Indonesia: Health costs of smoking may be higher than tobacco profit

6 September 2016

Quitting smoking is hard as cigarettes contain nicotine, an addictive substance in tobacco that fuels cravings. After smoking, the brain becomes dependent on the nicotine and has thus rewired itself.

Because of this physical dependency, if a person stops smoking for a period of time, they will start experiencing symptoms of withdrawal. This is the brain and body adjusting to no longer having nicotine in the system.

But quitting smoking in a country like Indonesia, where 67 percent of men smoke, poses a different kind of challenge altogether.

After smokers overcome their withdrawal symptoms, such as anger and anxiety, they still have to face the last stage of overcoming nicotine addiction, which is reinforcement.

“The reinforcement challenges in Indonesia are very strong. People who have quit smoking will start smoking again once they see their neighbors smoking and smell the smoke. They might also see cigarette ads and start smoking again,” Widyastuti Soerojo of the Public Health Scholars Association (IAKMI) told The Jakarta Post.

This has led to an extremely low quit ratio for smokers in Indonesia. According to data from the World Health Organization (WHO), the quitting ratio for men in Indonesia is only 9 percent, while it is 23.2 percent in women.

Lioni Hendrawaty, a 30-year-old NGO worker, is an example of someone who finds that the temptation to smoke again after quitting is too much to resist.

She has been a smoker for 14 years. Throughout that time, she had tried repeatedly to quit smoking.

She said that she noticed her breathes getting shorter and so she was afraid that her habit would eventually kill her.

Lioni was diagnosed in 2014 with hypothyroid, a common disorder in which the thyroid gland does not produce enough thyroid hormone. “Since I was diagnosed, every time I smoke, my heart beats faster. It’s uncomfortable,” she told the Post.

Consequently, she was told by her doctor to stop smoking as her smoking habit would only exacerbate her illness.

But it turns out that being ill is not enough for someone like Lioni to stop smoking.

“Actually I had succeeded in reducing my cigarette consumption to once a day. At the most, I smoke three cigarettes in one day,” she said.

Therefore, it is important to make smoking not normal and not cool as the stakes are too high for Indonesia.

Though the government often argues that the tobacco industry brings much-needed revenue to the country, with it targeting to collect Rp 148.86 trillion from tobacco excise this year, the economic loss from tobacco consumption is actually much greater.

In 2013, the total loss due to tobacco consumption hit Rp 378.75 trillion, according to the Health Ministry, resulting from lost productivity due to illness, disability and premature death in youth and medical expenses.

Indonesia’s economy is also expected to lose Rp 59,580 trillion (US$4.5 trillion) by 2030 from tobacco-related diseases.

The University of Indonesia’s demographic institute associate director, Abdillah Ahsan, said Indonesians are having the hardest time to quit smoking because smoking is already considered normal in the country.

Smokers who want to quit will be constantly seduced by everyone who smokes around them as well as by pervasive cigarette advertisements.

“Access to cigarettes is very easy. If I live in a housing complex, I will find a small stall selling cigarettes just a few houses from me. It’s also easy for children to buy cigarettes. If they step out of their schools, they will find a warung. Above the warung will be a banner advertising cigarettes,” Abdillah said.

Furthermore, public officials are often shown to be smoking in public spaces, such as lawmakers around the parliament building.