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Chain-smoking children: Indonesia’s ongoing tobacco epidemic

SOUTH SUMATRA, Indonesia — Surrounded by farmland and plantations in the small village of Teluk Kemang Sungai Lilin in South Sumatra, a boy, just 8 years old, sits smiling with his mother.

But this boy has a tumultuous past and a reputation that precedes him, having undergone a recovery most children will never face.

Six years ago, Aldi Suganda, also known as Aldi Rizal, was a 2-year-old chain smoker addicted to cigarettes, smoking packs each day. “It was hard for me to stop,” he said. “If I am not smoking, my mouth taste is sour and my head feel dizzy.

“I am happy now. I feel more enthusiastic, and my body is feeling fresh,” he said.

He became a global sensation as the “chain-smoking toddler,” with video clips of him puffing excessively on an endless cigarette supply watched by millions around the world.

His mother, Diana, thinks back to that period and recoils at the memory. Her son would get angry, she remembers, and throw tantrums if she withheld cigarettes from him or failed to give him money to obtain them. “He (would) start to smash his head to the wall. He was crazy, hurting himself if he didn’t get a cigarette,” she said.

People would accuse her of being a bad mother and regularly question her parenting skills, she said. “I am a weak mom. He always threaten me if I didn’t give him money. … I (was) afraid he (was) going to die.”

Aldi is the youngest of three boys born to Diana and her husband, who requested not to be named. But he is far from the only child who picked up the habit across the islands of Indonesia: More than 267,000 children there are estimated to use tobacco products every day.

A childhood habit

Diana believes Aldi’s addiction began with peer pressure and exposure to smokers. He accompanied her each morning to the market where she sells vegetables grown on their land. People there could have taught him to smoke, and he could easily get cigarettes by asking at the market, she said.

In many regions of the world, this might seem unrealistic and like an excuse, but in Indonesia, it’s highly likely. The country has the highest percentage of male smokers globally and among the highest rate of adolescent and child smokers in the world — fueled by lack of control over advertising, relaxed sales and low prices.

Today, Aldi is a healthy young boy who attends school and gets good grades, but to get here, it took years of rehabilitation with the country’s leading child psychologist, Dr. Seto Mulyadi, chairman of the nation’s National Commission for Child Protection. His road also didn’t end with his tobacco cravings. Soon after his recovery, he replaced tobacco with food and began to overeat as a means of compensation, eventually becoming obese.

But a second bout of rehabilitation to tackle this overeating created the healthy, stable young boy sitting beside his mother today.

Mulyadi believes the one benefit of working with children who have an addiction is their mental agility. In Aldi’s case, his age and intelligence meant he responded quickly to his treatment, in which Mulyadi distracted the 8-year-old with running, climbing and playing while slowly reducing the number of cigarettes he smoked each day. But treatment was intense and required Aldi to go to Jakarta for a few months to be with Mulyadi every day.

“He was just 3 years old, and he smoked four packs a day,” Mulyadi said. “(But) I was confident because he is still very young. Psychologically, as a child, he is very flexible and easier to be cured.”

And cured he is — at least for now.

“I don’t want to smoke anymore. I don’t want to get sick,” said Aldi, who now wants to help prevent other children going through a similar ordeal. “Please don’t smoke. Don’t even try it. It’s hard to quit.”

In 2013, more than 57% of men were reported to be smokers in Indonesia and more than 42% of teens ages 13 to 15, according to the Tobacco Atlas, compared with 17% and 8.2%, respectively, in the United States. It’s estimated that more than 217,000 people die from diseases linked to tobacco use each year in Indonesia, including heart disease and respiratory conditions such as emphysema and lung cancer.

With smoking so commonplace and numbers remaining steady or even rising among some groups in recent years, Aldi’s message could go unheard, believes Dr. Lily Sulistyowati, director of prevention and control of noncommunicable diseases at Indonesia’s Ministry of Health.

“I’m very worried about smoking in Indonesia,” she said, especially among teens ages 15 to 19.

No sign of decline

While rates in most countries fell between 2013 and 2016, the rate of smokers under 18 in Indonesia rose from 7.2% to 8.8%.

But more worryingly, among 10- to 14-year-olds, more than 3% were smokers in both 2013 and 2016 — the majority of them boys — and more than 18% of boys and more than 9% of girls 10 to 14 had tried a cigarette, according to Indonesia Basic Health Research data reported in 2013.

The research also found that 1.5% of boys and 1.4% of girls 5 to 9 years old had tried a cigarette.

Sulistyowati believes the problem is worse in rural areas and among poorer populations. “Poor people are spending their money on cigarettes,” she said.

