Almaty – the first smoke-free city in the post Soviet region

WHO smoke-free city case study

Almaty – the first smoke-free city in the post

Soviet region

© World Health Organization 2011

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WHO smoke-free city case study: Almaty, Kazakhstan

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Abbreviations

NGO Non-governmental organization

US$ United States dollar

WHO World Health Organization

WHO FCTC WHO Framework Convention on Tobacco Control


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Contents

Acknowledgements .................................................................................................................... 3

Foreword .................................................................................................................................... 4

1. Introduction ........................................................................................................................ 6

2. The Context......................................................................................................................... 6

2.1 City Background .......................................................................................................... 6

2.2 Tobacco Use and Smoking Behaviour ......................................................................... 6

2.3 The Health Costs of Tobacco ....................................................................................... 7

2.4 The Tobacco Control and Smoke-Free Policy Context ................................................ 7

3 Key Stages and Elements in Developing and Implementing the Smoke-Free Almaty

Programme ................................................................................................................................ 8

3.1 Lobbying Almaty Government (Akimat) for a Smoke-Free Almaty Programme ........ 8

3.2 The Smoke-Free Almaty Programme ........................................................................ 11

4. Impact ............................................................................................................................... 13

5. Conclusions and Lessons .................................................................................................. 14

References………………………………………………………………………………………………………………………….16


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Acknowledgements

The WHO smoke-free city case study Almaty – the first smoke-free city in the post Soviet

region was developed for the WHO Centre for Health Development in Kobe, Japan, WHO

Tobacco Free Initiative in Geneva, Switzerland and the Regional Office for Europe in

Copenhagen, Denmark. It was written by Jamilya Sadykova, National Coalition “For Smoke-

Free Kazakhstan” in Almaty, Kazakhstan and edited by Jon Dawson, Jon Dawson Associates

in Chester, United Kingdom.


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Foreword

All people have a fundamental right to breathe clean air. There is no safe level of exposure

to second-hand smoke (SHS), which causes heart disease, cancer and many other diseases.

Even brief exposure can cause serious damage. Only a total ban on smoking in all indoor

public places, including workplaces, protects people from the harms of SHS exposure, helps

smokers quit and reduces youth smoking. Guidelines to Article 8 of the WHO Framework

Convention on Tobacco Control (WHO FCTC) help countries know exactly what to do to

protect their people from SHS. An increasing number of countries have adopted legislation

to accomplish smoke-free environments. Smoke-free legislation is popular wherever it is

enacted, and these laws do not harm business. Any country can implement effective smoke-

free legislation. However, only a small proportion of the world’s population currently has

meaningful protection from SHS.

While a national law protecting all the people in a country is ideal, cities can often pass

legislation sooner than countries. In many cases public sub-national legislation or local

regulations can be effective ways to address the issue with measures beyond the legal or

political scope of national governments, and even to anticipate or promote national

interventions. A growing number of cities and counties across the globe have already taken

action. Many cities have every authority to pass comprehensive smoke-free laws to

eliminate SHS exposure. If comprehensive smoke-free legislation does not exist at another

jurisdictional level, these cities should use their authority to adopt laws or other available

legal instruments to prohibit tobacco smoke in these places. Some cities may not have

adequate authority to pass strong, comprehensive legislation. However, this does not mean

that they should not take action. Most cities will at least have the authority to prohibit

tobacco smoke in certain types of workplaces, for example, local public transportation and

municipal public buildings. They can adopt legislation prohibiting smoking indoors in

whatever categories of establishments they have authority to regulate. In addition, all cities

can advocate for action at other governmental levels. Mayors and other city leaders can

directly advocate for national comprehensive smoke-free laws.

In a joint project, WHO Centre for Health Development, Kobe (WKC) and the WHO Tobacco

Free Initiative (TFI) aimed to facilitate local action by documenting the experiences of nine

selected cities in becoming smoke-free. Their interventions and processes were examined

by local experts, based on evidence from a wide range of local sources. These included

documentation, archival records, direct observation, interviews and participant-observation.

