The WHO Regional THE CURRENT STATUS OF THE TOBACCO EPIDEMIC IN POLAND Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. 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E-mail: [email protected] Original: English Web site: www.euro.who.int The current status of the tobacco epidemic in Poland ABSTRACT This report was prepared within the framework of the current biannual joint cooperation agreement between the World Health Organization and the Ministry of Health of Poland as an element in the implementation of the Bloomberg Global Tobacco Control Initiative. Poland was one of the countries that pioneered the tobacco control effort. In 1995 it passed the Act on Protection of Health against the Consequences of the Use of Tobacco and Tobacco Products, amended multiple times since then. In 2006 Poland joined the Framework Convention for Tobacco Control. This report presents the current spread of tobacco-smoking in Poland, including the health and social aspects, epidemiological data and economic, legal and political issues. The report also seeks to define key areas in need of improvement and the consequential priorities of tobacco control policy in the medium term. Keywords SMOKING – adverse effects – economics –prevention and control TOBACCO – legislation TOBACCO INDUSTRY – legislation HEALTH POLICY EPIDEMIOLOGIC STUDIES POLAND Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2009 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. CONTENTS Page Foreword................................................................................................................. i Executive summary ..................................................................................................ii Introduction............................................................................................................ 1 General .................................................................................................................. 2 Population...................................................................................................... 2 Administrative structure .................................................................................. 4 Economic conditions ....................................................................................... 7 Health expenditure ......................................................................................... 8 Tobacco-smoking and the health status of the population.......................................... 9 Cigarette sales and consumption ..................................................................... 9 Prevalence of smoking in the adult population.................................................10 Tobacco-smoking among children...................................................................15 Passive smoking ............................................................................................16 Tobacco-related diseases – incidence and mortality .........................................17 Health consequences of passive smoking ........................................................23 The health protection and health care system and its role in tobacco control policy....26 The health care system: stewardship in anti-tobacco politics ............................26 Medical professionals and their part in fighting tobacco-smoking ......................27 Economic information related to tobacco .................................................................31 Tax policy .....................................................................................................31 Smuggling and illegal trade in tobacco products ..............................................32 Production and marketing of tobacco products.........................................................37 Tobacco cultivation........................................................................................37 Production and market share of tobacco products............................................38 Marketing strategies of the major tobacco companies ......................................38 Political commitments and priorities in tobacco control policy....................................41 Current legal and tax regulation .....................................................................41 Programmes for national health......................................................................42 Poland and the Framework Convention on Tobacco Control .............................43 Current tobacco control policy objectives and directions...................................45 Economic aspects of development of the tobacco control policy........................46 Mechanism for coordinating tobacco control programmes .........................................51 National tobacco control programmes .............................................................51 Funding ........................................................................................................51 Intersectoral coordination and cooperation inside government .........................51 Monitoring of implementation of the tobacco control programmes ....................52 Intersectoral cooperation with governmental institutions and nongovernmental organizations .........................................................................................................53 Human resources engaged in tobacco control activities ............................................55 Summary and conclusions ......................................................................................57 References ............................................................................................................59 Annex 1. Act on the Protection of Health Against the Consequences of the Consumption of Tobacco and Tobacco Products of 9 November 1995.......................63 Annex 2. National Health Programme ......................................................................72 Annex 3. Funding of the Programme for Limiting the Health-Threatening Consequences of Tobacco-Smoking from the State Budget .............................................................73 Annex 4. Life Expectancy at Birth, EU Countries, Russian Federation, Turkey and Ukraine, 2004–2006 ...............................................................................................74 Annex 5. Regular Daily Smokers aged 15+ Years, EU Countries, Russian Federation, Turkey and Ukraine, 2004–2006..............................................................................75 Annex 6. Smoking-related Deaths per 100 000 Population, EU Countries, Russian Federation, Turkey, and Ukraine, 2004–2006...........................................................76 Annex