Reduce population exposure to common factors

Since the development of the National Strategic Plan on Tobacco Education and Reduction 2011-2015, much progress has been made on tobacco control in Cambodia. The highest priority strategic area to address is increasing tobacco taxation. The Draft Tobacco Control Law currently before government contains provisions for expanding smoke-free environment, as well as restricting the sale of tobacco.

The Draft Law also specifies that tobacco taxation must be increased, and that the government shall allocate a percentage of tobacco taxation for health promotion activities.

Short term actions

• Finalise Tobacco Control Law (2013)

• Tobacco Taxation Working Group to finalise plan to implement regular increases on tobacco taxation (2013)

• Expand implementation and enforcement of smoke-free environments sub-decree (2013-)

• Enforce sub-decree on advertising ban and health warnings (2013-)

• Implement tobacco taxation increases (2014-) Medium term actions

• Continue to implement regular/annual tobacco taxation increases

• Introduce sub-decree require pictorial warning labels

• Dedicate percentage of tobacco taxation income to financing NCD prevention and control

• Implement provisions of Draft Tobacco Law:

 Restricting sale of tobacco and regulating vendors

 Expanding smoke-free environments to cover all enclosed public spaces (including transportation and private workplaces/businesses)

Page 25 of 57 Long-term actions

• Continue to implement regular/annual tobacco taxation increases

• Continue enforcing provisions of Tobacco Law and tobacco control sub-decrees, on restriction of sale, smoke-free environments, importation and advertising bans

5.3.1.2 Scale up alcohol control

There is an urgent need to scale-up alcohol control measures in Cambodia. The government’s strategies will focus on the most proven, cost-effective strategies: raising alcohol taxes, restricting alcohol

advertising and restricting the availability of alcohol ²⁰. Unlike tobacco, education and awareness raising campaigns about alcohol-related harms do not reduce alcohol harm ²⁰. Public education campaigns will only be used in the context of promoting alcohol legislation or sub-decrees.

Short term actions

• Ministry of Health to work with Ministry of Finance to increase alcohol taxation (2013-14)

• Establish Inter-Ministerial Committee on Alcohol Control (2013)

• Develop sub-decree to restrict alcohol advertising, promotion and sponsorship (2013)

• Enforce drink driving law (2013-)

• Enforce sub-decree on alcohol advertising restrictions (including raising public awareness of the ban) (2014-)

Medium term actions

• Develop sub-decree to restrict alcohol availability (including a minimum purchasing age, and restrictions over number/nature of retail outlets) (2015)

• Develop Alcohol Control Law (2015)

• Percentage of annual alcohol taxation to be allocated to fund for NCD prevention & control (2015-)

• Expand ban on alcohol advertising (2016) Long-term actions

• Enforce restrictions on alcohol availability (including raising public awareness of the ban)

• Offer counselling for hazardous drinking in primary care 5.3.1.3 Promote healthy diets and physical activity

The priority focus in Cambodia must be on reducing salt consumption, as this is a leading contributor to hypertension, cardiovascular disease and stomach cancer. A salt consumption survey is an important first step, in determining a baseline figure for salt consumption, and clarifying the main dietary sources of salt for people in Cambodia Healthy eating and physical activity will be promoted through the health promoting schools programme.

Substitution of trans-fat for polyunsaturated fat will be pursued as part of the national MSA plan for NCD. Consuming the right amount of vegetables and fruits is not possible for many Cambodians because of insufficient income and lack of availability. To promote the consumption of fruit and vegetables, especially for the poor, the government will work across ministries and with the private sector, to consider subsidies, and incentives that make a healthy diet more affordable and more available. Multi-sectoral actions on diets will need to occur at the national level (between Ministry of Agriculture, Ministry of Finance, Ministry of Industry, Mines and Energy) but also at a local level.

Initiatives to promote physical activity should focus on the urban centres, where the prevalence of physical inactivity is higher. The Healthy Cities initiative being implemented in Phnom Penh will provide

Page 26 of 57 a platform for strengthening action to promote healthy eating and physical activity in Phnom Penh city – through Health Promoting Schools and other initiatives. Promoting physical activity and healthy diets through the mass media is also effective, and is one of the WHO “best buys”.

Short term actions

• Undertake small scale salt consumption survey (2012-2013)

• Undertake national salt consumption survey (2013-14)

• Pilot salt consumption reduction interventions (2014)

• Strengthen Healthy Cities initiative in Phnom Penh City:

 Launch Health Promoting Schools programme in 3 schools in Phnom Penh City(2013)

 Explore other strategies to make healthy diets the norm in Phnom Penh (eg working with food vendors) (2014-)

• Begin multi-sectoral discussions on how to reduce salt content of foods (2014-)

• Raise public awareness of healthy diet and physical activity through mass media campaigns (2013-2014)

Begin multi-sectoral discussions on substituting trans-fats for polyunsaturated fats (2014-) Medium term actions

• Develop national salt reduction action plan (2015)

• Implement national salt reduction action plan (2015-)

• Include NCD dietary risks in next version of National Nutrition Strategy (2016-)

• Expand Health Promoting Schools Long-term actions

• Restrict marketing of unhealthy food and beverages to children

• Continue implementation of national salt reduction action plan (2016-2020)

• Explore financing mechanisms (subsidies and taxation) to make healthy diets more affordable &

available

• Promote healthy diets and physical activity through workplaces(especially large low income workplaces, eg garment factories)

5.3.1.4 Immunise against cancer causing infections

Hepatitis B vaccination is already implemented in Cambodia as part of the infant immunisation schedule. A key area for improvement is to increase the percentage of infants who receive the birth dose within 24 hours of birth (68% in 2011).This aligns with broader strategies already underway as outlined in the HSP2 to improve the percentage of births attended by a trained attendant. A key short-term focus for the health sector will be to ensure that all babies born in a health facility receive their birth dose within 24 hours.

Introducing mass HPV vaccination is feasible in Cambodia in the medium to long-term, taking into account the schedule of other new vaccines to be introduced into the country over the next 4 years, and the need to undertake a demonstration project before GAVI will consider a full application for co-funding.

Short term actions

• Develop national guideline on HPV vaccination, to inform national mass vaccination programme (2014)

• Ensure all babies born in a healthy facility receive Hep B vaccination within 24 hours (2013-)

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 Ensure all provincial hospitals have a cold chain on maternity wards

 Educate staff on immunisation guidelines Medium term actions

• Plan for a demonstration project for GAVI application, for HPV vaccination of girls in schools (2015)

• Conduct demonstration project for HPV vaccination of girls in schools (2015) Long-term actions

• With results of demonstration project, make full application to GAVI for co-funding of HPV vaccination (2016)

• Implement national HPV vaccination to girls (2017-ongoing)

5.3.2 Pursue cost-effective detection, treatment and palliative care