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Curbing Tobacco Use in Poland

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Curbing Tobacco Use in Poland Case 14 Curbing Tobacco Use in Poland Geographic area: Poland Health condition: In the 980s, Poland had the highest rate of smoking in the world. Nearly three quarters of Polish men aged 20 to 60 smoked every day. In 990, the probability that a 5-year-old boy born in Po- land would reach his 60th birthday was lower than in most countries, and middle-aged Polish men had one of the highest rates of lung cancer in the world. Global importance of the health condition today: Tobacco is the second deadliest threat to adult health in the world and causes in every 0 adult deaths. It is estimated that 500 million people alive today will die prematurely because of tobacco consumption. More than three quarters of the world’s .2 billion smokers live in low- and middle-income countries, where smoking is on the rise. By 2030, it is estimated that smoking-related deaths will have doubled, accounting for the deaths of 6 in 0 people. Intervention or program: In 995, the Polish parliament passed groundbreaking tobacco-control legisla- tion, which included the requirement of the largest health warnings on cigarette packs in the world, a ban on smoking in health centers and enclosed workspaces, a ban on electronic media advertising, and a ban on tobacco sales to minors. Health education campaigns and the “Great Polish Smoke-Out” have also raised awareness about the dangers of smoking and have encouraged Poles to quit. Impact: Cigarette consumption dropped 0 percent between 990 and 998, and the number of smokers declined from 4 million in the 980s to under 0 million at the end of the 990s. The reduction in smok- ing led to 0,000 fewer deaths each year, a 30 percent decline in lung cancer among men aged 20 to 44, a nearly 7 percent decline in cardiovascular disease, and a reduction in low birth weight. nly two major causes of death are growing As Poland’s story shows, there is reason to hope that worldwide: AIDS and tobacco. While the concerted efforts to tackle the growing smoking prob- course of the AIDS epidemic is uncertain, one lem in low- and middle-income countries can succeed. Ocan be more sure that current smoking pat- In many instances, this will likely take a very high level terns will kill about 1 billion people this century, 10 times of political commitment—enough to counter the sig- more than the deaths from tobacco in the 20th century.1 nificant economic influence of the tobacco industry—as Much of this burden will fall on poor countries and the well as state-of-the-art communication strategies to poorest people living there. While smoking rates have fall- induce major shifts in attitudes toward smoking. en in rich countries over the past two decades, smoking is on the rise in developing countries.2 Currently, more than Lighting Up: Dangers of Tobacco three quarters of the world’s 1.2 billion smokers live in low- and middle-income countries, and smoking-related Smoking causes an astonishingly long list of diseases, deaths are estimated to double in number by 2030. leading to premature death in half of all smokers. To- bacco is implicated in numerous cancers including blad- Case drafted by Molly Kinder. der, kidney, larynx, mouth, pancreas, and stomach. Lung CURBING TOBACCO USE IN POLAND cancer is the most common disease caused by smoking, combat the addictive nature of nicotine, those seeking and overall, smoking is responsible for about one half of to reduce cigarette consumption are stymied by the fact all cancer deaths.3 Smoking is also a major cause of car- that smoking is an ingrained social norm whose popu- diovascular diseases, including strokes and heart attacks, larity is sustained through billions of dollars worth of and of respiratory diseases such as emphysema. Addi- cigarette advertising (which in the United States alone tional health threats are emerging as research advances. totaled over $11 billion in 2001).9 Moreover, many A recent study in India found that smoking accounts for smokers in developing countries are unaware of the link about half of the country’s tuberculosis deaths and may between smoking and health—just as was the case in the well be increasing the spread of infectious tuberculosis.4 United States and other industrialized countries before the mid-1960s. In China, for example, a survey discov- Cigarette smoking takes a heavy toll not only on smok- ered that more than half of Chinese smokers and non- ers but also on those around them, particularly young smokers thought that smoking did “little or no harm.”10 children. Passive smoking (inhaling smoke in the sur- rounding air) contributes to respiratory illnesses among Although changing the behavior of smokers is daunt- children including ear infections, asthma attacks, sinus ing, it can be done—and it has been done. Governments infections, and throat inflammations. Tobacco use in and civil