With cigarettes being readily available and affordable — a single pack of cigarettes costs between one and two euros — and smoking being largely socially acceptable, it is perhaps unsurprising that Macedonia is in the top five countries with the highest annual tobacco cigarette consumption, at least in the Tobacco Atlas rankings, compiled in 2016.

According to the rankings, tobacco consumption in Macedonia averages out to 2,785 cigarettes per citizen per year, putting the country in fourth place out of 184 countries ranked worldwide. Albania follows immediately behind with average tobacco consumption standing at 2,491 cigarettes per person per year. The only countries in the world that are placed higher in the rankings are Andorra, Belarus and Luxembourg.

Other Balkan countries, such as Serbia and Bosnia and Herzegovina, can be found in 21st and 25th places respectively, whose consumption averages to less than 2,000 cigarettes per person annually. Kosovo is not listed in the rankings.

Despite these high placings, last year Radio Free Europe reported that while measures to reduce smoking had not been entirely effective, “smoking levels in the Balkans [were] down for the most part over the past two decades.”

Macedonia, however, is a notable exception in this regard. According to Silvana Oncheva from Macedonia’s National Institute of Public Health, there has been a 4 percent increase in the number of smokers over the last 15 years — rising from 42 percent in 2002 to 46 percent last year. In Kosovo, by comparison, smokers make up about 28 percent of the population, according to a study on smoking habits, published in the Slovenian Journal of Public Health.

Smoking related deaths and diseases are also on the rise in Macedonia, with the number of deaths from lung cancer rising between 2010 and 2016. In 2012, World Cancer Research Fund International placed the country as the 4th highest in the world for diagnosed cases of lung cancer when measured by an ‘age-standardised rate.’

However, despite the concerning public health statistics, in March this year, Macedonia’s new government passed amendments to the Law on Protection Against Smoking that have eased the ban on smoking in public places.

Smoking policies amended

When the Law on Protection Against Smoking was adopted in 2008, smoking was prohibited in all public places with the exception of adjacent terraces or summer gardens, and only then if the space in question is open from at least three out of four sides, in order to ensure an adequate air flow. This resulted in many restaurants and cafes enclosing terraces or summer gardens with flexible transparent PVC side coverings, which could be opened in dry conditions.

However, with amendments to the law passed this March, catering facilities (a broad term that covers all businesses that offer either food or drinks) will be able to designate these spaces as smoking areas, while the requirement for airflow is being removed, allowing such businesses to build roofs and walls to completely enclose these smoking zones.

The proposal for revisiting smoking legislation was submitted in July last year by several MPs, whose justification was that the introduction of the strict ban in 2008 had infringed the rights of catering service providers and facilities, their customers, and smokers.

Explaining the proposal for the legislative initiative, the MPs wrote: “Current smoking legislation has worsened the economic situation in the Republic of Macedonia, due to a drastic decline of customers in coffee shops, cafes, nightclubs, bars, cabarets, discos, breweries and gambling parlours … the catering sector is experiencing a drastic drop in turnover (about 75 percent), especially during periods when weather conditions are not favorable for work (winter, late autumn and early spring).”

The announced legislative changes were met by significant public backlash and outrage, as many saw them as a step backward for Macedonia and its attempts to improve public health. Close to 15,000 signatures were gathered for an online petition set up in an attempt to stop the proposed amendments to the law.

“Macedonia’s new flag — reforms against people’s health,” designer Nebojša Gelevski tweeted, alongside a gif showing smoke from a cigarette blocking out the sun of the Macedonian flag.

Even the Ministry of Health condemned the amendments when they were announced, tweeting that it “cannot promote easing the ban and supporting policies that are detrimental to people’s health. Smoking is a personal choice, but passive smoking is not.”

Fast-tracked legislation

In addition to their content, the amendments have also been criticized on the basis of how they have been adopted and why it was considered to be a priority at the time. The procedure for adopting the amended legislation was ‘fast-tracked,’ meaning there was very little public debate and little time to assess its consequences.

In a post on publishing platform Medium, political scientist (and smoker), Misha Popović, addressed the issue: “Why is it so urgent that it needs to be ‘fast-tracked?’ he asked. “One of the main points of criticism for the work of the Parliament is that certain legislation was fast-tracked when it did not need to be.”

In the same post, Popović continued to challenge MPs’ claims that the profit of catering providers decreased by 75 percent by sharing data from the State Statistical Office for the 2010-14 period, which shows that profits earned by caterers has steadily been increasing.

Nevertheless, legislators remained unconvinced and the amendments passed on March 15, 2018. Their response to the raised concerns was to claim that the effect from the law was being blown out of proportion and that it solely targeted adjacent terraces and summer gardens.

Popović told K2.0 that there are several aspects of the law that still remain problematic. “The law was adopted without a Regulatory Impact Assessment and the examples given during very brief public debate in the Parliament were inappropriate and very anecdotal, depicting smokers outside freezing, while there was no mention of issues such as service staff having to work in smoking areas, for example.”

K2.0 attempted to contact MPs Tomislav Tuntev and Ivana Tufegdžić, two of the signatories of the submitted initiative, to get a comment on these arising issues which were sidelined during the debate. However, we received no response.

For coffee bar owner, Luka Ginovski, better quality catering services should not be linked with smoking. “Cigarettes are no contributing factor for better quality catering. The quality of what we offer depends on other more important factors such as good service, good marketing etc.”

During April, with the amendments to the law having come into effect, smokers and non-smokers have started noticing the changes. Many of the cafes and restaurants have chosen to implement the legal solution, but not in its entirety which has resulted with non-smokers being exposed to smoke indoors, thereby limiting the number of places they can frequent.

“Although the changes in the law do not officially mean that we have returned to the situation we were in more than 10 years ago, I have already noticed several cafes leaving an open door to their closed smoking terrace, and other guests breathing in that smoke which enters the room and gets soaked in our clothes, hair and skin,” explains Maja Cvetanoska, a 46-year-old psychologist from Skopje.

Janko Smilevski, an owner of two coffee bars in Skopje, told K2.0 that he has been thinking about enclosing the terrace at one of his bars. “I’ve been thinking about investing 20,000 euros and making it a smoking zone but only if other places in the neighborhood do it. I don’t want to lose any regulars because they can smoke there and not here,” he explained. “Do I want to do it? Not really, I feel there’s no need to, but we are a 50 square meter bar, and we need to protect the number of customers we have.”

For others, the decision to invest and enclose their summer gardens meant increased profits. “We are finishing with the construction now. Other bars in the city have reported having increased profits. About 80 percent of people that go out in this city are smokers, so it makes sense to provide them with a place to smoke,” says Mane Meshkov, a bar owner from Kavadarci, a small town in Macedonia’s Tikveš wine region.

While some bar owners may be enjoying profits, according to Tobacco Atlas, smoking is damaging the Macedonian economy. A fact sheet produced by the organization claims smoking has cost Macedonia approximately 16,065 millions denars (or 262 million euros), which includes direct costs arising from health care expenditure and indirect ones arising from early mortality and morbidity which result in lost productivity.K

Feature image: Nebojsa Gelevski.