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CAMBODIA: Young Enough to Drink

PHNOM PENH | 31 May 2024

At 17, Kun Thea (not her real name) is a veteran when it comes to drinking alcohol. She started drinking at 14 or 15, with a cocktail with less than 4% alcohol content at a family party. Soon, she moved on to drinking beer. 

There were times when her parents would not allow her to drink, but “the consumption kept going because it became a habit for us to drink during parties,” said Kun Thea, who lives in Cambodia’s southern Takeo province. 

Sreyleak, an 18-year-old school dropout from Takeo who also asked not to be identified, recalls that her parents, who were rarely home, did not discourage or bar her from drinking when she started doing so at 14. She felt dizzy after her first can of beer, she recalls.

Sreyleak drank habitually, mostly beer, four times a week with a group of friends, until she began to feel unwell with gut problems. “The doctor said my stomach is weak, so I cannot drink as much as before. He advised me to cut down on my alcohol,” she said. Sreyleak has not totally quit, but has cut back to two to three cans of beer at a time when sees her friends twice or thrice a week.

Alcohol is a regular feature in gatherings like weddings and in some cases, in funerals too – social settings where young people come across alcohol as part of everyday life. Many youngsters may not drink when around elders, but are more likely to do so among peers. 

Unlike most neighbouring countries, this Southeast Asian country of some 17 million people does not have a legally set age for either consuming or purchasing alcohol products. Pending legislation, which was filed in 2015, seeks to limit sales to persons 21 years old or more.  

Huge billboards promoting alcohol, especially beer, compete for attention in the streets. Several beers’ names are closely tied to national cultural symbols such as Angkor Beer or even the country’s name – ‘Cambodia Beer’.

Young people are not asked about their age when they order or buy alcohol. One travel blogger  described as “infinitesimal” the chances of a person’s ID being checked when getting alcohol.

Children – she estimates them to 13 to 15 years old –  do come buy beers in her store, says Pray Saray of Chanthrea district in southeast Svay Rieng province. “I never asked why they bought the beers. But I believe that those were for their parents,” she said in an interview. 

As of 2019, Cambodians consumed 8.48 litres of pure alcohol per year, up by 369% from 1.81 litres in 2000. Cambodia, too, has the highest beer consumption per person in Southeast Asia and ranks 21st in the world.

WITHIN TOO EASY REACH

“Beyond concerning” is how drinking has become normalised, explains Quach Mengly, a Cambodian-American medical doctor who leads an educational foundation. People can’t seem to celebrate any occasion without it, even if they know that alcohol is bad for health, he says in an interview.  

Cambodians’ alcohol consumption has grown since the 2000s, as the economy expanded with the end of its decades-long armed conflict. Middle-class consumption patterns came with better incomes, especially in the capital Phnom Penh and other urban areas. 

The consumption of beer, too, has picked up and it now accounts for 88.1% of total alcohol consumed in the country.

The exposure to and use of alcohol by young people, some as young as 13, has been worrying health and medical professionals, social campaigners and other groups, who point to its steep cost on health, society and the economy.  

“My patients are only in their 30s but they have already got an unhealthy liver when they come for a health check,” Mengly said, adding this can lead to cirrhosis of the liver, a late-stage disease that comes from heavy drinking.  “This happens a lot, especially among men,” he added. While it is mostly men with these problems, “the number of female teenagers and women drinking alcohol is also on the rise.” 

Cardiovascular illnesses, liver diseases and diabetes are the most common illnesses Mengly has seen among drinkers.

Alcohol use among adolescents and young people has been identified as a major concern by the World Health Organization, which reports that a quarter of all people worldwide aged 15 to 19 years are current drinkers.

Eight years ago (WHO’s latest data on alcohol is as of 2016), a total of 19.2% of Cambodians aged 15 to 19 were drinkers, according to the WHO Global Health Observatory. Among Cambodian adults (defined as 15 years or older) that same year, 30.9% consumed alcohol, a figure far below Vietnam’s 99.7% and Singapore’s 70%.

But these figures are likely to have grown in recent years, as Cambodia’s economic development has picked up. Various other reports point to a greater proportion of Cambodians taking alcohol in the last few years, as well as people drinking more on a per-capita basis – more than 4.5 times more from 2000 to 2019. These are likely to impact trends in the younger population too.