society can implement proven and highly and around pregnant women can contribute to sudden cost-effective interventions to control tobacco use. infant death syndrome, low birth weight, and intrauter- Governments have at their disposal a range of legislative ine growth retardation.5 measures that can limit the supply of cigarettes and pro- mote nonsmoking behavior, including increasing taxes Smoking places an economic burden on individuals, on tobacco products; limiting tobacco advertising and families, and societies chiefly because of its massive promotion; limiting the harmful ingredients in tobacco death and disability toll and also because of the high products; requiring health warnings on products and cost of treatment, the value of lost wages, and the diver- advertisements; and establishing “nonsmoking” ar- sion of income from other basic needs such as children’s eas.2,8,10 Both the government and civil society can work food.6 Because the poor are more likely to smoke than to educate the public about the negative health effects of their rich neighbors, the economic and health impact smoking. of smoking disproportionately burdens the poor. In Poland, most of the gap in risk of dying early between Implementation of such interventions requires high lev- uneducated and educated men is due to smoking.7 els of political commitment, as well as the determination Furthermore, because cigarettes claim the lives of half of and energy of civil society and antitobacco advocates to their users, often during their prime years, smoking robs counter commercial interests. Tobacco companies are countries of valuable labor and strains health systems. well financed and have played a key role in thwarting progress in tobacco control internationally.11 Curbing Tobacco Use Poland: Highest Cigarette Consumption Compared with controlling other health scourges, in the World stopping the deadly effects of smoking requires chang- ing personal behavior rather than undergoing complex Before the fall of the Berlin Wall in 1989, Poland had medical procedures. Preventing smoking-related cancer the highest cigarette consumption in the world. In the and respiratory disease simply requires that smokers late 1970s, the average Pole smoked more than 3,500 quit smoking and that fewer people light up their first cigarettes each year. Nearly three quarters of Polish men cigarette. Because most tobacco deaths over the next aged 20 to 60 smoked every day, and by 1982, 30 percent few decades will occur among today’s smokers, getting of adult women smoked regularly.12,13 adults to quit is a special priority.2,8 The impact on the health of Poles was staggering. In However, despite the clear health and economic benefits, 1990, the probability that a 15-year-old boy born in quitting is extremely difficult. In addition to having to Poland would reach his 60th birthday was lower than CURBING TOBACCO USE IN POLAND most countries in the world—even India and China. 10 percent a year. As a result, smoking rates in the early Half of these early deaths were attributable to tobacco 1990s climbed steadily, particularly among children consumption.12 Middle-aged Polish men had one of aged 11 to 15.12 the highest rates of lung cancer in the world—higher than every European country except for Hungary—and Roots of the Tobacco-Control other smoking-related illnesses, such as laryngeal and Movement oral cancer, were at all-time high levels. It is estimated that 42 percent of cardiovascular deaths and 71 percent As the tobacco epidemic was escalating in the early of respiratory disease in middle-aged men were due to 1990s, historic changes in Poland set in motion powerful smoking. influences that helped amplify antitobacco voices. Few Poles were quitting, largely because of the politi- Poland’s scientific community laid the foundation of the cal and social climate of the time. Because the state-run antitobacco movement when they first established the tobacco production was a significant source of revenue, in-country scientific evidence illustrating the devastat- the government—which controlled information—did ing health impact of smoking. Research conducted in not fully disclose the negative consequences of smoking. the 1980s by the Marie Sklodowska-Curie Memorial As a result, Polish smokers were less informed about Cancer Centre and Institute of Oncology contributed the dangers of smoking than most of their European to the first Polish report on the health impact of smok- neighbors. In addition, tobacco-control laws were rarely ing, highlighting in particular the link between smoking enforced, and stronger tobacco-control legislation intro- and the escalating cancer outbreak in Poland. The body duced in the early 1980s was rejected by the government of evidence about the harmful effects of smoking and because it was seen as a threat to government revenue the need for tobacco-control legislation were further during an economic downturn.
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