In 2013, the richest fifth of the population used 7.1% of their monthly expenditures on tobacco and betel leaf to wrap tobacco, while the poorest fifth spent 12.5%, according to Indonesia’s Central Bureau of Statistics. The poorest fifth spent similar proportions of their wages on grains and tobacco — 15.5% and 12.5%, respectively — and spent six times more on tobacco than on dairy and egg products.

Rural regions also tend to be populated with people with lower incomes. There, parents’ priorities are working and earning money for their families, which can leave children vulnerable to influences such as smoking while parents are distracted. “(These areas) are a different situation. Parents focus on how to work and get money, not on the health of their children,” Sulistyowati said.

In addition, children begin working young to earn money that they can then spend on cigarettes, said Dr. Aman Pulungan, president of the Indonesian Pediatric Society, who has been monitoring and working on the issue of childhood smoking for decades. “It’s country life,” he said.

Smoking among children and teens is still a problem in the cities, highlights Silistyowati, but there, people know that the habit is bad for their health and children instead hide their addiction from their parents, she said. “They try it with friends,” she said.

This was the case for Icha, 16, in the capital, Jakarta, who began smoking when she was 13 after a friend offered a cigarette to smoke together. “The first time, I felt dizzy and coughed a lot,” she said. “But later on I (felt) the taste is good.”

Icha now smokes at least one pack of 12 cigarettes each day and says half of her classmates also smoke, some in front of their parents. Her own parents tried to ban her from smoking but after little success now just ask that she try to reduce her habit.

“There is no parental control,” Pulungan said.”They just do it, because no one says no.”

Pulungan added that many parents don’t fully understand the risks associated with smoking and that its prevalence among adults helps that ignorance persist, particularly in rural areas.

Part of the problem, Sulistyowati and other experts say, is the ease of access and pervasiveness of smoking in Indonesian culture.

Marketing and image invasion

“The problem is big,” Pulungan said, adding that smoking has been an issue in Indonesia for more than 40 years. “But it’s getting worse.”

He believes that in addition to peer influence, the root causes of the epidemic include advertising, lack of laws — or enforcement — in public spaces, sponsorship of venues by big tobacco companies and the way cigarettes are sold.

Nonsmoking sections in restaurants are very small, he said. In addition, tobacco companies are still sponsoring sporting and musical events as well as public buildings or clubs. This sponsorship has come down in recent years, he said, but he now believes that hidden advertising is growing — through TV and culture. “(Kids) think if you want to become a man, you have to smoke,” he said.

The issues of advertising and masculinity linked to smoking faced many other countries just a decade or two ago, but while rates across the West declined, companies and efforts to boost tobacco interest transferred to countries where bans and laws did not prohibit their existence, such as Indonesia, Pulungan believes.

In rural areas, “the small shops, grocery shops, are sponsored by cigarette companies, and they can put adverts anywhere,” he said. “No one controls this.” He also mentions sports clubs that have tobacco companies as part of their names.

“Advertising is of more interest to the youth,” Sulistyowati said, adding that companies entice adolescents by associating cigarettes with success and fame. “Schools can get sponsorship” from big companies, she said.

Again, while many countries have had bans against this for some time, Indonesia has no national laws in place — though some municipalities have introduced them, she said, including Western Sumatra.

Of the big six global tobacco companies, Phillip Morris International dominates the market in Indonesia, according to 2013 data from the Tobacco Atlas. The company did not respond to a request for comment.

The Ministry of Health is now working with the Ministries of Education and Communication to help prohibit sponsorship and advertising, as well as the Ministry of Transport to implement and enforce existing smoking bans on public transport.

Almost half of the country’s municipalities have regulations in place for smoke-free areas, said Sulistyowati, and universities have committed to having smoke-free campuses through the Ministry of Education. Graphic health warnings were also introduced on cigarette packets in 2014 to put people off the habit.

But “it all depends on the commitment of the local head, or mayor, of a district,” Sulistyowati said. “Indonesia is a big country,” at more than 1.9 million square kilometers (more than 740,000 square miles).

Easy access and affordability

The final hurdle is the cost and ease with which people can buy cigarettes: They can be bought individually — which makes them more affordable to people with lower incomes — and a pack of 12 can cost as little as $1 at most vendors and kiosks, said Sulitsyowati.

All 34 provinces have had regulations in place since 2012 to prohibit the sale of individual cigarettes, but enforcement has not been that effective.

“They buy one cigarette, not a pack usually … and everywhere you go, you can buy one cigarette, so it’s easy,” Pulungan said. “Shops easily sell them.”

One kiosk vendor in Jakarta, who did not provide his name, said most children buy individual cigarettes from him even though selling them in this form is breaking the law. “Everyone sells cigarettes to them,” he said.

Globally, experts agree that one of the strongest tobacco-control policies has been taxation. The rising cost of the habit, linked to higher taxes, has meant that many can no longer afford to smoke, and those who can smoke provide revenue for anti-smoking campaigns and quitting support services, to name a few options.