A case study database was created and the most relevant documents kept on file, including

statements from key-informants. Some cities have banned smoking in enclosed public

places including workplaces, educational facilities, transportation, shopping malls,

restaurants, and bars. Other cities have implemented smoking bans as part of


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comprehensive tobacco control regulations, while imposing other restrictions, for example

on tobacco sales and advertisements. Cities use different mechanisms to introduce such

regulations and their impact goes beyond the cities adopting the smoke-free policies.

The present case is one in a series of nine case studies of cities that have engaged in the

process of becoming smoke-free. Although not all of the cities have yet accomplished the

goal of becoming a "smoke-free city", they provide lessons learnt in relation to political

commitment for local action towards smoke-free air for their citizens and the role of civil

society in urging city governments to take action, helping them to build effective

partnerships and to conduct awareness campaigns that benefit enforcement and maximize

compliance. We hope that these lessons can be used by municipalities to succeed with local

smoke-free legislation or tobacco control programmes. Municipal success may trigger action

in other cities and countries, and thus contribute to worldwide protection from exposure to

SHS.


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1. Introduction

1.1 In March 2005, following a high profile and effective media and advocacy

campaign, the city of Almaty in Kazakhstan adopted a tobacco control

programme and invested resources in it. It was the first, and up to the present

time remains the only, example of a financially supported, long-term, city

tobacco control initiative in Kazakhstan and in the whole of the former Soviet

region. This case study examines how Almaty’s Smoke-Free Programme secured

political support and how it has been implemented. It discusses the impact of

the programme and the lessons that can be learnt from its experience.

2. The Context

2.1 City Background

2.1.1 Almaty was the capital city of the Republic of Kazakhstan until December 1997.

With a population of almost 2 million people, of different nations, cultures and

backgrounds, it remains the largest city in the country. Almaty is an important

economic and cultural centre for Kazakhstan, and for the wider Central Asian

region, with many leading international and national financial and cultural

bodies present in the city. Traditionally, Almaty is widely considered to be an

engine for economic and social reform in Kazakstan and across Central Asia.

2.1.2 The city of Almaty is governed jointly by the Akim (the City Mayor and Head of

the Municipal Government) and the, locally-elected, Maslikhat (the Municipal

Parliament) with its 42 members. The Akim, who is appointed by President of

Kazakhstan is responsible for executing the Maslikhat’s decisions and

regulations. Both the Akim and the Maslikhat constitute the governing body of

the city and run its municipal programmes.

2.2 Tobacco Use and Smoking Behaviour

2.2.1 In Kazakhstan, men are far more likely to smoke than women. Male smoking

prevalence is 44% compared to 10% amongst females. Amongst youths, 15% of

males and 8% of females smoke.1

2.2.2 Spending on tobacco within the country increased significantly between 1997

and 2004. According to surveys of household living standards, expenditure on

tobacco grew in real terms from 9.7 billion tenge (US$ 77.6 million) in 1997 to

26.6 billion tenge (US$ 212.8 million) in 2006.2* Cigarettes also became more

affordable to consumers at this time. Several factors have boosted spending on

* At 2004 prices


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and consumption of tobacco. In particular, real incomes doubled in less than a

decade and multinational tobacco companies made recognised brands

affordable to local consumers by producing them cheaply in Kazakhstan.3 At the

same time, aggressive marketing campaigns, largely unhindered by government

regulation, also increased demand and attracted new smokers.

2.3.2 Within Almaty, data from 2004 indicates that 23% of citizens smoke - including

19% of young people aged 13 to 15 years old.

2.3.3 In 2004, 85% of citizens reported being exposed to second-hand smoke in public

places.4 This reflects widespread perceptions that heavy smoking in public places

is the norm and a socially acceptable habit.

