Smoking in Kazakhstan - A Case Study

Transcription

1 WHO smoke-free city case study Almaty the first smoke-free city in the post Soviet region

2 World Health Organization 2011 All rights reserved. Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to the WHO Centre for Health Development, I.H.D. Centre Building, 9 th Floor, 5-1, 1-chome, Wakinohama-Kaigandori, Chuo-ku, Kobe City, Hyogo Prefecture, , Japan (fax: ; wkc@wkc.who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

3 Abbreviations NGO US$ WHO WHO FCTC Non-governmental organization United States dollar World Health Organization WHO Framework Convention on Tobacco Control 1

4 Contents Acknowledgements... 3 Foreword Introduction The Context City Background Tobacco Use and Smoking Behaviour The Health Costs of Tobacco The Tobacco Control and Smoke-Free Policy Context Key Stages and Elements in Developing and Implementing the Smoke-Free Almaty Programme Lobbying Almaty Government (Akimat) for a Smoke-Free Almaty Programme The Smoke-Free Almaty Programme Impact Conclusions and Lessons References.16 2

5 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. 3

6 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 smokefree 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 4

7 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. 5

8 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 Almaty was the capital city of the Republic of Kazakhstan until December 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 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 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 Spending on tobacco within the country increased significantly between 1997 and 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$ million) in * Cigarettes also became more affordable to consumers at this time. Several factors have boosted spending on * At 2004 prices 6

9 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 Within Almaty, data from 2004 indicates that 23% of citizens smoke - including 19% of young people aged 13 to 15 years old 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 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 The Tobacco Control and Smoke-Free Policy Context 2002 National Law on Tobacco Smoking Prevention 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 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 7

10 and the smoker all had to sign and submit an official protocol to be submitted to the Administrative court 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 Population Health and Health Care System Act New tobacco control legislation came into effect on October 9, 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 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 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 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» 8

11 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. Akimat pf Almatu City, 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 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 9

12 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 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 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 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) 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 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. 10

13 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 The Smoke-Free Almaty Programme 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 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 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 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 National Coalition For smoke-free Kazakhstan 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 11

14 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 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 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 Sadykova Jamilya 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 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 12

15 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 With support from the Polish Health Promotion Fund, 200 stop smoking specialists were also trained in 2007 and 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 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 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 13

16 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 smokefree 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 14

17 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 antitobacco 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 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

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