“The evidence suggests increasing pricing is the single most effective way to reduce demand,” said Vaughan Rees, director of the Center for Global Tobacco Control at the Harvard T.H. Chan School of Public Health, in a previous report by CNN.

“In states where we see the highest tax rates, we see the lowest prevalence,” he said, highlighting New York City, where former Mayor Michael Bloomberg introduced city taxes on top of state taxes in 2010.

In Indonesia, “the price of cigarettes is very cheap,” Sulistyowati said. “Everyone can buy them.”

Pushing for change

Now, the Ministry of Health is working to align with other ministries as well as international organizations, such as the World Health Organization, to tackle the appeal of cigarettes once and for all. This includes aligning with the WHO’s Tobacco Free Initiative and its strategy to reverse the global tobacco epidemic, known as MPOWER, which features six policies that have been proved to make an impact, such as protecting people from smoke, enforcing bans on advertising, and raising taxes.

The ministry also hopes to provide greater support for people trying to quit smoking and to increase public awareness about tobacco’s harms — as well as push harder for the country to join the Framework Convention on Tobacco Control, a global public health treaty formed in 2005 to tackle the global tobacco epidemic. Today, 181 states have signed the convention. Indonesia is not one of them.

With all this eventually in place, Aldi’s message may finally reach those who need to hear it: young children facing the allure of smoking tobacco.

Though cases like Aldi’s seem very rare on the surface, there are similar ones in Indonesia that don’t get serious attention, said Mulyadi, who treated Aldi.

“Aldi was very lucky because in his case, we get a fast response from the government and public. … Local and international media give him big attention,” he said. “Other children are not that lucky.”

The Indonesian government is not strict enough, he said. “As long as cigarette ads are spread out massively on TV, radio, newspapers, outdoor signage, everywhere, the problem of child smokers will get worse and worse.”

Indonesia tobacco bill would open tap for ads aimed at kids, health official says

By Eveline Danubrata and Stefanno Reinard | JAKARTA

A proposed Indonesian tobacco law will roll back regulations to discourage smoking in a country that already has one of the highest smoking rates in the world and open the floodgates to advertising aimed at teenagers, a health ministry official said.

http://uk.reuters.com/article/us-indonesia-tobacco-idUKKBN18S47O

If the bill initiated by the parliament is passed, companies will no longer have to put grim pictures on cigarette packs of lung cancer or other diseases linked to smoking, said Mohammad Subuh, director-general of disease prevention and control at the health ministry.

Under existing regulations, 40 percent of the front and back of a cigarette pack must contain a “health warning” in the form of pictures and text.

Under the tobacco bill, reviewed by Reuters, cigarette packs would not be required to have a specific portion dedicated to health-related pictures. Cigarette businesses that put up advertisements, either in electronic, printed or outdoor media, do have to include a health warning that is “written with clear alphabets, easily read and proportionate.”

School and playground areas would be designated as “no- cigarette-smoke zones” instead of “no-cigarette zones”, which would allow cigarettes to be sold or displayed there, Subuh said.

“Indonesia is the most liberal country for the tobacco industry,” said Subuh, who oversees the health ministry’s tobacco control efforts.

“Let’s not open again the opportunities for the industry to lure teenagers to party with cigarettes. It’s like jumping from a helicopter without a parachute,” he said in an interview.

OUTPUT INCREASE

Last year, 54.8 percent of males between 15 and 19 years old were smokers in Indonesia, more than double the percentage of smokers in 2001, according to the health ministry. The price of a pack of cigarettes in Indonesia can be less than $2.

A shocking video of a toddler reportedly puffing up to 40 cigarettes a day on the island of Sumatra went viral around seven years ago, firing up anti-tobacco activists who said it underscored the problem of underage smoking in Indonesia.

“Indonesia is terrifying because it has among the most baby smokers in the world. From elementary school until high school, the smoking rate is also one of the highest,” the health ministry’s Subuh said.

Indonesia is the only country in the Asia-Pacific region that has yet to ratify or be a party to the World Health Organization’s Framework Convention on Tobacco Control (FCTC), which seeks to protect against the harmful consequences of smoking.

The tobacco bill mainly aims to sharply increase cigarette output in Indonesia, already the world’s fourth-biggest producer, at a time when other Asian countries are taking measures to curb smoking.

Proponents of the bill say it would safeguard a vital economic sector that employs millions of people and contributes nearly 10 percent of state revenues.

“We don’t mind some regulations, as long as they are not excessive,” said Abdus Setiawan, a board member at the Indonesia Tobacco Growers’ Association. Setiawan said he already considers emblazoning cigarette packs with the message that “smoking kills” to be “excessive.”

To become law in Indonesia, the tobacco bill has to be agreed between the government and the parliament. President Joko Widodo agreed in March to start discussions on the bill with the parliament, but it is unclear when the president will make a decision.

