Small bottles – huge problem? A new phase of Poland’s ongoing alcohol epidemic

Alcohol consumption is, alongside tobacco smoking, the leading cause of morbidity and premature mortality of young and middle-aged adults (20-64-year-olds) in Poland. As much as 25% of premature deaths in Poland are alcohol related [1-14]. Both these factors are crucial in understanding why premature mortality in this age group in Poland is so high, at around 100,000 deaths per year. The percentage of deaths before the age of 65 years in Poland is among the highest in Europe, and over twice as higher as in Western Europe (see slides 33 and 34 in Webappendix 2 in the “One hundred years of health in Poland” presentation) [6].
Alcohol consumption in Poland has rapidly increased since the beginning of the 21st century. This trend followed the decision of the Polish government to cut the excise duty on spirits by 30% in 2002 (Fig. 1) [15-17]. In the years 2003-2008 annual vodka consumption rates doubled from 1.7 litres of pure alcohol per capita to 3.4 litres. In 2001 the rules on beer advertising have also been loosened (beer could be advertised on television from 8 p.m.) [17-19]. This might have contributed to the rapid increase in beer consumption, from 3.7 litres of pure alcohol per capita in 2000 to 5.2 litres in 2008. Poland, traditionally a country with one of the highest levels of vodka consumption in Europe, also became one of the countries with the highest beer consumption, trailing only Czechia, Austria, and Germany. In 1989 annual beer consumption in Poland stood at 30 litres per capita, and in 2016 it was about 100 litres [10].
In the years 2008-2009 the spirits industry began implementing a new business strategy and promoting small vodka bottles (SVBs) – 100 ml or 200 ml capacity, usually flavoured [20, 21]. A report published by the research company Synergion in May 2019 estimated that more than 1 billion SVBs are sold every year [20]. Moreover, the sale of SVBs increased by almost 10% in 2018. Currently, SVBs account for 17% of the entire vodka segment. Over half of all Poles drink SVBs once a month or more often, 54% of their consumers are women and 46% are men. In 2018, 3 million SVBs were sold each day. According to the Synergion report, 28% of SVBs are sold between 6 a.m. and 12 a.m. SVBs are equally popular in all socioeconomic categories [20, 21].
The growing popularity of SVBs may be the result of a combination of easy availability, wide variety of flavours catering to a range of tastes (in 2017 there were 46 varieties), convenience, and their discrete character. SVBs can be consumed easily and quickly. Their prices are extremely low (vodka costs around 5 zł/€1.15 per 100 ml) [14, 20].
There is some indication that these changes have been altering the pattern of alcohol consumption in Poland, which seems to be changing from weekend binges to a new style of daily drinking. This consumption pattern may result in a state of continuous alcohol exhilaration, while drinkers may not exceed the legal limit of sobriety.
The phenomenon of SVBs has attracted much media interest but little research from public health experts. The lack of reliable data makes it impossible to draw conclusions on the actual scale of the phenomenon. The Synergion data have been disputed in the media by the Polish vodka industry, which argues that the numbers are exaggerated. However, no independent research exists which could help verify any of those claims [20, 25].
Interdisciplinary research, involving epidemiologists, economists, sociologists, and other scholars, is urgently needed to gauge the social and commercial underpinnings of this emerging alcohol problem, and its implications for public health. Its results should motivate much-needed political and regulatory actions. This is particularly urgent given that epidemiological analyses indicate that the observed stalling and than the freezing of the health improvement in Poland in recent years is most likely related to the increase in alcohol consumption (see as well Zatoński W. One hundred years of health in Poland on pages 11-19; Zdrojewski T. Completing the cardiovascular revolution: smoking, alcohol, diet, and air pollution on page 38; Moskalewicz J. Evolution of alcohol policy in Poland during the transition period on page 41) [12, 22-28]. Finally, it is crucial in mitigating the health consequences of the new strategies of the alcohol industry, which in recent years has been trialling selling spirits in even smaller containers, such as 40 ml plastic shot glasses sold in retail stores for about 2 zł/€0.45 [29].

ACKNOWLEDGEMENTS

Authors would like to thank Katarzyna Rosik and Kinga Janik-Koncewicz for their valuable help in preparing the article.

DISCLOSURE

The authors report no conflict of interest.

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AUTHOR’S CONTRIBUTIONS
WAZ prepared the concept of the article. IM, MZ and ŁG prepared the draft version. All authors contributed to preparing final text of the publication.