JURNAL MEDIKA CENDIKIA
Volume 10 Nomor 01 Tahun 2023
ISSN Cetak: 2355-827X / ISSN Online : 2442-4412 STIKes Karsa Husada Garut
LITERATURE STUDY: THE RELATIONSHIP BETWEEN CIGARETTE CONSUMPTION AND REDUCTION IN EARLY
MORTALITY FROM NON-COMMUNICABLE DISEASES IN INDONESIA
Adjrina Dawina Putri¹, Kania Rizqita Dewi², Khoirunnisa Ghefira Yusrani³, Marina Ery Setiyawati⁴
1234Departemen Kesehatan Masyarakat, Fakultas Ilmu Kesehatan, Universitas Pembangunan Nasional Veteran Jakarta, Indonesia
Email: [email protected]
Abstract
One of the main risk factors for chronic illness and death is smoking. As many as 4,000 highly hazardous chemicals are contained in the smoke produced from a single cigarette. The number of deaths from diseases caused by smoking reached 300,000 per year in Indonesia in 2019. In fact, Indonesia is the third-largest cigarette consuming country in the world, with consumption surging to 322 billion cigarettes by 2020. The increasing rate of cigarette consumption is feared to hamper the achievement of target 3.4 of the Sustainable Development Goals (SDGs). Point 3.4 aims to reduce premature mortality from non-communicable diseases by a third through prevention and treatment, and improve mental health and well-being by 2030. This study aims to determine the relationship between cigarette consumption and the achievement of Sustainable Development Goals (SDGs) target 3.4 in Indonesia. The literature review method was conducted on six articles obtained from two databases, namely Google Scholar and PubMed. Based on the results of the article review, it can be concluded that increasing cigarette consumption can hinder the achievement of Sustainable Development Goals (SDGs) number 3, especially target 3.4. Therefore, the government and society are expected to participate in reducing cigarette consumption in Indonesia in order to realize a healthy society and improve the welfare of the entire Indonesian population.
Keywords: Cigarette consumption, Non-communicable diseases, Cigarettes, Sustainable Development Goals.
INTRODUCTION
One of the main risk factors that cause chronic illness and lead to death is smoking (Meikawati & Prajayanti, 2020).
As many as 4,000 very dangerous chemicals are contained in the smoke produced from one cigarette (Wandita, 2020). Cigarettes are an addictive substance that contains various harmful chemicals,
such as carbon monoxide, nicotine, or tar.
Carbon monoxide is a compound that can reduce or even replace the function of oxygen in the blood, nicotine can cause dependence, and tar can cause cancer (Zulaikhah et al., 2021).
Data from 2019 in Indonesia shows that smoking has caused up to 300,000 deaths per year (Meikawati & Prajayanti,
contributed almost 60% of the total number of deaths from non-communicable diseases (Meikawati & Prajayanti, 2020). Diseases that cannot be transmitted from one person to another, where the development of the disease progresses slowly over a long period of time, are also called non- communicable diseases (Ministry of Health, 2015). The diseases in question include cancer, heart disease, COPD, or diabetes (Said et al., 2016).
Quoting from the Tobacco Atlas 2020 data, Indonesia is the country with the third largest cigarette consumption in the world after China and India (Wandita, 2020). Based on data from the Directorate General of Customs and Excise, the number of cigarette consumption in Indonesia jumped to 322 billion cigarettes in 2020.
The increasing consumption of cigarettes is directly proportional to the quantity of cigarettes produced. According to Rachmat (2010), the largest type of cigarette production in Indonesia (90.3%) is the kreteki or cigarette type. These cigarettes consist of Sigareti Kreteki Tangani (SKT), Sigareti Kreteki Mesini (SKM), and Sigareti Kloboti (SKB) (Suprihanti et al., 2019).
Meanwhile, the Sustainable Development Goals (SDGs) is a long-term global plan that has 17 goals and 169 targets. These goals and targets guide world
a long-term and sustainable approach and emphasize existing issues according to the needs of society (Hapsari, 2019). Indonesia itself is one of 193 countries that participated in signing a commitment aimed at realizing the Sustainable Development Goals (SDGs) which have been ratified through Presidential Regulation Number 59 of 2017. One of the goals listed in the SDGs, namely goal 3, reads "Ensure a Healthy Life and Improve the Welfare of All People of All Ages". In this goal, there are several targets that have been set. One of them is in point 3.4 which has a target to reduce one third of premature deaths from non-communicable diseases, which is realized through prevention and treatment, and improve mental health and well-being by 2030 (Said et al., 2016).