$17 BILLION INDUSTRY

Indonesia, a country of 250 million and the biggest economy in Southeast Asia, is attractive for major cigarette companies at a time when growth is slowing in more developed markets.

Indonesia produced 269.2 billion cigarettes in 2015, while the total market was valued at 231.3 trillion rupiah ($17.3 billion), according to research firm Euromonitor International.

Philip Morris International Inc and British American Tobacco PLC have controlling stakes in local cigarette makers PT Hanjaya Mandala Sampoerna Tbk and PT Bentoel Internasional Investama Tbk, respectively.

Other major domestic players include PT Gudang Garam Tbk and privately held Djarum Group.

Regulations for the industry have been poorly enforced and some companies target young Indonesians with new products such as fruit-flavored cigarettes or clever advertising, activists say.

“A lot of advertisements here send the message that if you don’t smoke, you’re not macho, you’re not cool,” Muhammad Khanavi, a 14-year-old student, said on the sidelines of an anti-smoking event to mark World No Tobacco Day on Wednesday.

($1 = 13,321.00 rupiah)

(Editing by Ed Davies and Bill Tarrant)

Indonesian tobacco watchdog urges govt to sign FCTC to protect people

Ahead of World No Tobacco Day on May 31, the National Commission on Tobacco Control (Komnas PT), a coalition of organizations that has been staunchly campaigning on tobacco issues in Indonesia, has asked the government to draft a comprehensive regulation on tobacco control to protect society.

http://www.thejakartapost.com/news/2017/05/30/indonesian-tobacco-watchdog-urges-govt-to-sign-fctc-to-protect-people.html

Komnas PT chairman Prijo Sidipratomo said on Tuesday that the most important thing was for the government to immediately sign the Framework Convention on Tobacco Control (FCTC) to protect society from the dangers of smoking.

“Second, the existed tobacco bill that is being discussed by the government and the House of Representatives must be dropped,” Prijo asserted in a press statement.

Prijo said the demand was in line with President Joko “Jokowi” Widodo’s statement in February during the 2017 National Health Meeting, saying that we should not let the money that was supposed to increase children’s nutrition to be instead used to buy cigarettes.

The Komnas PT asked every party to join hands to protect the young generation from the dangers of nicotine addiction that could degrade the nation’s productivity.

Without a comprehensive regulation, more than 250 million people are left unprotected when facing the dangers of the cigarette industry that always looks for profits while harming the environment, economy, society and human rights, he added.

The commission criticized the House for wanting to delete the existing article declaring a “total ban of cigarettes advertisement in broadcasting” in a revision of the Broadcasting Law. (hol/dan)

Indonesian teachers group declares anti-tobacco stance

Ahead of World No Tobacco Day on May 31, Indonesia’s largest teachers group signed on Wednesday a declaration to underline the role of educators in supporting measures for tobacco control.

http://www.thejakartapost.com/news/2017/05/24/indonesian-teachers-group-declares-anti-tobacco-stance.html

Created by the Indonesian Teachers Association (PGRI), the declaration consists of six points, which include teachers’ commitment to “protect students from the dangers of smoking” and “oppose CSR [Corporate Social Responsibility] campaigns from the tobacco industry.”

Teachers also called on the government to create a comprehensive tobacco control regulations to curb cigarette consumption.

“Teachers have to be role models for their pupils by not smoking […] Exemplary acts by teachers are very strategic in the [anti-tobacco] campaign,” PGRI chairwoman Unifah Rosyidi said at the declaration’s signing event in Kuningan, South Jakarta, on Wednesday.

The event was organized by the National Commission on Tobacco Control (Komnas PT), a coalition of organizations that has been staunchly campaigning for tobacco related issues in Indonesia, one of the world’s biggest tobacco consumers.

Komnas PT chairman Prijo Sidipratomo welcomed the declaration, saying that it was in line with one of PGRI’s missions to support the country’s development.

“Some 25 percent of students’ daily time is spent at school, which highlights the role of teachers in shaping their way of life,” Prijo said. (rin)

What’s keeping Indonesia, China addicted to smoking?

A World Trade Organisation ruling backing Australia’s hard line on cigarette packaging highlights a gulf between Asia and much of the rest of the world

http://www.scmp.com/week-asia/society/article/2094162/whats-keeping-indonesia-china-addicted-smoking

It was during a trip to Egypt in 1995 when Edison Siahaan first felt that something wasn’t quite right with his throat. Four decades had gone by since he started smoking at the age of 15. His voice had been raspy for years. Maybe this was just the dry air tickling the back of his throat.

