Reflections on a half-century of Polish-U.S. cooperation on health and tobacco control

In my brief contribution, I want to discuss the power of international alliances in promoting research and good health. I would address this issue in the context of tobacco control and, specifically, using Poland as a prime example of the value of international alliances. The story may be eye-opening for those of you who are under 40 years old or so, and promote “Oh, I remember that!” for those of you who are over 40.
I first came to Poland in the Autumn of 1990. It was a time of great change – the communist system had 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 spectre of the Soviet Union hovering over their daily lives.
And yet, at that time, Poland – perhaps in spite of the dizzying events that began in the late 1980s, 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, then of the Marie Skłodow­ska-Curie Cancer Centre in Warsaw. Witold and I had met a couple of years before, when he came through Washington, DC and came to the National Cancer Institute, and I think, right away, we saw the potential for alliances between our two countries. There was already an agreement in place between our two organisations, and we then involved Dr. Federico Welsch, who was the Director of International Affairs at the National Cancer Institute, and he also saw the potential for an alliance. Witold invited Federico and I 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.
The task before us was formidable – over 40% of Polish men were dying prematurely from smoking- attributed diseases, 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 – you could not walk down Nowy Swiat, the main street in Warsaw, without seeing an array of tobacco advertisements, and there was little in the way of an organised Polish public health response to the economic and health costs of tobacco use.
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 – there was also some reason for optimism. The Solidarity movement in the 1980s 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 organised 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 [ref. publication on Kazimierz meeting].
Importantly, Dr. Zatoński and his colleagues, notably Mr. Krzysztof Przewoźniak, had the foresight to seek support for the conference from, and closely involve, international organisations such as the U.S. National Cancer Institute, the World Health Organisation, and the American Cancer Society. These alliances were essential in moving things forward in Poland and enabled budgets to be met, more experts to be involved, and they enabled the longevity of the projects. So, I cannot emphasise enough the importance of these alliances.
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 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, but its positive effects can also be felt and seen in the Poland and Eastern Europe of today, a generation later.
While research has clearly demonstrated that no single event or policy, or alliance, can ever be held responsible for success in tobacco control (or control of any other health risk, such as alcohol abuse or obesity, as has been discussed at this conference), 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, the alliances, and the subsequent founding of the Health Promotion Foundation in Warsaw in 1991, still in existence today, 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 Organisation’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 [ref. publication on Smoke-out] 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.
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 second-hand smoking is needed, sales on menthol and so-called “new tobacco products” need to be addressed, 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 1980s and 90s, and eventually ending the stranglehold that tobacco and the tobacco industry has held over Poland, but that has been substantially loosened over the past generation.

DISCLOSURE

The author reports no conflict of interest.