Impact of Tobacco Use on Poverty, Economic Development and
Patterns of Tobacco Use by Poverty and Country Income Groups
Ika Septyaningsih
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
ika.septya17@gmail.com
Keywords: Economy, Tobacco, Cigarette, Poverty, Development.
Abstract: The impact of smoking is not only on the aspect of health, but will also affect socioeconomics; one of the
effects is poverty. Therefore, there needs to be a control in accordance with UU No. 36 year 2009, that is,
for negative impact of health to decrease. The purpose of writing this article is to determine the impact of
tobacco use on poverty, economic development and the pattern of tobacco use by the poverty and country
income groups. The method used is the study of literature. Data from several references indicate the
following: the smoking proportion is higher among the poor, compared with the rich; household expenditure
on cigarettes can reduce the burden of basic needs, so the nutritional status of the community will decline
further; cigarettes exacerbate the degree of poverty; and cigarettes not only exacerbate household poverty,
but also the country, because the income is slightly less than the impact of cigarettes.
1 INTRODUCTION
Indonesia is famous as an agricultural country,
the country’s majority livelihood is farming. The
products of Indonesia agriculture are, rice, corn,
wheat, and so on. According to Kosen, in TCSC
IAKMI (2014:31) Indonesia was the world's fifth
largest tobacco producer in the year 2012, with
production of 135,678 tonnes, or approximately
1.9% of the total world tobacco production.
In addition, being the biggest tobacco
producer, Indonesia has the highest number of
tobacco consumers, particularly smoking tobacco
products in ASEAN countries. Based on the results
of the Riskesdas, in 2013, the average
resident age ≥ 10 years in Indonesia smoked 12.3
cigarettes or the equivalent of a pack, as
well as there being more male smokers than female
smokers. Over the years, the proportion of
people who smoke has rise; in 2007 it amounted
to 34.2% in 2010 it was 34.7%, and, according to
Riskesdas, in 2013 it amounted to 36.3%. It is
also supported by the growing number of tobacco
between the years 2010 and 2012.
The impact of smoking is not just in terms of
n health in, but will also be promoted in terms
of socioeconomics and environmental effects for
smokers themselves or those around them. From the
economic sphere alone, smoking can increase the
burden of the family when there are family
members who smoke. In addition, due to spending
on smoking, other needs within the family can
be reduced. As well as other impacts which can add
to the burden of a family impacted by tobacco
consumption.
Because of the many problems that are
posed, including the tobacco, this is a complex
problem to solve. The government is unable to act
on its own, but it also requires the role of health
workers, community leaders, as well as the whole
society in order to achieve the government’s
objectives to increase the degree of public health by
lowering the number of active smokers in Indonesia.
2 METHODS
This is literature study. The data were collected in
the form of secondary data from the data of the
Badan Pusat Statistik (BPS), Riset Kesehatan Dasar
(Riskesdas) in the year 2013, the Journal of TCSC,
as well as supported by government regulations and
legislation in force. Data from the Central Bureau of
Statistics provided information about the percentage
of household expenditures per capita a month
according to group of goods and the place of
Septyaningsih, I.
Impact of Tobacco Use on Poverty, Economic Development and Patterns of Tobacco Use by Poverty and Country Income Groups.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 73-77
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
73
residence of the year 2016. Data Riskesdas
2013 provided information on diseases caused by
tobacco consumption. Regulation is the Indonesian
Ministry of Health Regulation Number 69 year 2013
about Standard of Health Care Tariff in Primary
Health Care and Advanced Health Care in
accordance of National Health Insurance program to
provide information about the cost required for
inpatient care due to illnesses caused by tobacco.
These data are interpreted and linked in order
to obtain the needed results.
