Recent studies affirm the common perception that smoking aggravates poverty and health problems in Indonesia. However, the administration of President Joko “Jokowi” Widodo remains unyielding with its protobacco policy despite more scientific evidence on tobacco’s catastrophic effects on people’s health. The Jakarta Post journalist Vela Andapita examines the issue.

A 21-year study by the University of Indonesia’s Social Security Research Center (PKJS-UI) made public last month found that tobacco smoking not only wreaks havoc on one’s health but also undermines household economy and stunts children physically and intellectually.

The most important finding from the research, which involved 2,700 families in 13 provinces across the country, is that children exposed to cigarette smoke at home are at a higher risk of stunting.

The study concluded that children of nonsmoking parents were 1.5 kilograms heavier and 3.4 millimeters taller than those of heavy smokers. The latter also had a 5.5 percent higher probability of stunting.

“It was proven that children whose parents are active smokers tend to be shorter,” UI School of Economics head Teguh Dartanto, who authored the report, said in an interview with The Jakarta Post.

“The correlation might be indirect, but the impact is real. Parents heavily addicted to cigarettes sacrifice anything to keep smoking at the cost of nutritious diets essential for their children’s growth.”

In the span of the 21-year study, from 1993 through 2014, the proportion of household spending on cigarettes rose from 3.6 to 5.6 percent. On the contrary, the respondents’ expenditure on protein-rich food like meat and fish dropped by 2.3 percent.

Even though stunting may be caused by many factors, such as malnutrition and genes, Teguh said, exposure to cigarette smoke creates an unhealthy environment that hampers children’s growth.

The research also revealed that children whose parents are chain-smokers tend to have poor academic performance at school, especially in mathematics, due to inadequate nutrient intake and an unhealthy home environment that is not conducive to their studying.

“Imagine a child whose father is a smoker with meager earnings to support the family, but he prioritizes cigarettes over nutritious food for his children,” Teguh said. “The predicament continues as a vicious circle with the children becoming stunted and unintelligent. When entering the workforce, they will likely lose in the competition for decent jobs and all this perpetuates poverty in the family.”

Smoke-free: Parents pick up their children at Bruder Melati elementary school in Pontianak, West Kalimantan. The school is one of several that strictly forbids smoking. (JP/Severianus Endi)

Terrible statistics

Researchers think that every 1 percent increase in cigarette spending in a household raises their probability of staying poor by 6 percent.

Indonesia is among the countries with the highest number of smokers. The Central Statistics Agency (BPS) has included cigarettes — along with rice, meat, eggs, instant noodles and sugar — as a commodity that is a significant contributor to poverty.

Its latest survey published in September 2017 showed that spending on cigarettes was the second-biggest contributor to poverty, after rice, at 9.98 percent in urban areas and 10.7 percent in rural areas.

In 2017, the Health Ministry revealed that there were more than 60 million active smokers in the country, 70 percent of whom were from impoverished families. Though most of the smokers were adult males (67 percent), the ministry also discovered that the number of smokers aged 10 to 18 years old had increased by 8.8 percent.

Antitobacco activists argue that low cost is a leading cause of the large number of smokers in Indonesia. As of this June, a pack of cigarettes costs between Rp 12,000 (83 US cents) and Rp 23,000, depending on the size and type, such as kretek (clove-blended), mild, filter etc.

Child protection group Lentera Anak Indonesia (LAI) singled out low prices as the leading factor that allows many people to begin smoking at a young age. Its research in May and June 2017 in 10 regencies and municipalities showed that cigarettes were so inexpensive that even students from poor families could afford to buy them.

Advertisement rules in the country are so lax that cigarette producers are free to exploit the low prices of their products to lure potential buyers. According to LAI, 78 percent of cigarette banners in the street announced how much their products cost.

“Some of them went as far as telling people they may buy cigarettes per stick if a pack costs too much. This delivers the message that cigarettes are very affordable; it costs only Rp 1,000 to Rp 2,000 a piece,” LAI head Lisda Sundari said.

“[High school] students in big cities usually receive Rp 10,000 to Rp 20,000 in pocket money from their parents, amounts big enough for a meal and cigarettes.”

According to cigaretteprices.net, a website that compiles cigarette prices in countries all over the world, the addictive commodity is much more expensive in developed countries, where pricing is set as part of their strict tobacco policies.

In Norway, for example, a pack of cigarettes cost on average $15 in 2017. In Japan, it costs $5.30 and in the United States $3.40 to $12. In Indonesia’s neighbors like Malaysia, Singapore and Thailand, a pack costs $3.30, $9.70 and $2.60, respectively.

In this case, Indonesia belongs to the league of such poor countries as Cambodia, where smokers can get a pack of cigarettes for $1.10, Bangladesh for $1.70 and Liberia and Zimbabwe for $1.

Antitobacco activists believe that one of the most effective ways to curb cigarette consumption in the country is to raise cigarette prices by increasing its excise by up to 57 percent.

But in reality, raising the excise is somewhat whimsical. This year, the government decided to raise tobacco excise by only 10 percent despite criticism of its probusiness policy.

The Jokowi administration is sticking to its conviction that increasing taxes would deal a heavy blow to the tobacco industry, which 6 million people rely on for their livelihoods. Moreover, the government is worried that expensive cigarettes could give rise to a black market and slash income tax.

UI demographic institute researcher and antitobacco activist Abdillah Ahsan said the government should prioritize public health over income tax and tobacco companies’ business interests.

The industry and the government’s claim about the large number of workers and farmers at risk is questionable.

“Over the years, more and more workers in cigarette factories have been dismissed due to mechanization. Major cigarette companies no longer roll cigarettes manually; they’ve shifted to machines,” he says.

Last year, the BPS documented tobacco imports that have kept rising over the past few years. And the imports account for most of the domestic consumption, which stands at 100,000 tons annually. In the first half of 2017, Indonesia imported 50,700 tons of tobacco from China, Brazil, the US and Turkey. The figure increased from 37,600 tons in the same period in 2016.

Inconsistencies

BPS figures show that active smokers in the country collectively consume 240 billion cigarettes every year, and the numbers will likely further soar due to the road map. The government has turned a deaf ear to warnings that health problems stemming from smoking eats away at public money.

The Health Care and Social Security Agency (BPJS Kesehatan) has also sounded the alarm over rising medication costs for illnesses associated with tobacco smoking. In 2014, total claims amounted to Rp 1.8 trillion and rose to Rp 2.2 trillion in 2015. Last year, the state insurance entity ran a deficit of about Rp 10 trillion.

The Health Ministry revealed in 2015 that 650 people died every day of tobacco-related diseases, such as cancer, asthma, stroke and heart attack.

The Jokowi administration has refused to ratify the Framework Convention on Tobacco Control (FCTC), which mandates stringent rules on tobacco production, taxation, marketing, advertising, sponsorship and sales. Although 180 countries, which represent 90 percent of the world’s population, have ratified the accord, Jokowi insisted that Indonesia does not have to follow others.

Ironically, President Jokowi aims to achieve universal health coverage and reduce the prevalence of smoking among children younger than 18 years old by 25 percent, from 7.2 to 5.4 percent in 2019 — an ideal that will unlikely be reached through inconsistent policies.