2.3 The Health Costs of Tobacco

2.3.1 Over the last 20 years, lung cancer has become the most likely cause of mortality

from cancer. More than 3,000 people die from lung cancer every year in the

country (23.8 per 100,000). It is the “leader” among all cancers, registering

about 4,000 of new lung cancer cases annually.5

2.4 The Tobacco Control and Smoke-Free Policy Context

2002 National Law on Tobacco Smoking Prevention

2.4.1 The National Law on Tobacco Smoking Prevention and Limitations, approved on

10 July 2002, was Kazakhstan’s first national law focussing on tobacco.

Interviews for this case study suggested that the tobacco industry was actively

involved in the drafting of the law and lobbying Parliament about it.6 The law

specified that people would be protected from exposure to tobacco smoke in a

series of specific public places. The law listed the public places where smoking

would not be allowed, namely: administrative and educational premises, sports

stadiums, theatres, public transport and hospitality sector premises. However,

night clubs, offices, hotels and other “workplaces” were omitted from the list.

2.4.2 It has been claimed that the law’s authors intentionally weakened its

enforcement mechanism. The tobacco industry actively participated in the

drafting of the law including by hiring lawyers and lobbyists. Moreover, it was

argued that the law was designed to discredit the smoke-free agenda by

prematurely introducing smoking bans in public places. Whatever the truth

about these accusations and the actual motivation for the law, it was not

preceded or accompanied by any information campaign or any efforts to

mobilise the kind of public support that could stimulate the population to

comply with the law. Equally, enforcement of the law was weak and its

implementation was widely disregarded. Enforcement was handicapped, in

particular, by the complex procedures put in place for issuing penalties and

collecting payment. For instance, complying with the correct penalty procedure

required the involvement of the police and two observers. The police, observers


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and the smoker all had to sign and submit an official protocol to be submitted to

the Administrative court.

2.4.3 In practice, the law proved ineffective. People continued to smoke heavily in

bars and restaurants and there was the widespread perception that the national

law would not be enforced.

2009 Population Health and Health Care System Act

2.4.4 New tobacco control legislation came into effect on October 9, 2009. The

Population Health and Health Care System Act included a focus on tobacco. It

cancelled the 2002 law and incorporated a 100% ban on smoking in all public

places. Contrasting with the 2002 law, this recent law was drafted by the

Ministry of Health and tobacco control advocates. Its provisions were

successfully defended within both Parliament chambers. Penalty procedures are

now more straightforward. The Police can issue a penalty immediately or

provide a document enabling the violator to pay the fine in any bank.

2.4.5 The Act also adopted wider tobacco control actions. These included:

the use of graphic health warning images and an indication of harmful

ingredients on packs of cigarettes;

a ban on misleading information - such as classifying cigarettes as “light”

or “mild”;

a ban on selling tobacco from self-service tobacco shelves and other

tobacco sale restrictions.

2.4.6 Notwithstanding this positive development, a clear national tobacco strategy

has not yet been put in place. Indeed, the Ministry of Health lacks a tobacco

control department, or other supportive infrastructure, that could develop the

regulations needed for a comprehensive national tobacco control agenda and

laws. Overall, tobacco control, at national level, in Kazakhstan is at an early stage

of formation.

3 Key Stages and Elements in Developing and Implementing the Smoke-Free Almaty Programme

3.1 Lobbying Almaty Government (Akimat) for a Smoke-Free Almaty

Programme

3.1.1 Prior to 2005, no special tobacco control programme or action plan had been

developed or implemented in Almaty. However, in 2005, the members of the

National Coalition “For smoke-free Kazakhstan”† took the decision to lobby for a

special, municipal budget to take forward a Smoke-Free Almaty Programme.

