Anti-smoking advocates decry absence of graphic-images requirement

THE Health Ministry on Wednesday unveiled mandatory text-only cigarette warnings that all manufacturers and importers will need to include on packages sold in the Kingdom beginning in July, a regulation that has disappointed public health workers pushing for visual warnings, which are believed to be much more effective smoking deterrents.

The text-only warnings fall short of complying with recommendations outlined in the World Health Organisation’s Framework Convention on Tobacco Control (FCTC), to which Cambodia became a signatory in November 2005. Article 11 of the convention states that health warnings should cover at least 30 percent of all cigarette packages and advises the use of pictures – “preferably shocking ones”.

Officials had indicated that they would require visual warnings on all cigarette packages as recently as May 2008, when all government ministers approved a series of graphic images that had been produced by the Health Ministry.

But at some point between the approval of the images and last October, when the cigarette warning sub-decree was formally adopted, the visual warnings requirement was dropped.

Council of Ministers spokesman Phay Siphan said Wednesday that the decision to stop short of requiring visual warnings had been made in part because the government wanted to avoid insulting smokers.

“Smokers have a right to smoke,” he said. “We just want to warn customers, not insult them.”

He added that he did not know exactly when the decision had been made.

Anti-smoking advocates who have monitored the development of the warning labels expressed concern over the government’s decision, which they said would significantly lessen the measure’s impact.

“In the end, the Council of Ministers chose not to put the graphic warnings on the packets. It was obviously a disappointment to many of us in tobacco control, but that was their final decision,” said Mark Schwisow, country director for the Adventist Development and Relief Agency.

Health Minister Mam Bunheng defended the warnings at a press conference Wednesday. “We believe that those who smoke can understand the text even without graphics, because we have different kinds of text warnings,” he said.

Speaking at the same press conference, World Health Organisation representative Dr Pieter JM van Maaren refrained from criticising the text-only warnings, but he pointed out the benefits of visual ones.

“Warnings that use pictures or graphics in addition to text have been shown to be particularly effective in communicating risk,” he said. “This is especially true to the large number of people who can not read.”

Dr Yel Daravuth, national professional officer for the World Health Organisation’s Tobacco Free Initiative, echoed that point in an interview.

“We still want pictures on the packets, because pictures mean a lot to Cambodians,” he said. “Many people can’t read, but if they see the pictures they might understand what ‘lung cancer’ means.”

Article 9 of the October sub-decree calls for the following punishments to be levied against local manufacturers and importers that do not adhere to the warning label requirement: a written warning, temporary closure for first offenders and permanent closure for frequent violators.

“For temporarily postponing the business and permanently closing the business, there shall be approval from the leader of the Royal Government,” states the sub-decree, a copy of which was obtained Wednesday.

A widespread problem

Van Maaren said Wednesday that Cambodia has one of the highest rates of smoking in Southeast Asia – 48 percent of men and 3.6 percent of women over the age of 18 smoke cigarettes, and 17 percent of women and 1 percent of men chew tobacco, according to a 2005 survey that was published by the Ministry of Planning in 2009.

Mom Kong, director of the Cambodian Movement for Health, said in an interview at the press conference that the text-only warnings signify a step forward for anti-smoking campaigners.

But he said he hopes that visual warnings are required at some point.

“We hope that the government will take a further step by having pictorial health warnings in the future, as strongly recommended by the WHO,” he said.

“The graphic warning is the best measure to prevent smoking by young people who want to start to smoke.”

Mam Bunheng appeared to leave the door open for the eventual adoption of a visual warnings requirement, saying: “We are doing this step by step. We must enforce this text label effectively.” But he did not specify any concrete plans to expand on the text-only warnings.

IN DATES: Tobacco warnings make their way to Cambodia

November 2008

May 2008

July 2008

August 2009

October 2009

January 2010

Cambodia ratifies the WHO’s Framework Convention on Tobacco Control, which requires written health warning messages and recommends that visual warnings appear on all cigarette packages.

A series of graphic images produced by the Ministry of Health is approved by all government ministries.

Sung Vinn Tak, head of the tobacco health unit at the National Centre for Health Promotion, says Cambodia will not meet the WHO’s 2009 deadline for requiring warnings on cigarette packages.

The Council of Ministers approves a sub-decree that will require health warnings to be printed on the outside of cigarette packages. However, the edict mandates only written messages, not images, a fact not widely recognised at the time.

The sub-decree is officially adopted by the government, and tobacco importers and manufacturers are given nine months to comply with the new regulations.

The government announces the exact text of the five warnings that will be mandatory on all cigarette packets from July this year.