In the late 1980s, Poland was one of the countries with the highest per capita cigarette consumpt... more In the late 1980s, Poland was one of the countries with the highest per capita cigarette consumption, smoking prevalence, and lung cancer morbidity and mortality in Europe. After the political and economic transformation of 1989, transnational tobacco companies (TTCs) entered the market. The TTCs expected the cigarette sales in Poland to increase by at least 10% in the 1990s. Unexpectedly, the opposite happened. In the 1990s, the social attitudes towards smoking began to change, spurred by the involvement of civil society, the medical community, religious institutions, as well as national and local administration in developing and conducting a comprehensive tobacco control programme. For the first time since World War II, cigarette consumption in Poland began to decline. As a report by Fagerstrom et al. published in 2001 in a renowned medical journal showed by the end of the 1990s Poland had one of the best anti-smoking climates in Europe. Between 1990 and 2015 tobacco sales in the country fell from 100bn cigarettes to 40bn. This was accompanied by a decrease in lung cancer incidence and mortality. This paper discusses the factors underlying these positive developments.
The roundtable seminar on the past, present, and future of tobacco control took place in October ... more The roundtable seminar on the past, present, and future of tobacco control took place in October 2016 at the Harvard University Science Center. It was hosted by Professor Allan Brandt and the Harvard University Department of the History of Science, and co-organised by the Polish Health Promotion Foundation (Fundacja “Promocja Zdrowia”). The event brought together a range of international public health leaders and scholars, including health economists, political scientists, historians of science, health advocates, and policymakers. During the seminar the extensive range of regional and disciplinary expertise of the guests was drawn upon to generate broad, strategic thinking on the history and perspectives of tobacco control, as well as future research and collaboration ideas.
The witness seminar, organised by the Health Promotion Foundation (Fundacja “Promocja Zdrowia”) a... more The witness seminar, organised by the Health Promotion Foundation (Fundacja “Promocja Zdrowia”) and hosted by the Chief Sanitary Inspectorate, brought together leading politicians, public health activists, and senior bureaucrats, some of whom have been historically involved in Poland’s anti-tobacco advocacy and policymaking, and others who continue their involvement.
The conference, organised by the Ministry of Health of Poland in collaboration with the Health Pr... more The conference, organised by the Ministry of Health of Poland in collaboration with the Health Promotion Foundation (Fundacja “Promocja Zdrowia”), was attended by over 100 participants representing a wide variety of backgrounds – physicians, politicians, civil servants, artists, journalists, and many others. This breadth was characteristic of the diverse nature of the anti-tobacco movement in Poland. It was this extensive coalition that helped to bring the Polish Anti-Tobacco Law to be accepted by the Polish Parliament in 1995 and enacted in May 1996.
In May 2016 Poland celebrated the 20th anniversary of the introduction of the Polish Anti-Tobacco... more In May 2016 Poland celebrated the 20th anniversary of the introduction of the Polish Anti-Tobacco Law, lauded at the time by the World Health Organisation as an “example to the rest of the world". The Health Promotion Foundation (Fundacja “Promocja Zdrowia”), in collaboration with the Polish Ministry of Health and the Chief Sanitary Inspectorate, marked the 20th anniversary of the Polish Anti-Tobacco Law by organising a series of events bringing together key figures involved in promoting smoke-free policies and healthy behaviours in Poland, including clinicians, scientists, politicians, public health advocates, journalists, social workers, and industry representatives.
Alcohol consumption levels, as well as mortality and morbidity resulting from alcohol misuse, are... more Alcohol consumption levels, as well as mortality and morbidity resulting from alcohol misuse, are at unprecedented levels in Poland. One of the most prominent factors very likely influencing this surge is the generally affordable prices of alcohol products. In 2015, Polish consumers could buy roughly twice as much beer, wine, and spirits with their disposable income compared to 2001. This increase in alcohol products affordability was one of the most pronounced among all high-income countries. One way to reverse these trends in affordability is through alcohol taxation. Cigarette taxes can serve as an example of a successful use of fiscal policy to reduce product affordability and advance public health goals. Significant cigarette tax increase resulted in higher cigarette prices and lower cigarette affordability. In Poland, from 2007 to 2015, significant declines in smoking rates and decreases in lung cancer rates were noted. Positive experiences with tobacco taxation should serve as guiding examples for governments to successfully utilise similar excise tax policy approaches in the control of alcohol-related diseases.
Industry lobbying remains an obstacle to effective health-oriented alcohol policy. In 2013, an in... more Industry lobbying remains an obstacle to effective health-oriented alcohol policy. In 2013, an increase in excise tax on spirits was announced by the Polish government. This article presents a qualitative analysis of the public debate that ensued on the potential economic, health and social effects of the policy. It focuses on how competing groups, including industry actors, framed their position and sought to dominate the debate. Online archives of five Polish national newspapers, two spirits trade associations, and parliamentary and ministerial archives were searched. A thematic content analysis of the identified sources was conducted. The overall findings were compared with existing research on the framing of the Minimum Unit Pricing (MUP) debate in the UK. A total of 155 sources were analysed. Two main frames were identified: health, and economic The spirits industry successfully promoted the economic frame in their own publications and in the media. The debate was dominated by arguments about potential growth of the grey market and losses in tax revenue that might result from the excise tax increase. The framing of the debate in Poland differed from the framing of the MUP debate in the United Kingdom. The Polish public health community was unsuccessful in making health considerations a significant element of the alcohol policy debate. The strategies pursued by UK health advocates offer lessons for how to make a more substantial impact on media coverage and promote health-oriented legislation.
Tobacco-related diseases are among the most significant contributors to Russia's premature mortal... more Tobacco-related diseases are among the most significant contributors to Russia's premature mortality burden. Smoking prevalence has been rising in Russia in the last decades, leading to worsening health and economic outcomes. This policy recommendation to members of the Russian Federal Government suggests that Russia carry out legislative and tobacco control measures including increasing the tax on tobacco products, better enforcement of smoke-free legislation, and the introduction of graphic warning on tobacco products, in order to tackle this public health.
