Poland’s anti-tobacco advocacy – a historical outline

The topic of Polish anti-tobacco efforts could be of considerable interest to public health experts around the world. The success of Poland, which from a country with the highest smoking prevalence in the world in the 1980s, turned into a regional leader in tobacco control in the 1990s, can be a useful blueprint for developing countries which today face similar challenges to Poland 25 years ago. This paper offers a short historical outline of the anti-tobacco movement in Poland.
The founder of the post-war anti-tobacco movement in Poland was a rather unlikely figure. Alfred Jaroszewicz was a secret service operative before World War II. After the war, during the purge within the ranks of Polish communists, he was arrested and spent 8 years in prison. After his release in 1956 Jaroszewicz moved to London. His stay in England coincided with the publication of pioneering studies of English and American scientists on the causal relation between smoking and lung cancer and cardiovascular diseases, as well as the onset of the debate about the stricter regulation of tobacco products in these countries. Jaroszewicz must have been strongly influenced by this new information on smoking harm, because soon after his return to Poland in 1960 he established the Interministerial Committee for Limiting Smoking at the Ministry of Internal Trade, of which he was director. In 1964 Jaroszewicz’s organisation was transformed into the Social Committee for Limiting Smoking [1].
Archival documents indicate that in the first decade of its existence the activity of the anti-tobacco movement in Poland was limited to the internal struggle for influence between its central authorities and its regional branches, Jaroszewicz’s attempts to obtain the status of higher public utility for his organisation from the government (which would mean higher public subsidies), and the production of anti-smoking leaflets [2].
The Committee’s activity increased somewhat in the 1970s, when Bogusław Kożusznik, a former Vice-minister of Health, became its President. It was partly thanks to the efforts of the Committee that in 1974 the Minister of Health issued a decree banning smoking in healthcare facilities and in Ministry of Health offices, and calling on the rest of the public administration to introduce similar restrictions [3]. Despite, or maybe because of the progressive nature of this legislation, it was widely ignored. The authorities were fully aware of this, which was confirmed by governmental analysis of the legislation’s implementation from the mid-1980s [4]. Undoubtedly, the Committee was unsuccessful in shaping healthier attitudes towards smoking among Poles. Tobacco consumption in Poland increased almost fourfold, from 1000 cigarettes per adult in 1949, to 3600 cigarettes in 1979 [5].
In 1979 the Committee was transformed into the PTP – Polish Anti-tobacco Society. The system of monitoring smoking trends in Poland was improved, and from 1980 the Cancer Institute in Warsaw began conducting annual studies on smoking prevalence among different socio-demographic groups. PTP collaborated with healthcare and educational institutions, providing them with anti-tobacco literature and organising anti-tobacco lectures and talks throughout the country [1]. The anti-tobacco advocates in the 1980s were also able to involve media more actively in disseminating information about smoking harm. One manifestation of this was the weekly radio show “Before you light up – listen up” in Channel 2 of the Polish Radio, and numerous articles about the negative effects of smoking in the popular “Evening Express” newspaper. From 1988 Poland participated in the World No Tobacco Day. PTP also collaborated closely with medical organisations and religious groups (the leaders of the Seventh Day Adventist Church in Poland, Stanisław Dąbrowski and Prof. Zachariasz Łyko, were particularly involved in the fight against smoking in this period). What might seem puzzling from today’s perspective is that the PTP also collaborated with the state tobacco industry. It was hoped that this co-operation will help to push the producers to supply the market with less harmful and carcinogenic cigarettes [6, 7].
The PTP frequently released official declarations of collaboration with state institutions. In 1984 PTP’s President Bogusław Kożusznik wrote that “visits paid to the representatives of the state authorities always constituted a positive and inspirational element in the history of the movement” [1]. Some senior politicians were personally very involved in the anti-tobacco movement, including the Secretary of State in the Ministry of Health, General Dr. Jerzy Bończak. Despite this, the PTP was unable to persuade the decision-makers to introduce legislation which could help arrest the development of the smoking epidemic in Poland. Two attempts were made in the 1980s, in 1983 and 1988. In both cases the legislative proposals originated from the Ministry of Health, and in both cases they contained very progressive proposals suggested by the PTP, including a ban on smoking in many public places, bars, restaurants and trains, a ban on the sale of tobacco products to minors, introduction of health warnings on cigarette packages, and the creation of a significant anti-tobacco fund. Unfortunately, in both cases the policymakers failed to pass the legislation [8, 9].
The contrast between the unprecedented scale of smoking in Poland and the unwillingness to address it using legislative means on one hand, and between the complete understanding of the health and social harm of smoking in the scientific circles in Poland on the other, can be surprising. Polish specialists, such as Tadeusz Górski, or Józef Granatowicz in Poznań, the founder of Poland’s first smoking cessation clinic, already in the 1960s and 1970s, led pioneering research on the treatment of tobacco addiction using drugs with central action on the brain’s nicotine receptors [10]. Organisations such as the PTP or the Polish Medical Association collaborated closely with public health experts from western countries and already in the early 1980s organized international conferences devoted to the protection of children and adolescents from smoking [11]. Legislative proposals of the PTP from this period were strikingly similar to the Anti-tobacco Law passed several years later and enacted in 1996 [12]. And yet, at the same time the authorities made decisions which deepened Poland’s tobacco epidemic, such as the introduction of ration stamps for cigarettes in 1981, which were given to every adult citizen. This decision led to an increase in the number of smokers by one million in the following year [13]. The opposition anti-communist movement had a similarly carefree attitude to smoking. During the first countrywide convention of Solidarity delegates in October 1981 the news was broken that the government is intending to increase cigarette prices. Lech Wałęsa, the Solidarity leader, to great applause of the delegates and in the presence of the Minister of Finance, announced that if the rise is not stopped, “We’ll have a riot. We can control it, but whether you can control us, I doubt that” [14].
