MANY people have seen the smoking baby on YouTube – the chubby, cheerful two-year-old from Sumatra with a pack-a-day habit. But Ardi Rizal was not a one-off curiosity. In the land of the child smoker, he is one of scores of toddlers and preschoolers addicted to nicotine.
Muhammad Dihan Awalidan is one. He’s four years old, smoked his first cigarette at 2½, and gets through a pack of 25 a day. He started when he stole one of his father’s cigarettes and lit it on the kitchen stove.
His parents, Iyan Ansori and mother Sulawati, are farmers from a hillside village in West Java. They know their son’s habit is unhealthy, but feel powerless to stop him. He walks down to the local warung, or cafe, to buy his own cigarettes, sometimes staying for a coffee as well. If he’s denied, ”it’s like he’s possessed, he really wants it”, says Iyan, who smokes a few cigarettes a day himself.
While the cigarette industry is beginning to lose its grip in developed nations – the federal government’s victory on plain packaging legislation was hailed as an international breakthrough – health experts warn of a humanitarian disaster looming in poorer countries, particularly in the Asia-Pacific region.
“They [cigarette companies] are just wilfully imposing a pandemic on developing countries,” says
Professor Mike Daube, a World Health Organisation tobacco control adviser and president of the Australian Council on Smoking and Health. “They’ve known for more than 60 years that smoking kills. This is going to cause far more deaths than any wars we’ve ever seen.”
Dihan does not play much with other children, and doesn’t say much to strangers. But when asked what smoking is like, he says ”enak” – an Indonesian word which in this context means both ”delicious” and ”it makes me feel good”.
Australia’s northern neighbour is the wild west of tobacco. It’s one of the few countries that has not signed the World Health Organisation’s Framework Convention on Tobacco Control, which means there are few restrictions on advertising, warnings or smoking indoors. Outdoor cigarette advertising, footnoted by the mildest of warnings, assaults you wherever you go.
About 90 per cent of smokers here favour ”kretek”, clove cigarettes that are an Indonesian product and regarded by some with nationalistic fervour. They can be high in tar (39 milligrams compared with 16 milligrams for the strongest cigarette in Australia) and are sold in packets or by the stick. Some stalls set up outside schools to attract students.
Despite the preference for kretek, the Marlboro man – literally and figuratively dead in the West – is also alive in Indonesia. Global giants Philip Morris and British American Tobacco have moved in to Indonesia in the past 10 years, attracted by sales of a massive volume of cigarettes – 270 billion a year, and growing fast.
About two-thirds of men smoke either cigarettes or some form of tobacco, vastly outnumbering women because of cultural taboos. But young, smart, city women are now appearing in smoking ads, and some are beginning to break with tradition in pursuit of what Andika Priyono, an official from the country’s child protection agency, calls the ”three Bs” of modern success. ”BlackBerry, braces and black menthol [cigarettes],” she told the Jakarta Globe newspaper recently.
Smokers in Indonesia are also getting younger. The University of Indonesia’s Demographic Institute found that 71,000 Indonesians aged 10 to 14 were smokers in 1995. By 2010, there were 426,000 at least. Local cigarettes often have sweetened tips, making them taste like sweets.
The child protection agency, Komnas Anak, gave The Sunday Age a list of 10 smoking children whose names and histories it could confirm. It says almost 2 per cent of Indonesian smokers start at the age of four – a number that’s rising. Even for the poor it’s affordable, with a pack of 20 cigarettes starting at about 90¢.
Sandi Adi Susanto has been smoking since he was 18 months old. Every morning he asks for a coffee and a cigarette. He drinks alcohol too, if he can get it, and his parents believe he is possessed by the hard-bitten spirit of his late grandmother.
Reno Ardiansyah has been smoking since he was 14 months old; Aldi Ilham is only eight, but has already been smoking for four years; and Falen is two and does not speak much but can distinguish between different brands of cigarettes. All of them, like Dihan, are surrounded by a culture steeped in tobacco.
”I think it’s because of the environment,” says father Iyan, ”because the village people always sit around together and he saw people smoking and wanted to try it.”
Dihan’s fellow villagers, and his family, farm tobacco, among other things. But he shows no interest in the local product. What he likes is Sampoerna A, a smooth-tasting machine-made brand of kretek owned since 2005 by Philip Morris.
