Systems Thinking

Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra

WM80

Problem Formulations:
1. What are the factors that increase the number of active smokers?
2. What are the factors that decrease the number of active smokers?
Problem Limitations:
1. Casual Loop Diagram was created in accordance with the government’s perspective and conducted the
practice of thinking in circles/ system thinking.
2. Casual Loop Diagram was influenced by the tobacco industry trends and health issues.
Methods:
1. Archetype System-Fixes that fail
2. Casual Loop Diagram (CLD) based on Behavior Over Time (BOT)
Several Feedbacks in the casual loop diagram in this problem case produce 2 reinforcing feedbacks
and 3 balancing feedbacks to determine the positive and negative factors of the systemic problem. Those five
feedbacks will be explained later in this report including the behavior over time graphs and the Casual Loop
Diagram itself.
a. Background
Smoking cigarettes are categorized as a systemic problem due to the increasing number of active
smokers in Indonesia, the problems that have been controlled to decrease its numbers but failed inefficiently.
Before presenting the data, the definition of an active smoker is the person who smokes (a cigarette) or inhales
the tobacco smoke into the lungs and exhales the tobacco smoke (Depdikbud, 2002). A person is called a
cigarette smoker when he/she smokes at least one cigarette per day in a year. Heavy Smokers are the people
who smoke for almost 15 cigarettes per day (Nasution, 2007). These two pictures below will be the
representatives of the behavior over time graphs of the active smokers in Indonesia. The increase total number
of Active Smokers who are at the age of under and over 15 will be seen in the behavior over time graphs.

The Number of Active Smokers Who are at

the age of over 15
80
The Percentage (%)

60

40 Men
Women
20
Total
0
2007 2010 2013 2016 2018
Years

Figure 1. The proportion of Tobacco Smokers at the age of over 15 (2007-2018)

Source:(KEMKES, 2018)
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80
The Percentage of Smokers by The Age of 10 - 18
10
9 9.1
8.8
8
The Percentage (%)

7 7.2

6
5 Percentage of Smokers by The Age
4 of 10 - 18

3
2
1
0
Riskesdas 2013 Riskesdas 2016 Riskesdas 2018

Figure 2. The proportion of Tobacco Smokers at the age of 10-18

Source:(KEMKES, 2018)

The increasing number of both women and men in 2018 is accumulated to be active smokers and
combined with the proposition of smokers by age. The increasing number of active smokers causes the
increase of the revenue of the top three tobacco industries in Indonesia which are PT. HM. Sampoerna Tbk,
PT. Gudang Garam Tbk, and PT. Bentoel International Investama Tbk. The increases in the revenues are
automatically added to the growth of the three industries of tobacco in Indonesia. The graphic below represents
the increase in the revenue of tobacco manufacturers in Indonesia

The Revenue of the Big Three Tobacco

Manufacturers in Indonesia in million Rupiah
120000000
PT. HM. Sampoerna Tbk
100000000
Revenues

80000000
60000000
PT. Gudang Garam Tbk
40000000
20000000
0
PT. Bentoel
2015 2016 2017
International Investama
Years Tbk

Figure 3. The Revenue of The Big Three Tobacco Manufacturers in Indonesia (2015-2017)
Source:(KEMKES, 2018)

