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Sabtu, 26 Januari 2008

[mediacare] Smoking in Indonesia (Straits Times)

 
 
 
Jan 23, 2008  
SMOKING IN INDONESIA
Social costs rising, but who's counting?
By John McBeth, Senior Writer
LIGHTING UP: Jakarta is worried about upsetting the tobacco industry, which generates billions of dollars in revenue and employs hundreds of thousands of people. -- ST FILE PHOTO
IN THE four decades since the US Surgeon General's landmark report, successive Indonesian governments have paid less than lip service to highlighting the dangers of smoking, worried about disturbing an industry that generates billions of dollars in revenue and employs hundreds of thousands of people.

In a recently updated study, Indonesian public health researchers say evidence continues to mount that the social cost of smoking far outweighs the industry's economic benefits - and that the nation's women and children are lighting up more than ever before.

But without political will, the report will have little impact, at least not until after the 2009 elections. 'The government doesn't believe in figures,' says Dr Widyastuti Soerojo, head of tobacco control at the Indonesian Public Health Association. 'The issue is much too political for that.'

Ms Widyastuti Wibisana, the World Health Organisation's (WHO) technical adviser for tobacco control, agrees. 'The influence of the tobacco industry is very strong,' she notes. 'Most of the politicians still think that the taxes coming from tobacco are more important (than the health of the people).'

Despite being involved in all its negotiations, Jakarta has so far failed to sign the WHO's Framework Convention on Tobacco Control, a legally binding instrument aimed at developing anti-smoking programmes as part of a global health strategy.

Key articles in the convention call for effective price and tax measures to deter smoking, restrictions on advertising, sponsorship and labelling, clean air laws, new disclosure and ingredient regulations and concerted action against cigarette smuggling.

One of the saddest aspects of the whole issue is that almost to a man Health Ministry officials see an urgent need for the government to lead a serious anti-smoking campaign. But campaigners say that above director-general level, there is no political will to do anything about it.

Two years ago, National Mandate Party legislator Alvin Lie led an initiative by 30 fellow lawmakers to introduce draft legislation in the House of Representatives aimed at protecting non-smokers. The Bill was later suspended by the House legislative committee and has never seen the light of day.

Even former Jakarta governor Sutiyoso's pioneering campaign in 2005 to ban smoking in all public places has run out of steam, mostly because there has been no effort to seriously enforce it. Mr Sutiyoso has finally kicked the habit himself - after two failed attempts.

One clear sign of how confident most of the big manufacturers are about maintaining the status quo can be seen in the fact that they have never made any serious attempt to diversify away from their core business. In the United States, they did because they could see the writing on the wall.

There is no writing and no wall in Indonesia. In fact, cigarette consumption rose drastically from 215 billion in 1998 to 220 billion sticks in 2004, making Indonesia fifth in the world behind China, the United States, Japan and Russia. Together, these five countries consume more than half of the global production of 5.6 trillion cigarettes.

In the period between 1995 and 2004, when the last reliable data was collected, smoking prevalence among Indonesian adults 15 years and older increased from 26.9 per cent to 34.4 per cent, with the rate of increase for males alone soaring from 53.4 per cent to 63.1 per cent.

Equally disturbing has been a surge in tobacco use among wo-

men, despite the stigma attached to the practice in a Muslim society. According to data collected from a variety of socio-economic sources, there was a threefold increase in females smoking from 1.3 per cent to 4.5 per cent between 2001 and 2004.

Then there is the youngest generation. Former health minister Farid Moeloek, the chairman of the National Commission for Tobacco Control, says the number of child smokers aged between five and 10 has risen alarmingly from 0.5 per cent to 2.8 per cent in the last decade.

Mr Moeloek, who served in former president B.J. Habibie's government, recalls accompanying the president on a hospital visit in 1999. In one ward, they came across a 14-year-old boy who had already contracted Buerger's Disease, a smoking-related disorder that constricts arteries and blood vessels in the arms and legs.

