Smoking rates decline in Cambodia but challenges remain to #endTobacco

Shobha Shukla / Bobby Ramakant *

New study findings show that the number of tobacco smokers in Cambodia has declined by one-fifth during the 2014-2021 period. However, to end tobacco use which remains the single largest preventable cause of diseases and untimely deaths, stronger urgent actions are needed in Cambodia, and globally.

Findings of Cambodia’s National Adults Tobacco Survey 2021 show that overall cigarette smoking prevalence has come down from 16.6% in 2014 to 13.04% in 2021. There was a 6.93% decrease in cigarette smoking prevalence among men (from 32.3% in 2014 to 25.37% in 2021). Cigarette smoking prevalence among women also reduced from 2.4% in 2014 to 2.05% in 2021.

“These positive results reflect the success of the comprehensive tobacco control legislation and sustained whole-of-government efforts. The Union remains committed to building its partnership with the Ministry of Health, as well as other national and international partners, for promoting tobacco control and ultimately ending tobacco use,” said Dr Tara Singh Bam, Asia Pacific Director of International Union Against Tuberculosis and Lung Disease (The Union).

Agrees Dr Chhordaphea Chea, Director of the National Center for Health Promotion, Ministry of Health, Cambodia: “The results of this survey show that Cambodia is on the right track in tobacco control and it’s time to make innovative efforts to bring down smoking prevalence significantly.”

Most Cambodian people support stronger tobacco control

Attitudes of Cambodian people are also changing, with 95% of the survey respondents supporting an increase in cigarette tax, and 95.75% supporting an increase in the price of tobacco products.

Raising taxes on tobacco products is vital because it leads to an increase in the price of tobacco products, which makes tobacco less affordable. When tobacco becomes less affordable people use it less and initiation of tobacco use in youth also decreases. As youth and low-income groups are more responsive to increases in tobacco prices, they disproportionately enjoy the health and economic benefits of quitting and not starting. Saving lives with tobacco taxes lessens the enormous healthcare burden and economic losses that result from tobacco-related diseases. Tobacco taxation is also relatively inexpensive to implement and generates significant revenues over the short and medium term.

Smokefree laws are reducing exposure to deadly tobacco smoke

The number of people who were exposed to tobacco smoke in 2014 has come down drastically in 2021. The number of those exposed to tobacco smoke at home declined from 66% in 2014 to 27% by 2021. Likewise, those exposed to tobacco smoke at workplaces reduced by half, from 48% in 2014 to 24% by 2021.

But it is worrisome that despite smoke-free laws, exposure to tobacco smoke in public transport rose from 33% in 2014 to 62% by 2021.

Cambodia ratified the global tobacco treaty (formally called the World Health Organization Framework Convention on Tobacco Control) on 13 February 2006. As per Cambodian law, smoking is prohibited in all indoor workplaces and indoor public places. In order to #EndTobacco, smoking bans must be extended to outdoor workplaces and outdoor public places as well.

Smokefree laws and policies protect people who do not smoke from life-threatening health hazards caused by secondhand smoke and thirdhand smoke. Evidence shows that smoke free laws also encourage tobacco users to quit and prevent initiation of tobacco use.

Will Cambodia go for bigger pictorial warnings and plain packaging?

Cambodia law mandates a picture warning to cover 50% and a text warning to cover 5% of the upper front and upper back panels of all tobacco product packages. The survey shows that awareness of these warnings was good, as more than 90% of males and 89.65% of females saw the health warning on cigarette packages in the past 30 days. Over 80% of respondents – 84.10% of males and 82.55% of females – supported larger pictorial health warnings on cigarette packages.

Scientific evidence shows that larger graphic pictorial warnings and plain packaging of tobacco products are cost-effective public health interventions. Cambodia needs to urgently increase the size of pictorial warnings and move towards plain packaging.

Despite ban on e-cigarettes, industries are addicting many

There is no safe level of tobacco and alcohol use, as per the WHO. Whether it is e-cigarettes or other forms of electronic nicotine delivery systems (ENDS), if they contain tobacco, they need to be regulated like other tobacco products.

Cambodia bans the sale and use of e-cigarettes etc but it needs stronger laws and policies to effectively ban all forms of advertising, promotion and sponsorship of all such products (like e-cigarettes or heated tobacco products etc) that are escaping through the net of tobacco control laws, and devastating lives of children and youth.

While people are suffering the onslaught of tobacco products, industries are reaping rich profits. In 2019, e-cigarettes were sold in six Southeast Asian markets with a total market value of US$ 595 million, which is projected to grow to US$ 766 million by the end of 2023. The global e-cigarette market has proliferated from around US$ 50 million in 2005 to over 20 billion in 2019, and is expected to grow to US$34 billion by 2024.

Goal to end tobacco is a vital cog-in-the-wheel to accelerate progress towards SDGs

“Tobacco costs lives, causes economic losses, contributes to environmental degradation, and poses significant threats to sustainable development,” said Dr Bam.

Over 16,000 people die of tobacco use every year in Cambodia - one third of whom are among the poorest. Each of these deaths could have been prevented if #endTobacco had become a reality earlier. But the tobacco industry continues to aggressively and deceptively expand its market, causing an epidemic of tobacco-caused killer diseases.

Not just disease and death, tobacco also jolts the economy: every year the global economy bleeds over US$ 1.4 trillion due to tobacco use. In Cambodia, over US$ 227 million is the economic cost every year due to healthcare expenditures and lost productivity alone. Overall, Cambodia suffers annual economic losses of KHR 2.7 trillion (US$ 663 million), which is equivalent to 3% of Cambodia’s GDP, due to tobacco use.

According to the WHO FCTC Investment Case for Cambodia launched in 2019, investing in the country’s five priority tobacco control measures- namely higher tobacco taxes, smoking bans in public places and workplaces, plain packaging, mass media campaigns and advertising ban- will save 57,000 lives and provide a return of KHR 178 for every Cambodian riel invested - saving KHR 7.9 trillion (US$ 1.9 billion) in health costs and economic losses by 2033.

Cambodia and all countries globally must ensure tobacco use drops to zero so that no one suffers from tobacco-caused preventable diseases, disabilities or dies prematurely. Tobacco control is also essential for the global economy as well as for the environment and overall progress to SDGs.

Also, Cambodia and other countries that have ratified the global tobacco treaty, should advance stronger tobacco control policies in intergovernmental negotiations later this year at the Conference of the Parties of the WHO Framework Convention on Tobacco Control - including stronger progress on its Article 19 to hold tobacco industry liable - legally and financially for the harm it has knowingly caused to human life and our planet.