Introduction: Data from the USA shows that of all the persons killed in traffic crashes approxima... more Introduction: Data from the USA shows that of all the persons killed in traffic crashes approximately one-third die due to alcohol-impaired driving. In an attempt to tackle this mounting death toll, in the past several decades policy-makers have increasingly relied on mass media campaigns. These campaigns involve delivery of educational messages through one or more media channels. However, despite over six decades of research, little consensus exists regarding the efficacy of such interventions. A recent comprehensive meta-analysis of 67 studies by Phillips and colleagues (published in 2011) assessed the effect of road safety campaigns on accidents, including campaigns against alcohol-impaired driving (AID). It has, however, only included studies published up until 2007. Aim of the study: To update the review conducted by Phillips and colleagues with studies published between 2007 and 2014, with a focus on assessing whether mass media campaigns are helpful in preventing AID. Material and methods: MEDLINE and EMBASE databases were systematically searched on 13.03.2014. Results and conclusions: Four US-based studies met the inclusion criteria. The identified studies were generally of moderate quality. All four included self-reported AID as their measure, and this was selected as the primary outcome for the present review. Across the four studies, the mean decrease in self-reported AID was about 2%. The reviewed studies indicate that under some conditions, and with careful design and good execution, and preferably with a focus on positive messages, mass-media campaigns can successfully contribute to the reduction in AID. Nevertheless, some of the methodological shortcomings and challenges that characterise research on mass media campaigns and AID, and their focus on US-based populations, indicate that further rigorous studies in this area are needed.
In December 2012 the European Union (EU) Commission announced that it will propose a revision of ... more In December 2012 the European Union (EU) Commission announced that it will propose a revision of the 2001 Tobacco Products Directive (TPD). This paper traces the policy debate that followed, in order to highlight some of the intricacies of the research-policy nexus. It focuses on the voting decisions of the Polish Members of the European Parliament (MEPs) during the European Parliament vote on the TPD in October 2013. The presented analysis employs a variety of theoretical models, including the engineering , enlightenment and strategic models of evidence-based policy making, the " two communities " model, framing, as well as Black's list of reasons for why research evidence has little influence on service policies. The analysis demonstrates that a linear model of relation between research and policy is of little value in understanding the EU TPD voting outcomes due to the broad and strongly antagonistic nature of the advocacy coalitions competing to influence the political decisions of the MEPs on this issue.
By the end of the 1980s Poland was at the brink of a health catastrophe. Cardiovascular diseases ... more By the end of the 1980s Poland was at the brink of a health catastrophe. Cardiovascular diseases and lung cancer mortality steadily increased and were among the highest ever observed in the world. Life expectancy for young adult and middle aged men reached levels similar to China and India. The main cause of this health decline was tobacco smoking. In the 1980s Poland became the country with the highest cigarette consumption in the world and smoking prevalence in both sexes was the highest in Europe. The milestone for tobacco control and health improvement was the Tobacco Control Bill passed by the Polish Sejm on 9 November 1995. The Law enforced a multitude of novel legal measures such as large health warnings on cigarette packs and a complete ban on tobacco advertising, promotion and sponsorship. The legislation was lauded by the WHO as an " example to the rest of the world ". It also contributed to implementing governmental and social solutions that changed the health behaviours of Poles and had a direct effect on health outcomes. Cigarette sales dropped from 104 billion cigarettes in 1990 to 42 billion today. The prevalence of daily smoking declined from 62% in 1982 to 28% in 2014 in men and from 30% to 19% in women. Today, incidence rates for cardiovascular diseases and lung cancer in middle age men are twice lower than in the beginning of 1990s. These changes were also crucial for the substantial improvement of life expectancy in Poland, which increased at one of the fastest rates in the world in the 1990s. Now there is urgent need to formulate a plan for the eradication of smoking in Poland in the next decade and to start striving towards the tobacco endgame.
The post-war anti-tobacco movement in Poland was founded in 1960 in the form of the Interminister... more The post-war anti-tobacco movement in Poland was founded in 1960 in the form of the Interministerial Committee for Limiting Smoking at the Ministry of Internal Trade, which by 1964 was transformed into the Social Committee for Limiting Smoking. In 1974 the Committee was instrumental in convincing the Minister of Health to issue a decree banning smoking in healthcare facilities and in Ministry of Health offices. However, both the decree and the broader work of the Committee brought few results, as tobacco consumption in Poland increased almost fourfold, from 1000 cigarettes per adult in 1949, to 3600 cigarettes in 1979. In 1979 the Committee was transformed into the PTP – Polish Anti-tobacco Society. This energized the movement – the system of monitoring smoking trends in Poland was improved, collaboration with healthcare, educational and religious organisations was improved, and more the engagement with the media became more pronounced. However, the PTP was unsuccessful in convincing politicians to introduce comprehensive anti-tobacco legislative measures. In the 1990s the anti-tobacco movement in Poland coalesced around the Health Promotion Foundation. The Foundation ran a very successful health promotion action, The Great Polish Smoke-out, and lobbied politicians for a comprehensive anti-tobacco law. This succeeded in 1995, when the first Polish Anti-tobacco Law was passed by the Parliament, and amended in the following years. The Polish anti-tobacco legislation which, among other provisions, limited smoking in public places, and introduced the largest health warnings on cigarette packaging in the world, was called by the World Health Organisation an “example to the rest of the world”. The success of Polish anti-tobacco efforts can provide a useful blueprint for developing countries which today face similar challenges to Poland 25 years ago.