The growth in the tobacco industries produces one reinforcing feedback and it will lead to the number
of marketing strategies used to increase the sales of cigarettes and the other one will lead to the easy access
and supply of cigarettes in Indonesia and then will cause the increase in the number of newbie smokers/
beginner smokers. According to Kompas Online, the tobacco industry was one of the highest contributors to
advertise on television with the total number of 6.3 trillion Rupiah. Djarum spent 1.91 trillion Rupiah, Gudang
Garam spent 1.32 trillion Rupiah and Sampoerna spent 1.25 trillion on television advertisement (Sarnia, 2017).
The Study by Permanasari, Yudiastuti, Puteri, and Haksama (2014), in Jakarta the total of 93.9 % of
teenagers were consumed by tobacco advertisement on Billboards, 88.7% of teenagers were consumed by
tobacco advertisement on televisions, and 92.4 % of teenagers were consumed by tobacco advertisement at
Sports Events and concerts.
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80
Beginner Smokers grow because there are several things that influence them to smoke, such as
smoking as an experiment and the environment full of smokers/ social smokers. According to National Health
Indicator Survey by the Institution of Health Research and Development in Indonesia in 2016, the number of
the newbie smoker rose to 8.8 % in 2016 from 7.2 % in 2013. For almost 88.6 % of smokers started to smoke
at the age of under 13. The ministry of Health concluded that the price of cigarettes which rather be called
cheap led young smokers to buy cigarettes (Depkes, 2016).
As stated by Atlas Tobacco Research, Indonesia was placed in the third rank as a nation with the
highest number of cigarette smokers. The number of cigarette smokers in 2016 was almost 90 million people.
In accordance with the research conducted by the National Commission for Protection of Child Rights, the
result stated that the number of child smokers at the age of under 10 in Indonesia reached up to 239.000
children.
19.8 % of the children who were under the age of 10 started to smoke and almost 88.6 % started to
smoke for the first time under the age of 13. Some of the child smokers were from poor families. It revealed
that 84.8 people who smoked in Indonesia, earned less than 20,000 Rupiah per day. 70 % of smokers in
Indonesia were from families who lived in poverty (Setyaningsih, 2018).
In the period of time, the newbie smokers will take smoking as a routine activity. The more cigarettes
they smoke the more addictive substances inside the smokers’ bodies that cause smoking addiction that at the
end will increase the number of active smokers. Addictive Substances are kinds of drugs or active ingredients
that, when consumed by living organisms can cause addictions which are difficult to stop. When people who
are used to consuming addictive substance stop their routines, the side effect will be extraordinary fatigue, or
they will suffer extreme pain. According to the constitution of the Republic of Indonesia of 1997 No. 5
concerning about psychotropic, there are several drugs that contain addictive substances, such as
Amphetamine, Amobarbital, Flunitrazepam, Diazepam, Bromazepam, Phenobarbital, Alcoholic beverages,
Tobacco, Cigarettes, Cigar, Hallucinogens and solvents including gasoline, thinner, glue, and paints.
Though there are two reinforcing feedbacks in the loop, there are also three balancing feedbacks that
will change the previous loops in the reinforcing feedbacks. The increase in the number of active smokers will
affect the increasing number of passive smokers. Passive smoker is someone who breathes tobacco/cigarette
smoke from active smokers. Exposure to tobacco/cigarette smoke can cause serious illness to death.
Responding to the dangers of cigarette smoke; then rules were made regarding the prohibition of smoking in
various places such as restaurants, workplaces, and public spaces.
Passive smokers can suffer from chronic diseases just like the active smokers such as cardiovascular
disease, lung cancer, and respiratory diseases, breast cancer, pancreatic cancer, cervical cancer, bladder cancer,
the risk of asthma and other chronic diseases. According to the survey conducted by Data Global Youth in
1999 - 2006, 81 % of children of age 13 to 15 in Indonesia were exposed to cigarette smoke in public places
and became passive smokers.
The survey indicated that more than 150 million Indonesians are passive smokers at home, offices,
public spaces, and public transportations. Referring to National Health Indicator Survey by the Institution of
Health Research and Development in Indonesia in 2004, more than 87 % of active smokers, smoked inside
their houses with their family members that it also showed 71 % of households had spent for smoking.
Both active and passive smokers cause the increasing number of chronic diseases that will lead to
an increasing number of the death rate from smoking. Smoking activity is still the biggest cause of death that
can actually be prevented. Smoking affects fetal development, significantly increases the risk of certain
