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Cambodia’s fresh challenges

16 blood pressure checked

Strong economic growth has brought many dramatic changes to Cambodia in recent years. Consumption is up – but with it, has come some unwelcome challenges.

Cambodians are now consuming more processed foods than ever. Between 2003 and 2008, imports of soft-drinks and candy into Cambodia rose by 5,041 per cent, and 24,334 per cent respectively. Over eight in 10 Cambodians do not have enough fruit and vegetables in their daily diet. One in five Cambodian adults has high cholesterol and one in 10 has high blood pressure, indicating a diet too high in saturated fats and salt.

This is only part of a “silent epidemic” that threatens the positive health of all Cambodians – the epidemic of non-communicable diseases (NCDs). NCDs are a set of chronic diseases, including cardiovascular disease, cancer, chronic respiratory disease and diabetes.

Not too long ago, NCDs were considered a problem for the wealthy. Not anymore. These diseases are on the rise globally as a result of smoking, unhealthy diet, harmful use of alcohol, and physical inactivity.

Across the globe, this has resulted in a sharp increase in the rates of obesity and high blood pressure.

Among NCDs, cardiovascular disease, cancer, chronic respiratory disease and diabetes alone cause 46% of deaths in Cambodia. Importantly, NCDs are affecting Cambodians in their productive years. Over half the men and over a third of women dying from NCDs are younger than 60.

The high cost of long-term health care and medicines, along with loss of income, pushes many Cambodian families deeper into poverty. It also overburdens the country’s health system, constraining efforts to improve maternal and child health and tackle infectious diseases.

In Cambodia, smoking is a particular problem. Currently two million Cambodians – including 40 per cent of all men – use tobacco, with over half the population, including children, exposed to tobacco smoke at home or work. Smoking significantly increases the risk of a variety of cancers and cardiovascular disease. Many of Cambodia’s poorest citizens are spending over 10 per cent of their income on cigarettes.

Several initiatives of the World Health Organization (WHO) have drawn attention to the high burden of NCDs and the importance of interventions to curb this epidemic. The global call for prevention and control of NCDs has been spearheaded by the Framework Convention on Tobacco Control – which Cambodia ratified – as well as the Global Strategy on Diet, Physical Activity and Health, and, more recently, the WHO 2008-2013 Action Plan for the Prevention and Control of Non-communicable Diseases. This Plan, together with regional plans for prevention and control of NCDs offers guidance to member countries to establish national strategies.

The Cambodian government recognises the risks. The Second National Health Strategic Plan for 2008-2015, which seeks to improve healthcare and preventive health services for the Cambodian people, included NCD as one of its key programs for the first time.

The World Bank is working with government and development partners to support these efforts. The Second Health Sector Support Program (HSSP2), supported by pooled funding from the Bank, AusAID, DfID and UNICEF, provides flexible support to the Health Strategic Plan.

Through HSSP2, the Bank and partners are helping Cambodia develop policies and strategies that aim to reduce common risks found across non-communicable diseases; implement behaviour change communication campaigns; improve training for health professionals, including midwives; strengthen health service delivery at hospitals and health centres; and work with the Ministry of Health and civil society to expand screening and treatment coverage for diabetes, hypertension, and cervical cancer.

The good news is that 80 per cent of NCDs can be prevented, and there are a range of highly cost-effective measures that can be taken.

Raising awareness among Cambodians is one such action – the cost of promoting the benefits of exercise, tobacco control, reducing the harmful use of alcohol, reducing salt and fat in food through mass media, is estimated at 40 cents per person each year.

Investing in a package of individual interventions, including basic drugs for cardiovascular disease and diabetes and early detection of cervical cancer, costs less than $1 a person a year.

Because of the nature of NCDs, which are rooted in multiple causes ranging from smoking, drinking and diet to maternal and child malnutrition, it is important to note that strengthening the health system alone will not reduce the burden of NCDs.

Many of the actions needed to prevent and control these diseases require the participation of the ministries of finance, foreign affairs, education, agriculture, transport, trade, local government and the private sector.

Outside the health community, for instance, the food and advertising industries need to be actively engaged.

The Copenhagen Consensus, a panel of Nobel laureates recently concluded that programs to reduce tobacco consumption, including through increased tobacco taxes and behaviour change campaigns, were among the top 10 most cost-effective investments for economic development.

NCDs are a development challenge. For Cambodians to continue enjoying the fruits of economic growth, a strong commitment by the government, the people, and the international community is a must.

Dr Pieter JM van Maaren is the World Health Organization’s representative in Cambodia and Mr Alassane Sow is the World Bank’s country manager for Cambodia.

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