Ministry of Health Republic of Indonesia The Tobacco Source Book Data to support a National Tobacco Control Strategy March 2004 The Cover One day, a santri (student) was found to have been smoking in the toilet where he threw his cigarette butt to the floor, causing a small explosion and minor burns to his bottom. “What a commotion it caused, to be sure,” says Lily Qurrotul Ishaqiyah, the wife of Abdullah Munif, deputy head of the pesantren (boarding school). Lily can relate the incident in detail not only because it took place less than one year ago but also because it has now become a legend. A smoking ban has been in place for more than six years at the Langitan Islamic Boarding School in the village of Wedangan. The young man—who shall not be named here—has since stopped smoking, says Abdullah Munif. “He was not badly hurt, but he was really embarrassed.” The santri (student) was reduced to smoking in the toilet because there was no other place inside the school compound for him to do so. Smoking has been prohibited by the pesantren’s charismatic leader, Abdullah Faqih. Today, even the food stalls and small cafes outside of the boarding school have notices that say “we do not sell cigarette” plastered across their walls. Established in 1852, the pesantren is the oldest in Indonesia and stands on the bank of Bengawan Solo. Every year the school produces thousands of graduates--many of whom go on to higher education both here and overseas, or to work as da'i (preachers) in various parts of the country. Some work as teachers in Quranic Kindergartens (Taman Pendidikan Quran) that Lily set up some 10 years ago in the village and which has grown to more than 300 today. "We have hopes that of the thousands of students that leave here and work elsewhere will also tell their students not to smoke," Munif says. Cover picture and story by Santi Soekanto Acknowledgments A Core Technical and Editing Team compiled this book based on material and initial drafts resulting from the efforts of a group consisting of Anhari Achadi and Soewarta Kosen, Ministry of Health, Republic of Indonesia; Adviser to the Minister of Health, and Head of the Tobacco Control Task Force, MoH; Triasih Djutaharta and Abdillah Ahsan from the Demographic Institute, Faculty of Economics, University of Indonesia; Syarifah Liza Munira, Widyastuti Soerojo, and Sarah Barber, WHO. The book enormously benefited from overall review from the members of the MoH Tobacco Control Task Force; Farid Husain, Deputy for Health and Environment, Coordinating Ministry for Social Welfare Head, and Head of the Multi-Sectoral Tobacco Control Task Force; F A Moeloek; Head, Indonesian Medical Association; Puguh Irawan, Social Economist, Poverty and Labor Force Issues, Central Bureau of Statistics; Firman Lubis, Kusuma Buana Foundation; Ermalina, Executive Secretary, Indonesian Forum of Parliamentarians on Population and Development; Tjandra Yoga Aditama, LM3 (Smoking Problem Control Institution); Merdias Almatsier, Former Head of the National Committee (Komnas), Smoking Control Association. The final draft in English underwent review by WHO Geneva Tobacco Free Initiative (TFI) staff under the direction of Douglas Bettcher, Coordinator of the Framework Convention for Tobacco Control (FCTC); although WHO HQ is not responsible for errors. The book also benefited from inputs from the Ministry of Health (MoH) namely, Yusmansyah Idris, Suyatmi, and Jonli Indra from the Directorate of Mental Health; Farida Sarkawi, National Institute for Health Research and Development; Osman Saragih, Directorate of Pharmaceutical Services and Medical Devices; Suginarti, Directorate of Medical Services and Dental Specialistic; R. Indira, Center for Health Policy and Research; Nuning Kurniasih, Center for Health Data and Information; Ismojowati SKM and Yussiana Ela from Center for Health Promotion; Guntur Ardana, Center for Occupational Health; and Sri Rahayu, National Agency for Drug and Food Control. For Chapter 1, Hendro Hendratno, Demographic Institute, Faculty of Economics, University of Indonesia, contributed data on prevalence and consumption; Julianty Pradono, Center for Health Research and Technology, MoH contributed the analysis of passive smoke. We also thank Kartono Muhammad, Health Observer, for his valuable input in this chapter. Chapter 2 is the result of research carried out by a technical team led by Soewarta Kosen, with its members: Soeharsono Soemantri, Coordinator National Health Survey, 2001, Center for Health Research and Technology, MoH; Yuwono Sidharta, Epidemiologist, MSH Consultant, Jakarta acted as clinical expert; Faculty of Medicine, University of Indonesia. The Core Team is grateful for external reviewers including Yusmansyah Idris, Directorate of Mental Health and