Despite government and public health experts’ advice saying smokers may be at risk of more severe COVID-19 symptoms, they continue to light up their cigarettes and tobacco-related products at alarming levels.

The smoking rate among Indonesians is currently embarrassingly high. As many as 61 million Indonesians smoke, of whom 67.4 percent are male and 4.5 percent women.

This disturbing number of active Indonesian smokers was confirmed by Health Minister Budi Gunadi Sadikin during a virtual conference titled, Our Shared Responsibility: Ending Epidemics — Smoking and COVID-19 in Indonesia.

The virtual conference was jointly cohosted by the Health Ministry, Home Ministry, the Association of All Indonesian Health Offices (ADINKES) and Asia Pacific Cities Alliance for Health and Development (APCAT) on March 16.

“Tobacco smoking rates have increased by 1 percent in Indonesia during the pandemic, despite health advice and information on the adverse impacts of the virus on smokers,” the minister said his keynote speech.

Alarmingly, the prevalence of smoking among the youth increased from 7.2 percent in 2013 to 9.1 percent in 2018, according to the Health Ministry’s Basic Health Survey (Riskesdas).

“We are trying to reduce it to 8.7 percent by 2024. We will reinforce our prevailing laws, regulations and tobacco control strategies,” Budi said. The figure is still far from the 5.4 percent target stated in the National Medium-Term Development Plan (RPJMN).

Smoking cigarettes has many health risks for everyone, young and old, rich and poor, including tuberculosis and other life-threatening diseases like lung and heart-related diseases. Unfortunately, the smoking prevalence among people from low-income brackets continues to rise.

“They prefer to buy packs of cigarettes than nutritious food for their family,” Budi added.

As we know, smokers have a higher risk of getting infected with COVID-19 because of their weakened immune systems. Tobacco use is also linked to the increase in tuberculosis cases in Indonesia, which now has a prevalence rate of 319 per 100,000 population.

“Indonesia is the world’s third-highest TB burden country and we have promised to end TB by 2030,” Budi said.

More than 20 percent of global TB cases are related to smoking.

Despite the fact that Indonesia has not yet ratified the World Health Organization Framework Convention on Tobacco Control (FCTC), the country has enforced Law No. 36/2009 on health and numerous other joint decrees between the Health Ministry and Home Ministry on free smoking zones, as well as with the Education and Culture Ministry. Finance Ministry has also issued a landmark decree on tobacco tax policies.

In addition, at the national level, the Health Ministry has formulated the 2009-2024 National Health Tobacco Control Roadmap. At the provincial and regional levels, around 21 provinces and 348 cities and regencies have their own regulations and decrees on free smoking zones and tobacco use control.

With the assistance of the International Union Against Tuberculosis and Lung Health (The Union), Indonesian mayors and regents established Indonesian Mayor Alliances to fight against tobacco use in their respective areas. The Union also helped assist the establishment of Asia Pacific Cities for Health and Development (APCAT), cochaired by Bogor Mayor Bima Arya Sugiarto in West Java.

“Bogor as a pioneer of a free smoking zone city has been committed to controlling tobacco by strengthening prevailing policies and regulations,” said Bima, a survivor of COVID 19.

He conceded that there were parties who had tried to weaken the policies.

“We answered them with more powerful law enforcement.”

Big questions remain unanswered. All of these legal infrastructures against tobacco use might look rosier on paper but toothless on the ground, especially when facing the monstrous and powerful tobacco corporations.

Even during the current pandemic, tobacco and its related industries have remained aggressive in promoting their products. Some companies have shamefully had the audacity to offer free masks and a large variety of donations and sponsorships during the lockdown and quarantine periods under their Corporate Social Responsibility (CSR) programs. They continue to carry out marketing and advertising tactics to maintain their faithful customers and especially to lure first-time smokers.

WHO data shows that globally, the tobacco industry spends more than US$9 billion on advertising its products. Indonesia is one of its largest and lucrative markets, with more than 60 million active smokers; around 80 percent of them smoke kretek (clove) cigarettes.

Public health experts frequently warn us that with Indonesia having one of the highest smoking rates in the world, the country not only faces public health but also economic disasters.

Every year, tobacco kills around 8 million people, including almost 250,000 people in Indonesia alone — that is about 659 people every day. More than 97 million Indonesians, including infants, children and pregnant women, are regularly exposed to second-hand smoke. It is estimated that exposure to second-hand smoke accounts for up to 25,000 deaths among non-smoking Indonesians annually.

WHO’s 2017 study implies that tobacco-related healthcare costs reached Rp 15.075 quadrillion in 2012 (or 6 percent of health expenditure). The total cost of smoking (including the loss of productivity) amounted to a staggering Rp 639.173 quadrillion in that year, representing about 1.8 percent of Indonesia’s gross domestic product (GDP).

Another study also portrayed a grim picture, saying that tobacco use increases the poverty level in both urban and rural areas by 10.7 percent (data from Statistics Indonesia, 2016).

Looking at those statistical figures is indeed sickening. But what is currently happening on the ground across the archipelago is equally depressing. Those figures are the real representations of the daily lives of Indonesians in every corner of the country.

In East Nusa Tenggara, for instance, parents sell their harvests to buy cigarettes, bottles of local liquor and packs of instant noodles. Educators are smoking while teaching their students in dilapidated classrooms in West Timor. In Bali and other tourist destinations, thousands of locals and visitors alike frequently violate smoking regulations and health protocols during the pandemic.

The government, with all its legal power, cannot work alone. It is our responsibility to play our part to stand up and fight against these lingering threats to public health.

 ***

The writer is a founding member of the Asia Pacific (APCAT) Media Alliance for Health and Development.

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