Tobacco and inequality: the case of Indonesia – por Gustavo Machado de Melo

By Gustavo Machado de Melo*

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Once I traveled from Balikpapan to Samarinda by bus and the man in front of me smoked almost uninterrupted for the full three-hour trip. I felt so bothered. Similar situations happened thousands of times everywhere else I visited in Indonesia and in my home city of Yogyakarta. In the beginning I was so scared with the never-ending tobacco ads, but after some time I got used to them, though I simply couldn’t admit this. Neither could I accept the situations in which fathers smoked in front of their small children, children themselves bought cigarettes after school and students thought that smoking was a must for anyone who wants to be cool. I have never seen any broad anti-tobacco policy, nor anyone encouraging friends to quit smoking, nor even disclaimers about how bad smoking is. Instead, I found a growing number of smokers, a lack of an anti-tobacco policy and smoking as an empowerment method.

During my one-year exchange in Indonesia I tried to do my best to help friends stop smoking. By bringing information through this article, I aim to bring some information for those who don’t know about the situation of tobacco in Indonesia. But mainly, I hope to inspire readers to give up smoking and to help others doing so. Not coincidentally, today is World’s No Tobacco Day, whose 2017 campaign is focused on smoking and development. [1] Nearly the same focus I have in this article. (this was a coincidence!)

There are few anti-tobacco policies in Indonesia, but most of them are still shy and not nationwide. It seems that horizon for change is slow-moving. Indonesia is world’s  4th largest cigarette consumer and tobacco production chain branches out in many provinces and economics fields, generating thousands of jobs and, of course, significant interests. The interest groups that profit with Indonesian 90 million smokers lobby heavily on the Executive and Legislative powers, avoiding restrictive policies. When it comes to tobacco, Indonesian House of Representatives is still backwards: it discusses if smoking really harms health, a debate overcame in most countries more than 30 years ago. Bribery from tobacco companies also play an important role on this, but it will be better explained in my next article in this blog.

The smoking prevalence among Indonesian adult men is 76%. [2] Prevalence among people below the age of 18 has raised to 8,8% in 2015. [3] And, yes, this number includes very small children as Ardi Rizal, the two-years-old boy who shocked the world in 2007 when he used to smoke 40 cigarettes per day. Tobacco industry represents 1,66% of Indonesian GDP and its yearly exports amounts to US$700 million. [4] Some firms that run this business are the most valuable in Indonesia. The average price of a package (generally with 16 units) is around 16.000 rupiahs, US$1,20. [5] It’s quite common to find single cigarettes costing 1.500 or 2.000 rupiahs, around US$0,15.

Layers of inequality

The discouraging situation of smoking in Indonesia has close relation to inequality problems, at different levels.

Country: international power and trade relations are inscribed in a North-South dichotomy in which Southern resources and markets are heavily exploited by firms from the North. In the last fifteen years, the Indonesian biggest tobacco groups, Sampoerna and Bentoel, were acquired by Philip Morris International and British American Tobacco, two of the world’s largest tobacco companies, headed in the US and in England respectively. The Indonesian market is an opportunity for them to increase their market shares while most countries are tightening regulations on smoking. They are also taking advantage of Indonesian corrupt political system (which facilitates lobby and bribe) and of its huge population (whose purchasing power is on rise). For them, it is quite fruitful to burden a Southern society while dispatching millions on profits to their Northern headquarters.

Age: it is widely known that youngsters and children are more susceptible to advertising. These groups became the targets of advertising by Indonesian tobacco companies. Most ads portray young people smoking and having fun, presenting tobacco as a way to be cool and attractive. Moreover, cigarette brands sponsor many youth cultural events (concerts, exhibitions, festivals, etc.) and TV shows. By doing so, tobacco industry guarantees addicted consumers since very young age, raising profits and assuring loyal consumers in the case of more restrictive policies in the future. But it leaves behind disastrous health problems for the country.

Gender: the smoking prevalence among Indonesian women is 6,7% [6], nearly 70% lower than among men. Undoubtedly, this gap reflects gender inequality in the country: smoking is related to the occupation of public spaces and power. With growing awareness among women regarding gender disparity, struggles to gain voice and authority emerged. However, smoking has raised as a tool of empowerment, a  symbol of status which helps equating men and women. Not surprisingly, the number of female smokers increased 400% in the last 20 years, pushed up mainly by younger generations.

That’s not new at all – for decades since the 1920s, USA tobacco companies had resorted to women in order to make their markets larger. Advertising linked smoking to self-confidence and independence, attributes women were struggling for. In XXI century Indonesia we notice the repetition of these same marketing strategies, which probably will lead to the very same healthy problems that US experienced.