But it wasn’t dry air and it wasn’t a tickle. It was cancer. Doctors excised a portion of his trachea leaving a hole the size of a nickel at the base of the throat. He lost his bank job because for a year following the surgery he couldn’t speak. Even now, what passes for speech makes him sound like the emperor from Star Wars only with more hissing. Now 79, Siahaan, a kindly old gent with a full head of hair, is tough to look at. “I see kids smoking all the time here,” he says, gesturing back and forth along the length of the street from his front room. “It makes me sick to think they are going to ruin their life. I point at this hole in my throat and say to them: do you want to look like this?”

Asian men already account for the lion’s share of the world’s tobacco related illnesses, yet a World Trade Organisation ruling this week that upheld tough anti-smoking rules introduced in Australia in 2012, showed that if anything, the gap in attitudes between Asia and the rest of the world may be widening.

“Tobacco in China is absolutely devastating,” says Dr Angela Pratt who helps handle external relations at the World Health Organisation’s office for the Western Pacific in Manila.

In China, roughly 300 million people smoke, according to the WHO. Most of these are men. More than half of Chinese adults are smokers and two-thirds of young Chinese men start smoking. While smoking rates are steady, the absolute number of smokers is rising in line with population growth. Chinese smokers account for 44 per cent of all the cigarettes puffed in the world. At current rates 200 million Chinese will die this century from tobacco-related illnesses, Pratt says. “That’s a huge burden. The people afflicted are often the sole income earners,” she says.

This week, the WTO ruled that Australia’s plain packaging rules, which ban branding and distinctive colouring from packs of cigarettes, were a legitimate public health measure. The ruling knocked back a complaint from Indonesia, Cuba, Honduras and the Dominican Republic, who said the rule amounted to an illegal trade barrier. As the former chief of staff to the Australian health minister who introduced the plain packaging measures, Nicola Roxon, Pratt helped develop the policy, bulletproofing it from court challenges from tobacco companies and governments.

“We were proud to be taking on plain packaging,” Pratt recalls. “But we wanted to be sure to be able to defend it.”

Together with graphic warnings and taxes that will push cigarettes up to A$40 (HK$230) per pack by 2020, the measure is credited with accelerating the fall in Australia’s smoking rate. The most recent figures show about 13 per cent of Australian adults smoke and less than five per cent of school children. A dozen countries, from Canada to Chile and Britain to Uruguay are either introducing similar rules or seriously considering them.

At the other extreme is Indonesia. The most recent figures, which date back to 2013, show 240,000 Indonesians die every year from tobacco related illnesses. Two-thirds of Indonesian men and boys, over the age of 15, smoke, according to the Ministry of Health.

Most troubling are the numbers of new young smokers throughout the archipelago, says Dr Widyastuti Soerojo, chair of the tobacco control unit at the Indonesian Public Health Association. She says some 16 million Indonesian youngsters between the ages of 10 and 19 experiment with smoking every year – a rate of about 44,000 every day.

Indonesia is among the few countries that are not signatories to the United Nation’s Framework Convention on Tobacco Control, which among other things aims to curb the appeal of smoking for children.

Indonesia television and billboards feature handsome intrepid men jumping out of planes or into business meetings. Roadside kiosks individually sell clove cigarettes, known as kretek, for as little as 10 US cents each.

Governments in Jakarta and local governments in vote-rich provinces, such as Central Java and East Java, fend off calls for more curbs on smoking saying they provide badly needed jobs to rural families.

But mechanisation and growing taste for machine-made cancer sticks rather than hand-rolled types, belie that argument. Tobacco accounts for about half of one per cent of all jobs in Indonesia, according to the Southeast Asia Tobacco Control Alliance. Campaigners are quick to point out the country’s richest families have tobacco to thank.

The Hartonos, Indonesia’s richest family and worth US$17 billion, own kretek maker Djarum.

Indonesian cigarette sales totaled US$16 billion in 2015. Sampoerna, which is more than 90 per cent owned by Philip Morris, is Indonesia’s most valuable company.

“The government treats tobacco like it’s a normal industry but really this is neocolonialism by tobacco companies,” Dr Soerojo says.

In China, the culprit for health advocates is the China National Tobacco Corporation, which controls more than 98 per cent of the local market. Implementation of the UN tobacco convention falls to the Ministry of Industry, which is also home to the body that owns China Tobacco. “A parallel would be, back when I was with the health ministry, meetings were chaired by a representative of Philip Morris,” Pratt said. “There’s plenty of room for conflict of interest.”

Still, there’s progress. Beijing, Shanghai and Shenzhen, with a combined population of more than 60 million, have banned smoking in public areas. China hiked taxes on cigarettes in 2015. The move resulted in a 20 per cent jump in the retail prices of the cheapest brands. Owing to its massive market, that move alone resulted in a more than 2 per cent drop in world tobacco consumption in 2016.