Substance Abuse, MoH; Farida Sarkawi, Center for Health Research and Technology, MoH. iv Preliminary data for Chapter 3, 4 and 5 were collected by Triasih Djutaharta and Abdillah Ahsan, while editing and analyses were done by Sarah L Barber, Widyastuti Soerojo and Syarifah Liza Munira. We are grateful to the support from the following external reviewers of Chapter 3: Farid Husain, Deputy for Health and Environment, Coordinating Ministry for Social Welfare; Head, Multi-sectoral Tobacco Control Task Force; Anhari Achadi, Adviser to the Minister of Health, and Head of the Tobacco Control Task Force, MoH; Erna Karmawati, Acting Head of Research and Development, Ministry of Agriculture; Hasanuddin Ibrahim, Director of Seasonal Crops, Ministry of Agriculture; Edison Situmorang, Adviser to the Minister, Ministry of Labor and Transmigration; Stephen Marks, Professor of Economics, Pomona College; Puguh Irawan, Social Economist, Poverty and Labor Force Issues, Central Bureau of Statistics; Ermalina and Sri Utari Setyawati from the Indonesian Forum of Parliamentarians on Population and Development (IFPPD); Yose Rizal Damuri, Department of Economics; CSIS; University of Indonesia; and Tony K., Coordinating Ministry for Social Welfare. Chapter 5 benefited substantially from the comments of Erlangga Mantik, Head, Sub- Directorate of Excise, Ministry of Finance; Sudirman, Sub-Directorate of Excise, MoF; Ayda Yurekli, Health Economist, World Bank; Jack Molyneaux, Senior Economist, RAND Association, Consultant to the Ministry of Agriculture; Stephen Marks, Department of Economic, Pomona College, Firman Lubis, Executive Director, Kusuma Buana Foundation. Data and analyses for Chapter 6, 7, 8, 9 and 10 were carried out by the Core Technical and Editing Team, Sarah L Barber, Widyastuti Soerojo, Anhari Achadi, and Syarifah Liza Munira. We are also grateful to the support from the following external reviewers: A. Retno Tyas Utami, Chief, Sub-Directorate for the Review Copy Drug and Biological Products, NADFC; Hary Wahyu T, Chief Sub-Directorate Evaluation of Specific Use of Therapeutic Products, NADFC; Engko Sosialine, M.Biomed, Chief Division of Review of New Drugs, Channel I & III, NADFC; Suyatmi, MM, Directorate of Mental Health; Puguh Irawan, Central Bureau of Statistics; Abdillah Ahsan, Demographic Institute, University of Indonesia; Meidia Octarina, Office of Deputy II, Coordinating Minister for Social Welfare; Firman Lubis, Yayasan Kusuma Buana; Widjajati, LM3; Ahmad Hudoyo, Komnas PMM; Kartono Muhamad; Jonli Indra, Directorate of Community Mental Health; and Meliani Sutanto. We also thank Retno Sulistyowati, who provided administrative support and Meliani Sutanto, who translated the materials. Financial support was provided by WHO Indonesia. The Technical and Editing Team: Anhari Achadi Soewarta Kosen Widyastuti Soerojo Sarah Barber v Indonesia: The Trash Bin Of Nicotine Taufiq Ismail To an old friend, Dr Achmad Suyudi Indonesia is a paradise, staggeringly friendly toward smokers If heavens are classified by the number of skies protecting them Then this country of ours is the seventh heaven Indonesia is a vast trash bin that contains all garbage of nicotine This nicotine trash bin is extraordinarily huge An expanse stretching from the west tip to the east tip Traversing a distance that covers 3 time zones That is an 8-hour ride on a jet plane 10 days of sea journey one year if you ride a Sumbanese horse or 5 year of a daily ride on the kuda kepang Ponorogo 1) This trash bin is extremely huge Not only nicotine waste goes into it, but also thrown into this bin are Various liquids, powders, aromas and colors Alcohol, heroin, sabu-sabu 2) , ecstasy and marijuana All kinds of toxins and residues, such as materialism and porn VCDs Do name all varieties of waste of the world Agape, our mouths take them all in All these, because our gates are open wide Friendly, politely, we accept all the garbage sent us Before the airport gates, because of the urgent foreign investment Because we simp t the mouth-watering fees and bribes Bowing so deep we intone, Monggo, monggo mlebet, dipun sakecakaken 3) (Please, please come in, make yourself comfortable) Sog asup, sadayana, asup, asup 4) (Please, please come in everybody) 5) (Are you able to do it, if you could, Mister, just do it) This trash bin is astonishing in its capacity Those vendors of nicotine, in whose homelands Were beaten black and blue in the courtrooms, dodging fines of billions of dollar vi Exposed, their fraudulent acts, after killing millions of their smokers Chased away, helter-skelter running to the third world And with inferiority feelings uncommonly deep We welcome them all 6) (Do please sit down, o master) Ngersaakane menopo den bagus 7) (What would you have, oh master?) Mpun