Indonesia

By Widyastuti Soerojo
Tobacco Control Support Center (TCSC)-Indonesian Public Health Association

Indonesia has the world’s fifth highest cigarette consumption. Consumption rose from 33 billion sticks in 1970 to 217 billion sticks in 2000, an almost sevenfold increase⁽¹⁾ . Two out of three male adults smoke. As well as a threefold increase in female smoking between 2001 and 2004, there was a large increase in smoking initiation among people under 19 years of age – from 68% in 2001 to 78% in 2004. The most significant increase was in the youngest age group of 5-9 years from 0.4% in 2001 to 1.8% in 2004⁽²⁾ . The Global Youth Tobacco Survey 2006 found that one in four boys aged 13-15 years were active smokers⁽³⁾ . 67% of males with no education smoke compared with 48% of university graduates⁽⁴⁾ . An estimated 43 million Indonesian children are regularly exposed to secondhand smoke in their homes⁽⁵⁾ . 81% of students are exposed in public places⁽³⁾ .

On average 11.5% of the monthly household expenditure by 50 million Indonesian smokers was on cigarettes in 2004, a 20% increase from 2001. The poorest spent more (11%) than the richest (9.7%) ⁽⁶⁾ In 2001 smoking was estimated to kill 427,948 people annually. In 2001 the total economic loss due to premature mortality, morbidity and disability was estimated at US$ 14.94B (Rp 127.4 trillion), about 7.5 times higher than the tobacco tax revenues in the same year (totalling US$ 1.94B or Rp 16.5 trillion)⁽⁷⁾ .

About 92% of the Indonesian tobacco market is kreteks (clove cigarettes)⁽⁸⁾ . Sampoerna (Philip Morris owned), Gudang Garam and Djarum were the three largest tobacco companies, comprising over 75% of the total cigarette market in the past five years. Philip Morris’s acquisition of Sampoerna, worth US$ 5.2 billion in 2005, has triggered more aggressive competition among the tobacco companies to become the market leader. Tobacco advertising, promotion and sponsorships are used to target young people⁽⁹⁾ .

Tobacco has been a low priority in the public health agenda for many years. Among other political reasons is the perceived contribution of tobacco to government revenues and employment. Indonesia is the only country in Asia that did not sign or accede to the FCTC⁽¹⁰⁾ . The existing Government Regulation No 19/2003 is weak, and compliance is uncommon. The draft tobacco control bill failed to be included in the national legislation agenda. There are almost no restrictions on tobacco industry conduct, advertising and promotion. Despite political barriers, a number of local governments have enacted smokefree regulations. Implementation has yet to take place.

The complexity of tobacco control has made this a war. Three major challenges are government-industry partnership, skepticism and even resistance by the public due to low awareness, and weak civil society advocacy on tobacco control. This has resulted in inadequate pressure and missed opportunities for influencing policy change. Most NGOs are voluntary organizations, who are under-resourced and work alone. Activities are ad hoc and do not lead to specific goals. Indonesia needs to encourage its tobacco control NGOs to work together as an effective network.

The Bloomberg Initiative can help build the foundation for a systematic response to the tobacco epidemic in Indonesia by strengthening the infrastructure, improving the capacity of NGOs, and sharing best practices for policy change.

References
⁽¹⁾ Ministry of Health, Republic of Indonesia (2004). The Tobacco Source Book: Data to Support a National Tobacco Control Strategy
⁽²⁾ TCSC-Indonesian Public Health Association, SEATCA, WHO (2007). Tobacco or Health: Country Profile
⁽³⁾ Tjandra Yoga Aditama (2006). Indonesia Global Youth Tobacco Survey (GYTS)
⁽⁴⁾ TCSC-Indonesian Public Health Association, SEATCA, WHO (2007). Tobacco or Health: Country Profile.
⁽⁵⁾ Ministry of Health, Republic of Indonesia (2004). The Tobacco Source Book: Data to Support a National Tobacco Control Strategy
⁽⁶⁾ TCSC-Indonesian Public Health Association, SEATCA, WHO (2007). Tobacco or Health: Country Profile.
⁽⁷⁾ Kosen, S (2004). Health Economic Impact of Tobacco Use in Indonesia. Center for Health Services and Technological Research and Development. National Institute of Health Research and Development, Ministry of Health.
⁽⁸⁾ http://www.wartaekonomi.com/indikator.asp?aid=8208&cid=25
⁽⁹⁾ TCSC-Indonesian Public Health Association, SEATCA, WHO (2007). Tobacco or Health: Country Profile.
⁽¹⁰⁾ SEATCA (2008). Indonesia Report Card: Status of Tobacco Use and its Control