Where there’s smoke…there’s TB. Cambodia joins the fight against smoking.

A problem for health authorities is that cigarettes are priced so cheaply, even the poorest sector can get hooked on smoking.

A problem for health authorities is that cigarettes are priced so cheaply, even the poorest sector can get hooked on smoking. It doesn’t help that a leading Senator is importing cheap cigarettes.

A recent factoid caught my eye the other day –  the value of cigarette imports to Cambodia. Cigarettes  are, by value, one of the leading imports to this nation. What an extremely  unfortunate  thing to trade  in exchange for the hard labour that goes into producing rice,  Cambodia’s leading export crop.

In 1999 one researcher reported that the very poor spend a 2-3 times greater fraction of their income on tobacco relative to the rich. In urban areas, a poor Cambodian might spend in excess of 7% of their income on tobacco, as opposed to 2% or less spent by the affluent. A secondary analysis of the 1999 Socioeconomic Survey of Cambodia indicated that the annual cash expenditure of Cambodian smokers on cigarettes was about $US69.44 million. This annual expenditure on cigarettes is enough to buy 274,304 tons of quality rice, 1,388,382 bicycles, or construct 27,778 wooden houses.

Alarming figures! And that’s without counting the health costs associated with smoking. By 2011 the annual spend on tobacco was just this side of $US100 million.

The Ministry of health in Cambodia  has set objectives to reduce the percentage  of smokers  who are,  overwhelmingly,  males. in 2011  a thorough survey estimated that 42% of males aged 18+ a tobacco users.  Of these males,  20% began smoking before the age of 15.

Tobacco usage amongst females, as we see in other parts of Asia,  is relatively low – in the single digits –  and,  in Cambodia,  often reflected in tobacco chewing rather than smoking.  Tobacco chewing  this often seen as a mild stimulant that eases period cramps.

In total  there are 2 million tobacco users in Cambodia.

In many countries  smoking is not an option for the very poor,  due to the prohibitive cost of cigarettes. However  price is not a barrier in Cambodia, and mainstream cigarette brands  are available for less than $.40c for a pack of 20.  (In 2011 the average price per pack of 20 was 20 cents.) So without a serious barrier, the demographic group most likely to be smoking in Cambodia are poor, rural males.

Cigarette tax  seems to be most obvious way of curbing the number of smokers in Cambodia. Some  90% of the population agree that smoking is bad for once health, and a similar figure support the idea of a tobacco tax. Would it work? When the National Institute of statistics conducted its adult tobacco survey in 2011the fieldworkers were instructed to take note  of cigarette packs of the users they interviewed. Some 95%  of these packs for the seal of existing government taxes –  evidence that  black-market cigarettes are less well is distributed and some had feared. So a tax hike would be realistic.

Any  visitor to Cambodia  will have noticed the big billboards promoting cigarettes as glamorous –  real Marlboro Man stuff! There is widespread public support  for banning such advertising.

Change usually has to come from the top – the very top. For  what it’s worth, Prime Minister Hun Sen, a lifelong smoker himself,  recently announced that he had quit. Perhaps that clears the air  for a more concerted public policy  to prevent young Cambodian males in particular to take up cigarettes.

That seems unlikely. Oknha Ly Yong Phat, a CPP Senator, and previously an economic adviser to the Prime Minister is President of LYP Group that imports high nicotine cigarettes from Indonesia, Hero brand and Jet.

Road safety in Cambodia – is it getting even worse?

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The photo above was published in the Phnom Penh Post following a tragic road accident in which the driver of this van was killed. The van itself was carrying more than half a dozen factory workers time, and it is lucky that there were no other losses of life. But look at that photo.To me it encapsulates several reasons why road safety in Cambodia is appalling at best, and showing signs of getting worse due to the rapidly increasing numbers of motor vehicles on the roads. (Today there are more than 1.7 million 4 wheeled light vehicles and around 1.5 million motorbikes and tuktuks.)

There are many reasons why road safety produces such bad statistics for Cambodia. In the year 2012 almost 2000 people died in traffic accidents, a figure that was double that from seven years previous. According to one report from the Voice of America, traffic fatalities in Cambodia account than nine times the number of deaths from malaria, dengue fever, HIV and AIDS put together. On a typical holiday weekend Cambodia can expect to lose between 30 and 50 lives.

Of the deaths, 80% are males and half are aged 15-29 years old.

Here are some of the causes – or issues that need addressing:

  • Driver attitudes. This encompasses poor driver training, the notable presence of drunken drivers, as well is the characteristic high speed “get out of my way” stubbornness that seems prevalent on Cambodian roads. By government reckoning, 96% of Cambodia’s road accidents come from human error.
  • A second cause for the bad chemistry is the mixed usage of roads by a wide variety of pedestrians, cyclists, motorbikes, cars, heavy trucks – but also by non-transport users including children at play, wandering livestock and the presence of roadside stalls.
  • The third cause for the high road toll is the way vehicles are over-utilised. Visitors to Cambodia are always amazed to see entire family’s poised on a motorbike, or to see flatbed trucks populated with no fewer than 40 passengers piled on top of cargo goods. When one of these vehicles has an accident the risks are multiplied.
  • A fourth contributor to the high road toll is the compliance with road safety practices such as the wearing of seat belts in cars and trucks, or the wearing of helmets by cyclists and motorcyclists.2012 pedestrians, bicyclists and motorcycle riders accounted for 83% of fatalities. Figures from 2010 suggested that just 65% of motorcyclists were wearing helmets, and only 9% of passengers were wearing helmets. And while there are laws that ban driving while using a handheld mobile phone compliance with this is not consistent.
  • The fifth contributor is the poor standard of vehicles themselves. Often these cheap and elderly imports, second-hand from other countries. Compounding this problem is the fact that so many vehicles are so poorly maintained.
  • Finally there is only a weak emergency assistance infrastructure with between 11% and 49% of accident victims receiving ambulance attendance.

Is the picture getting worse? It depends on how you look at it. On the one hand the rate of fatalities per million kilometers of travel appears to be dropping slightly thanks to improved roading and the introduction of some basic safety measures. The government is likely to be stricter at enforcing helmet wearing for example.

But in raw terms, the sheer number of deaths, the chart keeps pointing upwards. In 2001 there were just four deaths per hundred thousand people in Cambodia. By 2010 the figure had risen threefold to just over 12 deaths per hundred thousand people.

Of course this has social costs quite apart from the grief when a family member, friend or colleague is killed. A death or injury can easily make the difference between a family making its way versus being destitute.

Road safety specialists from overseas put a cost on traffic fatalities, and in Cambodia they suggest this is costing the country the equivalent of 3.5% of GDP. Put in those terms it is perhaps no surprise that the government is prioritising road safety. It’s initiatives tend to focus on compliance, so Cambodians can expect a police force more vigilant toward helmet usage and possibly random breath testing.

When you look at the list of causes of poor road safety in Cambodia, it is hard not to see that a big underlying reason is poverty. It is poverty that puts 30 or more people on the back of the truck. It is poverty that prevents the owner of that truck from investing sufficiently in the maintenance and upkeep of the truck’s mechanicals. It is not enough to say the rule breakers are the main cause of road fatalities in this developing nation. But perhaps it is a start.

PS. Below. Thank you to sponsor Kim Deane for donating helmets for the senior students supported by Savong. These students navigate the busy roads in Siem Reap.

HELMETS

Road safety irony at work – fancy a Suzuki Smash?