In Indonesia, smoking is banned in most public spaces but enforcement peters out the further one travels from the centre of Jakarta. Indonesia introduced graphic warnings on packaging in 2012 and hiked excise taxes on cigarettes by 15 per cent in 2016. Even so, additional hikes for this year were scotched. Glimmers of light are on the horizon, says WHO’s Pratt, but plain packaging is still “a long way off”.

For Siahaan, his government’s halting go-slow approach is proof that cigarettes are insidious, and for him, more ruinous than narcotics. “At least with drugs you can get help,” he gasps. “For cigarettes, you see them everywhere.”

Is tobacco bill really necessary?

Last week we learned that President Joko “Jokowi” Widodo verbally rejected a proposal from lawmakers for a new tobacco bill that would increase protection of the industry and production of cigarettes. However, he finally gave written agreement for discussion by government and the legislature about the proposed law.

http://www.thejakartapost.com/academia/2017/03/24/is-tobacco-bill-really-necessary.html

Smoking and the tobacco industry have long been big business here with well documented impacts on national, family and individual economies, health and welfare. Today I call on activists concerned for the people of Indonesia to reject the proposed tobacco law, which threatens the health and well-being of our people. It is in conflict with prevailing laws on health and other fields.

We must also raise our voices to point to positive action that the government can take to address some key concerns of the President — an increase in revenues and the welfare of tobacco farmers and workers in the cigarette industry.

A review of some basic facts about smoking and tobacco in Indonesia makes clear the importance of acting promptly.

Among the country’s 255 million people, an estimated 65 percent of adult males are regular smokers, making Indonesia the second-largest cigarette market in Asia after China. Furthermore, in Indonesia the rate of smoking among women has increased rapidly in recent years. This threatens not only the health of these women, but that of their babies and children. Smoking while pregnant increases the risk of miscarriage, low birth weight and respiratory problems in children after birth.

A child growing up with a mother or father or both smoking is at risk in multiple ways. Children’s health may be permanently affected by second-hand smoke in the house. Furthermore children may associate smoking with “being adult” and rush to start smoking themselves leading to early, long-term addiction.

Finally, the households of smokers, particularly low-income families, live with cruel competition for family funds between expenditure on cigarettes and expenditure on good nutrition, clothing, school books and basic medical care. Research shows that it is often the basic needs that lose out — a punishment for the whole family that falls particularly hard on children who are building bones, brains and muscles.

As a pediatrician I would like all parents to be disciplined, caring and active in promoting the best possible life chances for each of their children. Yet science and global experience make clear that the addictive nature of cigarette smoking, peer-group pressure among young people and alluring cigarette advertising makes it easy to start lighting up. Later, smokers find it difficult or impossible to shake the habit.

Therefore I argue not only against the proposed bill.

I also suggest four important actions that could eventually help reduce the threat of smoking to people’s health, thus reducing individual and health expenditure, increase revenue, improve the situation of tobacco farmers and help cigarette factory workers.

First, accede to the Framework Convention on Tobacco Control (FCTC). This global public health treaty aims to reduce tobacco-related causes of ill health and death through cutting legal and illegal supply and demand for tobacco, and protection of health and the environment from tobacco-related damage. Having been adopted by 180 of the 193 UN member states, Indonesia is one of only 13 which is not yet a party to the convention.

Second, increase revenues from tobacco and smoking. The expansion of cigarette production and sales in the proposed bill is presented in terms of expansion of employment opportunities and income for the government.

Yet this increase can be achieved without the bill by increasing the price of a pack of cigarettes (20 sticks), now at US$ 1.40, among the world’s lowest. A significant increase in price will automatically increase revenues from taxes and excises, which benefits the national and regional levels.

Increasing the price would both raise revenue and reduce smoking among the young and the poor -meaning lower treatment costs of tobacco-related diseases.

Third, protect and develop tobacco farmers. Since independence, Indonesia has worked to improve its citizens’ productivity, health services and welfare. There is already a law for the protection and empowerment of farmers (Law No. 19/ 2013). Presidential or other government regulations with special focus could fully meet the needs of tobacco farmers.

Also urgent are special efforts to support farmers wanting to transit out of tobacco farming but without the resources for the startup investment, including training, equipment, seeds etc.

Fourth, protect and attend to the welfare of cigarette factory workers. Similar to farmers, there are laws and regulations that could be used to address their special needs as the industry evolves. And it is clear that even if the cigarette industry expands production in line with the proposed law, it would not expand employment, given the industry’s preference for the speed, efficiency and simplicity of mechanized production.

Layoffs of workers and the shift from hand-rolled cigarettes to mostly mechanized production is already well advanced – 75 percent of kretek (clove-based) cigarettes is now machine rolled. Thus the new law would unlikely provide any significant new employment or support for workers displaced by mechanization.

