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Tobacco advertising still rife in southeast Asia

2014; Elsevier BV; Volume: 384; Issue: 9951 Linguagem: Inglês

10.1016/s0140-6736(14)61804-3

1474-547X

Chris McCall,

Public Health and Nutrition

Tobacco advertising has a strong foothold in many countries in southeast Asia, where regulations are not only weak but also poorly enforced. Chris McCall reports from Jakarta. In a skimpy black skirt not much below her hips, a young girl dances to dangdut music, a blend of pop and ancient Javanese rhythms. The women watching her wear long skirts and Muslim headscarfs, but this sales pitch is for the men. She is not selling sex. She is selling cigarettes. In this small village in western Java, the girl is promoting one of Indonesia's top-selling cigarette brands, and one whose name is spread far and wide on billboards, in cinemas, and on television, at least after 9·30 pm. Cigarette advertisements can be found on electronic billboards at airports, on point-of-sale adverts at small shops selling cigarettes along with other day-to-day items, and even on banners over Indonesia's trademark warung—the small roadside restaurants where millions of consumers eat lunch daily. It can be seen on billboards over roads. You just cannot get away from them. They project images of sky-diving, sports cars, and a luxury life way beyond most Indonesians' means, but not beyond their dreams. For those from other countries used to smoke-free public spaces, a trip to Indonesia is like a step back in time. Official data show nearly two-thirds of adult Indonesian men smoke. A particularly popular style of cigarette is the kretek, which mixes tobacco with cloves. The distinct smell of a kretek is often the first thing visitors notice on arrival in the country. At the same time, Indonesia and its population of around 240 million has a serious problem with tuberculosis and other lung diseases, not to mention other smoking-related illnesses. The kind of advertising seen in Indonesia would be illegal in many other countries, including neighbouring Singapore. But in Indonesia and at least some of its neighbours, it is all still largely regarded as normal. And although tobacco control advocates say Indonesia's record on tobacco advertising is the worst in the region, some of its neighbours are not that far ahead. Most countries in the region now have laws to control tobacco advertising, in some shape or form, even if implementation is often patchy. Tobacco control advocates hope they are slowly winning a battle of attrition with tobacco companies. “We don't know if we are winning or not. We can say that we are winning based on the law”, said Worrawan Jirathanapiwat, a Thai official of the Southeast Asia Tobacco Control Alliance. In Laos, it is umbrellas at cafés. In the Philippines it is slogans on roofs, scholarships, and prominent press releases at times of disaster relief, pointing out generous donations to victims. For Jirathanapiwat, there is a fundamental difference between tobacco companies and other lines of business. Normal commercial issues of advertising and marketing a product simply do not apply here, for one simple reason, the clients' lives are actually at stake. “In other businesses companies don't kill the consumer. But cigarettes kill the consumer”, she said. In 2003, WHO negotiated the Framework Convention on Tobacco Control, which came into force in 2005 and has been adopted since then by most countries around the world. There are two large countries that are notable exceptions. The USA is one and Indonesia is the other. A law on tobacco advertising was finally passed by Jakarta in 2012, but it is very weak and most forms of tobacco advertising are still permitted. The only substantial restriction is that advertising on television is only permitted between 9·30 pm and 5·00 am. In Indonesia's university city of Yogyakarta lives Sambudiono, a 47-year-old smoker and father of one, with a second child on the way. His job is filling up large plastic bottles of drinking water that his clients keep at home. The shop he works at uses spring water taken from up on the slopes of the volcanoes that run all along the island of Java. He has to carry the bottles, each with a capacity of 19 litres, to people's homes slung over his shoulders. It is hard work. Like most Indonesian men, he says he smokes to relax. “I have smoked since high school. I have been smoking a long time. I have tried to give up but I couldn't do it”, said Sambudiono. Like most smokers, Sambudiono does not think he is influenced by cigarette advertising, although he sees it all the time and he has been smoking since he was about 15 years old. He reads the health warnings on the cigarette packets and he knows it is unhealthy. His wife would like him to give up and his son, who is