15 July 2019
Nadhira Nuraini Afifa
Many of us still mourn the death of the much-loved disaster agency spokesman Sutopo Purwo Nugroho, affectionately known as Pak Topo, who, despite stage-four lung cancer, continued to provide regular updates on the country’s inordinate number of natural disasters.
The fact that he had lung cancer was shocking, since he was never a smoker. In a recent video by the antismoking campaign #SuaraTanpaRokok (Voices Without Cigarettes), Pak Topo delivers a powerful message for active and passive smokers alike to join efforts to control tobacco.
“I’m not a smoker. There are no smokers in my family. I also lead a healthy lifestyle… Maybe one of the causes [of my lung cancer] was that I’m a passive smoker,” he said, adding that most of the staff at the headquarters of the National Disaster Mitigation Agency (BNPB) are smokers.
Pak Topo’s death has once again brought up public discussion of the dangers of smoking, especially passive smoking.
There are about 66 million active smokers and 90 million passive smokers in Indonesia. More than 230,000 Indonesians are killed by tobacco use annually, accounting for approximately half of the tobacco deaths in the Association of Southeast Asian Nations, where tobacco use kills roughly 500,000 people per year.
In earlier 2009, the Global Youth Tobacco Survey (GYTS) reported that 78.1 percent of 13- to 15-year-old school children were exposed to secondhand smoke, making them passive smokers. Of those, 72.4 percent had at least one parent who smoke and 71 percent realized that secondhand smoke was harmful to them.
Secondhand smoke is not an innocuous byproduct of smoking. This mixture of freshly burned tobacco and exhaled smoke contains hundreds of chemicals, including formaldehyde, benzene, carbon monoxide, ammonia, arsenic and lead. Some are known to cause lung cancer, just as Pak Topo had.
Data from the Ministry of Health shows that exposure to secondhand smoke increases the risk of contracting lung cancer by 30 percent and coronary heart disease by 25 percent. Secondhand smoke is almost as bad for nonsmokers as smoking is for smokers.
Unfortunately, many passive smokers have high-level tolerance when dealing with smokers. Passive smokers are often discouraged to express their dislike of secondhand smoke for fear of being impolite. People exposed to smoking appear somewhat stoic, which in this case, worsens smokers’ ignorance.
As I am talking about well-informed youths and adults, what do you expect from less educated ones, let alone small children?
The government has taken various efforts to address smoking. The health ministry, in concert with some regional governments, has issued regulations on smoke-free zones. A smoke-free zone is a room or area declared off-limits to smoking or activities related to the production, sale, advertisement and/or promotion of tobacco products.
Local governments have a mandate to establish smoke-free zones in their respective regions through various regulations. There are currently 19 provinces and 309 districts or cities that have regulations related to smoke-free zones. In addition, discussions with the Ministry of Finance have also taken place regarding the provision of incentives to parties that provide information on smoking bans in their public spaces.
However, smoke-free policies have not yet been imposed in government facilities, indoor offices, restaurants, bars or other indoor areas. They have, however, been implemented in public transportation and health and education facilities, although many still criticize the lack of enforcement.
Other than that, cigarette advertising plays a big role in affecting people, especially teenagers, to smoking. Mainstream media have been portraying the culturally normal values of smoking. The GYTS study found that 10 percent of teenage nonsmokers would have the tendency to smoke after seeing cigarette adverts on the internet.
To protect young people from exposure to tobacco, Indonesia has established a ban on cigarette advertisements across digital and social media platforms. The Southeast Asia Tobacco Control Alliance has applauded the country for this move and urged others to follow suit.
However, it is a minor victory. The adverts are still on television, in newspapers and magazines and plastered on trees lining the roads. Cigarette advertising is still massive and has succeeded in framing smoking as cool and popular.
We know now that government and partner organizations have been cooperating on interventions at a higher level. However, strong and persistent grassroots community empowerment must not be neglected.
If you are a smoker, try as hard as you can to quit. Much of the damage caused by smoking is reversible, and the earlier you quit, the more chance your body has to repair itself. The longer you abstain from smoking, the greater your chance of avoiding a smoking-related disease.
However, we all know quitting smoking is tough. Nicotine is so addictive that many smokers, even those who desperately want to quit, cannot. If you cannot quit now, try to smoke outside or just in one room nobody else needs to uses. Air cleaners and other technologies that filter out smoke or clean the air cannot eliminate the hazards of secondhand smoke.
A study by the Lawrence Berkeley National Laboratory in California shows that nicotine in smoke residue clings to walls, carpets, clothing and other surfaces. It can react with nitrous oxide, a common indoor air pollutant, to form cancer-causing compounds known as tobacco-specific nitrosamines, which can persist for months.
If you are an ex-smoker or have never smoked, then do not ever think of starting. It is also good to have the courage to express fear and dislike of secondhand smoke. Not only school-aged children, pregnant women, mothers and all nonsmokers should also realize that smoking and secondhand smoke are equally harmful and they should no longer stay quiet about this.
The workplace can also be a major source of exposure to secondhand smoke. If your business allows smoking at work, talk with your managers about implementing changes that protect nonsmokers. A smoke-free policy is best for everyone’s health, but that may take some doing. Even setting up a designated smoking area that nonsmokers never need to enter is a good start.
Secondhand smoke is much more than a smelly nuisance. It is a serious public and personal health hazard that must be treated as such.
Nadhira Nuraini Afifa is a physician studying towards a master’s degree in public health at Harvard University in Massachusetts.