So is the proposed tobacco bill needed to raise revenues and protect agricultural and factory workers in the industry? No. If we are concerned about the people, their health and well-being, the proposed tobacco bill is clearly unnecessary!

***

The writer is presently leaders’ envoy and board chair for the Asia Pacific Leaders’ Malaria Alliance (APLMA). She served as health minister (2012-2014) and chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria (2013–2015)

Indonesia tobacco bill would fire up output despite health fears

Indonesia’s parliament has proposed a draft law that could lead to a sharp increase in tobacco output in a country that is already a top producer with one of the heaviest rates of smoking in the world.

http://uk.reuters.com/article/uk-indonesia-tobacco-idUKKBN16M1FK

Indonesia’s tobacco industry employs millions of workers and contributes almost 10 percent to government revenues through taxes, but has faced a backlash from the health ministry and anti-smoking organizations.

Health Minister Nila Moeloek said her ministry “definitely” opposes the tobacco bill as it has the responsibility to “safeguard the health of the people”.

The bill, which covers production, distribution and excise taxes, has to be approved by President Joko Widodo.

Indonesia’s industry minister, Airlangga Hartarto, said the government has to assess how the tobacco bill would affect existing regulations for the industry.

Firman Subagyo, the parliament member who initiated the bill, played down health concerns, saying tobacco is a “strategic” commodity that can increase the prosperity of Indonesian farmers and state revenues.

“Health should not be used as an excuse to destroy people’s livelihood,” Subagyo, who comes from Indonesia’s second-biggest political party, Golkar, said in an interview on Wednesday.

Under the draft law, manufacturers of tobacco products have to use locally sourced tobacco for at least 80 percent of their production, while imports of ready-to-use cigarettes may be subject to an excise tax of 200 percent.

‘RATIONAL PRICING’

Abdus Setiawan, a board member at the Indonesia Tobacco Growers’ Association, said he welcomed the draft law as it could help to protect farmers. But an increase in production should be balanced with “rational pricing”, he said.

Indonesia was the world’s fourth-biggest cigarette producer with an output of 269.2 billion sticks in 2015, according to the latest data from research firm Euromonitor International. The market was valued at 231.3 trillion rupiah (£14.20 billion).

Nearly two-thirds of men are smokers in Indonesia, where an average pack of cigarettes costs less than $2.

Major cigarette companies operating in the country include Phillip Morris-controlled PT Hanjaya Mandala Sampoerna Tbk, Djarum Group and PT Gudang Garam Tbk.

Sampoerna, through its tobacco suppliers, has partnered with about 27,000 tobacco farmers in Indonesia and gets almost three-quarters of its tobacco domestically, said Elvira Lianita, Sampoerna’s head of fiscal affairs and communications.

However, the industry’s total tobacco requirements have outpaced the domestic growth in tobacco output, Lianita said. Restricting access to raw materials through import regulations or taxes would disrupt the “overall economic stability”, she said.

“Partnership programs, not risky restrictions, would be the solution to bridging this gap and increasing farmer prosperity,” she added.

Gudang Garam and Djarum declined to comment.

(Reporting by Eveline Danubrata and Agustinus Beo Da Costa; Additional reporting by Cindy Silviana and Jakarta Newsroom; Editing by Ed Davies and Bill Tarrant)

Indonesia’s Child Tobacco Workers in Peril

In the next week, Indonesian President Joko (“Jokowi”) Widodo will decide whether to encourage parliament to move forward with a draft tobacco bill aimed at increasing domestic tobacco production. The bill would gut many important existing health regulations, like the requirement that companies include a health warning with a picture on the label of tobacco products.

Those are troubling proposals given that millions of children in Indonesia start smoking each year, and that 40 million more are “passive smokers” from secondhand smoke. The Indonesian Ministry of Health, 17 prominent health organizations, and many others have denounced the measure as an attempt to undermine Indonesia’s already weak tobacco control laws. Jokowi should reject the bill.

But the draft bill is not the only tobacco policy issue awaiting action by the Jokowi administration. Each year in Indonesia, thousands of children, some just 8 years old, work in hazardous conditions producing tobacco that ends up in products marketed and sold by huge Indonesian and multinational tobacco companies.

My colleagues and I published a Human Rights Watch report documenting hazardous child labor on Indonesian tobacco farms last May. Since then, another tobacco season has come and gone, but the child workers behind Indonesia’s tobacco industry remain unprotected.

We interviewed 132 children who worked on tobacco farms in four of Indonesia’s biggest tobacco-producing provinces. We found that child workers are exposed to nicotine and pesticides—toxins that can be especially harmful to children who are still growing and developing. Half the children we interviewed had experienced nausea, vomiting, headaches, or dizziness while they worked. Those symptoms are consistent with acute nicotine poisoning, which happens when workers handle tobacco plants and absorb nicotine through their skin. Many children said they also mixed and sprayed toxic chemicals on the plants with no protective equipment, and some became violently ill afterward.