Based on the problems that have been described, it can be seen that smoking is one of the biggest health problems in society and is believed to have a very bad impact on health (Meikawati & Prajayanti, 2020). The increasing rate of cigarette consumption is feared to hinder the achievement of target 3.4 of the Sustainable Development Goals (SDGs). Therefore, this study aims to determine the relationship between cigarette consumption and the achievement of Sustainable Development Goals (SDGs) target 3.4 in Indonesia, which is to reduce premature
mortality due to non-communicable diseases by one third.
METHODS
The method used in this literature review is a literature study. Literature was searched using the Google Scholar search engine and the journal database, PubMed.
The literature search used the keywords:
"Sustainable Development Goals",
"Cigarettes", "Non-communicable diseases", and "Cigarette consumption".
Next, we filtered the articles that had been found, resulting in 6 articles. The articles used were journal articles from the last 5 years in the range of 2017-2022 and used Indonesian or English.
The article review process was carried out using the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) checklist method. The process includes creating a table containing a summary of the content of the article to be analyzed, the name of the author of the article, the year of publication of the article, the title of the study, research methods, and research results. Then the data is analyzed by discussing the results of the summary table so that the discussion of the research results will be the basis for drawing conclusions narrative literature review. The series of literature search processes have been summarized in Figure 1.
Figure 1. PRISMA Diagram Identification
Filtering
Inclusion
Eligibility
Articles identified through searches in databases: Google Scholar (27)
and PubMed (8) with keywords:
n = 35
Screened article n = 17
Full-text articles assessed for eligibility n = 6
Articles included in the criteria n = 6
Full-text articles that are excluded because they are not in Indonesian
or English and the article was published within more than 5
years.
RESULT AND DISCUSSION RESULT
The literature search obtained a total of 6 research articles, which are related to the
link between cigarette consumption and the reduction of premature mortality due to non- communicable diseases in Indonesia, as outlined in Table 1.
Table 1. Results of Literature Search on the Link Between Cigarette Consumption and Reduction in Early Mortality from Non-Communicable Diseases in Indonesia
Author Name Year Of Publication
Article Title Research Methods
Research Result Gatari Dwi
Hapsari
2019 Indonesia's
Efforts in Tobacco Control to Achieve Target 3.A of the Sustainable Development Goals 2017- 2019
Qualitative Methods
Indonesia's tobacco control efforts in achieving target 3.a already exist and have a policy
framework.
Tobacco control is a very complex
program
because it is closely related to sustainable human
development.
Putri Anyelir 2019 The
Relationship between Smoking
Behavior and the Incidence of Hypertension in Neglasari
Village in the Work Area of UPT Puskesmas Neglasari
Bandung City 2019
Quantitative method with cross sectional study
The results showed that there was a relationship between smoking
behavior and the incidence of hypertension in Neglasari
Village.
Sinodi Nasrani Daeli dan
Arin Fithriana
2020 Indonesia's
Efforts to Achieve
Sustainable Development
Qualitative approach and descriptive method
Based on the results of the study, there was
no effect
between the
Goals (SDGs) Point 3 Through Integrated Guidance Post (Posbindu)
implementation of Posbindu and the reduction of
NCDs in
Indonesia, so the
target of
Sustainable Development Goals (SDGs) point 3 "public health and welfare" has not been achieved.
Faika
Rachmawati, Tities Puspita,
dan Anton
Suryatma
2021 Smoking and
Hypertension (Secondary Data Analysis of Healthy
Indonesia Program-Family Approach at Puskesmas Iringmulyo and Mulyojati, Metro City, Lampung
Province)
Research method/quantita tive cross- sectional
analysis cross-sectional
Based on the results of the study, smoking behavior and hypertension sufferers were more prevalent in health centers with low IKS, namely
Mulyojati Health Center, compared to those with high IKS.
Puskesmas that has a high IKS, namely
Puskesmas Iringmulyo, in Metro City, Lampung
Province.
Ghany Vhiera Nizamie dan Achmad Kautsar
2021 Probability
Analysis of Socioeconomic Factors
Affecting Cigarette
Consumption in Indonesia
Logit regression analysis method with secondary data
Education level, income,
employment status, age, and gender have a significant
effect on
cigarette
consumption in Indonesia.
Tin Arifatun Al Fadilah, Hadi
2021 The Effect of
Poverty,
Double-log multiple
Poverty, cigarette price
Sasana, Panji Kusuma
Prasetyanto
Cigarette Price, Per Capita Income, and Cigarette Excise on Cigarette Consumption in Indonesia 1990- 2019
regression analysis
cigarette price and cigarette excise have a negative effect on cigarette consumption.
While income per
capita income has no effect on cigarette
consumption.
DISCUSSION
The Relationship between Cigarette Consumption Expenditure in Indonesia and the Prevalence of Smoking in Indonesia.