Philip Morris identifies Indonesia as its biggest growth market. At its results presentation on July 19, chief financial officer Hermann G. Waldemer boasted that Sampoerna A was the fastest-growing brand in Indonesia, up 1.2 points to be 13.1 per cent of the market. The company’s other brands, including Marlboro, are also growing.
”We’re just doing extremely well,” Waldemer told analysts. ”The elements are all there for a very positive performance to continue in the Indonesian market.”
Part of the quality of tobacco companies’ performance is that Indonesia’s politicians are unwilling to take on the might of Big Tobacco.
A law proposed in 2009 tried to limit smoking and its promotion. If passed, it would empower local governments to designate and control smoke-free zones, limit advertising and include graphic pictorial warnings on cigarette packets.
But lobbying by the tobacco industry has left it on the backburner for three years because, according to Ignatius Mulyono, chairman of the House of Representatives’ legislative body, it was ”very biased towards the anti-tobacco lobby”.
Human Rights Watch Indonesian representative Andreas Harsono says politicians do not want to take on the industry. Only 20 to 30 per cent of the industry’s costs are in making cigarettes, he says, ”the rest goes to sponsoring, advertising and lobbying”. There are no electoral disclosure laws in Indonesia, but Harsono believes if there were, it would show money from tobacco flowing into the campaigns of politicians.
Sponsorship, particularly of sport and education, is another big part of the industry’s influence. A recent survey showed tobacco companies sponsored 1042 events in Indonesia between 2009 and 2011. The Djarum Foundation, run by a private cigarette company, has given educational scholarships to more than 7000 university students since 1984.
Everything from badminton matches to schools themselves are sponsored – one public high school in East Java uses a tobacco company foundation logo as its school badge, says child protection commission spokeswoman Lisda Sundari.
These activities have made tobacco a powerful lobby, and highly resistant to the message from health practitioners. A recent book, Killing Indonesia: Global Conspiracy to Destroy Kretek, paints smoking almost as a nationalist requirement, and the health lobby as a conspiracy by American interests to kill the clove industry.
A community group, Komunitas Kretek, says the traditional cigarette, and Indonesia’s sovereignty itself, is under threat both from ”white cigarettes” (the non-clove variety pushed by the multinational companies) and the health lobby.
The group’s national co-ordinator, Abhisan Demosa Makahekum, says cloves are good for health: ”People in Papua use clove to cure their toothache, in Kudus [Central Java] it is used to cure coughing.”
For Indonesians, the result of the cigarette epidemic is tragic, with 200,000 people dying every year, including 25,000 from passive smoking. And because they start smoking so young, they are dying younger.
Persahabatan Hospital is the national referral hospital for cancer. Specialist Dr Elisna Syahruddin says one-fifth of her patients are under 40. In the United States, by contrast, just 2.3 per cent of lung cancer cases occur in people under 44 years, and the median age for diagnosis is 72.
”I am very worried,” Dr Syahruddin says. Kretek are actually worse than ”white cigarettes”, she says, because the cloves anaesthetise the throat, allowing smokers to draw deeper. The cancers she sees are at the further reaches of the lungs.
One of her patients, Rambe Partogi, is 31. She has fourth-stage lung cancer, and only a 50 per cent chance of surviving more than nine months.
He started smoking when he was 12 because all the men in his family smoked, and his friends too. ”It’s a normal condition,” he said. At 15, he changed to Marlboro after he won a competition and became part of the Marlboro Adventure Team, hiking and doing other activities in Yogyakarta.
”It wasn’t about marketing and promotion, it was just about adventure,” Rambe says. ”They didn’t give us cigarettes, but then the program committee, they did smoke and of course we smoked too.”
His friends, still smokers, have come to visit him in hospital. ”I say to them: smoke and go to hell,” Rambe says. ”Sometimes they listen.”
Another of Dr Syahruddin’s patients, Dewi Husmawati, never smoked, but worked in an advertising office with 11 men who did.
”In Indonesia it’s very difficult to make a definition of a passive smoker because smoke is everywhere – the office, stations, houses, restaurants,” Dr Syahruddin says.
She allowed The Sunday Age carte blanche to tour the hospital, film her patients and ask questions because she is sick of waiting for the government to respond to what she sees as a crisis. “If the politicians won’t help,” she says, “maybe the media can.”