It is hard to understand the dissonance between this theoretical understanding of what needs to be done with smoking in Poland, and the lack of political will to introduce these measures. In the 1980s tobacco consumption in Poland oscillated around 3500 cigarettes per person per year and in this period Poland was the country with one of the highest levels of smoking prevalence in the world [15]. Both the production and the sale of cigarettes were a state monopoly, and the prices of cigarettes were kept on a low level. The World Health Organization estimated that half of all premature deaths among Polish men at this time were linked to smoking [16].
The situation in Poland after the regime change of 1989 did not augur well for the future of public health in the country. Transnational tobacco companies quickly entered the Polish market. They invested $100 million annually on publicity of their products, conducted aggressive lobbying among politicians, and kept cigarette prices low. The American company R.J. Reynolds, the producer of Camel cigarettes, in the early 1990s built an ultramodern cigarette factory in the town of Piaseczno outside Warsaw. It became the symbol of the expansion of transnational tobacco companies into Poland. Internal documents of the tobacco industry indicate that the development of Central and East European markets was their strategic priority, especially as in many western countries a decline is smoking prevalence has been observed for some time already. Tobacco companies predicted that in the 1990s the sale of cigarettes in Poland will increase by between 10% and 20% [17, 18].
Yet, contrary to those predictions, the collapse of communism was followed by a decline in cigarette consumption by 10%. Some of the most progressive anti-smoking laws in the world were passed by the Polish parliament in the 1990s, prohibiting smoking in workplaces, banning tobacco advertisements and introducing the largest health warnings on cigarette packs in the world [12]. The factory built by R.J. Reynolds in Piaseczno went bankrupt just a few years after its opening.
The harbinger of change was the summit of Central and East European anti-tobacco advocacy leaders in Poland in November 1990. The conference on “A Tobacco-Free New Europe” was organized by the PTP, under the patronage of Lech Wałęsa, and in collaboration with the International Union Against Cancer and the American Cancer Society. The conference culminated with the Kazimierz Declaration, a call by the delegates to the Polish government, and other governments of the region, to implement comprehensive anti-tobacco legislation and strengthen tobacco control programs. The Polish health advocates, coalesced around the newly formed Health Promotion Foundation1, focused their effort on lobbying politicians to achieve this goal. From this point on, a change could be observed in the approach of policymakers to the problem of smoking in Poland [19].
Legislative proposals aiming at tackling smoking harm quickly began to appear in the Parliament. In 1991 the Sejm (lower chamber of the Parliament) passed a resolution calling the government to increase the level of the tobacco products sales tax, and spending the extra income on the treatment of tobacco-related diseases. Throughout the early 1990s the debate on the privatization of the Polish tobacco industry both sides heavily employed health arguments. In October 1991 the Polish Senate (the upper chamber of the Parliament), represented by senator Maciej Krzanowski, proposed to the Sejm a resolution calling for a bill that would address the health consequences of smoking. In July 1992 senator Adam Struzik initiated the legislative process for such a bill. In October 1994 the Sejm accepted an appeal by MP Grzegorz Marciniak, in which the MPs he urged the government to present a comprehensive anti-tobacco programme. The culmination came in November 1995, when the Sejm passed the Law for the Protection of Health from the Consequences of using Tobacco and Tobacco Products. The Anti-tobacco Law was strongly supported throughout the legislative procedure by the Sejm Health Committee and its chairman, MP Seweryn Jurgielaniec. After a brief delay linked to the veto of the outgoing President Lech Wałęsa, the Law was restored, at the urging of the anti-tobacco advocates, by the incoming President Aleksander Kwaśniewski. It was implemented in May 19962.
The Anti-tobacco Law, amongst others, limited smoking in public places, established the first governmental programme to reduce smoking prevalence in Central and Eastern Europe, and, most importantly, introduced the largest health warnings on cigarette packaging in the world [12]. The World Health Organisation declared that the Polish Anti-tobacco Law is an “example to the rest of the world” [20].
Of course one might, and should, ask why the legislation wasn’t passed sooner than in 1995 and why a ban on tobacco advertisement was introduced only in the year 2000. It must however be underlined that the legislation, and the broad social anti-tobacco movement that developed around it, have completely changed the attitudes of Poles towards smoking. As a result, it helped to turn around the negative health trends Poland has been experiencing in the previous decades3. Over 500,000 Poles declared every year that the Great Polish Smoke-out organized by the Health Promotion Foundation helped them to make a quit attempt [19]. In a report prepared by the European Commission in 1998 Poland was ranked as the country with the best anti-smoking climate in Europe [21]. Poles expected that the government will as much as possible to decrease smoking prevalence in Poland. The Anti-tobacco Law both helped fulfil these expectations, and served to continue building the health literacy of Poles.

DISCLOSURE

Author reports no conflict of interest.

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