The Cambodia Demographic and Health Survey 2021-2022, which is conducted by the country’s health ministry and statistics institute, found that 69% of men and 16% of women said they had consumed alcoholic drinks in the month leading to the survey.

Male consumption is “is generally high in all provinces”, reaching 64% and 80% in several provinces, where locally brewed spirits and traditional wine are popular. Men drink more frequently than women, and there was no difference in men’s drinking between cities and rural areas, the survey found.

HUGE RISE IN ALCOHOL CONSUMPTION – AND SOUTHEAST ASIA’S BIGGEST BEER DRINKER

As of 2019, Cambodians aged 15 years and over consumed 8.48 litres of pure alcohol per year, up by 369% from 1.81 litres in 2000. (WHO’s global figure for average per capita consumption in 2016 was 6.4 litres. It estimated 6.6 litres in 2020, and projects this to reach 7 litres in 2025.)

Cambodia, too, has the highest beer consumption per person in Southeast Asia and ranks 21st in the world. Per person annually, Cambodians drink an average of 4.12 in litres of pure alcohol (from beer) as of 2019, up from only .34 liters in 2000, One World in Data says from WHO data

Beer is also cheaper than in many other places – a can usually sells from 2,000 to 5,000 riel (50 US cents to 1.25 dollars) in shops and supermarkets in Phnom Penh. 

Beer consumption continues to grow. Data from Japan’s Kirin Holdings, producers of Kirin Beer, show that the average Cambodian drank 72 litres of beers (114.1 bottles of 633- ml sizes) in 2022, up 27.1 percent from 2021.

A 2016 study on alcohol use and Cambodian school-going adolescents, published in the Nagoya Journal of Medical Science, found that 10% of the students it studied reported using alcohol, while 10.8% reported lifetime drunkenness and 2.8%, problem drinking. The study used data from a 2013 Global School-based Student Health Survey of 3,806 children with a mean age of 15.7 years. 

It found that “42.2% of students reported that their father or male guardian drinks alcohol, 11.1% said that they would drink alcohol if it was offered by their best friend, and 51.4% had seen daily or almost daily alcohol advertisements in the past month.” 

ALCOHOL MAKES YOU SICK

The use of alcohol exacts a huge toll on public health and quality of life. 

Along with tobacco use, physical inactivity, unhealthy diet and air pollution, it is among the major risk factors for chronic illnesses or non-communicable diseases (NCDs), the top killer of people worldwide. In Cambodia, NCDs – cardiovascular diseases, cancers, chronic respiratory illnesses and diabetes– account for 64% of premature deaths (before the age of 70).

Globally, more than half of 3 million annual deaths attributable to alcohol use are from NCDs, including cancer, the WHO says. A total of 4.1% of new cancer cases were estimated to be caused by alcohol, says the WHO and the International Agency for Research on Cancer. (Alcoholic beverages were identified as a Group 1 carcinogen for humans in 1988.)

“No safe amount of alcohol consumption for cancers can be established”, the two organisations said in a November 2023 statement. They point out that light or moderate drinking also increases cancer risks.

Harmful alcohol use is a causal factor in 230 types of diseases and injuries, WHO says. Consumption is related to liver cirrhosis, stroke, digestive disease and mental health issues, tuberculosis and HIV and AIDS. 

Deaths attributable to alcohol worldwide were due to injuries (28.7%), digestive diseases (21.3%) and cardiovascular diseases (12.9%), says the WHO’s Global Status Report on Alcohol and Health 2018.

Alcohol accounts for many traffic accidents and deaths and is a key risk factor for death and disability for men aged 15 to 24. Alcohol use is also major factor in domestic violence, and violence against women.

“Despite its relatively widespread social acceptance, alcohol is a toxic, psychoactive, carcinogenic, and dependence-producing substance capable of causing severe damage to health,” said a briefer by the NCD Alliance , an international civil-society network.

Alcohol beckons – a common sight in Cambodia. Photo: Mech Choulay

“Alcohol is no better than cigarettes or drugs. This is a habit of addiction to alcoholic drinks,” Mengly said. In fact, he adds, it is an even larger threat to public health because unlike tobacco products – which are regulated by law – alcohol is within easy reach of every young person in Cambodia.

