Last month, tobacco control advocates in Indonesia suffered a terrible loss. A friend and advocate, a spokesperson who couldn’t speak, left us for good. Robby Indra Wahyuda, a 27-year-old from Samarinda, died on 23 June from laryngeal cancer. He had been a heavy smoker, reportedly hooked on cigarettes since grade six. But when he was diagnosed with cancer, Robby became an active anti-smoking campaigner. In widely shared posts on social media, he detailed the operation to remove his larynx and his ongoing treatment, and encouraged others to reflect on his story.
Robby is just one of many tobacco victims in Indonesia. We have the third highest number of smokers in the world after China and India. Cigarette smoking is like an un-natural disaster. Approximately 200,000 Indonesians die as a result of tobacco consumption each year, more than were killed by the 2004 Indian Ocean tsunami in Aceh. More than two-thirds of adult males in Indonesia smoke, and Indonesian boys are not far behind. The 2014 Global Youth Tobacco Survey, for example, reported that a staggering 35 per cent of boys aged 13-15 were smokers.
Multiple factors have contributed to high rates of youth smoking. First is the aggressive targeting of young people by the tobacco industry. Cigarette advertising often openly targets children, describing cigarettes as asik, or cool. A now infamous advertisement from Philip Morris subsidiary Sampoerna played on an Indonesian idiom, stating: “It is better to die than leave behind a friend. Sampoerna is a cool friend.” Another Sampoerna ad declared: “Without you, it’s boring!” (Nggak ada loe, nggak rame!). Tobacco companies are among the most prolific and important sponsors for live music events targeting teens. And it is not only mainstream bands. Cigarette sponsorship is important for the indie scene, and bands such as White Shoes and the Couples Company often perform at cigarette-sponsored events.
The second factor is access. The 2014 youth survey found that 65 per cent of cigarette smokers aged 13-15 were able to buy cigarettes from a store, shop, street vendor or kiosk. Three-quarters of young smokers bought cigarettes as individual sticks, often for as little as Rp 1000 (AU$0.10). While the government recently passed legislation banning the sale of alcohol in minimarts to restrict underage drinking, it seems to be far less concerned about the easy access children have to tobacco.
Part of the problem is that Indonesia has yet to pass the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), which contains provisions banning tobacco advertising, as well as on package warnings and restrictions on sales to minors. It has been ratified by most countries in the world, including all of Indonesia’s neighbours.
Tobacco control advocates continue to attempt to engage national and local governments on tobacco control. Partially as a result of their efforts, many districts in Indonesia have now begun implementing smoke-free zones in public places, such as Bogor, Padang Panjang, Palembang, and Pontianak. Bali was the first province to pass a provincial smoke-free law in 2011 and eight out of its nine districts have passed and implemented district smoke-free laws. Bogor and Denpasar are now regulating and or removing outdoor advertisements, and the Indonesian Broadcasting Commission (KPI) has proposed a complete ban on tobacco advertising on television.
Despite steps toward banning smoking in public spaces, such prohibitions are rarely observed, least of all in government offices. Overall, The World Health Organisation gives Indonesia a score of just 3 out of 10 for its compliance with smoke free legislation (although compliance is about 50 per cent in Bogor and Denpasar). At the national level, the government has recently begun enforcing a regulation requiring health warnings on 40 per cent of the packet, although this is significantly smaller than requirements in neighbouring countries.
Public awareness campaigns are, and will continue to be, important, but there are suggestions that many young people already know about the dangers of smoking. In the Global Youth Tobacco Survey, more than 70 per cent of young people recognised that second-hand smoke could be harmful and nearly 90 per cent favoured a ban on smoking inside public spaces.
To really make a dent in youth smoking, however, the government must tackle the campaigns and activities directed at children. Bans on tobacco advertisements in any kind of media should be implemented and enforced. Bans on tobacco sponsorship of youth events and concerts would be a good first step. Scholarships offered by the tobacco industry under the guise of corporate social responsibility must be prohibited at all levels of education. To restrict access to cigarettes, greater efforts need to be made to prosecute people caught selling cigarettes to children, and bans placed on the selling of single cigarettes. As children have less disposable income, increasing taxes on cigarettes is also an effective way of reducing underage smoking. Above all, of course, the government must also take the long overdue step of ratifying the Framework Convention on Tobacco Control.
Reducing youth smoking will also require attitudinal change, the kind Robby was urging. If anything can be taken from his early death it is that his messages were powerful tools for the anti-smoking movement. The government may have shown little initiative to reduce youth smoking, but anyone can see that a 27-year old dying from throat cancer is certainly not asik.