Indonesia is locked in one of the world’s most entrenched tobacco epidemics. With roughly 70 million adult tobacco users and hundreds of thousands of preventable deaths every year, the country continues to pay an enormous price in human lives, healthcare costs, and lost productivity. The crisis is especially striking because it is so heavily concentrated among men, deeply intertwined with national culture through the clove cigarette known as kretek, and still only partially constrained by regulation.
According to the 2021 Global Adult Tobacco Survey, 34.5 percent of Indonesian adults used tobacco, equating to about 70.2 million people. The gender divide is extreme: around 65 percent of men smoke compared with only about 3 percent of women. More recent estimates place adult smoking prevalence near 28–30 percent, yet the absolute number of smokers remains enormous because of Indonesia’s large population. Tobacco Atlas data indicate that smoking causes approximately 295,000 deaths annually, accounting for roughly 15.7 percent of all deaths in the country. Among men the figure is higher still, with tobacco linked to more than one in five male deaths.
These numbers translate into a heavy disease burden. Smoking drives or worsens Indonesia’s leading causes of death, including ischemic heart disease, stroke, chronic respiratory illness, tuberculosis, and several cancers. Second-hand smoke exposure is widespread in homes and workplaces, adding further preventable illness. The economic toll is equally severe. Studies have estimated the total cost of smoking-attributable disease—covering healthcare spending, premature death, and lost productivity—at hundreds of trillions of rupiah. One 2019 analysis put the range between Rp 184 trillion and Rp 410 trillion, equivalent to 1–2.5 percent of GDP at the time. Government health insurance schemes absorb a large share of the direct medical costs, straining public budgets that could otherwise fund other priorities.
At the heart of the epidemic is the kretek. These clove-flavored cigarettes, which produce a characteristic crackling sound when burned, dominate the market, accounting for 90–95 percent of cigarettes sold. Ordinary “white” cigarettes make up only a small fraction. Kretek originated in the late 19th century in Kudus, Central Java, when a local man mixed tobacco with ground cloves and a special sauce in an attempt to ease respiratory symptoms. What began as a folk remedy quickly grew into a major industry. By the early 20th century, factories employed tens of thousands of workers, many of them women rolling cigarettes by hand. Today the sector supports hundreds of thousands of direct jobs and millions more indirectly through farming, distribution, and retail. Proponents frame kretek as a uniquely Indonesian product that blends New World tobacco with the archipelago’s historic spice trade, giving the industry a powerful nationalist narrative that has long complicated efforts at stricter control.
This cultural and economic weight has shaped policy for decades. Indonesia remains one of the few countries that has neither signed nor ratified the World Health Organization Framework Convention on Tobacco Control. Advertising has historically been highly visible, cigarettes are relatively affordable, and single sticks (rokok ketengan) have been widely sold, lowering the barrier to entry for young or low-income buyers. Excise taxes, while an important source of government revenue—exceeding Rp 200 trillion in recent years—have often been structured in complex tiers that keep prices lower than many public-health advocates recommend. Industry influence and concerns about employment in tobacco-growing and manufacturing regions have repeatedly slowed stronger measures.
The impact on the next generation is particularly alarming. Surveys show high rates of youth smoking. One 2019 Global Youth Tobacco Survey found that more than a third of boys aged 13–15 were current smokers. National data indicate that the number of smokers aged 10–18 rose sharply from about 2 million in 2013 to 5.9 million in 2023. Many children report easy access to cigarettes at small shops, and a significant share say they are not refused when attempting to buy. Tobacco companies have been accused of targeting young people through advertising near schools, social media promotion, and sponsorship of events. Early initiation locks in lifelong addiction and multiplies long-term health costs.
In 2024 the government took a notable step forward. President Joko Widodo signed Government Regulation No. 28, which raised the minimum purchase age to 21, banned the sale of single cigarettes, restricted marketing (including on social media), expanded pictorial health warnings, and limited sales near schools and playgrounds. These measures align more closely with international best practices and apply to both conventional cigarettes and electronic nicotine products. Implementation, however, remains the critical test. Enforcement of single-stick bans and age restrictions at the vast network of small retailers is challenging, and industry opposition continues. Tax policy also remains a battleground: higher, simpler excise rates could further reduce affordability, especially for young people, while generating additional revenue that could offset any short-term losses.
The path ahead requires sustained political commitment. Raising taxes to levels recommended by global health authorities, fully enforcing advertising and sales restrictions, expanding smoke-free public spaces, and investing in cessation support would all reduce smoking rates over time. Modeling studies suggest that significant tax increases could prevent millions of premature deaths and cut healthcare costs substantially while still increasing government revenue. At the same time, policymakers must address legitimate concerns about workers and farmers dependent on the tobacco economy by supporting gradual economic diversification in affected regions.
Indonesia’s cigarette addiction is not inevitable. Other countries with high historical smoking rates have achieved sharp declines through consistent policy. The combination of cultural acceptance, economic interests, and delayed regulation has allowed the problem to persist at scale. Yet the human cost—hundreds of thousands of lives cut short each year, families left without providers, and a health system burdened by preventable disease—makes further delay increasingly difficult to justify. The 2024 regulations offer a foundation. Whether they mark the beginning of a genuine turnaround will depend on rigorous enforcement, continued tax reform, and a public conversation that finally prioritizes long-term health over short-term economic and cultural attachments to a product that kills so many of those who consume it.
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