He believes there are more drinkers than smokers these days, noting that drinking and smoking often go together. “Sometimes, they feel the urge to smoke as soon as they drink alcohol. That’s the relation between the two addictions.”

What can happen down the road? 

Ri Bora, 48, started drinking at 17. He was a soldier in the northern Dangrek Mountains at the time, and a friend had him try out some traditional liquor. “When I drink alcohol, it makes me strong and brave,” is what he used to think, he explains. He continued to drink with three or four of his friends – until he got sick and quit the habit.

A father of three, Bora stopped working as a tour guide in 2021 after arthritis, which he attributes to having had too much alcohol and red meat, limited his walking and mobility. He is being supported by his wife, who makes less than a dollar a day from doing laundry work in Ta Ek commune, Banteay Seri district in north-western Siem Reap province. “Every time I get sick, I wish I could just die,” he said in an interview.

Ri Bora says drinking is the cause of his arthritis and inability to work. Photo: Mech Choulay

STILL WAITING FOR THE LAW 

Cambodia does not have in place laws regulating the use, sales, promotion of alcohol, though many nearby countries took similar steps decades ago. Workplaces and other establishments set their own rules barring alcohol. Education officials have barred alcohol, and advertisements of this, in schools.

“Cambodia has limited alcohol regulations and a particularly weak policy framework for the regulation of alcohol,” said a 2016 report  by The Asia Foundation on the country’s alcohol industry

While reminders about avoiding driving after drinking are on the labels of beer and liquor bottles as well as posters, many are often in hardly readable sizes of text. There are no other health warnings on alcohol products. 

Since 2015, Cambodia’s information ministry has had a circular restricting advertisements during peak television viewing times of 6 to 8 pm, but it is not legally binding and has had “no significant impact on the advertising industry”, the Asia Foundation report said. 

Breweries and sellers offer promotions that encourage consumers to drink more to win prizes and earn rewards ranging from cash, free beers, motorcycles or cars. They also use entertainers as brand ambassadors.

Amid highly publicised reports about role of alcohol in road deaths and accidents, Cambodia’s government says it has taken steps to address the aggressive promotion of alcohol.

In April 2024, it set up a task force to draw up a code of conduct for alcohol advertising. This comes on the heels of Prime Minister Hun Manet’s directives earlier this year for officials to regulate advertisements to clamp down on drink driving.

Beer-tasting segment during a Kun-Khmer tournament in January 2024. Photo: RFA Khmer Facebook page

In January, a public uproar erupted over the live broadcast of a beer-tasting segment featuring four young men and women during a break in a Kun-Khmer (traditional martial arts) tournament. They were shown sipping ‘Cambodia’ beers, whose logo and signage adorned the fighting ring. 

Subsequently, the health ministry issued a warning to the public about harm from alcohol.

‘There should be punishment for adults who urge underage/young people to drink alcohol, and for retail sellers who sell alcoholic drinks to young people without requiring age (information),” Mengly pointed out.

For some time in recent months, authorities set up road checkpoints, where drivers were being stopped by police for breath tests for alcohol.

Cambodia’s draft law on alcohol control proposes to prohibit the sale of alcohol products to people 21 years and younger, pregnant women and intoxicated  persons. It would also bar alcohol sales from midnight to 6 am, and within places that include health centres, educational institutions, sports clubs, public parks and student condominiums.

But this draft has remained pending for eight years. Not a few activists and reports attribute this delay to factors that include the clout of the alcohol industry and concerns about losing revenue from taxing these products – issues that conflict with the need for regulation due to health concerns and social costs.

Setting a legal drinking age is a first step to addressing what has become a social ailment. “To stop young people from drinking alcohol, firstly there should be a law that limits the age of drinkers to 21,” said Mengly, the doctor. Pa Chanroeun, president of the Institute of Democracy of Cambodia, added: “Young people are the future leaders, but are being damaged by alcohol use.”

(*This story is part of the ‘Communicating NCDs’ media fellowship project of Probe Media Foundation Inc., Reporting ASEAN and World Health Organization. Banner photo: Meng Seavmey)

© 2024 Reporting ASEAN – Voices and views from within Southeast Asia. All Rights Reserved.

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