AbstrAct The collapse of the communist regime in Poland at the end of the 1980s, followed by the ... more AbstrAct The collapse of the communist regime in Poland at the end of the 1980s, followed by the opening of the country to market economy, precipitated a " natural experiment " in population health. Poland emerged from communism with very poor health indicators, high rates of lung cancer and cardiovascular diseases. In the years immediately following the collapse of communism the situation deteriorated further, as a surge in alcohol consumption led to a dramatic increase in premature mortality. However, after 1991 the health situation of the Polish population began to improve. Mortality rates began to decline for all age groups, driven mainly by the decline in cardiovascular disease morbidity and mortality. One reason for this health improvement can be sought in the 10% decrease in smoking prevalence that took place in the 1990s, and was stimulated by the implementation of very progressive anti-tobacco legislation. Another contributor was the reversal in alcohol consumption trends, with alcohol consumption falling from 11 litres in 1991 to 8.5-9 litres in 1995. However, the chief reason for the rapid improvement in health were the revolutionary changes in the diet of Poles – the fall in animal fat consumption compensated by the increase in vegetable fat consumption, and the increase in the consumption of fruits and vegetable. The resulting increase in life expectancy between 1991 and 2002 among Polish women was the fastest in Europe, and among Polish men it was the third fastest.
Before World War II (WWII) Poland was one of the countries with the poorest health in Europe. In ... more Before World War II (WWII) Poland was one of the countries with the poorest health in Europe. In the 1930s life expectancy in Poland was around 46 years in both sexes; in the same period in Germany it was over 61 years. Infant mortality was estimated at the level of 150 deaths per 1000 live births. The situation was exacerbated by WWII; between 1939 and 1945 life expectancy in Poland fell by 20-25 years. The health transformation that took place in Poland after WWII proceeded very rapidly. Control of infectious diseases and infant mortality became a state priority in the postwar Polish People's Republic. The epidemiological transition that in the United Kingdom or Germany took almost a century, in Poland, and many other Central and East European (CEE) countries, occurred in the two decades following WWII. This process led the CEE region to almost closing the health gap dividing it from Western Europe in the 1960s. Life expectancy in Poland increased to 70 years and infant mortality decreased to 30 deaths per 1000 live births. However, simultaneously, after WWII the seeds of the epidemic of man-made diseases were sown in CEE. In Poland the consumption of vodka and smoking prevalence reached some of the highest levels in Europe. This dramatic increase in exposure to lifestyle risk factors (an increase in cigarette sale from 20 billion cigarettes per annum after WWII to around 100 billion in the 1980s, and an increase of alcohol consumption from 3 litres per annum to nearly 9 litres in the same period), led Poland and the CEE region to a health catastrophe caused by the rise of chronic diseases. Diseases such as lung cancer, laryngeal and oral cavity cancers, cardiovascular diseases (e.g. ischaemic heart disease and stroke), sudden deaths from external causes (e.g. accidents, injuries, poisonings etc.), and liver cirrhosis, all reached in Poland some of the highest levels observed globally. In contrast to most Western democracies, authorities in communist states of CEE were unable to cope with these new health challenges, which demanded comprehensive, also non-medical solutions. Health literacy was low, also among the better educated segments of population, including the political class.
One of the chief arguments of advocates of European Union (EU) accession in Central and Eastern E... more One of the chief arguments of advocates of European Union (EU) accession in Central and Eastern Europe (CEE) was that EU membership will help CEE states to catch up with the more developed Western Euro-pean countries. The economic and technological chasm that existed between the two parts of the continent was closely echoed by the enormous gap in premature adult mortality levels. This health gap was present throughout the 20 th century. Intensive efforts to control infectious diseases in the Soviet bloc allowed the life expectancy figures of CEE states to almost catch up with the West in the 1960s, but in the subsequent decades the health gap widened again. This was largely due to the man-made disease epidemic that engulfed the CEE region as a result of over-medicalisation of health, persisting low levels of health literacy, and unhealthy lifestyles (high levels of smoking and alcohol consumption, poor diets). The collapse of communist regimes in 1989 and the following years led to another change in health trends in CEE countries. Antiquated models of healthcare were abandoned, market economy helped precipitate positive changes in diet, a reduction in smoking and alcohol consumption were observed in many countries. However, even after 25 years of improvement, health in CEE countries remains significantly behind Western Europe, and while huge advances have been made in some areas in many countries (e.g. tobacco control), there is still much to be done in others (e.g. limiting alcohol consumption). Currently, three distinct health zones can be identified in Europe. The first is Western Europe, where mortality before 65 in many countries is in single-digit figures. The second are the CEE countries, where one if three men die before the age of 65. The third is Russia and the former Soviet states, where over half of all men do not life to the age of 65.
In the late 1980s, Poland was one of the countries with the highest per capita cigarette consumpt... more In the late 1980s, Poland was one of the countries with the highest per capita cigarette consumption, smoking prevalence, and lung cancer morbidity and mortality in Europe. After the political and economic transformation of 1989, transnational tobacco companies (TTCs) entered the market. The TTCs expected the cigarette sales in Poland to increase by at least 10% in the 1990s. Unexpectedly, the opposite happened. In the 1990s, the social attitudes towards smoking began to change, spurred by the involvement of civil society, the medical community, religious institutions, as well as national and local administration in developing and conducting a comprehensive tobacco control programme. For the first time since World War II, cigarette consumption in Poland began to decline. As a report by Fagerstrom et al. published in 2001 in a renowned medical journal showed by the end of the 1990s Poland had one of the best anti-smoking climates in Europe. Between 1990 and 2015 tobacco sales in the country fell from 100bn cigarettes to 40bn. This was accompanied by a decrease in lung cancer incidence and mortality. This paper discusses the factors underlying these positive developments.
The roundtable seminar on the past, present, and future of tobacco control took place in October ... more The roundtable seminar on the past, present, and future of tobacco control took place in October 2016 at the Harvard University Science Center. It was hosted by Professor Allan Brandt and the Harvard University Department of the History of Science, and co-organised by the Polish Health Promotion Foundation (Fundacja “Promocja Zdrowia”). The event brought together a range of international public health leaders and scholars, including health economists, political scientists, historians of science, health advocates, and policymakers. During the seminar the extensive range of regional and disciplinary expertise of the guests was drawn upon to generate broad, strategic thinking on the history and perspectives of tobacco control, as well as future research and collaboration ideas.
