In Kazakhstan some 44% of males and 10% of females smoke, and between 1997 and 2004 tobacco spending increased significantly, due to increased spending power and highly effective tobacco marketing campaigns. Data indicated that 19% of young people between the ages of 13 and 15 were also smoking. Lung cancer is the most significant cause of cancer deaths in the country. In 2002 the first national tobacco law was passed, restricting thepublic places where smoking was permitted. It was banned in theatres, educational establishments, theatres, sports stadiums and some other premises. However the law was widely disregarded and enforcement was seldom implemented (nightclubs, offices, hotels and certain other “workplaces” were omitted from the list).

Almaty is the largest city in Kazakhstan and an important economic and cultural center. In March 2005 it was decided to invest in an anti-tobacco program in the city and this subsequently developed into a successful pioneering movement which indicated how government and non-governmental organizations can successfully work together for the well-being of a nation’s health. The program has been featured in promotional activities by the World Health Organization.

• The Smoke-Free Almaty Program was organized by a former Minister of Health, DrIzmukhambetov Talapkali, the Akim (City Mayor)and the 42-member Maslikhat (municipal parliament). It was initiated in 2005 by the members of the National Coalition for Smoke-Free Kazakhstan, who lobbied for the Almaty council to provide a budget to this end. The National Law on Tobacco Smoking Prevention and Limitations was approved in 2002 and specified that people would be protected from exposure to tobacco smoke in a series of specified public places. These were: administrative and educational premises, sports stadiums, theatres, public transport and hospitality sector premises. Monitoring of the national tobacco laws became the responsibility of journalists, local parliamentarians, police, health professionals, volunteers, and others. Violations were in turn given widespread mass-media coverage and in due course smoking was recognized as a major social and health risk in Almaty.

At the same time as the new laws came into force, the National Coalition for Smoke-Free Kazakhstan concentrated on raising awareness, drawing attention in the media to the danger to health of smoking including cancer, cardiovascular and pulmonary diseases, and the risks of passive smoking. Social problems were also presented, such as the fact that 250 fires due to smoking occurred annually in the city, some of them fatal. Environmental issues were equally strongly highlighted. The Almaty Healthy Lifestyle Centre had a budget of 45 million Kazakhstani tenge (US$250,000) in 2006–7. The program committee consists of representatives of the Maslikhat and city departments for health, education, sport, and culture, and a number of NGOs. A number of professional organizations became responsible for implementing information campaigns and activities, including state universities and NGOs. The program targets the general public and also specifically young people, medical personnel and women. It has a high profile throughout the city and information is accessible to all. Today the program comprises an information campaign, medical support for smoking cessation, creating smoke-free places, building capacity for the prevention of smoking, and program monitoring.

The National Coalition for Smoke-Free Kazakhstan continues to work closely with organizations to encourage 100% smoke-free working areas. Smoking is being actively de-normalized. There is now a network of smoke-free educational establishments and an annual “Almaty No Smoking Day” on which stakeholders and partners highlight projects and publish results. Young people are particularly targeted via competitions, sport-related activities and the development of an interactive smoke-free game. Training programs on the dangers of smoking have been developed for health professionals and teachers, clinics have been set up for people wishing to stop smoking, and a telephone quit line has been set up which receives some 2,000 calls annually.

Benefits

Although in practice not all public areas have achieved smoke-free status, the city has vastly extended its smoke-free zones, and all medical and educational institutions remain smoke-free. In October 2009 the Population Health and Health Care System Act was passed, which included a 100% ban on smoking in all public places, and this has had a significant effect throughout the country. In Almaty smoking has declined since the introduction of the smoke-free program. Teenage smoking fell from 19% in 2004 to 15% in 2008, and among medical personnel it fell from 35% in 2004 to 15% in 2009. Public awareness of the dangers of smoking and passive smoking presents a more positive image for the future health of the nation. The success of the program is due to a number of factors, not least the cooperation of political leadership, particularly Dr Talapkali as a key figure, and committed NGOs, particularly the National Coalition for Smoke-Free Kazakhstan. Dr Talapkali inspired public debate and facilitated the implementation of the smoke-free agenda, and the National Coalition provided strong lobbying activities which in turn ensured comprehensive media support.