New research comparing Kazakhstan’s tobacco policies with those of Sweden highlights a striking contrast.
Sweden has reduced adult smoking to just 5.3%, making it the world’s leading example of tobacco harm reduction. Kazakhstan’s smoking rate remains almost three times higher at 15%, and tobacco still claims an estimated 17,285 lives every year.
The Tale of Two Nations report, which I co-authored with Smoke Free Sweden leader Dr Delon Human, concludes that evidence-based harm reduction policies could dramatically reduce the terrible toll of smoking in Kazakhstan.
The findings should prompt an important discussion about how Kazakhstan tackles one of its greatest public health challenges.
Around 84% of all deaths in Kazakhstan are caused by non-communicable diseases. The leading causes are cardiovascular disease, cancer and chronic respiratory disease. The principal risk factors include tobacco use, physical inactivity, harmful alcohol consumption, unhealthy diets and the use of narcotic substances.
According to the World Health Organization, only about 8% to 10% of a person’s health depends on the healthcare system itself. Around half is determined by lifestyle, habits and behaviour.
Changing those behaviours is rarely straightforward. Many people struggle to overcome physical and psychological dependence on nicotine, alcohol or other addictive substances. Some succeed in quitting without assistance. Others do not.
That is why prohibition alone is often an incomplete answer. Restrictive policies may reduce access to certain products, but they do not always eliminate the behaviour they are intended to prevent.
Public health also needs practical strategies that help people reduce their risk when complete abstinence proves difficult.
This principle, known as harm reduction, is already accepted in many areas of medicine. Opioid substitution therapy, recommended by the World Health Organization (WHO), is one example. In alcohol policy, encouraging lower-strength products has also been explored as a means of reducing harm.
The same principle applies to tobacco.
There is no question that completely stopping smoking is the best option for health. But many smokers continue to use nicotine despite repeated attempts to quit. For those individuals, switching from combustible cigarettes to smoke-free nicotine products can substantially reduce exposure to the toxic chemicals created by burning tobacco.
These products are not risk-free, but the evidence indicates that they present significantly lower risks than continuing to smoke cigarettes.
This is precisely the lesson emerging from Sweden’s experience. Rather than treating every nicotine product as equally dangerous, Sweden has distinguished between combustible cigarettes and lower-risk alternatives.
It has allowed adults to access regulated smoke-free products while maintaining measures to protect young people. Over several decades, that approach has produced the lowest smoking rate in Europe and the lowest rates of smoking-related disease on the continent.
Kazakhstan has made important progress in reducing smoking since the early 2000s. However, that progress has slowed in recent years. Continuing to rely primarily on prohibitions and restrictions may not be enough to achieve the next stage of progress.
The evidence from countries such as Sweden suggests that complementing traditional tobacco control measures with evidence-based harm reduction could help many more smokers move away from combustible cigarettes.
The stakes extend beyond public health. According to available estimates, non-communicable diseases cost Kazakhstan around 4.5% of its gross domestic product each year through healthcare expenditure and lost productivity.
Reducing that burden will require a comprehensive strategy. Prevention remains essential. So does encouraging people to quit smoking entirely.
But public policy should also recognise the needs of smokers who are unable or unwilling to stop using nicotine. Giving them access to scientifically supported, lower-risk alternatives has the potential to reduce disease, save lives and lessen the economic burden of tobacco-related illness.
Kazakhstan has an opportunity to build on the progress it has already made. The evidence increasingly suggests that combining prevention with harm reduction offers the best chance of accelerating the decline in smoking and improving the nation’s long-term health.
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Dr. Kentra is a cardiologist and deputy chairman of the Council and member of the Expert Council of the Densaulyk ULL, which is the Harm Reduction Association of Kazakhstan, focusing on the institutionalisation of harm reduction in non-communicable diseases.
