In the bustling fisherman villages of Jakarta, the sight of men smoking while repairing boats is as common as the tide. But beneath this everyday scene lies a deeper crisis. Indonesia, according to recent data from the World Population Review, ranks fifth globally for smoking rates, with a staggering 74.5 percent of men regularly consuming tobacco—the highest male smoking rate in the world. This pervasive habit, as health experts and economists warn, is not just a public health concern but a profound economic and nutritional challenge, particularly for the nation’s poorest households.

The Scale of the Smoking Epidemic

Indonesia’s smoking epidemic is a public health crisis of staggering proportions. The World Health Organization (WHO) estimates that tobacco use contributes to over 8 million deaths annually worldwide, with a significant burden in countries like Indonesia where smoking prevalence is high. Among men, the habit is deeply entrenched, often seen as a cultural marker of masculinity and a coping mechanism for stress. Yet, the consequences extend far beyond individual health risks, seeping into household budgets and national development goals.

Data from Statistics Indonesia (BPS) paints a grim picture. As of March 2024, the average per capita monthly expenditure on cigarettes and tobacco stood at 94,476 Indonesian Rupiah (US$6), making it the third-largest food-related expense after prepared foods and grains. For low-income families, this expenditure often comes at the expense of essential nutrition, creating a silent crisis of malnutrition that disproportionately affects children and women.

A Nutritional Trade-Off

The nutritional impact of smoking in Indonesia is not a mere hypothesis but a well-documented reality. According to the March 2024 National Socio-Economic Survey (Susenas) conducted by BPS, individuals in households where the head smokes consume significantly fewer calories and less protein compared to those in non-smoking households. This gap is most pronounced among the poorest families, where baseline nutritional intake is already inadequate.

In these households, every rupiah counts. When spending is diverted to tobacco, it often means forgoing developmental building blocks like eggs, fish, vegetables, and milk. The consequences are dire: undernutrition, weakened immunity, stunted growth, and impaired cognitive development in children. As one public health researcher noted, “Malnourished children today become less healthy, less productive adults tomorrow” highlighting the intergenerational impact of this crisis.

The demographic most affected by high smoking rates—men aged 30 to 49—often bear the economic responsibility for their families. When household heads in this age group prioritize tobacco over food, they compromise the well-being of dependents, including children and elderly relatives. Studies, such as one by Djutaharta et al. in 2021, reinforce this, showing a direct correlation between increased cigarette consumption and reduced calorie and protein intake within households.

Smoking in Indonesia is not merely a personal choice; it is a behavior shaped by social norms, economic stress, and limited access to education or alternatives. In poor and near-poor households, the financial margins are razor-thin, and every decision carries outsized consequences. Yet, the price elasticity of demand for cigarettes among low-income consumers remains low, meaning that even as prices rise due to incremental excise taxes, consumption does not significantly drop. Instead, families may cut back further on food to sustain the habit.

This dynamic reveals a structural issue that policy has yet to fully address. Smoking thrives in environments of job insecurity, social expectation, and cultural acceptance, particularly among men. In many households, while men smoke, women are left to manage food budgets, often bearing the burden of stretching limited resources to meet nutritional needs. This intra-household power imbalance exacerbates the crisis, as spending priorities are skewed away from long-term well-being.

Policy Gaps and Fragmented Responses

Indonesia’s approach to tobacco control remains fragmented and insufficient. While excise taxes on cigarettes have been raised over the years, enforcement varies widely, and the impact on consumption among the poor is minimal. Public health facilities offering free or low-cost smoking cessation programs are scarce, particularly in rural and low-income urban areas where smoking rates are highest. Even where such programs exist, awareness and uptake are low, leaving many without viable paths to quit.

Moreover, social protection programs have yet to fully integrate anti-smoking measures. Conditional cash transfers, often used to encourage school attendance or prenatal care, could be adapted to discourage household tobacco consumption. Embedding educational content, incentivizing nutrition-based spending, or linking benefits to smoking cessation sessions could shift behaviors at the household level. Yet, such nuanced approaches remain largely unexplored.

Beyond immediate household impacts, tobacco consumption imposes significant fiscal burdens on the state. Healthcare costs related to smoking-related diseases strain public insurance systems like the BPJS health scheme. Meanwhile, the unmeasured cost of malnutrition—children struggling in school, requiring remedial support, and entering the workforce with diminished potential—represents a long-term loss of human capital that Indonesia can ill afford.

Toward a Holistic Solution

If Indonesia is to meet its Sustainable Development Goals (SDGs), particularly those related to zero hunger (SDG 2) and good health and well-being (SDG 3), it must confront tobacco consumption as a systemic development challenge rather than a standalone health issue. Cigarette spending among the poor is not just a vice; it is a structural indicator of economic vulnerability and disempowerment, undermining nutrition, education, gender equality, and intergenerational progress.

Policy must move beyond reactive measures like taxes to proactive investments in smoking cessation, nutritional assistance, and behavioral interventions. Empowering women with greater financial control and targeted education could help redirect household spending toward essentials. At the same time, the state should develop new indicators of household vulnerability that account for consumption patterns, not just income or assets, to better target support.

A paradigm shift is needed in how Indonesia defines “household welfare.” Tracking income or food expenditure alone is no longer sufficient; policymakers must assess what families sacrifice to maintain harmful but socially accepted habits. As one statistician at BPS poignantly stated, “Cigarettes burn more than lungs; they burn futures” encapsulating the urgency of addressing this crisis holistically.

Looking Ahead

As Indonesia grapples with the intertwined challenges of smoking, nutrition, and economic development, the path forward remains uncertain. Will the state muster the political will to implement comprehensive tobacco control measures? Can social protection programs be recalibrated to prioritize long-term well-being over short-term habits? These questions loom large as the nation strives to build a healthier, more resilient future for its people, particularly those on the margins who bear the heaviest burden of this silent epidemic.