† Национальная Коалиция «За Казахстан, свободный от табачного дыма»


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Lobbying began in January

2005 when coalition members

met and negotiated with the

Almaty Mayor and with key

committees. An advocacy and

media campaign was launched

in February. These actions had

a swift result. In March, the

XIV session of Almaty

Maslikhat (the Municipal

Parliament) officially approved

a decree for implementing and

funding the Smoke-Free

Almaty Programme. A two

year budget totalling 45

million tenge with scope for a

further budget extension was

awarded.

3.1.2 A leading and highly respected Maslikhat Parliamentarian, Dr Izmukhambetov

Talapkali, a former Minister of Health and, in 2005, the Director of the

Republican Medical College‡ and the Executive Director of the National Coalition

“For smoke-free Kazakhstan”, was effective advocate in persuading the Mayor

and the city administration. In January 2005, he arranged direct negotiations

with the Mayor of Almaty – Dr Imangali Tasmagambetov - and with the City

Council’s Health and Financial Committees. Through telephone calls and direct

meetings, Dr Izmukhambetov’s position and standing in the Parliament helped

to secure the support of the majority of Parliamentarians for the Smoke-Free

Almaty proposals. The City Mayor, for his part, was receptive to the smoke-free

agenda and was willing to support change. This was vital in avoiding delays to

efforts to progress the programme.

3.1.3 In tandem, advocates from the National Coalition, developed a media campaign,

with modest resources - US$1000 secured from the Open Society Fund. Key

elements of this campaign approach were:

monitoring of the national tobacco law by a range of groups - including ,

journalists, local parliamentarians, police, health professionals, teenager’s

volunteers and national coalition advocates.

the production of strong video materials;

briefing materials for the leaders and local decision-makers;

absolute transparency to media.

‡ Республиканский медицинский колледж

©Akimat pf Almatu City, 2005


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3.1.4 All media channels - TV, radio, newspapers, magazines, information agencies

and other press - were invited and welcomed to participate directly. Mass media

had free access to interview all the group members and broadcast/ translate

every aspect of the monitoring and were provided with the final monitoring

results and the report.

3.1.5 Equipped with video cameras, the monitoring groups inspected 107 venues

throughout Almaty during a week in February for compliance with the national

tobacco law and to document violations. They visited shops, markets,

restaurants, cinemas, government and public buildings, schools, hospitals,

airport, stations, buses, police offices and other premises. Among the violations

caught on tape were the selling of single cigarettes instead of by the pack, sellers

neglecting to ask for age verification, and people smoking heavily in public

places including hospitals where it is against the law. This activity secured

significant mass-media coverage which, in turn, generated public pressure and

resulted in tobacco smoking becoming recognized as a major social problem in

the city.

3.1.6 Throughout the week, TV and radio channels highlighted smoking related

materials, monitoring results and interviews discussing smoke-free issues.

Following its high profile on television, the issue was featured further in the

printed and internet press giving continued coverage to tobacco control issues

for almost a month.

3.1.7 The National Coalition, at this time, placed particular emphasis on health

hazards, poor implementation of the smoke-free law and the environmental

image of the city. Specifically, the Coalition focused its media messages on:

health dangers - indicating that “smoking leads to 3000 annual deaths of

Almaty citizens due to cancer, cardiovascular and pulmonary diseases and,

above all, it is dangerous for non-smokers”7

social problems - highlighting that about “250 fires occur annually in

Almaty due to smoking cigarettes which leads to young people dying”8

environmental issues - stating that cigarettes on the streets make “3,5

tons of garbage from butts alone, poisoning the clean and green city of

apples with dirty and smelly streets”. 7

Clean air- emphasising that “nobody cares, even about the law for

protecting non-smokers’ rights” to breath clean air (free from tobacco).9

3.1.8 These messages were used, in different combinations, throughout the city-wide

media campaign, press-conferences and public debates as part of an overall

strategy to call for action and to emphasise the urgent need to implement a

concrete, municipal smoke-free agenda.

3.1.9 Following three months of creative and media-supported campaigning, the

Almaty City Council approved, in April 2005, the special city programme “Smoke-

Free Almaty” - effectively making tobacco control a political priority for the city.


