In the late 1970s and early 1980s, Poland had one of the world's highest tobacco use rates: most 14 million Poles were smokers (62% of all men, 30% of all women) who smoked daily and over 3500 cigarettes each year, making Poland first in the world in 1992 (Jacek et al., 2014). The health effects were equally formidable, for example, 71% of middle aged men had tobacco-caused respiratory disease, and among the highest rates of lung cancer in the world (Levine, 2007).
Beginning in the 1980s however, and especially after the end of the Cold War and the transition to democratic reforms including political lobbying and the right to a free press, the culture of smoking in Poland began to change for several reasons. First, the public finally received information about the health risks to smoking from a variety of sources: Poland's scientific community set out the health risks associated with smoking, releasing a report on smoking's health impact linking smoking and cancer outbreaks in Poland; and non-governmental organizations (NGSs) formed to educate the public about smoking, lobby Poland's policy-makers to make stiffer laws, and they partnered with international organizations the World Health Organization to back their activities and help with their education and lobbying objectives. Further, post-Communist free media meant the publication of scientific studies and other anti-tobacco information that turned public opinion against smoking, which impacted legislation (Levine, 2007). And, countries like the United States, through Global Health Initiatives, started to see an improvement in global health, especially a cessation in smoking, as critical to its own national security and supported NGOs through the WHO to support smoking cessation programs, and to decrease the health risks ("Global Health").
Public pressure led to a comprehensive law in 1995, which Jacek et al. (2014) argue was the most successful action to control tobacco in Poland. The law banned smoking ad the sale of cigarettes at schools, health centers and enclosed workspaces, no selling to minors, ban on smokeless tobacco and electronic media advertising, and health warnings on cigarette packages, and free treatment to kick the habit. Increased anti-tobacco public initiatives like the "Let's Stop Smoking Together" held each November to encourage all Poles to quit, which is promoted by schools and the Catholic Church. Between 200,000 and 400,000 Poles say they quit because of this one campaign (Levine, 2007). Finally, the government ended artificially low tobacco prices by increasing taxes and consequently the price (Levine, 2007).
These initiatives worked: by 2000, less than 10 million smoked, with 40% of men and 20% of men. This reduction in smokers has lowered the mortality rate by 10% in the 1990s, and the cancer rate for men between 20 and 44 years of age fell from 44% to 30%. Life expectancy in Poland increased by over four years, too.
Kaleta et al. (2014) argue, however, Poland's tobacco use, along with the rest of the developing world, has revered trend and is back on the rise. They note that perhaps it is due to the initial decrease in light smokers, leaving the hardcore smokers to continue smoking. So, the real issue now is how to help hardcore smokers quit, with hardcore smokers defined as: smoked for at least five years, smoke 15+ cigarettes per day, and in the past year no attempt to quit, and no expected attempt in the next year. As anticipated, hardcore smokers started smoking before the age of 18: urban residents had a higher chance of becoming hardcore smokers, many of the hardcore smokers grew up in smoking households, and many people in the study still had no clear idea about health risks. Age that one starts smoking is a significant risk factor for becoming a hardcore smoker in Poland. Most hardcore smokers in Poland are middle aged, and many started to smoke just as the anti-smoking push started (although was not in full steam in the mid-1990s) or were established smokers.
Clearly, Poland's anti-smoking education is still lacking. And, Poland also lagged Europe and other countries in placing bans on public smoking. In 2003, Poland ratified a WHO framework to end smoking in public. However, Poland did not institute a smoking ban in public places, including public transportation, schools, workplaces, sporting events, until November 15, 2010 ("Smoking in Poland"). However, tobacco production is up, and women continue in 35-44 age bracket to smoke, giving Poland one of the highest prevalence rates of women smokers in the world, and the percentage of smokers in Poland is particularly among less educated and employed, up to 50% of all men. Nonetheless, there are still successes. After the ban in public smoking, exposure to smoke has dropped considerably, with a huge decline in children's second hand smoke (a drop to 6%, from 19%). And, less cigarettes are being sold in Poland, rates from coronary heart disease deaths down 50%, even though the cost is still cheaper than all of Europe (Jacek et al., 2014).
What social and political factors allowed cigarette smoking to become a part of the Polish culture?
The main political factor was the government's clear conflict of interest. Up to the end of the Cold War, the state ran the tobacco industry and Poland was one of the largest tobacco producers in Europe (Jacek et al., 2014). Thus, tobacco was a significant source of the Polish government's revenue; so, the government had a clear interest in preventing the known health risks from being published to the public. Among Europeans, Poles were the least informed about the hazards of smoking. A second political issue was that the few tobacco laws the government had enacted were not enforced because the economy was continuously in difficulty (Jacek et al., 2014). And, Levine (2007) suggests that tobacco revenue was used as a hedge against a loss in revenue during economic downturn, therefore, the government had no incentive to pass legislation curtailing smoking. After the end of the Cold War, initially, as the tobacco industry was privatized, cigarettes were even more abundant, with new and cheaper popular brands (the government forced the new tobacco multinationals to keep prices artificially low). Also, democratization meant more aggressive marketing, with $100 million spent, making tobacco the number one marketed product in the country. As such, the tobacco industry could aggressively market to children, 11 to 15 years of age, which contributed to a rise in smoking throughout the 1990s (Levine, 2007).
Moreover, smoking, then, was a socially acceptable practice, since it was not linked to adverse societal effects, like the significant health risks. Smoking in homes, exposure of children and non-smokers to second hand smoke, was also not considered to be socially abhorrent behavior (Jacek et al., 2014).
ReferencesGlobal health (2017).
Jacek, J., Przewozniak, K., & Xatoriski, W. (2014). Tobacco control in Poland - successes and challenges. Transl Lung Cancer Research, 3(5), 280-285.
Kaleta, D. et al. (2014). Prevalence and factors associated with / hardcore smoking in Poland: Findings from the Global Adult Tobacco Survey (2009-2010). BC Public Health 14(583). Doi: 10.11186/1471-2458-14-583
Levine, R. (2007). Case studies in global health: Millions saved. Sudbury, MA: Jones and Bartlett Learning.
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