The families we interviewed did not intentionally put their children in harm’s way. They were committed to helping their children get an education so they could have a better future.

Indeed, most of the children we interviewed attended school and worked in tobacco farming only outside of school hours.

But direct contact with tobacco in any form is hazardous work for children because of the nicotine in the leaves. Most of the families we spoke with had never received comprehensive information about the hazards for children of work on tobacco farms, so they did not know the risks to their children.

We urged the Jokowi government to take action to protect children from danger in tobacco fields. We called on the Health Ministry to work with other ministries to develop a public education campaign to raise awareness of the dangers to children of work on tobacco farms. In recent meetings with Human Rights Watch, government officials have said they need additional support and resources to get the campaign underway this year.

Indonesia already prohibits children under 18 from work “with harmful chemical substances.” The Ministry of Manpower and Transmigration should explicitly prohibit children from working in direct contact with tobacco in any form and increase labor enforcement efforts to make sure government inspectors check for workers’ safety, especially on small tobacco farms where children might be in danger.

In our meetings with government officials, we have heard many times that the tobacco industry is powerful in Indonesia, and that it is difficult to achieve policy changes the industry opposes. Surely eliminating child labor in tobacco farming is an issue tobacco companies also want to address.

The UN Guiding Principles on Business and Human Rights make clear that companies have responsibilities for addressing human rights abuses in their supply chains. We shared our findings with the largest tobacco companies operating in Indonesia—Djarum, Gudang Garam, Philip Morris International (which owns Sampoerna), British American Tobacco (which owns Bentoel), and others. The large multinational tobacco companies have policies to prevent children from doing the most dangerous tasks on tobacco farms, but their policies are not strong enough, and they should do more to monitor for child labor when they buy Indonesian tobacco on the open market through traders.

The largest Indonesian companies—Djarum and Gudang Garam—do not appear to be taking any steps to prevent or address child labor in their supply chains. They have never responded to our many requests for information and meetings, and they do not make any information publicly available about their child labor policies.

These companies should not be profiting off the backs of Indonesian child workers.

Two months from now, the next tobacco-growing season will be underway, and children will be heading to the fields again. The controversy around the draft tobacco bill likely will not be resolved by then. But with decisive action, the Jokowi administration and tobacco companies could take steps to protect children from dangerous work in tobacco fields. Their futures depend on it.

Metro TV welcomes plan to ban cigarette ads

http://www.thejakartapost.com/news/2017/01/14/metro-tv-welcomes-plan-to-ban-cigarette-ads.html

Metro TV news director Suryapratomo said Friday that the private TV station welcomed lawmakers’ plan to ban cigarette advertisements on television and radio, saying that a ban would not significantly affect its revenue.

“Lawmakers have the right to make any regulation. But I hope the House of Representatives carries out comprehensive discussion before making a final decision,” Suryapratomo told The Jakarta Post on Friday.

He added that a ban would have minimal impact on Metro TV, as cigarette ads contributed only a small portion to the company’s revenues.

“So please do ban [cigarette ads on TV] if you want. Metro TV does not make much from cigarette ads. We also don’t air cigarette ads frequently on our TV station,” Suryapratomo emphasized.

TV stations are currently allowed to air cigarette ads only after 10 p.m. However, the government may issue a total ban on cigarette ads on TV and radio, with a draft bill comprising stipulations of a ban awaiting deliberation at the House.

The House is expected to start deliberations this month and has assured that it will include various stakeholders in the discussion to gain comprehensive insight.

Cigarette ad ban aims to protect children, lawmaker says

The House of Representatives’ plan to ban tobacco companies from advertising their products on television and radio aims to protect young audiences, says a lawmaker.

http://www.thejakartapost.com/news/2017/01/13/cigarette-ad-banaims-to-protect-children-lawmaker-says.html

Lawmaker Elnino M. Husein Mohi argued that cigarette advertisements could be easily viewed by children.

“Broadcasting companies run the industry using state-owned frequency, which is supposedly used to help build good character,” Elnino told The Jakarta Post on Friday, adding that smoking did not help build positive character. “The plan to ban cigarette advertisements is basically meant to protect youngsters from the campaign”.

The politician from the Gerindra Party explained the House had included stipulations to ban such advertisements in a draft bill on broadcasting to amend a prevailing law passed in 2002. The current draft was initiated by the House.

Elnino, a member of House Commission I overseeing defense, foreign affairs and information, however, ensured that Commission I would open the deliberation process to the public to include relevant stakeholders in the discussion.

“We are aware of the complexity of the issue. Therefore, deliberations will later invite insights from various stakeholders, including the broadcasting industry, so that we can obtain a comprehensive understanding before passing the bill into law,” he emphasized. (dmr)