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The City allocated a total programme budget of 45 million tenge for 2006 and

2007 with provision for a further 200 million for 2008 to 2011.

3.2 The Smoke-Free Almaty Programme

3.2.1 Immediately after the official approval of the Smoke-Free Almaty Programme, a

special inter-sectoral committee was established to implement and coordinate

it. Under the supervision of the Deputy City Mayor, the committee consists of

representatives of Maslikhat deputies and city departments for health,

education, sport and culture. NGOs are also represented. The Almaty Healthy

Lifestyle Centre became the budget holder for the programme.

3.2.2 Partnership working became a characteristic feature of the programme and its

achievements. For example, at least four professional organisations are

responsible for implementing information campaigns under the direct

supervision of the programme administrator. Equally, for society mobilisation

activities, at least 17 entities have been involved, including state universities and

NGOs.

3.2.3 The Smoke-Free Almaty Programme has five main strands. It comprises:

an information campaign;

mobilising society support and creating smoke-free places;

building capacity for smoking prevention;

medical support for stopping smoking;

programme monitoring.

Information campaign

3.2.4 The overall programme

agenda targets youth and

teenagers, medical personnel,

women and the general public.

Information campaigns lie at

the heart of the programme.

Each year, two key messages

are promoted. For instance, in

2008, campaigns had a focus

on encouraging smokers not to

expose others to second-hand

smoke. Promoting the message “Don’t smoke near me”, the campaign utilised

billboards on many streets in the city, video and audio advertisements, leaflets,

images, media articles and public actions. The dissemination of information was

extensive and the smoke-free agenda has a high profile in the city. All citizens,

schools and Universities could access tobacco-related information and are able

©National Coalition “For smoke-free Kazakhstan”


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to join the smoke-free places movement (see section 3.2.5) - enabling them to

collaborate with smoke-free programme stakeholders, make their premises

smoke-free and take part in other public actions.

Mobilising society support and creating smoke-free places

3.2.5 The National Coalition works closely with organisations who wish to become

100% smoke-free in developing smoke-free policies. In particular, it has initiated

the “smoke-free places” movement to encourage public administration

buildings, universities, schools and

hospitals to become smoke-free. Specific

criteria have been laid down for achieving

full smoke-free status in these places. In

addition to the display of signage and

compliance with smoke-free policies,

employees, students and others are

encouraged to participate actively in

public smoke-free related events and

wider tobacco control actions.

3.2.6 In this context, a wide range of public,

private and civil society organisations,

under the overall supervision of the

Smoke-Free Almaty Programme

Administrator, have over three years

conducted a range of public actions to de-normalise smoking and to mobilise

support for smoke-free environments. Examples of interventions include:

a network of smoke-free academic institutions (e.g. colleges and

universities)

an annual “Almaty No Smoke day”, where the key stakeholders and

partners present results and highlight effective smoke-free projects to

Almaty citizens, especially youths;

an interactive smoke-free game “Dr ZOZ recommends”;

city-wide student debates to involve young people, students and

scholars;

a series of sport – related actions, involving young people and teenagers;

a competition between school theatres with public performances on the

theme of “the tobacco smoke illusion”.

Complementary tobacco control actions

3.2.7 Alongside advances in smoke-free agendas, considerable progress has been

made in recent years to build capacity for smoking prevention and to establish

stop smoking services. Health professionals and teachers have benefited from

©Sadykova Jamilya


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training and educational seminars that focused on the health hazards of tobacco

and on developing consultation skills. Equally, a stop smoking clinic and a

telephone quit line - which annually registers 2000 calls - were set up in 2007.

With support from the Polish Health Promotion Fund, 200 stop smoking

specialists were also trained in 2007 and 2008.

4. Impact

4.1 This section considers the impact of the Smoke-Free Almaty programme in

terms of:

exposure to second-hand smoke;

the incidence of smoking;

the wider influence of the Almaty experience on national tobacco control

policy.