Dr Habibie, the ex-minister recalls, recoiled at seeing someone so young with a two-packet-

a-day addiction whose fingers had atrophied to a point where gangrene and amputation seemed inevitable. Interestingly, the Habibie administration is still the only one that has made any effort to tackle the problem.

The latest Tobacco Resource Book, prepared by the WHO and a group of non-governmental organisations, shows that upward smoking trend continuing, despite a 10 per cent excise tax increase in April 2006 which put a temporary brake on annual volume growth of 7 per cent.

Health Ministry economist Soewarta Kosen, who has done much of the seminal work on the subject, estimates that total economic losses due to tobacco consumption reached as high as 154.8 trillion rupiah (S$23 billion) in 2005, nearly four times the 42 trillion rupiah that the government earned in excise taxes.

Tobacco use in 2001 alone is estimated to have killed 412,000 people, about 9.2 per cent of total deaths across Indonesia. It was also deemed responsible for 22 per cent of all cardiovascular diseases, up to 80 per cent of respiratory illnesses, and more than 90 per cent of lung cancer cases.

Dr Kosen calculates losses from tobacco-related deaths in those three categories in 2005 at 61.6 trillion rupiah - US$4.7 billion (S$6.8 billion) measured in premature deaths and on the basis of per capita income of US$1,280, and US$1.7 billion in lost productivity. The 2001 study extrapolated that further into 11.1 million so-called 'disability-adjusted life years'.

Adding to those numbing statistics, Dr Kosen puts total hospital costs for 11 selected diseases related to cancer, cardiovascular, respiratory and perinatal disorders at 1.9 trillion rupiah. But at the community level, he figures the financial burden rises to a whopping 91.2 trillion rupiah.

In a society where tobacco use is culturally ingrained, Indonesian smokers spend at least US$10 billion on cigarettes a year - a figure that fits with the revenues of the country's three largest cigarette manufacturers - or 11.5 per cent of total household monthly expenditures.

Nearly 88 per cent of Indonesian smokers prefer cheaper clove-sprinkled kreteks over white tobacco-only cigarettes, most of them purchased individually and not in packets that contain health warnings.

In 2000, the Abdurrahman Wahid government effectively scrapped a regulation, introduced by Dr Habibie's short-

lived administration a year earlier, which sought to limit levels of nicotine and tar in each cigarette to 1.5mg and 20mg respectively.

It had never been enforced anyway because not a single clove cigarette sold in Indonesia meets that standard. A sample of 23 different brands reveals a range from 1.6mg to 2.5mg for nicotine and from 28.1mg to 53.2mg for tar, with an extra 4.71mg to 12.8mg of eugenol, an oily clove derivative.

The 1999 regulation, which also sought to bring anti-smoking education to schools and introduce a 12-year programme to replace tobacco with other crops in the main growing areas of East and Central Java, appears to have been doomed the day Dr Habibie left office.

Mr Abdurrahman's National Awakening Party - and the mass Muslim organisation Nahdlatul Ulama from which it draws many of its voters - counts on the East Java cigarette industry, with its 900,000 tobacco farmers and 250,000 factory employees, for money and support.

Under Indonesian law, cigarettes cannot be shown on billboards and in television and newspaper advertising. But even people who don't smoke can make the association between the big tobacco companies and the creative images that continue to seduce new generations of smokers.

No wonder. Yet another study conducted by the National Commission for Child Protection and the University of Muhammadiyah counted tobacco companies sponsoring at least 870 sport events and 387 musical concerts between January and October last year.

'Smoking here is still perceived to be cool, to be part of the cosmopolitan lifestyle,' says Mr Gumilar Somantri, rector of the University of Indonesia, with a sigh. The university's leafy campus has been off-limits to smokers for the past five years.

He adds: 'It's almost as if society needs a cigarette.'

thane.cawdor@gmail.com


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