Half a century of cooperation between US and Poland in health promotion and tobacco control

Both Poland and the US have made tremendous progress over the past several decades in addressing the burden of cancer through reducing tobacco use and through innovations in cancer control and treatment. For example, both countries have seen a decrease in lung cancer incidence since 2000, particularly among men, due to reductions in cigarette smoking. But this pattern of a rise and fall in cigarette smoking, followed by a similar trend in lung cancer, obscures the complexity of efforts to control tobacco use that were responsible for this dramatic reversal.
In the US, following publication of the 1964 report of the Surgeon General on Smoking and Health, a warning label was added to cigarette packages. However, this did not lead to an immediate drop in cigarette consumption. Indeed, it was not until 20 years later, in the 1980s, that we begin to see a sustained drop in cigarette consumption. This drop was largely due, not to specific government actions, but to the development of a strong anti-tobacco advocacy movement and non-smokers rights movement which began to push for policies restricting smoking in public places and change public attitudes towards cigarettes. Poland would follow a similar trajectory a few years later as a civil society tobacco control movement developed in the 1990s, with support from US advocates.
The US and Poland have a lengthy history of bilateral cooperation in health, dating back to the 1960s when the US supported cancer research projects in Poland under the Foreign Assistance Act. Following the 1971 National Cancer Act, which expanded the international work of the National Cancer Institute, the US and Poland signed a bilateral agreement to collaborate on cancer research through the Institute of Oncology in Warsaw. This was one of the first such international agreements the US signed for cancer research (following agreements with the USSR and Japan). At the same time, the US tobacco industry was making inroads into Poland. In December 1973, the Crackow Tobacco Industry Plant began production of Marlboro cigarettes made under contract with Philip Morris, purportedly using only American tobacco.
During the years 1989-1991, the Polish State was transformed as the Communist party lost power and the country moved towards a capitalist market. At the time, multinational tobacco companies rapidly entered Poland, keeping cigarettes prices low, lobbying politicians, and building state of the art factories. In the early 1990s over half of all billboards in Polish cities were used to advertise cigarettes. They also targeted women and youth with advertising. At the same time, while aggressive tobacco control policies were being introduced in the US in the 1990s, this approach did not always extend to US acti­vities abroad. The US government was actively promoting greater exports of US tobacco products and threatening trade sanctions to open up markets for US cigarettes. And the US government was also subsidizing sales of US tobacco to Poland.
As a civil society tobacco control movement deve­loped in Poland, the movement received assistance from US groups. The movement was successful in advancing tobacco control legislation and turning Poland into a tobacco control success story. In 1990 ‘A New Tobacco Free Europe’ conference held in Kasimierz, organized with help from UICC and the American Cancer Society, called for advertising ban, a ban on smoking in public places, tar level reductions, cyclical health warnings, regular tax increases, and a major ongoing health campaign. The Health Promotion Foundation, established in 1991, successfully advocated for a national tobacco control law, enacted in 1995. By 1999 Poland had introduced a complete advertising ban for cigarettes, and the following year the billboards were gone. US support for these efforts came not from US government policy, but from journa­lists, voluntary organizations, and activists.

DISCLOSURE

The author reports no conflict of interest.

Mark Parascandola is Director of the Research and Training Branch in the Center for Global Health at the NCI. He has authored over 75 published articles on global cancer prevention, implementation science, and tobacco control. Dr. Parascandola served as an Embassy Science Fellow and advisor on tobacco control and air pollution at the U.S. Embassies in Beijing and Warsaw.