Exposure to second-hand smoke

4.2 Almaty’s smoke-free programme has led to medical and educational institutions

in the city becoming smoke-free. However, because of the weakness of the law,

there have been limitations to the extent that other premises are smoke-free.

Nevertheless, tobacco control advocates are confident that the new Health Act -

which now provides for 100% smoke-free environments, throughout

Kazakhstan, has already led to far more extensive smoke-free places both in

Almaty and elsewhere in the country - including many restaurants.

Smoking incidence

4.3 Smoking prevalence declines have been identified amongst specific groups in

Almaty since the smoke-free programme began. Smoking prevalence amongst

teenagers has fallen from 19% in 2004 to 15% in 2008. It has also fallen

significantly amongst medical personnel - from 35% in 2004 to 15% four years

later.10

Influence of the Almaty experience

4.4 The Smoke-Free Almaty Programme has inspired other cities and regions within

Kazakhstan. For instance, the cities of Astana - the capital of Kazakhstan - and

Karaganda are considering applying the Smoke-Free Almaty model.11

4.5 It can also be argued that the actions taken by tobacco control advocates in

Almaty have been influential in securing the more protective smoke-free

legislation set out in the 2009 Health Act. In particular, in addition to its

enhanced experience, the budgetary support for the Smoke-Free Almaty

Programme has significantly strengthened the role of NGOs - and especially the


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National Coalition “For smoke-free Kazakhstan”. The lobbying and

implementation experience for Smoke-Free Almaty enhanced the skills of

leading advocates to play a role on the national stage. Indeed, the National

Coalition worked closely with the Ministry of Health in drafting the tobacco

control sections of the 2009 Health Act. Moreover, the leader of the National

Coalition continues to play an influential role in developing tobacco-related

policy in the Kazakhstan Parliament, the ruling party, the Ministry of Health and

other agencies and has good access to the media. This position has become

particularly important in ensuring that the implementation of the smoke-free

law is supported by a strong enforcement system.

5. Conclusions and Lessons

5.1 The Almaty smoke-free experience highlights key elements that have

contributed to the achievements in the city. These flag up important lessons for

taking forward smoke-free agendas:

Lessons learnt

5.2 The city’s experience highlights a series of factors that have contributed to its

achievements. These provide important lessons for taking forward smoke-free

agendas in the region and further afield. They include:

5.3 Political leadership. The role of political leadership was central to achieving and

sustaining support for the Smoke-Free Almaty Programme. Dr Izmukhambetov

Talapkali was a key figure in inspiring public debate and securing direct lobbying

of the City Mayor. Equally, the Mayor of Almaty became a staunch supporter of

the smoke-free agenda and facilitated its implementation.

5.4 Strong and committed NGOs. The National Coalition “For smoke-free

Kazakhstan” had good knowledge and awareness about how to utilise public

messages and create media campaigns that would effectively progress smoke-

free agendas. The Coalition was a driving force in implementing lobbying

activities - in drafting key materials, arguing for the programme and garnering

media support. Key civil society advocates had a high profile in media campaigns

and were able to respond rapidly to political imperatives at both city, and

subsequently, national levels.

5.5 Effective partnership working. The Smoke-Free Almaty Programme

demonstrates the benefits of joint action by stakeholders and of tobacco control

“champions” willing to work together. An inter-sectoral partnership that can

reach many different parts of the society helps to maximise the impact on public

opinion. For instance, stakeholders in Almaty were able to access, variously, the

health department, city administration, universities, NGOs, the media and PR


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agencies, the youth movement, the police and public leaders. Equally, having a

co-ordination committee and an administrator able to steer the overall

programe strengthened the coalition and helped to make it more effective.

5.6 Generating media support. The Smoke-Free Almaty Programme benefited from

a supportive media. Tobacco control advocates recognised the value of having a

pool of sympathetic journalists and the advantages of feeding the media with

creative, provocative and straightforward messages for influencing public

opinion in favour of smoke-free agendas.

