Indonesia: Smoking at 2-years-old

Indonesia is the wild west of tobacco – an example of what happens if you allow big tobacco to do what they want with few government restrictions. The result is a child smoking epidemic, driven by an aggressive marketing campaign in what is shaping up to be one of big tobacco’s most important market.

And now, Indonesia has bowed to the tobacco lobby again and is refusing to attend the World Health Organization’s tobacco meeting in Seoul this week.

The shocking numbers

In the last decade, as smoking rates in western countries have dropped in line with increasing regulation, low and middle-income countries have become the playground for big tobacco, and now account for 80% of all smokers. As the fourth most populous country and with a strong growing economy, Indonesia is a big prize.

In 2010, over 181 billion cigarettes were sold in Indonesia. A full 36% of Indonesians smoke, including 67% of men – the highest rate in the world. The results are unsurprising but devastating – research concludes that nearly 5 million people died from smoking worldwide in 2000, and in Indonesia, smoking kills at least 200,000 people each year.

But it is the huge numbers of child smokers in the country that provide the most disturbing images. Millions of people worldwide have watched a viral YouTube video of a young boy smoking – but it’s far from an isolated phenomenon. One-third of all children smoke before the age of 10 in Indonesia, with 2% of children starting by the age of four. And once they start, they keep going.

An aggressive campaign

During the last decade, child smoking has more than tripled in the country.

Tobacco companies spent more than $200 million in marketing in Indonesia last year, and are a major sponsor of music festivals, sporting events and even school sports festivals – events they would not be permitted to brand in most other countries.

In addition to the permissive advertising environment, laws restricting smoking indoors are weak and poorly enforced, and a tax rate well below WHO recommendations means that cigarettes are cheap and easily available, even for children. Regulation is so poor that a popular Indonesian clinic touts cigarette smoke as a cancer cure – incredibly, they blow smoke into a patient’s mouth, ears and nose to destroy the cancer and even halt the aging process – without being shut down by the government.

Indonesia does require text health warnings on cigarette packs, but in the face of this marketing onslaught this one small measure has proved ineffective at halting the risk of smoking rates.

A problematic relationship

So why has the Indonesian government given tobacco such a free run?

Part of the answer is likely public corruption. In 2009, a heavily debated provision in the country’s health bill that identified tobacco as an addictive and hazardous substance mysteriously disappeared before it was signed into law. While lawmakers claimed the omission was a simple mistake, the tobacco industry and their government allies were immediately suspected.

Former politician Hakim Sarimuda Pohan, who served on a government health commission, claims that bribes were common practice during his time as a legislator. But while an investigation was launched into the omission, it does not appear that any conclusions were ever reached.

Tobacco is a major source of revenue and employment in Indonesia – it employs over 237,000 people and represents the vast majority of Indonesia’s excise tax. But the corresponding losses in healthcare costs and lost productivity are so much bigger that the permissive policy doesn’t make any sense – until the influence of the tobacco industry is considered.

Pushing for reform

Anti-smoking activists are pushing ahead with their calls for reform, challenging the powerful tobacco lobby. And they’re having some success. In the face of their campaign, the government is considering additional controls on tobacco advertising (though the controls are still far too weak) and the introduction of graphic warnings on cigarette packs. New health minister Nafsiah Mboi has even stated she plans to introduce legislation to sign the country up to the WHO’s global tobacco treaty, but hasn’t given any timeline for the move.[]


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