3 RESULT
To obtain the needed information, i.e. to
know the impact of tobacco control on facets of the
economy, data related are needed, including, among
others, regarding the percentage of smokers in
Indonesia, spending on average in a month, the
diseases caused due to tobacco consumption, as
well as the cost needed for treatment when a person
suffers from a disease caused due to
the consumption of tobacco. From some of the
data collected, the following can be said:
Table 1: Proportion of inhabitants aged ≥ 10 years according to the habit of smoking and the characteristics, Indonesia for
year 2013
The characteristics
Current Smokers
Smokers daily
Smokers sometimes
Jobs
Does not work
6.9
3.0
Employees
33.6
7.4
Self-employed
39.8
6.5
Farmers/fishers/workers
44.5
6.9
Others
32.4
5.8
Source: Riskesdas 2013
Based on Table 1, it can be seen that the
population with jobs as farmers/fishers/labour
has the highest percentage (44.5%) of active
smokers when compared with other jobs.
Table 2: The percentage of average expenditure per capita a month according to group of goods and place of residence for
year 2016
No
Group Of Goods
Percentage (%)
Rural
Urban+Rural
I
Food
1.
Grains
10.04
6.82
2.
Tubers
0.80
0.53
3.
Fish/shrimp/calamari/scallops
4.40
3.55
4.
Meat
1.94
2.17
5.
Eggs and milk
2.79
2.96
6.
Vegetables
4.75
3.65
7.
Nuts
1.30
1.09
8.
Fruit
2.02
2.04
9.
Oil and coconut
184
1.34
10.
Material drinks
2.,30
1.69
11.
Spice
1.28
0.97
12.
Other consumption
1.19
1.00
13.
Food and drink
12.27
14.14
14.
Smoking
8.91
6.72
The amount of food
55.83
48.68
II
Not Food
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
74
No
Group Of Goods
Percentage (%)
Rural
Urban+Rural
1.
Housing and facilities
22.99
26.60
2.
A wide range of goods and services
10.23
12.91
3.
Clothing, footwear and headgear
3.12
3.05
4.
Durable goods
4.65
4.75
5.
Taxes, charges and insurance
1.60
2.28
6.
The purposes of the party and ceremony/kenduri
1.58
1.72
The amount of non food
44.17
51.32
The Amount of Food+ Non Food
100.00
100.00
Source: Badan Pusat Statistik 2016
From the table, two significant findings can be
seen, that spending for smoking in one of the two
biggest spending for most of society in the city
and the third most populous, in ninth place, for the
villages. The community believe that spend money
for smoking is better than spend money for rice or
foods, which only amounted to 4.98, and energy
sources of protein such as eggs and milk, which
only amounted to 3.01%. For the rural community,
spending on smoking is greater when compared to
the huge expenditure to meet the needs of
protein, such as eggs and milk, which
only amounted to 2.79% of the total expenditure in
total.
Table 3: Proportion of tobacco consumption related
diseases and ICD-10 codes in Indonesia for year 2013
Diseases
ICD 10
Code
Proportion
of Disease due
to Tobacco
Tumors of the Mouth
and Throat
C 00-14
0.7
Tumor of the
Oesophagus
C 15
0.3
Tumors of the stomach
C 16
0.25
Liver tumors
C 22
0.1
Tumors of the
Lung, Trachea and
Bronchus
C 33-34
0.9
Cervical Tumor
C 53
0.3
Ovarian Tumor
C 56
0.1
Bladder Tumor
C 67
0.1
Coronary heart disease
I 20-25
0.35
Stroke
I 60-69
0.4
Chronic obstructive
pulmonary disease
J 44-47
0.7
Low birth weight Infant
P 05, P 07
0.3
Source: Beban Kesehatan dan Dampak Ekonomi Merokok
di Indonesia tahun (2013)
Table 3, illustrates data produced based on the
results of a study conducted in Indonesia and
Indonesia. Consumption of tobacco can be assumed
for 7% of tumors of the mouth and throat of, while
the remaining 93% can be due to other factors.
