The recent death of a 27-year-old from laryngeal cancer has highlighted the problem of youth…
Tobacco control advocates were hopeful that the televised vice presidential debate between Ma’ruf Amin and Sandiaga Uno on 17 March would clarify both camps’ attitude to regulating the tobacco industry, taxing cigarette sales or, at the very least, provide a picture of their commitment to reducing smoking rates in Indonesia. But the issue was almost completely ignored.
Indonesia has one of the highest smoking rates in the world and a poor record for implementing the public health measures needed to see these rates fall. Smoking is estimated to kill more than 225,000 Indonesians per year and contributes to many more deaths.
Further, Indonesia is one of the only Asian states that has not signed the global Framework Convention on Tobacco Control (FCTC) (the other is Afghanistan). Tobacco control advocates have lobbied the government to commit to the FCTC for years, and called for firmer action on this key national health challenge. Meanwhile, the Ministry of Health aims to reduce tobacco consumption by 30 per cent in 2025, and has begun promoting healthy lifestyles and targeting anti-smoking programs to children, but these efforts are doing little to curb the nation’s smoking habit.
The conspicuous absence of tobacco issues during the debate was disappointing for tobacco control advocates but it was also unsurprising, given how polarising and politically complex tobacco control has proven to be in Indonesia.
Airing policies and opinions about tobacco on the very public and highly scrutinised stage of the vice presidential debate would no doubt lead to a flood of criticism no matter what side was taken. Worse yet, it could have jeopardised relationships with some of Indonesia’s wealthiest figures, who happen to be making plenty of money from selling cigarettes.
Why is tobacco policy so controversial?
Despite the silence of the vice presidential debate, tobacco regulation has been highly contested in recent years. There are several layers to this policy area, creating tensions that politicians and political parties can take advantage of at various times.
The first of these tensions relates to the uphill battle to decrease smoking rates, particularly the uptake of smoking among young people in a population that has a seemingly high tolerance for smoking. Much of this has so far focused on restricting advertising, although corporate sponsorship of popular music and sports events continues.
Regulations that set up smoke-free areas (kawasan bebas rokok) have been enacted nationally and have even been broadened by some local governments. But in many other districts nothing has been done at all and smoking remains tacitly permitted in public areas. More drastic measures that have been proven to discourage smoking in other countries – such as plain packaging and larger graphic health warnings – have not been seriously mooted by any government actors.
The second problematic area is that cigarette sales generate an enormous amount of money for the Indonesian government. In 2018, tobacco excises generated approximately Rp 153 trillion (AU$15.3 billion) for Indonesia’s budget. Even though the government claims that these funds will be used to cover the deficit of the Healthcare and Social Security Agency (BPJS Kesehatan) – which was above Rp 10 trillion in 2017/2018 – that still leaves plenty left over for other uses. Why would the government do anything to endanger this income stream? This goes a long way to explaining why it has been so difficult to convince the government to sign the FCTC or pass tobacco control legislation, leading to an ongoing tension between public health and economic concerns.
The third problem is the politicisation of tobacco growing and cigarette creation itself, both as a source of income, as well as its perceived place as a marker and creator of cultural heritage. The Ministry of Industry released figures earlier this year claiming that the tobacco industry generated 5.98 million jobs in 2018. While these figures are difficult to confirm, and there are certainly political reasons to inflate them, they reflect an instilled belief that the industry is so important that it is irreplaceable. There is a fear that curbing the tobacco industry could have dire effects for unemployment, especially in tobacco growing and cigarette producing areas like East Java, which also happens to have the largest voting populations in Indonesia.
Attempts to protect the tobacco industry through legislation, such as the national tobacco law that was proposed in 2016, drew heavily on ideals about the cultural and economic significance of cigarettes. The legislation has not been passed, but the fact that a law protecting the industry even made it to the legislature in the first place reflects how this image has been leveraged to justify government protection.
This is not to say that the public are necessarily protective of the tobacco industry but there is an uncertainty about what would happen if the industry were to lay off staff because of decreased production. Discourses of the tobacco farmer and the cigarette factory worker who need protecting remain strong in the political psyche. Politicians fear upsetting voters who buy into the idea that these groups require special protection.
The fourth issue is that the tobacco industry is notorious for behind-the-scenes lobbying. Just like any coordinated lobby group, it applies incentives and pressures to key decision makers, while also doing whatever it can to perpetuate the idea that Indonesia cannot survive without a tobacco industry.
Even Prabowo Subianto acknowledged the power of the lobby in 2016. He claimed that Gerindra had never accepted money from the industry but insinuated that many other parties had. While it is unclear and difficult to prove the scope of the industry influence, it goes a long way to explaining why meaningful tobacco control action has been stifled.
Debate silence but rumblings from elsewhere
The silence of vice presidential candidates during the debate was somewhat expected but one of the more interesting turns in the campaign has been the statements made by other members of each presidential campaign team.
Both teams have flagged, through emissaries — Hasbullah Thabrany for the Joko Widodo-Ma’ruf Amin camp and Hermawan Saputra from the Prabowo Subianto-Sandiaga Uno team — that if they win they have plans for tobacco control. Both spokespeople are from public health backgrounds and were active in tobacco control debates before the election campaign.
Hasbullah has argued that smoke free areas need to be expanded to cover more public spaces, which would have a deterrent effect for would-be smokers. He has also stated that the Jokowi-Ma’ruf team supports an increase in cigarette taxes, making it more expensive to buy cigarettes. This would especially discourage young people from taking up smoking in the first place.
Hermawan, meanwhile, has proposed assisting tobacco farmers to transition to different crops. He also stated that there had been a Rp 1,000 trillion “leak” (kebocoran) in the budget (a point frequently repeated by Prawbowo) that, if harnessed, could be used to assist with job transition for people employed in the cigarette industry. Hermawan argued that raising taxes would do nothing if the culture and attitude of Indonesians did not change and there was no alternative for farmers who were reliant on tobacco crops.
Apart from the allegations about the “leaked funds” that could be put toward alternatives to tobacco production, most of the proposed ideas have been floated by tobacco control advocates before. Any of these solutions would be heartily welcomed as part of a holistic approach to reducing smoking rates. However, it is interesting that this debate seems to be happening as a side-show, not part of the main event.
That discussions about tobacco control are happening at all during this campaign suggests that the presidential campaign teams do see some electoral benefit in expressing policies on tobacco control. With Hasbullah and Hermawan as spokespeople, both teams have credible mouthpieces to deliver their ideas, targeted at those who have an interest in restricting tobacco in Indonesia.
But the fact that tobacco issues didn’t feature in the vice presidential debate suggests that the nominees are not willing to open up the debate on a large scale. The presidential debates reach a much larger audience, and both vice presidential candidates actively avoided the topic, despite the massive impact it has on Indonesia’s mortality rate.
Given the role of populism in these campaigns, tobacco control seems to be viewed as lacking the public support that would make it a big ticket campaign issue.
Despite this, both sides are now on the record with at least some tobacco control policies, so advocates might be able to hold the winner to account, whichever presidential team wins.