Melissa Nondorf
Tobacco use is one of the most preventable causes of morbidity and mortality worldwide2. Implementing a successful anti-tobacco campaign is often extremely problematic, though. Aside from the obvious difficulty of persuading people to give up an addictive habit that they frequently enjoy, tobacco companies and their lobbyists always staunchly oppose such measures and do everything in their power to prevent governments from getting involved and passing tobacco use reduction legislation.
Poland has been an unusual success story in the fight against tobacco use. While in the late 1980′s it held the dubious title of most cigarette-addicted nation7, now the country’s legislation for tobacco control is considered one of the world’s most progressive1. Poland is in many ways a good case study for any nation looking to formulate its own tobacco control program. The country’s history, struggles and achievements are all worth investigating to discover common threads that might work elsewhere.
Poland could be considered something of a Phoenix that has risen from the ashes of Communism. Behind the Iron Curtain, the government “effectively brib[ed] and sedat[ed] its citizens with cheap tobacco, vodka, and red meat. Keeping proportionately low prices… was a means of keeping people happy7.” Such policies also caused Poles’ health to deteriorate. Smoking though, seems to have had the largest impact, especially on men. By the end of the 1980s, over half of the non-communicable disease burden among Polish men was due to smoking. Additionally, lung cancer – a direct effect of smoking – in Polish men was among the world’s highest10. Communism was overthrown in 1989 and Poles immediately went to work transforming their society into a freer and healthier one.
Under Communism, tobacco-related health information was heavily censored10. Many people smoked without any idea of the damage they were causing themselves and others. As democracy took hold in Poland and a market economy flourished, foreign tobacco companies descended upon the country. They mounted aggressive advertising campaigns, banking on the fact that Western-brand cigarettes had been a precious and revered commodity under the old regime7. Surprisingly, national smoking levels began to decline instead of increase. The percentage of adult males who smoked dropped from an all-time high of 64% in the mid 1970s to around 60% in 1985 and then 40% by 1998. The percentages for women fluctuated from 21% in the 1970s to 34% in 1985 and 20% in 19981.
There were several reasons for this unusual result. First, Polish scientists had taken notice of the plummeting health of middle-aged men back in the 1970s and began studying its relationship to smoking. Papers were published, but the information was withheld from the public. As soon as the country began to liberalize in the 1980s though, the scientific community acted. In 1990, the year after Communism fell in Poland, the country hosted a conference at Kazimierz titled “A Tobacco-free New Europe.” This was the first time health advocates from both sides of the Iron Curtain were able to come together and formulate plans of action to lessen disparities in health and address the damage being caused by cigarettes in Eastern Europe10. Then, in 1991, Poland’s Center of Oncology initiated what has become an annual event; the ‘Great Polish Smoke-Out.’ Every year prizes are offered to people who have quit smoking6.