Class: poorer families usually have less access to information and, therefore, they often do not acknowledge the harms that tobacco brings to health, mainly when there is no national campaign on the issue. These very same families are also the ones that suffer harsher with smoking. First of all, they buy the cheapest cigarettes, which are the worst because of higher levels of nicotine and toxins when compared to more expensive models. Then, as their familiar income is short, they are the ones who feel stronger the burden of tobacco on the familiar budget, robing resources they need to rise out of poverty. Finally, in the case of a smoking-related illness, a poor person has less recourses do pay for a treatment, what might shorten his or her lifetime.

What’s the solution?

Having achieved such a huge number of smokers makes solutions even more complex. Rising taxation and consequently the prices would be an effective beginning, since it could decrease the daily consumption and avoid newcomers to the market. However, efficiency of tributary measures might not work in the absence of a nationwide anti-tobacco campaign. Restrictions on packaging, advertising and selling are essential efforts.

Further procedures on tobacco control will be presented in my next article, to be released soon in this same blog. I will focus on corporate power and corruption related to tobacco companies, in addition to bringing information regarding tobacco-related diseases. Hope to have you as a reader soon again!

 

References:

[1] Find more information about World No Tobacco Day at http://www.who.int/tobacco/wntd/en/  (here you can also find hints on how to stop smoking)

[2] World Health Organization, Global Health Observatory Data Repository. Available at: http://data.worldbank.org/indicator/SH.PRV.SMOK.FE?locations=ID

[3] TEMPO.CO, Perokok Indonesia Capai Sepertiga Jumlah Penduduk. Yogyakarta, 26 November 2016. Avaiable at: https://m.tempo.co/read/news/2016/11/26/173823351/perokok-indonesia-capai-sepertiga-jumlah-penduduk

[4] DetikFinance, Begini Pentingnya Industri Rokok Bagi Ekonomi RI. Jakarta, 20 July 2015. Available at: https://finance.detik.com/industri/%202947821/begini-pentingnya-industri-rokok-bagi-ekonomi-ri

[5] Based on 28/May/2017 quotation

[6] Nova, Jumlah Perokok Perempuan di Indonesia Meningkat Hampir 4 Kali Lipat. 1 October 2015. Available at: http://nova.grid.id/Kesehatan/Wanita/Jumlah-Perokok-Perempuan-Di-Indonesia-Meningkat-Hampir-4-Kali-Lipat

 

*Graduando em Relações Internacionais na Universidade de São Paulo / Undergraduate student in International Relations at the University of São Paulo

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4 pensamentos sobre “Tobacco and inequality: the case of Indonesia – por Gustavo Machado de Melo

  1. I believe this is a very clear example of how big industries shape or influence our behavior, especially when we have no (or a very limited) access to information. The consequences of tobacco for our health are extremely serious, in particular when the public starts to consume it so young, and that’s why these industries should be more responsible (but, hey, this is capitalism, right?).

    A similar problem occurs with alcohol in many countries, where there’s a lot of advertising and stimulus to drink, but almost no campaigns to avoid or reduce the consumption. I strongly believe that these drugs shouldn’t be forbidden, because the prohibition is only a contribution to the illegal traffic. How the control or regulation should happen, however, is another very hard issue, so I look forward to reading your proposal for the solutions of this problem.

  2. Gustavo, muito interessante seu post e como você abordou o tema, demonstrando essas “faixas de desigualdades”.
    O tabagismo também afeta muito as Américas: de acordo com recente notícia publicada no site da ONU Brasil, 11,4% de todos os fumantes do mundo estão presentes nessa região.

    Certamente, a busca por soluções é um ponto essencial, principalmente levando em consideração os problemas de saúde e a redução na qualidade de vida das pessoas consumidoras de cigarro (e certamente das pessoas que não fumam, mas convivem com fumantes); concordo com você sobre os benefícios do aumento das taxas cobradas sobre os maços de cigarro (elevando, consequentemente os preços), já que pode levar à diminuição do consumo diário e evitar que mais pessoas entrem no mercado como consumidores. Na verdade, estudos comprovam que tal medida é eficaz, sobretudo para populações de menor renda (uma das faixas de desigualdade citadas por você), e a própria OMS recomenda que os impostos representem mais de 75% do valor de um maço de cigarro no varejo.

    De acordo com a mesma notícia, há ainda outras medidas que podem auxiliar na diminuição do tabagismo nas Américas, como a ratificação do Protocolo sobre a Eliminação do Comércio Ilícito de Produtos de Tabaco, o que implicaria na redução do acesso a esses produtos com baixo custo.

    Além disso, há necessidade de que os países fortaleçam políticas internas contra o tabagismo, devido aos danos causados à saúde da população; mas há, também, um fator econômico a ser considerado: o alto custo gerado aos sistemas de saúde dos países; em muitos deles, as perdas causadas pelo tabagismo ultrapassam 0,5% do PIB (ex. 0,86% do PIB no Chile).

