Hotib is practicing his speech, repeating the vowels “A-E-I-O-U” as taught by his therapist.
At 64, Hotib smoked cigarettes for almost 40 years before a cancer diagnosis led to the removal of his larynx. Now, he breathes through a hole in his neck and speaks with a raspy voice, relying on his esophagus to produce sounds. His pauses between sentences are noticeably long.
“Back in my day, smoking was considered a tradition and a casual thing to do by kids at that time,” said Hotib, who, like many Indonesians, uses only one name. “People said if you’re not smoking, you’re not manly enough,” he added.
May 31 is World No Tobacco Day, an occasion when health advocacy groups raise awareness about the dangers of using tobacco. The World Health Organization (WHO) reports that about 70% of Indonesian males aged 15 and up smoke tobacco, one of the highest rates globally. In contrast, about 2% of Indonesian females aged 15 and up smoke.
According to WHO research, Indonesia is one of only six countries with rising tobacco use rates.
“I think it’s being portrayed as part of our culture, that smoking is part of masculinity, and it’s also being portrayed by the tobacco industry that it’s cool for guys to smoke,” said Olivia Herlinda, policy director for the Center for Indonesia’s Strategic Development Initiatives, a nongovernmental organization focused on health issues.
“Because of the high rates of male smokers in Indonesia, we also have high rates of lung cancer and other heart- and lung-related diseases such as stroke and ischemic heart diseases,” Herlinda said, noting that nonsmokers can also be harmed by secondhand smoke.
On a recent weekend, 20-year-old Mukhsin relaxed on a bench in a Jakarta park, smoking a cigarette. It’s a habit he started two years ago. “I knew about the harmful effects of smoking when I started,” he said. “I smoke to relax, calm myself down. Smoking is so common here.”
The tobacco industry promotes itself in Indonesia through advertisements on television and billboards and by sponsoring popular events such as music festivals. According to Vital Strategies, a global public health organization, these types of promotions face tighter restrictions in most countries.
Some local and provincial governments, including Jakarta’s, have taken steps to ban cigarette billboards.
Indonesia is one of only 13 countries, and the only one in Asia, not party to the WHO’s Framework Convention on Tobacco Control, which requires strict limits on tobacco sponsorships and advertising.
In Indonesia, labels warning of the risks of smoking cover 40% of the front and back of cigarette packs, but the WHO recommends at least 50%.
“The warning labels need to be bigger, and the taxes on cigarettes need to be higher to help discourage tobacco use,” Herlinda said.
Indonesia has a complex tax system for tobacco with multiple categories. For many popular cigarette brands, about half of the consumer price is taxes, including a sales tax and an excise tax that tobacco companies pay before the cigarette packs reach store shelves. The WHO advocates for total taxes to be at least 75% of the final cost of a pack of cigarettes.
Local health advocates blame the high male smoking rates not only on the tobacco industry but also on the government, particularly the Ministry of Industry.
“The tobacco industry has very high influence in our policymaking, and that leads to very weak regulations in our country regulating tobacco,” Herlinda said.
Public health advocates are pushing for tight restrictions on the tobacco industry’s access to lawmakers and regulators. “The government is currently required to consult with the tobacco industry if they create regulations that might impact the industry,” Herlinda said. “There are a lot of behind-the-door negotiations happening between the tobacco industry and government too. We need to change things.”
VOA sent questions to the Ministry of Industry, the Association of Indonesian Cigarette Manufacturers, and Gudang Garam, one of Indonesia’s largest tobacco companies, but did not receive answers.
In 2023, taxes from tobacco made up about 7.5% of the Indonesian federal government’s revenue, according to economist Abdillah Ahsan. However, he also cited a 2017 report from Indonesia’s Ministry of Health stating that health costs from smoking were three times the amount generated by tobacco taxes.
Hotib, who had his larynx removed, says he’s living proof of the harms of using tobacco. He speaks at schools and youth groups, explaining the hardships he now faces after decades of smoking.
“I need to breathe through this hole in my neck. My nose doesn’t work, and my physical fitness has declined,” he told VOA. “I am the proof of the cruel effects of cigarettes.”