The witness seminar, organised by the Health Promotion Foundation (Fundacja “Promocja Zdrowia”) a... more The witness seminar, organised by the Health Promotion Foundation (Fundacja “Promocja Zdrowia”) and hosted by the Chief Sanitary Inspectorate, brought together leading politicians, public health activists, and senior bureaucrats, some of whom have been historically involved in Poland’s anti-tobacco advocacy and policymaking, and others who continue their involvement.
The conference, organised by the Ministry of Health of Poland in collaboration with the Health Pr... more The conference, organised by the Ministry of Health of Poland in collaboration with the Health Promotion Foundation (Fundacja “Promocja Zdrowia”), was attended by over 100 participants representing a wide variety of backgrounds – physicians, politicians, civil servants, artists, journalists, and many others. This breadth was characteristic of the diverse nature of the anti-tobacco movement in Poland. It was this extensive coalition that helped to bring the Polish Anti-Tobacco Law to be accepted by the Polish Parliament in 1995 and enacted in May 1996.
In May 2016 Poland celebrated the 20th anniversary of the introduction of the Polish Anti-Tobacco... more In May 2016 Poland celebrated the 20th anniversary of the introduction of the Polish Anti-Tobacco Law, lauded at the time by the World Health Organisation as an “example to the rest of the world". The Health Promotion Foundation (Fundacja “Promocja Zdrowia”), in collaboration with the Polish Ministry of Health and the Chief Sanitary Inspectorate, marked the 20th anniversary of the Polish Anti-Tobacco Law by organising a series of events bringing together key figures involved in promoting smoke-free policies and healthy behaviours in Poland, including clinicians, scientists, politicians, public health advocates, journalists, social workers, and industry representatives.
Alcohol consumption levels, as well as mortality and morbidity resulting from alcohol misuse, are... more Alcohol consumption levels, as well as mortality and morbidity resulting from alcohol misuse, are at unprecedented levels in Poland. One of the most prominent factors very likely influencing this surge is the generally affordable prices of alcohol products. In 2015, Polish consumers could buy roughly twice as much beer, wine, and spirits with their disposable income compared to 2001. This increase in alcohol products affordability was one of the most pronounced among all high-income countries. One way to reverse these trends in affordability is through alcohol taxation. Cigarette taxes can serve as an example of a successful use of fiscal policy to reduce product affordability and advance public health goals. Significant cigarette tax increase resulted in higher cigarette prices and lower cigarette affordability. In Poland, from 2007 to 2015, significant declines in smoking rates and decreases in lung cancer rates were noted. Positive experiences with tobacco taxation should serve as guiding examples for governments to successfully utilise similar excise tax policy approaches in the control of alcohol-related diseases.
Industry lobbying remains an obstacle to effective health-oriented alcohol policy. In 2013, an in... more Industry lobbying remains an obstacle to effective health-oriented alcohol policy. In 2013, an increase in excise tax on spirits was announced by the Polish government. This article presents a qualitative analysis of the public debate that ensued on the potential economic, health and social effects of the policy. It focuses on how competing groups, including industry actors, framed their position and sought to dominate the debate. Online archives of five Polish national newspapers, two spirits trade associations, and parliamentary and ministerial archives were searched. A thematic content analysis of the identified sources was conducted. The overall findings were compared with existing research on the framing of the Minimum Unit Pricing (MUP) debate in the UK. A total of 155 sources were analysed. Two main frames were identified: health, and economic The spirits industry successfully promoted the economic frame in their own publications and in the media. The debate was dominated by arguments about potential growth of the grey market and losses in tax revenue that might result from the excise tax increase. The framing of the debate in Poland differed from the framing of the MUP debate in the United Kingdom. The Polish public health community was unsuccessful in making health considerations a significant element of the alcohol policy debate. The strategies pursued by UK health advocates offer lessons for how to make a more substantial impact on media coverage and promote health-oriented legislation.
Tobacco-related diseases are among the most significant contributors to Russia's premature mortal... more Tobacco-related diseases are among the most significant contributors to Russia's premature mortality burden. Smoking prevalence has been rising in Russia in the last decades, leading to worsening health and economic outcomes. This policy recommendation to members of the Russian Federal Government suggests that Russia carry out legislative and tobacco control measures including increasing the tax on tobacco products, better enforcement of smoke-free legislation, and the introduction of graphic warning on tobacco products, in order to tackle this public health.
Introduction: Data from the USA shows that of all the persons killed in traffic crashes approxima... more Introduction: Data from the USA shows that of all the persons killed in traffic crashes approximately one-third die due to alcohol-impaired driving. In an attempt to tackle this mounting death toll, in the past several decades policy-makers have increasingly relied on mass media campaigns. These campaigns involve delivery of educational messages through one or more media channels. However, despite over six decades of research, little consensus exists regarding the efficacy of such interventions. A recent comprehensive meta-analysis of 67 studies by Phillips and colleagues (published in 2011) assessed the effect of road safety campaigns on accidents, including campaigns against alcohol-impaired driving (AID). It has, however, only included studies published up until 2007. Aim of the study: To update the review conducted by Phillips and colleagues with studies published between 2007 and 2014, with a focus on assessing whether mass media campaigns are helpful in preventing AID. Material and methods: MEDLINE and EMBASE databases were systematically searched on 13.03.2014. Results and conclusions: Four US-based studies met the inclusion criteria. The identified studies were generally of moderate quality. All four included self-reported AID as their measure, and this was selected as the primary outcome for the present review. Across the four studies, the mean decrease in self-reported AID was about 2%. The reviewed studies indicate that under some conditions, and with careful design and good execution, and preferably with a focus on positive messages, mass-media campaigns can successfully contribute to the reduction in AID. Nevertheless, some of the methodological shortcomings and challenges that characterise research on mass media campaigns and AID, and their focus on US-based populations, indicate that further rigorous studies in this area are needed.