Table 4: Cost of inpatient care per patient in accordance
with Indonesian Ministry of Health Regulation Number
69, 2013
Disease
Treatment
Cost in class III
Hospital (Rupiah)
Low birth weight infant
6.185.362
Tumors of the Mouth and
Throat
3.733.141
Tumors of the Oesophagus
3.733.141
Tumors of the stomach
3.733.141
Liver tumors
3.733.141
Tumors of the pancreas
3.733.141
Tumors of the Lung, Trachea
and Bronchus
3.733.141
Cervical Tumor
3.733.141
Ovarian Tumor
3.733.141
Bladder Tumor
3.733.141
Coronary heart disease
6.017.579
Stroke
7.726.946
Chronic obstructive
pulmonary disease
4.551.951
Source: Beban Kesehatan dan Dampak Ekonomi Merokok
di Indonesia tahun (2013)
Table 4 gives the maintenance costs of
hospitalization per patient for each illness due to
smoking in accordance with Indonesian Ministry of
Health Regulation Number 69, 2013.
Impact of Tobacco Use on Poverty, Economic Development and Patterns of Tobacco Use by Poverty and Country Income Groups
75
Table 5: Total cost of tobacco-related disease sufferers’ care for year 2013
Disease
Total case
Cost for a Episode
Total Costs in 2013
Low birth weight infant
216,050
6,185,362
1,336,347,460,100
Tumors of the Mouth and Throat
6,670
3,733,141
24,900,050,470
Tumor of the Esophagus
1,710
3,733,141
6,383,671,110
Tumors of the stomach
10,440
3,733,141
38,973,992,040
Liver tumors
13,400
3,733,141
50,024,089,400
Tumors of the pancreas
2,910
3,733,141
10,863,440
Tumors of the Lung, Trachea and
Bronchus
54,300
3,733,141
202,709,556,300
Cervical Tumor
28,940
3,733,141
108,037,100,540
Ovarian Tumor
7,690
3,733,141
28,707,854,290
Bladder Tumor
10,160
3,733,141
37,928,712,560
Coronary heart disease
183,950
6,017,579
1,106,933,657,050
Stroke
144,780
7,726,946
1,118,707,241,880
Chronic obstructive pulmonary disease
284,310
4,551,951
1,294,165,188,810
Total
5,353,829,437,990
Source: Beban Kesehatan dan Dampak Ekonomi Merokok di Indonesia (2013)
From Table 5 it can be seen that the government
had to pay about 5.35 billion rupiah alone for the
cost of inpatient care diseases caused due to tobacco
consumption during the year 2013.
Source : Infodatin hari tanpa tembakau sedunia (2015)
Figure 1: Smoker’s behavior in Indonesia based on
Riskesdas 2007 and 2013
Based on that picture, smoker’s behavior in
Indonesia is much the same in five years ago. If
smoker can comsume 12 cigarette, so it can be
calculate by:
0.234×199,178,321= 48,400,332 people. (1)
Average of cigarette’s consume in a day = 12
If one pack of cigarette is Rp 12,500
So,
48,400,332× Rp 12,500 = Rp 605,004,150.00 (2)
4 DISCUSSIONS
In Indonesia, the population with age ≥ 10 years
working as a farmer/fisherman/labourer is mostly
smokers for the year 2013. In some countries, many
have found that the proportion of active smokers is
greater among the poor than the wealthy elements of
society. For Indonesia, for which the benchmark of
welfare family income per capita was obtained it is
in the low income community mostly working as
farmers, fishermen and labour. Although Indonesia
is an agrarian and maritime country, the farmers and
fishermen still less prosperity well. This reinforces
the fact that the proportion of active smokers is
greater among the poor, particularly those who work
as farmers, fishermen or labourers, when compared
to the rich community.
According to data from Badan Pusat Statistik
(BPS) for 2016, a great percentage of average
expenditure per capita per month is generally spent
for consumption of tobacco among the community
and is very large in comparison with expenses for
food. Even in the city, spending for smoking is
greater when compared to grains and protein. In
other words, consumption of cigarettes can reduce
spending on the basic family necessities. The decline
in expenditure for basic necessities impacts on the
declining nutritional status of the public.
