In Indonesia, rampant smoking begins at early age, 13/06/11

Yogyakarta, Indonesia –The poster child for Indonesia’s tobacco culture is a 2-year-old boy who smokes 40 cigarettes a day.

A YouTube video of the chain-smoking toddler, from a fishing village on the island of Sumatra, went viral last year, drawing international attention to a virtually uncontrolled tobacco industry.

“Aside from some supermarkets not selling tobacco to minors under 18, there are no regulations,” said Dr. Yayi Suryo Prabandari, public health specialist at the University of Gadjah Mada in Yogyakarta.

In an era when tobacco firms are on the run in most parts of the world, they’re thriving in Indonesia, where one-third of the population smokes. In total number of smokers, Indonesia lags behind only China and India, which have five times its population.

Most Indonesians prefer Kreteks, a blend of tobacco and cloves that has become an ingrained part of the nation’s culture. They are shared by friends and doled out to cranky toddlers and relatives at circumcisions, an Islamic rite of passage for boys between 11 and 12 years of age.

Ads for Kreteks and other cigarettes regularly appear on television and billboards, and there are no bans in government and private offices or restaurants and bars. Indonesian cigarettes are among the cheapest in the world, costing about $1 dollar a pack. And while selling to minors under 18 is illegal, that law is rarely enforced.

The puffing population has increased sixfold since the mid-1960s, according to the World Health Organization. Sixty-three percent of men and 5 percent of women smoke and 3.2 percent of children from 3 to 15 years old are active smokers, according to Indonesia’s government.

Many Indonesians are oblivious to the health risks, according to Prabandari. The Griya Balur health clinic in Jakarta treats patients suffering from emphysema caused by smoking with “divine cigarettes,” which are piped into the lungs, ears and nose. The clinic’s staff claims tobacco cures cancer.

Indonesia is the only Asian-Pacific nation not to sign or ratify the WHO’s Framework Convention on Tobacco Control, which sets policy recommendations and benchmarks for nations aimed at reducing smoking, restricting sales to minors, increasing taxes on cigarettes to reduce demand and banning tobacco advertising.

Most critics say regulatory indifference is the result of the tobacco industry’s economic muscle. It provides the government with billions in excise taxes and directly employs 600,000 workers, as well as 3.5 million tobacco and clove farmers.

Even the poorest families spend more on tobacco than some necessities – eight times more on tobacco than meat and five times more on tobacco than on milk and eggs, according to a recent survey by the public health department at the University of Gadjah Mada.

But pressure by anti-smoking groups is mounting on the industry, whose products kill more than 400,000 Indonesians a year from such tobacco-related illnesses as cancer and cardiovascular and lung disease and another 25,000 from secondhand smoking, according to WHO.

Last year, Indonesia’s second-largest Islamic organization issued a fatwa (religious ruling) banning smoking, comparing it to suicide, which is prohibited in Islam. And protests from anti-tobacco groups obliged the tobacco company Djarum to withdraw its sponsorship of a concert by American pop star Kelly Clarkson.

An anti-smoking coalition is pushing parliament to approve bills that would require tighter restrictions in public places and in advertising, and enforcement of a 2009 law requiring graphic warnings on cigarette packages.

There are also awareness campaigns via text messages and anti-smoking counseling centers – but those efforts don’t seem to be making much of a difference.

At one such center in the Panembahan Senopati hospital in Yogyakarta, counselor Markus Wiyoto sat near a sign that said: “COUNSELING STOP SMOKING.” He said it had been two months since anyone had come to hear him give suggestions such as drinking more water to flush out the nicotine and chewing gum as an alternative.

“They typically come in and ask for medicine,” said Wiyoto, who stopped his 2- to 3-pack-a-day habit days after finishing his counseling training in 2008. “When we tell them there is no magic bullet, they leave.”

At the same time, an imaginative local psychologist has reportedly helped the celebrated smoking baby kick his habit.

“The boy liked singing songs, so we told him that if he continued smoking he wouldn’t be able to be a singer one day – and it worked,” psychologist Seto Mulyadi told reporters last year.

Chronicle Foreign Editor Jack Epstein visited Indonesia in May on a fellowship sponsored by the International Reporting Project. E-mail him at

This article appeared on page A – 2 of the San Francisco Chronicle

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