In December 2012 the European Union (EU) Commission announced that it will propose a revision of ... more In December 2012 the European Union (EU) Commission announced that it will propose a revision of the 2001 Tobacco Products Directive (TPD). This paper traces the policy debate that followed, in order to highlight some of the intricacies of the research-policy nexus. It focuses on the voting decisions of the Polish Members of the European Parliament (MEPs) during the European Parliament vote on the TPD in October 2013. The presented analysis employs a variety of theoretical models, including the engineering , enlightenment and strategic models of evidence-based policy making, the " two communities " model, framing, as well as Black's list of reasons for why research evidence has little influence on service policies. The analysis demonstrates that a linear model of relation between research and policy is of little value in understanding the EU TPD voting outcomes due to the broad and strongly antagonistic nature of the advocacy coalitions competing to influence the political decisions of the MEPs on this issue.
By the end of the 1980s Poland was at the brink of a health catastrophe. Cardiovascular diseases ... more By the end of the 1980s Poland was at the brink of a health catastrophe. Cardiovascular diseases and lung cancer mortality steadily increased and were among the highest ever observed in the world. Life expectancy for young adult and middle aged men reached levels similar to China and India. The main cause of this health decline was tobacco smoking. In the 1980s Poland became the country with the highest cigarette consumption in the world and smoking prevalence in both sexes was the highest in Europe. The milestone for tobacco control and health improvement was the Tobacco Control Bill passed by the Polish Sejm on 9 November 1995. The Law enforced a multitude of novel legal measures such as large health warnings on cigarette packs and a complete ban on tobacco advertising, promotion and sponsorship. The legislation was lauded by the WHO as an " example to the rest of the world ". It also contributed to implementing governmental and social solutions that changed the health behaviours of Poles and had a direct effect on health outcomes. Cigarette sales dropped from 104 billion cigarettes in 1990 to 42 billion today. The prevalence of daily smoking declined from 62% in 1982 to 28% in 2014 in men and from 30% to 19% in women. Today, incidence rates for cardiovascular diseases and lung cancer in middle age men are twice lower than in the beginning of 1990s. These changes were also crucial for the substantial improvement of life expectancy in Poland, which increased at one of the fastest rates in the world in the 1990s. Now there is urgent need to formulate a plan for the eradication of smoking in Poland in the next decade and to start striving towards the tobacco endgame.
The post-war anti-tobacco movement in Poland was founded in 1960 in the form of the Interminister... more The post-war anti-tobacco movement in Poland was founded in 1960 in the form of the Interministerial Committee for Limiting Smoking at the Ministry of Internal Trade, which by 1964 was transformed into the Social Committee for Limiting Smoking. In 1974 the Committee was instrumental in convincing the Minister of Health to issue a decree banning smoking in healthcare facilities and in Ministry of Health offices. However, both the decree and the broader work of the Committee brought few results, as tobacco consumption in Poland increased almost fourfold, from 1000 cigarettes per adult in 1949, to 3600 cigarettes in 1979. In 1979 the Committee was transformed into the PTP – Polish Anti-tobacco Society. This energized the movement – the system of monitoring smoking trends in Poland was improved, collaboration with healthcare, educational and religious organisations was improved, and more the engagement with the media became more pronounced. However, the PTP was unsuccessful in convincing politicians to introduce comprehensive anti-tobacco legislative measures. In the 1990s the anti-tobacco movement in Poland coalesced around the Health Promotion Foundation. The Foundation ran a very successful health promotion action, The Great Polish Smoke-out, and lobbied politicians for a comprehensive anti-tobacco law. This succeeded in 1995, when the first Polish Anti-tobacco Law was passed by the Parliament, and amended in the following years. The Polish anti-tobacco legislation which, among other provisions, limited smoking in public places, and introduced the largest health warnings on cigarette packaging in the world, was called by the World Health Organisation an “example to the rest of the world”. The success of Polish anti-tobacco efforts can provide a useful blueprint for developing countries which today face similar challenges to Poland 25 years ago.
AbstrAct The collapse of the communist regime in Poland at the end of the 1980s, followed by the ... more AbstrAct The collapse of the communist regime in Poland at the end of the 1980s, followed by the opening of the country to market economy, precipitated a " natural experiment " in population health. Poland emerged from communism with very poor health indicators, high rates of lung cancer and cardiovascular diseases. In the years immediately following the collapse of communism the situation deteriorated further, as a surge in alcohol consumption led to a dramatic increase in premature mortality. However, after 1991 the health situation of the Polish population began to improve. Mortality rates began to decline for all age groups, driven mainly by the decline in cardiovascular disease morbidity and mortality. One reason for this health improvement can be sought in the 10% decrease in smoking prevalence that took place in the 1990s, and was stimulated by the implementation of very progressive anti-tobacco legislation. Another contributor was the reversal in alcohol consumption trends, with alcohol consumption falling from 11 litres in 1991 to 8.5-9 litres in 1995. However, the chief reason for the rapid improvement in health were the revolutionary changes in the diet of Poles – the fall in animal fat consumption compensated by the increase in vegetable fat consumption, and the increase in the consumption of fruits and vegetable. The resulting increase in life expectancy between 1991 and 2002 among Polish women was the fastest in Europe, and among Polish men it was the third fastest.
