimal (WHO in Ayuningtyas, D., Maulidya, A.N., Misnaniarti, M. & Rayhani, M. 2018), with the causes being mainly due to limited resources and prevailing stigma against mental health. Although services in the field are increasing with 48 Mental Hospital and Drug Addiction Hospitals established in 26 of 34 provinces, there is still a low priority in the national budget for this area with only 1% dedicated to the cause (WHO in Ayuningtyas, D., Maulidya, A.N., Misnaniarti, M. & Rayhani, M. 2018). Where the mental health is low in exposure, a different industry is thriving with its voice in the community.

Indonesia ranks fifth highest in cigarette consumption, and “is the only country in the region that have not signed the WHO Framework Convention on Tobacco Control” (Barber et al. in Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014 ). The tobacco industry has begun to feature more young women in cigarette advertisements. With 87% of the female population being Muslim in Surabaya, advertisements are marketing cigarette-use with female independence, portraying “young women in sleeveless tank tops in a country where many women dress modestly and wear hijabs.” (Cohen, J.E., Hardesty, J.J., Kaplan, S., Kennedy, R.D. et. al 2019 p. 42). This has resulted in a steady increase in female smokers in Surabaya since 2012 (Cohen, J.E., Hardesty, J.J., Kaplan, S., Kennedy, R.D. et. al 2019).

The battle now is between the efficacy of public health awareness and the aggressive advertising campaigns of the tobacco industry. With the rates of female smokers rising, it’s important to recognise that more power must be given to the support of mental health programs.


References

Ariana, A.D., Fardana, N.A., Hartini, N. & Wardana, N.D. 2018, ‘Stigma toward people with mental health problems in Indonesia’, Psychology Research and Behaviour Management, vol. 11, pp. 535-41.

Ayuningtyas, D., Maulidya, A.N., Misnaniarti, M. & Rayhani, M. 2018, ‘Implementation of mental health policies toward Indonesia free restraint’, Policy & Governance Review, vol. 2, no. 2, pp. 161-173.

Barkina, T., Dewi, V. K., Isnaniah. & Kirana, R. 2014, ‘ Smoking behavior and attitude towards cigarette warning labels among informal workers in Surabaya city – East Java, Indonesia’, Advances in Life Science and Technology, vol. 21, pp.1-2.

Byles, J., Christiani, Y., Dugdale, P. & Tavener, M. 2015, ‘Socioeconomic related inequality in depression among young and middle-adult women in Indonesia’s major cities’, Journal of Affective Disorders, vol. 182, pp. 76-81.

Cohen, J.E., Hardesty, J.J., Kaplan, S., Kennedy, R.D. et. al 2019, ‘Smoking among female daily smokers in Surabaya, Indonesia,’ Public Health, vol. 172, pp.40-42.

Liew, H.P. & Gardner, S. 2016, ‘The interrelationship between smoking and depression in Indonesia’, Health Policy and Technology, vol. 5, no. 1, pp. 26-31.

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: 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>