Kazakhstan has been a regional leader in tobacco control — WHO Representative on shisha regulation and public health

Dr. Syla, thank you for joining us. In Kazakhstan, there is a ban on shisha smoking in public places. What is WHO’s position on that?

— The World Health Organization (WHO) strongly supports Kazakhstan’s decision to ban shisha smoking in enclosed public spaces. Keeping public spaces free from shisha smoke reduces exposure to harmful substances, prevents tobacco-related diseases, and helps create healthier environments for everyone, especially children and non-smokers.

Some argue that shisha is less harmful than cigarettes because the smoke passes through water. Is this true?

— That is a dangerous misconception. Shisha, or waterpipe tobacco smoking, is often mistakenly perceived as a safer alternative to cigarettes. However, shisha is a tobacco product, and the evidence is clear: waterpipe smoke contains toxic and carcinogenic substances, including carbon monoxide, heavy metals, and polycyclic aromatic hydrocarbons. These pose serious health risks not only to users but also to those exposed to second-hand smoke. There is no safe level of tobacco smoke.

What’s particularly concerning is the growing popularity of shisha among young people, driven by flavored tobacco, social-media promotion, and café culture. This trend threatens to undermine decades of progress in tobacco control. That’s why it is important to uphold the ban on shisha smoking in public places.

What are the specific health risks associated with shisha smoking?

— Shisha smoking is linked to a wide range of diseases, including lung cancer, cardiovascular disease, respiratory illnesses, and adverse pregnancy outcomes. It also contributes to nicotine addiction. Passive exposure to shisha smoke is equally harmful as exposure to any other second-hand tobacco smoke. Children, pregnant women, and people with chronic conditions are particularly vulnerable.

What does WHO recommend to governments regarding shisha regulation?

— Kazakhstan is a party to the WHO Framework Convention on Tobacco Control (FCTC), which clearly includes shisha within its scope. Reversing the current ban would contradict these international obligations. Kazakhstan has been a regional leader in tobacco control, and this leadership must continue. WHO stands ready to provide technical support and evidence to help protect the health and well-being of all citizens.

Some businesses claim that allowing shisha could boost the hospitality sector. How do you respond?

— While short-term economic benefits are often highlighted, they are insignificant when weighed against the heavy and lasting economic and social burden of tobacco-related diseases. The impact on lives, productivity, and the healthcare system far outweighs any commercial gains.

According to WHO estimates to be released at the end of September, productivity losses in Kazakhstan in 2021 alone exceeded $4.2 billion due to preventable deaths and $2.8 billion due to treatable deaths from non-communicable diseases, many of which are linked to tobacco use. Public health must take precedence over commercial interests.

Finally, what role can the media and civil society play in this issue?

— The media and civil society are crucial allies in raising awareness about the dangers of shisha smoking. We encourage journalists, educators, and health advocates to speak out, share facts, and support policies that prioritize public health. Together, we can prevent a new wave of tobacco-related harm. Let me share with you a note prepared by WHO in 2015 that remains relevant today.

It is the second edition of the WHO Study Group on Tobacco Product Regulation’s scientific advisory note on waterpipe tobacco smoking. This advisory note addresses growing concern about the increasing prevalence and potential health effects of waterpipe tobacco smoking, a practice that dates back at least four centuries in Africa and Asia. The note provides WHO Member States and research agencies with a more thorough understanding of the health effects of waterpipe smoking.

Last year, Kazakhstan established a ban on the sale and distribution of smokeless tobacco products, vapes, flavorings and related liquids, as well as their advertising.