Indonesia is one of the countries with the highest prevalence of smoking in the world. This can be seen from the prevalence of tobacco production in Indonesia which is ranked 6th in the world, after China (42%), Brazil (11%), India (10.62%), the United States (4.58%), and Malawi (3.02%). Based on data from the Indonesian Tobacco Farmers Association (APTI) in 2018, the area of tobacco land in 15 provinces in Indonesia was recorded at 245,000 hectares (Kontan, 2020). This is in line with data from the Ministry of Industry in 2019 which shows that the amount of tobacco production nationally reaches a range of 190,000- 200,000 tons of tobacco per year, while industry needs reach 320,000-330,000 tons of tobacco per year (Akurat News, 2019).
The increase in tobacco demand is due to the increasing number of smokers in Indonesia. This can be caused by a lack of awareness of health and smoking habits from an early age, even smokers do not hesitate to use part of their income to buy cigarettes.
The results of research conducted by Likha Inayati and Rizky Aryasa Pratama in 2018 show that household income has a positive effect on cigarette consumption (Arifatun, A. T., Sasana, H., & Prasetyanto, 2021). Each increase in income will increase the probability of heavy smoking by 3.74%
with the assumption of ceteris paribus.
Previous research conducted by Amalia in 2018 stated that individuals who get higher income will increase spending on cigarette consumption (Nizamie, G. V., & Kautsar, 2021). The results of this study are in line with the data released by the Central Statistics Agency in 2020, namely that the second highest per capita expenditure of the Indonesian people lies in tobacco commodities, which has increased
significantly every year (Arifatun, A. T., Sasana, H., & Prasetyanto, 2021).
Cigarettes in this case are considered a normalized item so that if income increases, demand and consumption will also increase (Nizamie, G. V., & Kautsar, 2021).
This statement is evidenced by the high prevalence of smoking in Indonesian society among other ASEAN countries. Adult male smoking prevalence reached the highest percentage, at 66%. Meanwhile, the prevalence of adult female smoking is between 5.8% and 8.4%. In line with the data from ASEAN countries, data released by Susenas and Riskesdas in 2020 stated that the prevalence of male consumers was highest at 68.1% in 2019, while the prevalence of female consumers was highest at 6.7% in 2017. The data also shows that the prevalence of cigarette consumption among children (10-18 years old) reached 9.1% in 2019 (Arifatun, A. T., Sasana, H., &
Prasetyanto, 2021).
Impact of Cigarette Consumption on Health
High rates of cigarette consumption can lead to new problems, especially in the field of health. This is because smoking is one of the risk factors for non-communicable diseases, such as coronary heart disease, hypertension, and cancer (Antimas et al., 2017). World Health Organization (WHO) 2015 data shows that elevated blood pressure is experienced by one in five adults
worldwide. Around 972 million people or 64% of the global population have hypertension. By 2030, this number is likely to increase to 29.2%. Of the 972 million people with hypertension, 639 million live in developing countries and the remaining 333 million live in developed countries. The African region has the highest prevalence rate of hypertension, with around 46% of adults aged over 25 years having been diagnosed with hypertension (WHO, 2015).
The WHO also states that around 7 million deaths each year are caused by smoking. By 2030, this is expected to increase to 8 million deaths per year (CDC, 2018). Nicotine and dance are the two harmful substances in cigarettes. Both are addictive and carcinogenic so that they can cause addiction and increase the potential for several diseases (Fatria, 2019).
Tobacco is the cause of 131,502 (28.4%) cancers and 105,830 (30.5%) cancer deaths in ASEAN countries in 2012 (Puspawati et al., 2020). Cancer that is often associated with smoking behavior is lung cancer. The long-term inhalation of harmful ingredients contained in cigarettes is one of the factors that trigger lung cancer. That is why smokers are at higher risk of suffering from lung cancer when compared to those who do not smoke (Cahyadie, 2016). In addition to cancer, coronary heart disease (CHD) is also one of the diseases triggered by smoking behavior. In 2019, a study
showed that the incidence of coronary heart disease (CHD) was 5.8 times higher for people with smoking behavior than for people with non-smoking behavior (Pracilia et al., 2019). This is caused by substances in cigarettes that can cause plaque in the coronary arteries so that it can slow blood flow and make a lack of oxygen intake and nutrients in the blood flow which can then cause the heart to have difficulty pumping blood and have to work harder. The heart that has to work harder will become tired and cause coronary heart disease.