Before World War II (WWII) Poland was one of the countries with the poorest health in Europe. In ... more Before World War II (WWII) Poland was one of the countries with the poorest health in Europe. In the 1930s life expectancy in Poland was around 46 years in both sexes; in the same period in Germany it was over 61 years. Infant mortality was estimated at the level of 150 deaths per 1000 live births. The situation was exacerbated by WWII; between 1939 and 1945 life expectancy in Poland fell by 20-25 years. The health transformation that took place in Poland after WWII proceeded very rapidly. Control of infectious diseases and infant mortality became a state priority in the postwar Polish People's Republic. The epidemiological transition that in the United Kingdom or Germany took almost a century, in Poland, and many other Central and East European (CEE) countries, occurred in the two decades following WWII. This process led the CEE region to almost closing the health gap dividing it from Western Europe in the 1960s. Life expectancy in Poland increased to 70 years and infant mortality decreased to 30 deaths per 1000 live births. However, simultaneously, after WWII the seeds of the epidemic of man-made diseases were sown in CEE. In Poland the consumption of vodka and smoking prevalence reached some of the highest levels in Europe. This dramatic increase in exposure to lifestyle risk factors (an increase in cigarette sale from 20 billion cigarettes per annum after WWII to around 100 billion in the 1980s, and an increase of alcohol consumption from 3 litres per annum to nearly 9 litres in the same period), led Poland and the CEE region to a health catastrophe caused by the rise of chronic diseases. Diseases such as lung cancer, laryngeal and oral cavity cancers, cardiovascular diseases (e.g. ischaemic heart disease and stroke), sudden deaths from external causes (e.g. accidents, injuries, poisonings etc.), and liver cirrhosis, all reached in Poland some of the highest levels observed globally. In contrast to most Western democracies, authorities in communist states of CEE were unable to cope with these new health challenges, which demanded comprehensive, also non-medical solutions. Health literacy was low, also among the better educated segments of population, including the political class.
One of the chief arguments of advocates of European Union (EU) accession in Central and Eastern E... more One of the chief arguments of advocates of European Union (EU) accession in Central and Eastern Europe (CEE) was that EU membership will help CEE states to catch up with the more developed Western Euro-pean countries. The economic and technological chasm that existed between the two parts of the continent was closely echoed by the enormous gap in premature adult mortality levels. This health gap was present throughout the 20 th century. Intensive efforts to control infectious diseases in the Soviet bloc allowed the life expectancy figures of CEE states to almost catch up with the West in the 1960s, but in the subsequent decades the health gap widened again. This was largely due to the man-made disease epidemic that engulfed the CEE region as a result of over-medicalisation of health, persisting low levels of health literacy, and unhealthy lifestyles (high levels of smoking and alcohol consumption, poor diets). The collapse of communist regimes in 1989 and the following years led to another change in health trends in CEE countries. Antiquated models of healthcare were abandoned, market economy helped precipitate positive changes in diet, a reduction in smoking and alcohol consumption were observed in many countries. However, even after 25 years of improvement, health in CEE countries remains significantly behind Western Europe, and while huge advances have been made in some areas in many countries (e.g. tobacco control), there is still much to be done in others (e.g. limiting alcohol consumption). Currently, three distinct health zones can be identified in Europe. The first is Western Europe, where mortality before 65 in many countries is in single-digit figures. The second are the CEE countries, where one if three men die before the age of 65. The third is Russia and the former Soviet states, where over half of all men do not life to the age of 65.
Europe has the highest premature
mortality attributable to alcohol in
the world. Despite WHO’s ... more Europe has the highest premature
mortality attributable to alcohol in
the world. Despite WHO’s emphasis
on the importance to restrict alcohol
consumption with fiscal measures,
the Lithuanian (in 1999), Polish
(in 2002), and Finnish (in 2004)
Governments all lowered excise
taxation of alcoholic spirits by 44%,
30%, and 44%, respectively. These
decisions led to instant and striking
effects on health.
Although cytisine is perceived as a novelty in the West, it has been used in daily medical pract... more Although cytisine is perceived as a novelty in the West, it has been used in daily medical practice in Poland for more than 50 years.
The role of anti-tobacco advocacy coalitions in mitigating the impact of transnational tobacco co... more The role of anti-tobacco advocacy coalitions in mitigating the impact of transnational tobacco companies on tobacco control policy-making in post-communist Poland.
Mateusz Zatoński will be presenting his dissertation research, “Socialism, Solidarity, and Cigare... more Mateusz Zatoński will be presenting his dissertation research, “Socialism, Solidarity, and Cigarettes – tobacco control in Poland between communism and capitalism”, in which he investigates the history of tobacco control in Poland during the late communist and early post-communist period, with a particular focus on the role of government, the medical establishment, religious organisations, and NGOs. He will also talk about his preliminary findings in the Tobacco Industry Documents on the attempts of the transnational tobacco companies to shape tobacco policy in Central and Eastern Europe.
Background
Alcohol-attributable mortality remains a particularly urgent public health challenge ... more Background
Alcohol-attributable mortality remains a particularly urgent public health challenge in Poland, where the consumption of heavy spirits has been rising in the last decade. Industry lobbying remains a principal obstacle for effective alcohol control policy. In 2013 an increase in the spirits excise tax was announced by the Polish government. This was followed by a public debate on the excise tax characterised by intensified alcohol industry lobbying and significant media coverage.
Aim
To analyse the debate about the potential health, economic and social effects of the increase of the excise tax on spirits in Poland, with a focus on how competing interest groups framed their position and sought to dominate the debate.
Methods
Online archives of five Polish national newspapers, two Polish spirits trade associations, the lower chamber of the Polish Parliament, and of the Polish State Agency for Prevention of Alcohol Related Problems were searched for sources relating to the increase in excise tax. A thematic content analysis of the resulting sources was conducted.
Results
A total of 155 sources were yielded and used in the data analysis process. Three leading frames were identified, symbolic, health, and economic, with the latter being dominant throughout the course of the debate. The spirits industry was found to successfully promote the economic frame in their own publications and in the media, and the resulting debate was dominated by issues of growth of the grey market and the budget loss that Poland would suffer as a result of the excise tax increase.