cancers, heart attacks, strokes, and aggravates the condition of people with diabetes (Putri, 2018). In 2030, the
death rate of smoking cigarettes in the world will reach the number of 10 million people and 70 % of them are
from developing countries including Indonesia.
When the death rate from smoking rises, the policy for the smoking area in public spaces is made.
The regulation from the government creates pros and contrasts from several sectors such as the tobacco
industries (top management, small traders and workers) in a negative way and also from the number of passive
smokers who are exposed to the tobacco smoke in a positive way. Based on Media Online Kompas in 2016
about the rejection by the tobacco society alliance on the Regional Regulation on non-smoking area will not
only harm the manufacturers of tobacco products but also attack the industry links, ranging from traders in
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80
traditional and modern shops, cigarette manufacturing workers and even the tobacco/ clove farmers (Aziza,
2016).
Referring to media online CNN Indonesia in 2016, Gabungan Produsen Rokok Putih Indonesia
(Gaprindo) was against the regional government regulation concerning non-smoking area that was created by
Regional Representative Council (DPRD) and Provincial Government of DKI Jakarta, due to regional
government regulation was too exaggerated in controlling the consumers of cigarettes (Primadhyta, 2016). As
stated on Online Media Kompasiana in 2015 concerning the cigarette producer versus the government
regulation number 109 of 2012 which is a derivative of the law of health number 36 of 2009 shrink the area
of tobacco industry development in Indonesia, due to the strict regulation and those are the drawbacks for
cigarette producer and will be able to decrease the sales of cigarettes vastly (Simbolon, 2015).
Based on Online Media by Liputan 6 in 2016 concerning the workers in The Muslim Indonesian
Workers Association in the tobacco and beverage sector who were against the regional government on the
non-smoking area in DKI Jakarta due to the discrimination on small traders (Nurmayanti, 2016). The pros and
cons of government regulation toward cigarette smoking will decrease the number of active smokers. The
warning about the danger of smoking cigarettes is stated in the Government Regulation Number 109 of 2012,
it includes the materials containing addictive substances in the form of tobacco products for health.
The rules are issued in the Ministry of Health Regulation No. 28 of 2013 concerning the inclusion of
health warning and information on tobacco product packaging. There are five figures used on tobacco product
packaging which are oral cancer, lung cancer, acute bronchitis, throat cancer, smoking endangers children and
pictures of the skull to warn the smokers of the real danger of heavy smoking. As per data of the total number
of smokers, the warnings as the solutions from the government do not give any significant decreases.
According to Government Regulation of the Republic of Indonesia Number 109 of 2012 concerning addictive
substances in the form of tobacco product for Health, in the Fifth Part, Article 49 concerning non-Smoking
Area. In the implementation of protecting the ingredients that include addictive substance in tobacco products
for health, the central and the regional government are obliged to create a non-smoking area. Article 50
concerning the non-smoking areas including Health Care Facilities, Schools/ Universities, Playing Grounds/
Children Arena, Praying Rooms/ Area, Public Transportations, Offices, and Public Spaces.
As referred to The Government Regulation number 109 in 2012 concerning about controlling the
promotion activities of tobacco industry, it is still not be an obstacle for the tobacco industry to generate and
influence the young smokers by giving them sponsorships for art or sport events, concerts and even
scholarships, such as Djarum Superliga Badminton, LA Lights Indiefest, and We the Fest. Those ways, they
maintain their branding for young adult smokers.
The massive amount of cigarette advertisings and the loose regulation of cigarette prices will not be
able to prevent young adult smokers to smoke if education about the danger of smoking is not implemented
strictly. One fact is that the government earns national income from the cigarette’s tax (Purnamasari, 2018).
Articles from the Ministry of Health in 2012 stated that the attempts of The Government to control the impact
of smoking cigarettes were creating a non-smoking area, the banning of cigarette advertisement, sponsorship,
the 40 % portion of the display of the dangers of smoking cigarettes on the packaging of tobacco products.
The Ministry of Finance of the Republic of Indonesia have released the increasing tax for tobacco industries
up to 57% and how expensive the pack of cigarettes should be sold according to the regulation number 146 in
2017. The Ministry of Health of the Republic of Indonesia has a regulation of taking the tobacco industry’s
tax for providing health facilities.
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80