Achievement Target of Reducing Early Mortality from Non-Communicable Diseases in Sustainable Development Goals (SDGs) Number 3 in Indonesia
Sustainable Development Goals (SDGs) is a long-term global plan that has 17 goals and 169 targets as a reference for world development over the next 15 years. The SDGs also have a main focus in the form of a long-term and sustainable approach and prioritize issues that are in accordance with the needs of the people (Hapsari, 2019). Of the 17 goals listed in the Sustainable Development Goals, there is one point that reads "Ensure a Healthy Life and Improve the Welfare of All People of All Ages". In it, precisely at point 3.4, the goal is that by 2030 premature deaths due to non-communicable diseases can be reduced by 30%, through prevention and treatment activities, as well
as improving mental health and well-being (Said et al., 2016).
Non-communicable diseases are diseases that cannot be transmitted from person to person, where their development progresses slowly over a long period of time (Kemenkes RI, 2015). Non-communicable diseases discussed further in the SDGsi include heart disease, diabetes, obesity, hypertension, and chronic respiratory disease. One of the national indicators that must be achieved in SDGs point 3.4 is that by 2030, there will be a decrease in the percentage of smokers in the population ≤18 years old to 5.4% (2015 data shows 7.2%) (KOMNASHAM, 2020).
This is because according to the Central Bureau of Statistics, one of the risk factors for non-communicable diseases, such as cancer, hypertension, and coronary heart disease is caused by smoking behavior.
Relationship between Cigarette Consumption and Achievement of Reduction in Early Mortality from Non- Communicable Diseases in Indonesia
The Ministry of Health and the World Health Organization (WHO) released research results on the Global Adult Tobacco Survey. Based on the results of this research, Indonesia is one of the countries with cigarette consumption rates that are in the emergency category, with a percentage of 25% of Indonesians being smokers. Over the past ten decades, from 2011 to 2021, there
has been an increase in cigarette consumption by 14.5% or 8.8 million people.
This figure is based on the number of smokers in Indonesia in 2011 of 60.3 million people and this number will increase in 2021, to 69.1 million people.
Tobacco is a category of toxins that are masked and work slowly but have the most harmful effects on the body. One cigarette contains an average of 600 different chemical ingredients and more than 7,000 chemical compounds that are produced from cigarette smoke (NGI, 2014). This tobacco product can cause a variety of diseases, such as oral cancer; throat cancer; cardiovascular (heart and stroke); nasal cancer and paranasal sinus cavity, acute myeloid leukemia; colorectal, liver, kidney, ovary, pancreas; cancer of the lower urinary tract (bladder, renal pelvis, and ureter); cervical cancer; breast cancer; and miscarriage and death in pregnancy (WHO, 2019).
WHO in 2021 stated that the tobacco epidemic has killed about 8 million people each year. There are more than 7 million people experiencing deaths caused by smoking behavior, while 1.2 million people experience deaths caused by exposure to secondhand smoke caused by cardiovascular disease and respiratory problems. The WHO statement provides an overview of the massive impact of cigarette consumption, both for individuals and other people exposed to cigarette smoke.
The high rate of cigarette consumption and smoking-related deaths negatively affects the achievement of a healthy life in Indonesia. This is because smoking can lead to lower human dignity, increase hunger and poverty, and can exacerbate social inequality in society.
Furthermore, high cigarette consumption rates can also hinder the improvement of human resources. This is because cigarettes can cause addiction, illness, and even death and can affect the decline in education levels, especially among the poor and make inequality or gender inequality higher (Von Eichborn and Abshagen, 2015).
High cigarette consumption rates can also increase the burden on state finances.
Based on a report by Minister Sri Mulyani, health costs due to cigarette consumption reach Rp17.9 trillion to Rp27.7 trillion per year. This results in the dependency of BPJS Health which increases and bears Rp10.5- 15.6 trillion of the total health costs of smoking-related diseases, while the distribution of cigarette tax revenues to BPJS Health is only Rp7.4 trillion. From these data, it can be seen that smoking has a very bad impact on health and provides economic losses to the state. Based on the impact and losses experienced by the state due to the high rate of cigarette consumption, it is believed that smoking can hamper the achievement of Sustainable Development Goals (SDGs) target number 3, precisely at
point 3.4, which targets that by 2030, premature mortality due to non- communicable diseases will decrease by one-third.
CONCLUSIONS
From the results of the article review, it can be concluded that an increase in cigarette consumption can hinder the achievement of Sustainable Development Goals (SDGs) number 3, especially point 3.4, which has a target of reducing premature mortality from non-communicable diseases.
This is because cigarette consumption is one of the risk factors for non-communicable diseases, such as hypertension and cancer, as well as causing addiction, illness and death.
Therefore, active participation from the community and the government is highly expected in reducing the rate of cigarette consumption in Indonesia. With the suppression of cigarette consumption in Indonesia, it will help achieve the Sustainable Development Goals (SDGs) target 3.4 to realize a healthy society and improve the welfare of the entire population of Indonesia.
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