only aged 4 years, frequently tells him not to smoke. But he says he will never give up. “I will always smoke as long as there is tobacco”, he says. Yayi Prabandari is a psychologist at the public health unit of Yogyakarta's prestigious Gadjah Mada University. She says people like Sambudiono have got it wrong. They clearly are influenced by cigarette advertising and the exotic images of wealth and luxury that go with it. They just do not realise it. “I asked senior high school students. They don't believe they are influenced, but they said that they liked the advertisements”, she said. “It is on television every day. Even though they broadcast after 9·30 pm, the young people are still awake. It is unconscious. They always see it.” Statistics from 2013 show that around 63% of Indonesian adult men smoked. The figure has not gone down over the years. The figures for women are much lower, about 4%, but that figure has doubled in 10 years, Prabandari said. For her, the culprit is obvious. It is the advertising. Prabandari feels some progress is being made. At the local level some people are starting to wake up to the dangers of tobacco consumption. A few local administrative districts around Yogyakarta have unilaterally declared smoke-free areas, she said. At the national level, however, she said the political will is lacking. Political parties cite the need to support tobacco farmers and although tobacco companies might not necessarily contribute directly to political campaigns, they have plenty of room to contribute indirectly—eg, by sponsoring events. Tobacco control advocates hoped that outgoing President Susilo Bambang Yudhoyono might sign the WHO treaty before leaving office later this month. There is no indication as yet, however, that this will happen. The party of his recently elected successor, President-elect Joko Widodo, has been notably reluctant to act on tobacco control. Three large tobacco companies are especially active in the region, namely British American Tobacco (BAT), Japan Tobacco International (JTI), and Philip Morris International (PMI), which has a major subsidiary in Indonesia known as Sampoerna. All three companies were contacted by The Lancet in preparation for this article, and only PMI responded. In a statement (appendix), Julie Soderlund, PMI's vice-president of communications, denied promoting tobacco products through disaster relief and said its contributions programmes were aimed at improving living conditions. PMI denied funding political campaigns through Sampoerna and said tobacco contributes substantially to the region's economy. PMI also criticised tobacco control in the region. “Asia is home to some of the world's most restrictive and extreme tobacco control policies. This includes plain packaging in Australia and health warnings in Thailand that cover 85% of a cigarette pack”, Soderlund said. Ironically, Indonesia's neighbour Australia has led the world in recent decades in controlling cigarette advertising. Plain packaging and some extremely graphic images of what smoking can do to various parts of a person's body have come in recently. But tobacco control advocates say it all started with targeting cigarette advertising. Arthur Chesterfield-Evans is an Australian doctor who in the 1980s, upset by seeing the results of smoking in his work, was involved with a controversial campaign called BUGA UP—Billboard Utilising Graffitists Against Unhealthy Promotions. They deliberately sprayed graffiti on cigarette billboards. Some of them went to jail, but Chesterfield-Evans credits the campaign with transforming national opinion about cigarette companies. “It was their social legitimacy that was being targeted. It was their right to tell lies”, he told The Lancet, adding that today in Australia, high taxes mean smoking is simply too expensive for younger people to get addicted in the first place and, perhaps more importantly, it is not seen as attractive. “It is seen as ‘uncool’. It is seen as ‘being losers’”, he said. The Philippines has recently introduced a major tax hike on tobacco products. Ulysses Dorotheo, a Filipino doctor and tobacco control advocate, says, however, that his country is not really much ahead of Indonesia. Tobacco companies have met attempts to restrict advertising with legal challenges, attempting, for example, to place adverts on the roof of a building selling cigarettes, saying this represented legal point-of-sale advertising. One such case has dragged on for 5 years. Nevertheless, Dorotheo said he was optimistic that in the foreseeable future other Asian countries will follow the example of neighbours such as Singapore, Brunei, and Thailand, which already have tough tobacco advertising controls. Asked how soon that would be, he said: “It'll be a while.” Download .pdf (.11 MB) Help with pdf files Supplementary appendix