Jack Epstein – The poster child for Indonesia's tobacco culture is a two-year-old boy who smokes 40 cigarettes a day.
A YouTube video of the chain-smoking toddler, from a fishing village on the island of Sumatra, went viral last year, drawing international attention to a virtually uncontrolled tobacco industry.
"Aside from some supermarkets not selling tobacco to minors under 18, there are no regulations," said Dr Yayi Suryo Prabandari, public health specialist at the University of Gadjah Mada in Yogyakarta.
In an era when tobacco firms are on the run in most parts of the world, they're thriving in Indonesia, where one-third of the population smokes. In total number of smokers, Indonesia lags behind only China and India, which have five times its population.
Most Indonesians prefer kreteks, a blend of tobacco and cloves that has become an ingrained part of the nation's culture. They are shared by friends and doled out to cranky toddlers and relatives at circumcisions, an Islamic rite of passage for boys.
Ads for kreteks and other cigarettes regularly appear on television and billboards, and there are no bans in government and private offices or restaurants and bars. Indonesian cigarettes are among the cheapest in the world, costing about $US1 ($A0.95) a pack. And while selling to minors under 18 is illegal, that law is rarely enforced.
The puffing population has increased sixfold since the mid-1960s, according to the World Health Organisation. Sixty-three per cent of men and 5 per cent of women smoke and 3.2 per cent of children from three to 15 years old are active smokers, according to Indonesia's government.
Many Indonesians are oblivious to the health risks, according to Dr Prabandari. The Griya Balur health clinic in Jakarta treats patients suffering from emphysema caused by smoking with "divine cigarettes", which are piped into the lungs, ears and nose. The clinic's staff claim tobacco cures cancer.
Indonesia is the only Asian-Pacific nation not to sign or ratify the WHO's Framework Convention on Tobacco Control, which sets policy recommendations and benchmarks for nations aimed at reducing smoking, restricting sales to minors, increasing taxes on cigarettes to reduce demand and banning tobacco advertising. Most critics say regulatory indifference is the result of the tobacco industry's economic muscle. It provides the government with billions in excise taxes and directly employs 600,000 workers, as well as 3.5 million tobacco and clove farmers. Even the poorest families spend more on tobacco than some necessities – eight times more on tobacco than meat and five times more on tobacco than on milk and eggs, according to a recent survey by the public health department at the University of Gadjah Mada.
But pressure by anti-smoking groups is mounting on the industry, whose products kill more than 400,000 Indonesians a year from such tobacco-related illnesses as cancer and cardiovascular and lung disease and another 25,000 from secondhand smoking, according to WHO. Kreteks contain double the nicotine and almost triple the tar of ordinary cigarettes, according to the journal Pharmacology Biochemistry and Behaviour.
Last year, Indonesia's second-largest Islamic organisation issued a fatwa (religious ruling) banning smoking, comparing it to suicide, which is prohibited in Islam. And protests from anti-tobacco groups obliged the tobacco company Djarum to withdraw its sponsorship of a concert by American pop star Kelly Clarkson.
An anti-smoking coalition is pushing Parliament to approve bills that would require tighter restrictions in public places and in advertising, and enforcement of a 2009 law requiring graphic warnings on cigarette packages.
There are also awareness campaigns via text messages and anti-smoking counselling centres – but those efforts don't seem to be making much of a difference.