Sun, 24 Aug 2003

Tobacco and poverty make for a deadly duo

Santi W.E. Soekanto, Contributor, Jakarta

For as long as 19-year-old "Mariah" can remember, her father has smoked cigarettes, often up to two packs a day. Even during the rainy season, when work for a well digger was scarce, her father spent more than Rp 10,000 for cigarettes.

"He would beat up my mother to get more money, screaming at the top of his lungs if he could not get his way, and start puffing as soon as he could get hold of a cigarette," she said.

Her mother, a beaten woman in her early 40s who wears a face as if every day was a funeral, opened a small shop at their house selling dried noodles and vegetables for the kampong dwellers in Pasar Minggu, South Jakarta.

She does not make much from the business, but managed to send her three children to school. Her husband's smoking habit, however, eats up her profit and often makes it difficult for her to buy her children the necessary school supplies.

Mariah, who dresses modestly in a headscarf, hates her father for many reasons, including the verbal and physical abuse she and her mother have suffered, which ultimately made her run away last year.

However, of all the abuse, the moment she remembers most was when he found out that she had been secretly throwing away his cigarettes.

"He yelled at me, became very rude and rough, shook me, and then he took a very deep puff on his cigarette, and blew the smoke in my face," Mariah said. "I never hated him as much as I did then."

"I would never marry a man who smokes, because smoking is haram," she added, using the Islamic word for forbidden.

She first became aware that Islam prohibits the consumption of harmful substances or any other actions that harm the body when she began taking Koranic lessons from a woman she calls "Auntie Nana".

Nana is part of a growing Muslim community in Indonesia, known as the Tarbiyah (education) movement, which models itself after the Ikhwanul Muslimun movement founded by the late Egyptian ulama, Hassan Al-Banna.

In 1999, the Tarbiyah formed the Justice Party and contested the elections, but it was recently transformed into the Justice and Welfare Party in order to comply with the new regulations for the 2004 general elections.

Mariah soon found herself to be an activist, in more ways than one. She is not only involved in religious and political activities, but also in anti-tobacco campaigns. In the all-girl pesantren (Islamic boarding school) that she went to to complete her high-school education earlier this year in a village in West Java, she set up small Koranic course for the kampong boys.

She told the dozens of boys, who all come from poor families, very clearly, "if you profess to be a Muslim, you do not smoke, because smoking is haram and smoking wastes money, causing poor people to be even poorer".

Tobacco is strongly related to poverty in Indonesia. At the height of the economic crisis, which began in 1997 and remains in evidence today, when Indonesians did not have enough money to buy meals, they still went out and bought a cigarettes.

In the face of aggressive promotion and marketing by tobacco firms, Indonesians are oblivious to the very real consequences of their habit.

Dadang, a small, gaunt man in his early 50s who lives with his second wife and three surviving children in a bedraggled shanty in a Bandung, West Java slum, chooses not to eat as long as he can smoke, even inside his house in the presence of all his children. He has no steady job, and regularly beats his wife if she dares to tell him to stop smoking -- on borrowed money.

Dadang buried three of his children when they were all younger than two-years-old -- all bore signs of severe malnutrition such as distended bellies, and suffered from respiratory problems.

"He beats us up if we refuse to do his bidding and take cigarettes on credit from the shops," said Epi, Dadang's 11-year- old daughter whose body look more like that of a seven-year-old.

"Countries still grappling with infectious diseases traditionally associated with low incomes increasingly also face a rising epidemic of cancer, and respiratory and circulatory diseases caused by tobacco," write Joy de Beyer, Chris Lovelace, and Ayda Yurekly in Poverty and Tobacco, Tobacco Control, 2001.

Indeed, the trend in expenditures on tobacco among poor people in developing countries is extremely worrying. In Indonesia, for example, tobacco expenditure has grown fastest among the poorest groups. In 1981, the lowest income group spent Rp 210 a day per capita on tobacco, which constituted 9 percent of their total daily expenditure.

This rose to Rp 1,278, or 15 percent of their total expenditure, in 1996 (World Bank estimates using statistics published by the Central Bureau of Statistics).

Smoking also exacerbates poverty in other ways. Beyond the short-term links between poverty and tobacco use, there are also long-term effects that arise because of the higher risks of illness that smokers face, and the particular vulnerability of poor families to illnesses, especially of the breadwinner.

Few Indonesians are covered by health insurance or unemployment benefits. When a breadwinner in a poor family becomes too ill to work, the family's food supplies and income often stop.

Dr. Merdias Almatsier of Cipto Mangunkusumo General Hospital in Central Jakarta describes how, of the thousands of patients it receives every year, some 50 percent are not covered by any insurance. Half of those patients are in fact recipients of the government's safety net program to ease the brunt of the 1997 economic crisis on health-care seekers.

"What can we do? This hospital applies such a low price for the basic health care, and yet so many people still cannot afford it," he said.

Indonesia ranks fifth in the world in tobacco consumption, contributing to millions of tobacco-related deaths every year, despite being a country where more than 27 million people of the total 210 million are still living below the absolute poverty line.

Legislation on tobacco-control has so far been admittedly minimal while enforcement is often nonexistent, frustrating anti- tobacco campaigners' bids for legal action. A large proportion of the country's youth -- making up more than 30 percent of its population of 210 million -- is facing aggressive marketing campaigns by tobacco companies.

Increasingly, however, communities are filling the hole where government actions are lacking with their broad-based alliances. They are taking a strong stance against tobacco, disseminating the message to their youth that not only is smoking dangerous, but that it is unlawful according to Islam and worsens poverty as it wastes money.