By Duong Sokha
With the ratification of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC) on November 25th 2005, Cambodia committed to implementing on its territory, by February 15th 2009 at the latest, a series of measures against tobacco consumption. Therefore, the Cambodian government only has two weeks to begin the necessary reforms, which among other ones, state the obligation to mention more clearly the risks linked with tobacco use on cigarette packs. In order to show their will to enforce the international treaty, the Cambodian Ministry of Health elaborated the project of a Circular imposing new regulations on tobacco distributors, namely requiring large labels to appear on packs, with not just health warnings in small print but also images showing the consequences of the consumption of tobacco products. The text is soon to be signed by prime Minister Hun Sen but strangely enough, the government have not said a word about it, not even to the factories it concerns.
A governmental Circular elaborated to comply with Article 11 of the FCTC
Article 11 of the FCTC obliges the 162 countries who have ratified it to this day (out of 168 signatories) to display health warnings, preferably images representing the visible consequences of tobacco use-related diseases, on at least 30% of the surface of cigarette packs. The treaty also provides states with clear indications on the nature of measures to take to effectively fight tobacco use, either in terms of taxation, regulation of products or the fight against cigarette smuggling.
In May 2008, an interministerial meeting was organised with the WHO to reflect on the content of a Circular on cigarette packs, the drafting of which is now supposed to be over. The text draft, which Ka-set obtained a copy of, goes further than what is stipulated in the FCTC: indeed, all packs will have to display, on at least 50% of their surface, an insert consisting of a colour picture and a warning message. In all, there will be six alternate illustrations and each of them will explicitly show the main health problems related to tobacco use: lung cancer, emphysema, heart diseases, strokes, tooth decay and the harmful effects of passive smoking on others.
In theory, those currently trying to denounce the harmful effects of the tobacco industry in Cambodia should be pleased. But, despite our repeated requests, authorities do not seem disposed to say anything about the Circular. Lim Thai Pheang, director of the National Centre for Health Promotion (NCHP) at the Ministry of Health and in charge of this dossier, refused outright to communicate any information to us. Phay Siphan, the spokesperson and Secretary of State at the Council of Ministers, did not answer our letter dated January 21st, whereas he asked us to formulate a request in writing, the core of which was to know when the bill for the Circular would be adopted by the Council of Ministers. As for representatives at the Cambodian government Secretariat General, they claim not knowing anything about the text, thus passing the buck onto the Ministry of Health.
However, associations working against tobacco consumption like ADRA (Adventist Development and Relief Agency) prove more talkative. Keo Krisna, project manager for the Tobacco Or Health programme (TOH) in this NGO, reckons that a priori, the preventive pictures mentioned in the Circular will have a real impact on the public and will contribute to a decrease in tobacco consumption. “Whatever its mode of production might be, tobacco contains at least 4,000 chemical substances. But the current warning message showing on packs of cigarettes [“Cigarettes are harmful to your health”, a message in small print which first appeared in July 1998] is tiny and does not catch the attention of smokers”, Keo Krisna points out. Moreover, some illiterate citizens do not understand it and are therefore still unaware of the fact that tobacco contains toxic substances.”
Doctor Yel Daravuth, a national officer for the WHO Tobacco free initiative and health promotion programme, is also pleased about the perspective of this measure, which he sees as a strong sign on the part of the government to have the FCTC law respected by all... provided it is indeed adopted. “Singapore and Thailand already impose health warnings on packs of cigarettes, and this allows citizens to be informed of the harmful effects of tobacco and therefore reduce their consumption”, says the long-term campaigner for tobacco controls, “Mister anti-tobacco”, who works together with the Ministry of Health on this issue.
Several thousand deaths every year
The measure is far from being of small importance: it should allow direct campaigning with some 1.9 million smokers (out of whom 1.2 million men, i.e. 40% of the adult population of men), present in Cambodia, according to a survey carried out in 2005 by ADRA, the WHO and the National Institute of Statistics and the Loma Linda University (USA). “Tobacco is a murderer which does not speak its name, unlike road accidents. According to our estimations, in 2007 in Cambodia, 73,500 people died of the consequences of tobacco use”, Keo Krisna stresses. Yel Daravuth agrees with this alarming report and assures that 90% of lung cancer cases are caused by cigarettes.
Prevention is therefore more important than ever, Keo Krisna says. According to him, some measures enforced by NGOs and Ministries such as the creation of “smoke-free areas” in public places, hospitals, pagodas and schools in several towns and provinces, have already contributed to reducing tobacco consumption.
Tobacco industry: ready to collaborate
The bill for the Circular, however, hardly raises the eyebrows of company representatives producing and selling tobacco on the Cambodian market. They claim to be ready to submit to another regulation concerning the packaging of their products. Speaking on behalf of the multinational giant British American Tobacco (BAT), present in Cambodia via a joint venture with a former state company initiated in 1996, Lim Kun, Corporate and Regulator Affairs Director in Cambodia and Laos, says the company “fully” supports the will of the Cambodian government to include the FCTC's general dispositions in its national legislations and regulations. The representative yet stressed that he would like to be informed by authorities and the WHO of such a Circular bill, to make sure that all representatives of the tobacco industry in Cambodia are involved in its elaboration... if it is not too late.
“The position of BAT in the world does not go against any disposition made by such or such country, nor does it go against such or such WHO treaty... But since this rule applies to the tobacco industry, [the BAT] must be invited to provide its recommendations, even if simply means informing of the time it needs to enforce it”, Lim Kun suggests, adding that up to the present day, his group has not been invited to take part in discussions on that text with the WHO and the Ministry of Health.
The absence of information and consultation makes Lim Kun doubt about the efficiency of the enforcement of such a measure. “Once the text is enforced, we need six months to a year to comply with such a decision, sell all our products which are already on the market and order packaging machines. But if the whole of the tobacco industry takes part in it, BAT will be first in the line there”, the director stresses, yet adding that he does not intend to express any criticism towards the government.
As for representatives of Texas Tobacco, they did not seem to mind the measure whatsoever. Kim Chhourn, in charge of administration for the company, reckons: “Our sales might go down slightly, but we will not worry about it, because the main market where we sell our products is not Cambodia but Singapore, and there, our exportations already have to be stamped with this type of health warning”.
And from a legal point of view, nothing, even after the Circular is enforced, will prevent companies from continuing to promote of their products, either via advertisement or commercial actions directly targeting Cambodian consumers.
Some advice to say no to tobacco
As part of its works, the NGO ADRA launched an awareness campaign among people who wish to quit smoking. An essential prerequisite: determination. Then, as explained by Keo Krisna, the organisation's representative in Cambodia, smokers must try to progressively delay the time of the day when they usually start smoking. “If they are used to smoking at ten in the morning, they must delay the consumption of their first cigarette by fifteen minutes. Then, they gradually reduce their consumption from one pack a day to half-a-pack a day. And finally, they must throw away any pack they have already started and stay away from cigarette smoke as it causes them to go back to smoking. If someone offers them a cigarette, they should simply thank the person and clearly tell them they have quit smoking”, Keo Krisna details. This process can take more or less time to complete: between a week and three months, according to smokers.