5.7 A transparent and accessible programme. The Smoke-Free Almaty Programme

has a coherent and clear approach and is accessible to the wider community.

Citizens can access information on a programme website and potential grantees

know how to apply for support. Reporting mechanisms to the Healthy Lifestyle

Centre ensure transparency and the quality of the smoke-free activities.

5.8 Sustainable and secure funding. The Smoke-Free Almaty experience illustrates

some of the benefits from a secure funding stream. With a financially-backed

programme running from 2005 to 2011, Almaty has been able to secure support

for experts and full-time staff. This has enabled long-term, smoke-free

interventions to be put in place. Financial resources have supported the

development of the network of tobacco control advocates - enabling key

professionals to continue engaging with smoke-free agendas. This was

particularly important in engaging with policy-makers at national level and in

supporting the development of the new Health Act.

Final remarks

5.9 The Smoke-Free Almaty Programme began two years before Kazakhstan ratified

the WHO FCTC. At that time, smoking was not widely recognised as a social,

economic or health problem and the tobacco industry was viewed favourably as

being socially responsible investors and donors. Equally, cooperation in anti-

tobacco activities between governmental, private and NGO’ sectors was virtually

non-existent. In this context, the Smoke-Free Almaty Programme has

demonstrated a systematic approach to taking forward smoke-free agendas. It

has built tobacco control into city policies, has significantly increased the

number of smoke-free places in the city and has strengthened local and national

smoke-free movements amongst organizations and citizens. The local

government decision - based on a positive assessment of its results - to continue

funding the programme secures continuing action until 2011. The Smoke-Free

Almaty Programme significantly and rapidly boosted the national policy for

tobacco control and, in particular, was highly influential in the implementation

of a comprehensive advertising ban on tobacco products in 2008 and complete

nationwide smoking ban in public places which was introduced in 2009.


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5.10 Smoke-Free Almaty has pioneered, and serves as an inspiration for, smoke-free

actions in Kazakhstan and the wider Central Asian and post-Soviet regions. It

provides an inspiring example of how dedication and joint efforts by civil society,

the media and other tobacco control advocates - with modest financial

resources - can shift public and political attitudes about smoke-free agendas. In

Almaty, campaigners secured local government support for smoke-free policies

and built on this experience to secure significant advances at national level. The

Health Act, and its 100% smoke-free ban in public places from October 2009, is

clear evidence that protecting people from exposure to second-hand smoke is

becoming a national priority.

References 1 “MPOWER Report” WHO, 2008 2 National statistical agency of Kazakstan, Annual household survey database 1998 -2005 observations. 3 “Economy of tobacco in Kazakstan”, economic research. S. Khakimzhanov and Dr H.Ross, Sept 2008, Almaty. Can be accessed on www.nosmoke.kz (research files) 4 Research report “Life style trends of Kazakstan population, 2004” National healthy life style center, Almaty. 2004 5 Kazakh Research Institute of Oncology and Radiology, 2004 6 Interview with National tobacco control coordinator, Zhylkaidarova Alma. National healthy life style center, Almaty. Aug 2009 7 Brochure “Smokefree Almaty city program” March 2005. Press-release on law monitoring, p 12 8 Press release of the “Smokefree Almaty” press-conference, 24 march, 2009. Fire prevention service report, Feb 2005 9 “Smokefree Almaty intervention” article at “Kazakstanskya Pravda” national newspaper, Olga Malakhova, 25 March 2005 10 “Smoking patters among Almaty citizens. Comparative analysis 2007-2008” Annual survey report of Public Health Institutes within the framework of Smokefree Almaty, 2008. 11 Interviews with Directors of Karaganda and Astana healthy life style centers in Sept 2009.

http://www.nosmoke.kz/

Almaty – the first smoke-free city in the post Soviet region

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