Tobacco and poverty make for a deadly duo

Tobacco and poverty make for a deadly duo

Santi W.E. Soekanto, Contributor, Jakarta
santi_soekanto2001@yahoo.com

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.