Edinburgh Napier University

Indonesia is the world’s second largest market for cigarettes after China, selling around 300 billion cigarettes a year. The country is one of the biggest producers of tobacco globally, and the industry is a significant part of its income, employing 2.5 million manufacturing workers and farmers, and contributing around 10% of Indonesia’s tax revenues. As well as having a high proportion of adult smokers, the country is particularly notable for the high number of young children who smoke; 89% of children are thought to have smoked before reaching the age of 13.

Tobacco control policy in Indonesia continues to be lenient, despite the 240,000 Indonesians that die from smoking-related causes every year. While the country allows for the provision of No Smoking Areas, known as KTRs, where smoking and the promotion and sale of tobacco products is prohibited, it remains up to local governments how and if these are implemented.

A complicated subject

In 2014, Edinburgh Napier’s Associate Professor Nathalia Tjandra set out to investigate public perceptions of the ethics of tobacco marketing in Indonesia. The study was funded by the Carnegie Trust and Edinburgh Napier University, and carried out along with Dr Lukman Araoen (University of East Anglia) and Professor Yayi Suryo Prabandari (University of Gadjah Mada, Indonesia). The researchers used interviews, focus groups and questionnaires to understand the views of people living in Indonesia’s Yogyakarta region, an autonomous province with 3.5 million inhabitants.

Dr Tjandra remembers: “It’s a complicated subject in Indonesia: tobacco provides jobs and money for people and sports events sponsorship, as well as community projects and CSR activities. But one thing that almost all of our participants agreed on was that it was unethical to use tobacco marketing to appeal to children. Young male consumers are their target market; and it was clear that the marketing activities were aimed to appeal to them.”

The findings turned out to be of considerable interest to local leaders. At a public talk, the research findings were discussed in front of 48 key stakeholders including government health and education officials, anti-tobacco activists, public order enforcers, doctors, academics and media. Among the attendees were staff from the Public Health Office of Sleman Regency, a sub-division of Yogyakarta Region with a population of 850,176.

Benefiting schools and the wider public

Based on what they’d learned at the event, the Public Health Office subsequently decided on a new regional policy – to ban tobacco advertising and sponsorship in schools in the Sleman Regency region. They also introduced a new mandatory monitoring process for schools, which must report biannually on implementation of their KTR.

300 primary schools in eight districts of Sleman Regency implemented KTRS and reported back on progress using the new criteria in the monitoring guidelines. The same guidelines have been expanded to cover KTRs in public transport, healthcare services, playgrounds, houses of worship, workplace and public places. By 2019, over three-quarters of the region’s teaching and learning, workplace, healthcare and public area institutions had set up KTRs – involving 1,941 public spaces in Sleman. As a result the research is benefiting the wider public as well as school children. Another initiative by Sleman’s Regent, or governor, instructed all local government leaders, village heads and school headmasters in the area to ban tobacco advertising within a 500m radius of KTRs – going well beyond existing national regulations.

Awareness around tobacco marketing, gained from the ENU research, is an ongoing focus of the Public Health Office’s smoking intervention activities and training, which is delivered to schools, community health centres and other institutions.

Taking great strides

Dr Tjandra said: “Our research was important because it untangled the issues. The policymakers realised they could be confident that a policy against advertising to children would have public support, despite other areas being more ambiguous.”

The research findings were carried in national newspapers including Tempo, Suara Merdeka, and nine local newspapers, as well as online news sites, and a resulting academic paper won Best Paper in Ethics and Marketing from the Academy of Marketing.

Dr Tjandra says: “It’s really heartening the impact that this has had. Smoking is pretty much embedded in Indonesian society, but just one region has been able to take considerable strides in changing that environment for its people. And if they can do it, others can follow.”