Australia is an undisputed world leader in tobacco control. From massive wins with plain packaging to widely enforced bans on smoking in public places, it is easy to see why. Australia is successfully creating a generational shift in tobacco use, with its youngest generation growing up in a society mostly free of smoking and its harmful effects.
Yet Stephen Grenville’s recent observations for The Interpreter (“Quitting cigarettes in Indonesia”) highlight that there are some very serious failings in tobacco control in the immediate neighbourhood which must be addressed. The rampant and persuasive cigarette advertising in Indonesia that Grenville notes is only the tip of the iceberg in a country with a massive tobacco problem, a problem that won’t go away without help.
Indonesia is poised to become a leading regional economy in coming decades, yet it also continues to have one of the highest rates of smoking in the world. The economic burden of tobacco use is a serious threat not only to Indonesia’s ability to reach its economic potential, but also, as a result, to Australia’s interests in the country as a strategic partner in our region.
Considering that the recent Foreign Policy White Paper called for government action to promote a prosperous region and encourage sustainable development, it would be a gross oversight not to take tobacco and its health impacts into account in Australia’s regional engagement.
But just how bad is the problem? In hard numbers, 2013 data shows that more than 60% of Indonesian adults are smokers, and as of 2014, one in three children aged 13–15 smoked. With the prevalence of smoking among Indonesia’s poor increasing from 30% in 2001 to 43.8% in 2013, tobacco is also disproportionately affecting those who can least afford it. Restrictions are few – cigarettes are easily purchased by children, and advertising is ubiquitous.
The pervasiveness of tobacco places an economic burden on society which will undoubtedly effect Indonesia’s anticipated rise to power. Diseases attributable to tobacco use, such as stroke and coronary heart disease, are a drain on Indonesia’s healthcare system, costing the country 1.85 trillion rupiahs (approximately US$192 million) in 2010.
Another critical concern is the rate at which children are taking up the habit, putting the next-generation workforce at risk of facing debilitating diseases in what should be the prime of their lives. A workforce that is unable to work poses a further risk to Indonesia’s future economic hopes.
Yet a major roadblock to tobacco control efforts is Indonesia’s failure to ratify the World Health Organization’s Framework Convention on Tobacco Control. This has meant that tobacco control advocates face a constant battle for government support to enforce proven, highly effective measures for reducing consumption, such as taxation and restrictions on advertising and smoking in public places.
This lax approach makes tobacco control a high-risk area for Australia to support with investment in Indonesia. However, that should not be an excuse to sit by idly. Instead, there is an opportunity to expand investments in Indonesia and design programs aimed at targeting the wide range of factors that negatively impact health in the country.
Health is unfortunately the lowest priority in Australia’s aid program to Indonesia, accounting for a paltry 2% of the total spent, which does not make for a good start. Australia does, however, allocate 33% of its aid spending in Indonesia to education, and it is perhaps here the contribution might be best placed.
Driving a change in behaviour among Indonesia’s youth might be where Australia could most help Indonesia gain ground in the fight against tobacco. The Australia–Indonesia Centre Health Cluster has already twigged to the importance of engaging youth, recently funding a number of youth-focused projects designed to raise awareness about non-communicable disease risk factors early in life. Two initiatives in particular aim to change the attitudes and behaviours of adolescents towards tobacco use through school-based programs.
In addition, a collaboration between Flinders University and Syiah Kuala University in Banda Aceh has found that a school-based smoking prevention program increased students’ knowledge of the negative effects of smoking. This model is widely used in many countries but remains under-researched in Indonesia.
Increased earmarking of funds towards projects within the education portion of the Australian budget to Indonesia would allow local civil society organisations and universities in the country to research, evaluate, and scale up school-based programs, which in turn could stem the demand for cigarettes among youth.
There is a long way to go with tobacco control in Indonesia, and an Australian contribution would only be one piece of that complex puzzle. By targeting youth, however, it would present an opportunity to drive long-term change in smoking behaviours, while remaining in line with the strategic goals of Australia’s aid program in Indonesia.
Encouraging Indonesia’s youth to say no to tobacco, to help them create a healthier society and a stronger economy, will ultimately benefit Australia and contribute to regional growth and stability.