    Mais dados e informações sobre o tabagismo e o combate ao mesmo nas Américas, podem ser encontrados no link: https://nacoesunidas.org/tributacao-sobre-cigarros-nao-cobre-prejuizos-publico-tabagismo-diz-banco-mundial/

    (Juliana Caires)

  3. Obrigado pelo artigo e principalmente por contribuir para disseminar a situação vivenciada na Indonésia. Tenho certeza que muitas pessoas serão alcançadas pela sua ação pela sua contribuição.
    Como bem apontado no artigo e nos comentários, o problema do tabagismo é bastante complexo e exige a tomada de ação por diversos atores nos níveis local, nacional e global de governança. Nesse sentido, compartilho do ponto de vista de que o acesso à informação deve ser um dos principais pilares de qualquer política anti-tabagismo e confesso que fiquei bastante chocado com o fato de que o legislativo da Indonésia ainda esteja discutindo a associação entre fumar e os danos à saúde.
    Aproveito para compartilhar um artigo da CNN sobre o conjunto de medidas adotado pela Finlândia com o objetivo de tornar o país livre do tabagismo até 2040, reduzindo para menos de 2% a porcentagem da população adulta que consuma tabaco em qualquer forma (http://edition.cnn.com/2017/01/26/health/finland-tobacco-free-plan/index.html). Dentre as medidas adotadas destacam-se: a proibição do consumo de cigarros em sacadas privadas caso este incomode a vizinhança, a imposição de altas taxas aos vendedores de cigarros e a proibição de incorporação de sabores nos cigarros comuns e elétricos.
    Embora cada país guarde suas características e desafios próprios, principalmente no que diz respeito às desigualdades existentes, a experiência internacional pode servir como objeto de comparação e tomada como instrumento de reivindicação de políticas públicas, principalmente por parte dos grupos da sociedade civil.
    Parabéns pelo artigo, Gustavo, e fico no aguardo do próximo!

    Thank you for the article and for your contribution to disseminate the situation lived by the people in Indonesia. I am sure that you will reach more people than you imagined.
    As you and the commenters well pointed, the smoking problem is very complex and demands responses from different actors in all levels of governance. Having said that, I share the view that places the access to information as one of the main pillars of every anti-tobacco policy and I need to confess that I was shocked by the fact that the Indonesian House of Representatives is still discussing the relation between smoking and the state of health.
    I would like to leave here the article made by CNN on the measures adopted by the government of Finland aiming to reduce the participation of adults smoking in the population to less than 2% until 2040, resulting in a country tobacco-free (http://edition.cnn.com/2017/01/26/health/finland-tobacco-free-plan/index.html). Banning smoking on private balconies if it disturbs neighbors, high fees for vendors selling tobacco and the prohibition of flavors in cigarettes and e-cigarettes are some of the measures that are in place since the plan launch in August 2016.
    Despite the fact that each country has its own characteristics and challenges, especially regarding its inequalities, the international experience may serve as a benchmark and an effective tool for civil society groups to demand public policies and responses.
    Congratulations for the article, Gustavo, and I can’t wait for the next one!

  4. Olá Gustavo, ano passado me dediquei a estudar a causa do tabagismo ao realizar um trabalho sobre a Nicorette, um produto da Johnson cujo objetivo é auxiliar pessoas a pararem de fumar. Realmente trata-se de uma questão complicada uma vez que de fato conseguíamos ter diferenças de média que justificassem diferentes comportamentos com relação ao uso do tabaco. Pelo que me lembro, além de gênero e idade, também região em que habitava (urbana ou rural) e também classe social.
    O fato é que pelo que percebi, o consumo do tabaco está relacionado aos níveis de ansiedade e também a uma routina ou hábito de fumar. Pessoas para pararem de fumar devem,estar conscientes de que querem parar e ter um motivo muito forte para tanto. Nossa solução foi justamente a de tentar reverter a imagem do uso de tabaco nos jovens, esses formadores de opiniões e transformadores de comportamentos. O produto consistia em uma goma de mascar que continha tabaco terapêutico em si de modo que ligava a elegância do mascar do chiclete entre os jovens para tentar tirar o glamour presente no ato de fumar. Trata-se de um vício químico e diário muitas vezes de forma a ter um impacto enorme no sistema de saúde e no bem-estar geral da população.
    No Brasil, temos indicadores muito altos de uso de tabaco, mas estamos evoluindo muito também na redução, mesmo tendo seus índices aumentado para certos segmentos de renda mais alta, o que demonstra que as pessoas estão se esquecendo dos malefícios do cigarro ou mesmo novos grupos de idades menores estão voltando a começar a fumar, muito devido a falta de conscientização sobre o tema nos últimos anos, revertendo um pouco a média brasileira. De resto, acredito que estejamos evoluindo. Claramente um bom exemplo dos determinantes sociais da Saúde.

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