The Smokers who are at the age of Precentage of Chronic Diseases at the age of
over 15 in Accordance with The over 10
First-Time Period of Smoking 25 23.2

Precentage (%)
20
82.5 15
10 11.9
The Percentage

82 5
81.5 1.6 2.9 1.5 0.7
0 0.2 0.5
81
80.5 Age of Over 15
80
2007 2010 2013
Years Diseases

Figure 4. The Prevalence of Cigarette Smoking at the age of Figure 5. Precentage of Chronic Diseases at the age of over 10

over 15 in Indonesia, Source:(KEMKES, 2013) Source : (KEMKES, 2013)

Marketing Expense Hypertension

3.5E+12 40
3E+12 35
PT. HM.
In Million Rupiah

30
Percentage (%)

2.5E+12 Sampoerna Tbk

25
2E+12
20
1.5E+12 PT. Gudang Garam
Tbk 15 Hypertension
1E+12 10
5E+11 PT. Bentoel 5
0 International 0
2015 2016 2017 Investama Tbk 2013 2018
Year Years

Figure 6. The Marketing Expenses for Tobacco Industries, Figure 7. The Disease Hypertension
Source: (BentoelInternasionalInvestama, 2015, 2017; Source: (KEMKES, 2018)
GudangGaram, 2016, 2017; HMSampoerna, 2016, 2017)
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80
b. Mental Models
There are several parties in the loop cycles of smokers in Indonesia, such as the government
including a President and The Ministry of Health of the Republic of Indonesia, Indonesian citizens including
smokers and nonsmokers, and Tobacco industries.
Current Mental Models
1.Tobacco Industries
Tobacco Industries assume that they can help the government to decrease the number of
unemployment. The bigger the tobacco industries, the higher number of new employment.
2. Smokers dan Nonsmokers
Smokers assume that smoking cigarettes are cool and can heal their stress. Newbie smokers
assume that if they only smoke one or two cigarettes a day will not make them a heavy smoker and
suffer some serious illness. Passive smokers or nonsmokers assume that they won’t suffer the
diseases that active smokers will suffer in the future.
3. The Ministry of Health of Republic of Indonesia
The Ministry of Health of the Republic of Indonesia assumes that the rules about smoking area
restrictions will help reduce the number of active smokers in Indonesia.
4. Presidential Regulation
The general government assumes that smoking advertisements include information about the
danger of smoking will slowly decrease the number of active smokers in Indonesia. The general
government also assumes that the more experience the tax for cigarettes industries the more earning
the will get to cover other government deficits.
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80
c. New Mental Models
There are several things that can be done by the government to decrease the number of active
smokers in Indonesia, such as:
1. Conducting socialization activities about the danger or negative effects of smoking by
advertising or publishing it frequently on online and offline platforms, in the educational
institutes or office areas and involving a former smoker or someone who suffers chronic
diseases due to heavy smoking.
2. Laying down a new law concerning the increase of the cigarette excise tax to 18% percent
annually in 5 years.
3. Shifting tobacco products not only for cigarette industries but can be used for pharmacy and
health industries as diabetes medicine, antibody, anti-cancer protein, anti-inflammatory, and a
cure for HIV and AIDS. Furthermore, tobacco products can be utilized as a raw-material for
insecticide, a natural pesticide, and biofuel.
4. Coordinating positive activities that are fully sponsored by the government in which directly
involving citizens, such as sports events and a healthy lifestyle festival. The events can be
held nationally and internally between households, neighborhoods, or in bigger scopes of
intercities and interprovincial.
Those interventions can be implemented efficiently with the accordance of high self-awareness from
active smokers who want to stop smoking. If those ways are done continuously, it will encourage and
create new understandings and habits to spend time with more productive activities.
 Systems Thinking
Aria Pramana · Raihan Alisha Nabila · Ramadhan Dwi Saputra
WM80
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