Poland’s journey to effective tobacco control – a brief memoir

I first came to Poland in the Autumn of 1990. It was a time of great change – communist system has recently fallen apart and democracy was on the doorstep, the countries to the East of Poland which had been under Soviet domination for generations were now free, and even the countries of Central and Eastern Europe, including Poland, did not have the specter of the Soviet Union hovering over their daily lives.

A Nation in Turmoil

And yet, at that time, Poland – perhaps in spite of the dizzying events that began in the late 1980’s, or perhaps because of them – was a nation of contradictions. There was rampant anxiety about an uncertain future and there was immense optimism about the potential for Poland taking its rightful place on the world stage. There was hope that a society that had been dominated by a system of government that did little to promote individual freedom could now express itself and there was concern that freedom itself was so fragile that it could again be taken away. I came to that Poland of contradictions at the invitation of Dr. Witold Zatoński of the Marie Skłodowska- Curie Cancer Center, to participate in the first of what became a series of ground-breaking conferences devoted to improving the health of the Polish people, as well as the newly freed countries of the former Soviet Union. Our focus was to be on alleviating the health burden of cigarette smoking which, in 1990, was the largest preventable cause of premature death in Poland and the former Soviet republics [1, 2]. The task before us was formidable – over 40% of Polish men were dying prematurely from smoking-attributed diseases [3], Poland was in the early stages of moving to a market economy which was opening the doors in Poland, and the nations further to the East, to the multinational tobacco companies, tobacco advertising was rampant, on trams, billboards, and even clothing, and there was little in the way of organized Polish public health response to the economic and health costs of tobacco use.

Flickers of Hope

While the health conditions in Poland in 1990 were very discouraging – there were exceedingly high rates of lung cancer, cardiovascular diseases, liver cirrhosis, infant mortality, and sudden deaths from a variety of external causes (e.g. accidents, poisoning, etc.) – there was some reason for optimism. The Solidarity movement in the 1980’s had demonstrated, to a Polish citizenry unfamiliar with the concept, that advocacy was an option for advancing public policy, the newly emboldened influence of the Catholic Church and its Polish leader Cardinal Józef Glemp enabled the Church to begin addressing the pressing health issues in Poland, and science and medical professionals had begun to understand that they could influence the direction of public health in Poland not only by practicing good science and medicine but also by becoming advocates for policies that could reduce the burdens of death and disease in Poland and, by extension, the nearly equally appalling health conditions in the former Soviet republics to the East. This was the context in which the conference that Dr. Zatoński organized in late 1990 was held. Global experts in tobacco control, especially from countries and regions where good science and advocacy had begun to turn the tide against tobacco, spoke and taught at the conference to an audience of less experienced, but nevertheless enthusiastic, scientists and medical professionals from Poland and the former Soviet republics. Importantly, Dr. Zatoński and his colleagues, notably Mr. Krzysztof Przewoźniak, had the foresight to seek support for the conference from, and closely involve, international organizations such as the U.S. National Cancer Institute, the World Health Organization, and the American Cancer Society. While this conference, held in Kazimierz, Poland, engaged and activated hundreds of tobacco control advocates not only in Poland and Central and Eastern Europe, its lasting contribution was the so-called Declaration of Kazimierz, which provided a clear road map for tobacco control efforts throughout the region. The influence of this Declaration, and the history of tobacco control in Poland and the region has been eloquently told elsewhere [4], but its positive effects can be felt and seen in the Poland and Eastern Europe of today, a generation later.

A Tobacco Control Model

While research has clearly demonstrated that no single event or policy can ever be held responsible for success in tobacco control (or control of any other health risk, such as alcohol abuse or obesity), the Kazimierz Conference, and its subsequent conferences, were held at an exceptionally opportune time in Poland. The timing of these conferences, the leadership which understood the need for international involvement, and the subsequent founding of the Health Promotion Foundation in Warsaw in 1991, put in place the elements required for acting on the recommendations of these conferences.
Today, Poland is a model of tobacco control success – it was an early signatory to the World Health Organization’s Framework Convention on Tobacco Control, it has strong, and enforced, tobacco control legislation, tobacco advertising is banned, tobacco warning labels are prominent, the Great Polish SmokeOut and World No Tobacco Day events annually encourage many thousands of Polish smokers to consider quitting, and tobacco-related disease and premature mortality are in retreat. The tobacco haven I encountered in Poland when I arrived in 1990 is a relic, a thing of the past. Yet, of course, there is more to be done if Poland is to continue its recent history as a role model for tobacco control, both to its own citizens and the countries in Central and Eastern Europe that it aided in addressing the tobacco menace when they were most vulnerable. A complete ban on smoking in public places remains elusive, more education on the dangers of secondhand smoking is needed, sales on menthol and so-called “slim” cigarettes need to be halted, and a progressive plan of tobacco pricing and taxation needs to be put in place. If history serves as a guide, however, Poland will continue its heroic efforts to become a smokefree society, seizing upon opportune moments, creating a new generation of tobacco control leaders, building on the civic movements built in the 1980’s and 90’s, and eventually ending the stranglehold that tobacco has held over Poland, but that has been substantially loosened over the past generation. I look forward to my next visit to Poland – I will be grayer than when I came in 1990, but the skies will be clear, blue, and smoke free.

Disclosure

Author reports no conflict of interest.

References

1. Doll R, Peto R, Bjartveit K, et al. Tobacco and death in Eastern Europe. In: Cancer Prevention in Europe. Bodmer W, Zaridze D. (eds.). Organization of European Cancer Institutes, London 1993; 71-97.
2. Feachem R. Health decline in Eastern Europe. Nature 1994; 367: 313-314.
3. Jassem J, Przewoźniak K, Zatoński W. Tobacco control in Poland – successes and challenges. Transl Lung Ca Res 2014; 3: 280-285.
4. Zatoński M. Poland’s anti-tobacco advocacy – a historical outline. J Health Inequal 2016; 2: 26-31.