A study of JS Mill's philosophy in relation to the efforts to ban smoking in public places. Avail... more A study of JS Mill's philosophy in relation to the efforts to ban smoking in public places. Available in Polish and English.
The WHO European Region has seen remarkable health gains in populations that have experienced pro... more The WHO European Region has seen remarkable health gains in populations that have experienced progressive improvements in the conditions in which people are born, grow, live and work. Inequities persist, however, both between and within countries.
This review of inequities in health between and within countries across the 53 Member States of the Region was commissioned to support the development of the new European policy framework for health and well-being, Health 2020. Much more is understood now about the extent and social causes of these inequities. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed on the social determinants of health, across the life-course and in wider social and economic spheres to achieve greater health equity and protect future generations.
"Closing the Gap - Reducing Premature Mortality; Baseline for Monitoring Health Evolution Followi... more "Closing the Gap - Reducing Premature Mortality; Baseline for Monitoring Health Evolution Following Enlargement (HEM) is a project lead by the Epidemiology and Cancer Prevention Division of the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology in Warsaw, Poland. It was submitted to the European Commission and has been accepted among other European Union programs in the field of public health for years 2004-2007.
The aims of the project are:
-> Closing the gap in premature, preventable morbidity, disability and mortality between EU15 and the new EU Member States, with special regard to improving the health of working population and diminishing inequalities in access to health.
-> Creating a baseline for monitoring evolution of preventable, premature mortality risk factors following enlargement.
-> Favourable modification of major risk factors for diseases, especially alcohol and selected nutritional factors (obesity), as well as future contribution to tobacco control."
Dzieje medycyny w Polsce, Tom 3. Lata 1944-1989 [History of Medicine in Poland, vol. 3. Years 1944-1989], Dec 2016
Niepohamowany wzrost przedwczesnej umieralności w Polsce ujawnił niezdolność krajów socjalistyczn... more Niepohamowany wzrost przedwczesnej umieralności w Polsce ujawnił niezdolność krajów socjalistycznych do skutecznej odpowiedzi na nowe wyzwania. Choroby przewlekłe wśród dorosłych stawały się coraz większym obciążeniem dla gospodarki. Kapitał ludzki był marnowany, a rozwój gospodarczy upośledzony. Te niepowodzenia w zakresie ochrony zdrowia były częścią większych niepowodzeń Polski w efektywnej rywalizacji z gospodarkami świata.
Potrykowska A., Strzelecki Z., Szymborski J., Witkowski J. (eds.) Zachorowalność i umieralność na nowotwory a sytuacja demograficzna Polski [Cancer incidence and mortality versus the demographic situation in Poland]. , 2014
Cancers are becoming the main cause of premature mortality in Europe. A similar trend is also bei... more Cancers are becoming the main cause of premature mortality in Europe. A similar trend is also being observed in Poland.
Time trends for standardised mortality indicators due to the most common cancers in both sexes demonstrate a considerable variety of patterns in their incidence and course of disease.
Two cancer sites, lung cancer and stomach cancer, dominated the epidemiol-ogical developments that occurred in Poland in the last 50 years in both sexes.
In the middle of the 20th century stomach cancer has been by large the most prevalent cancer in both sexes in Poland. For the entire period of observation stomach cancer incidence and mortality in Poland has been decreasing, making stomach cancer a rare disease at the beginning of the 21st century.
At the same time in Poland, as well as in other European states, a rising epi-demic of lung cancer has been observed, first in men and, following a 20-year delay, also in women. In the second decade of the 21st century lung cancer is the most prevalent cancer in Poland in both sexes.
While in the case of stomach cancer the reasons for its decline are not fully understood, the lung cancer epidemic has been thoroughly explained and could be prevented by the eradication of smoking from the human population. The experience of Poland has also confirmed this phenomenon.
A careful analysis of the epidemiologic cancer trends must become a key component in the preparation of a cancer control strategy in Poland.
Uploads
Papers by Mateusz Zatonski
Aim of the study: To update the review conducted by Phillips and colleagues with studies published between 2007 and 2014, with a focus on assessing whether mass media campaigns are helpful in preventing AID.
Material and methods: MEDLINE and EMBASE databases were systematically searched on 13.03.2014.
Results and conclusions: Four US-based studies met the inclusion criteria. The identified studies were generally of moderate quality. All four included self-reported AID as their measure, and this was selected as the primary outcome for the present review. Across the four studies, the mean decrease in self-reported AID was about 2%. The reviewed studies indicate that under some conditions, and with careful design and good execution, and preferably with a focus on positive messages, mass-media campaigns can successfully contribute to the reduction in AID. Nevertheless, some of the methodological shortcomings and challenges that characterise research on mass media campaigns and AID, and their focus on US-based populations, indicate that further rigorous studies in this area are needed.
Committee for Limiting Smoking at the Ministry of Internal Trade, which by 1964 was transformed into
the Social Committee for Limiting Smoking. In 1974 the Committee was instrumental in convincing
the Minister of Health to issue a decree banning smoking in healthcare facilities and in Ministry of
Health offices. However, both the decree and the broader work of the Committee brought few results,
as tobacco consumption in Poland increased almost fourfold, from 1000 cigarettes per adult in 1949,
to 3600 cigarettes in 1979. In 1979 the Committee was transformed into the PTP – Polish Anti-tobacco
Society. This energized the movement – the system of monitoring smoking trends in Poland was
improved, collaboration with healthcare, educational and religious organisations was improved, and
more the engagement with the media became more pronounced. However, the PTP was unsuccessful
in convincing politicians to introduce comprehensive anti-tobacco legislative measures. In the 1990s the
anti-tobacco movement in Poland coalesced around the Health Promotion Foundation. The Foundation
ran a very successful health promotion action, The Great Polish Smoke-out, and lobbied politicians for
a comprehensive anti-tobacco law. This succeeded in 1995, when the first Polish Anti-tobacco Law was
passed by the Parliament, and amended in the following years. The Polish anti-tobacco legislation which,
among other provisions, limited smoking in public places, and introduced the largest health warnings
on cigarette packaging in the world, was called by the World Health Organisation an “example to the rest
of the world”. The success of Polish anti-tobacco efforts can provide a useful blueprint for developing
countries which today face similar challenges to Poland 25 years ago.