In addition to the effect on the nutritional
status of the public, the presence of family members
who smoke, especially for poor families, will
certainly increasingly aggravate the level of
INAHEA 2017 - 4th Annual Meeting of the Indonesian Health Economics Association
76
degrees of poverty. In the fulfilment of the basic
necessities only, secondary community down
already issued more business, especially if coupled
with purchase on buy cigarettes, resulting in the
burden of household spending growing. Not to
mention the fact that, if there are family members
suffering from diseases caused by smoking,
then the burden borne will be even greater.
Based on data taken from the journal “Beban
Kesehatan dan Dampak Ekonomi Merokok di
Indonesia tahun 2013”, in conjunction with
Indonesian Ministry of Health Regulation Number
69, 2013, it was found that in terms of national
inpatient treatment for diseases arising from
consumption of smoking in one year (2013), the
Government spent around Rp 5,353,829,437,990 or
approximately 5.35 billion rupiah. This is a huge
amount and not proportional to the expenditure
involved in removing funding from cigarette
consumption compared to the revenues received by
the state from the proceeds of the production of
cigarettes. It has more than 5.35 billion difference
from the impact and the cost from smoker what used
up every day.
Due to there being a greater number of
losses arising from tobacco than the benefits it
brings, a controlled effort is needed. The
government itself performs a variety of efforts to
decrease tobacco consumption, ranging from
advocacy efforts, by creating laws and regulations,
as well as other efforts such as the establishment of
the No Smoking areas (KTR) and unsettling images
of what will be suffered if someone smokes.
Efforts have been made by the government to
address the welfare of the people. However, all the
efforts will be futile if there is no awareness among
the communities themselves about the impact
brought about by smoking, that it not only harms the
smoker, but also others around them. This is because
of the need for support from various parties
to implement the programs that have been designed
by the government. If consumption against smoking
declines, the certain impacts on various fields of
yesteryear also will fall. With a declining impact
caused by smoking, one the Government can be sure
in increasing the welfare of society. In a country
with an already prosperous society, national
development efforts initiated by government will
also be easy to be realized.
5 CONCLUSIONS
The proportion of smokers in Indonesia is greater
among the on poor population compared with the
wealthy. When a resident has an active smoker in
their family then it will give rise to the increasing
burden of expenses. For the poor, the presence
of family members who are active smokers may
exacerbate the degree of poverty, not only
because spending will increase, not just for basic
necessities, but also to buy cigarettes. In addition,
there are likely to be family members who suffer
from a disease as a result of tobacco. As well as
the harm to society, smoking also harms the
country, because the income from the production
of cigarettes alone is less than the cost to be
borne by the government to treat diseases caused by
smoking. Therefore, it needs the support of various
parties to lower the levels of consumption in the
community in order to realise national development.
REFERENCES
Badan Penelitian dan Pengembangan Kesehatan
Kementerian Kesehatan RI. 2013. ‘Riset Dasar
Kesehatan (Riskesdas 2013)’, pp. 134.
Badan Pusat Statistik. 2016. ‘Persentase rata-rata
pengeluaran per kapita sebulan menurut kelompok
barang dan daerah tempat tinggal tahun 2016’.
Kementrian Kesehatan RI. 2015. ‘InfoDATIN Pusat Data
dan Informasi Kementrian Kesehatan RI Perilaku
Merokok Masyarakat Indonesia Berdasarkan
Riskesdas 2007 dan 2013’, pp. 4.
Kosen, Soewarta. 2014. ‘Beban Kesehatan dan Dampak
Ekonomi Merokok di Indonesia Tahun 2013’, Bunga
Rampai Fakta Tembakau dan Permasalahannya di
Indonesia, p. 31.
Undang-Undang Nomor 36 Tahun 2009 abaout
Kesehatan.
Peraturan Menteri Kesehatan Republik Indonesia Nomor
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Impact of Tobacco Use on Poverty, Economic Development and Patterns of Tobacco Use by Poverty and Country Income Groups
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