Aim of the study: To update the review conducted by Phillips and colleagues with studies published between 2007 and 2014, with a focus on assessing whether mass media campaigns are helpful in preventing AID.
Material and methods: MEDLINE and EMBASE databases were systematically searched on 13.03.2014.
Results and conclusions: Four US-based studies met the inclusion criteria. The identified studies were generally of moderate quality. All four included self-reported AID as their measure, and this was selected as the primary outcome for the present review. Across the four studies, the mean decrease in self-reported AID was about 2%. The reviewed studies indicate that under some conditions, and with careful design and good execution, and preferably with a focus on positive messages, mass-media campaigns can successfully contribute to the reduction in AID. Nevertheless, some of the methodological shortcomings and challenges that characterise research on mass media campaigns and AID, and their focus on US-based populations, indicate that further rigorous studies in this area are needed.
Committee for Limiting Smoking at the Ministry of Internal Trade, which by 1964 was transformed into
the Social Committee for Limiting Smoking. In 1974 the Committee was instrumental in convincing
the Minister of Health to issue a decree banning smoking in healthcare facilities and in Ministry of
Health offices. However, both the decree and the broader work of the Committee brought few results,
as tobacco consumption in Poland increased almost fourfold, from 1000 cigarettes per adult in 1949,
to 3600 cigarettes in 1979. In 1979 the Committee was transformed into the PTP – Polish Anti-tobacco
Society. This energized the movement – the system of monitoring smoking trends in Poland was
improved, collaboration with healthcare, educational and religious organisations was improved, and
more the engagement with the media became more pronounced. However, the PTP was unsuccessful
in convincing politicians to introduce comprehensive anti-tobacco legislative measures. In the 1990s the
anti-tobacco movement in Poland coalesced around the Health Promotion Foundation. The Foundation
ran a very successful health promotion action, The Great Polish Smoke-out, and lobbied politicians for
a comprehensive anti-tobacco law. This succeeded in 1995, when the first Polish Anti-tobacco Law was
passed by the Parliament, and amended in the following years. The Polish anti-tobacco legislation which,
among other provisions, limited smoking in public places, and introduced the largest health warnings
on cigarette packaging in the world, was called by the World Health Organisation an “example to the rest
of the world”. The success of Polish anti-tobacco efforts can provide a useful blueprint for developing
countries which today face similar challenges to Poland 25 years ago.
mortality attributable to alcohol in
the world. Despite WHO’s emphasis
on the importance to restrict alcohol
consumption with fiscal measures,
the Lithuanian (in 1999), Polish
(in 2002), and Finnish (in 2004)
Governments all lowered excise
taxation of alcoholic spirits by 44%,
30%, and 44%, respectively. These
decisions led to instant and striking
effects on health.
Alcohol-attributable mortality remains a particularly urgent public health challenge in Poland, where the consumption of heavy spirits has been rising in the last decade. Industry lobbying remains a principal obstacle for effective alcohol control policy. In 2013 an increase in the spirits excise tax was announced by the Polish government. This was followed by a public debate on the excise tax characterised by intensified alcohol industry lobbying and significant media coverage.
Aim
To analyse the debate about the potential health, economic and social effects of the increase of the excise tax on spirits in Poland, with a focus on how competing interest groups framed their position and sought to dominate the debate.
Methods
Online archives of five Polish national newspapers, two Polish spirits trade associations, the lower chamber of the Polish Parliament, and of the Polish State Agency for Prevention of Alcohol Related Problems were searched for sources relating to the increase in excise tax. A thematic content analysis of the resulting sources was conducted.
Results
A total of 155 sources were yielded and used in the data analysis process. Three leading frames were identified, symbolic, health, and economic, with the latter being dominant throughout the course of the debate. The spirits industry was found to successfully promote the economic frame in their own publications and in the media, and the resulting debate was dominated by issues of growth of the grey market and the budget loss that Poland would suffer as a result of the excise tax increase.
This review of inequities in health between and within countries across the 53 Member States of the Region was commissioned to support the development of the new European policy framework for health and well-being, Health 2020. Much more is understood now about the extent and social causes of these inequities. The European review builds on the global evidence and recommends policies to ensure that progress can be made in reducing health inequities and the health divide across all countries, including those with low incomes. Action is needed on the social determinants of health, across the life-course and in wider social and economic spheres to achieve greater health equity and protect future generations.
The aims of the project are:
-> Closing the gap in premature, preventable morbidity, disability and mortality between EU15 and the new EU Member States, with special regard to improving the health of working population and diminishing inequalities in access to health.
-> Creating a baseline for monitoring evolution of preventable, premature mortality risk factors following enlargement.
-> Favourable modification of major risk factors for diseases, especially alcohol and selected nutritional factors (obesity), as well as future contribution to tobacco control."
Time trends for standardised mortality indicators due to the most common cancers in both sexes demonstrate a considerable variety of patterns in their incidence and course of disease.
Two cancer sites, lung cancer and stomach cancer, dominated the epidemiol-ogical developments that occurred in Poland in the last 50 years in both sexes.
In the middle of the 20th century stomach cancer has been by large the most prevalent cancer in both sexes in Poland. For the entire period of observation stomach cancer incidence and mortality in Poland has been decreasing, making stomach cancer a rare disease at the beginning of the 21st century.
At the same time in Poland, as well as in other European states, a rising epi-demic of lung cancer has been observed, first in men and, following a 20-year delay, also in women. In the second decade of the 21st century lung cancer is the most prevalent cancer in Poland in both sexes.
While in the case of stomach cancer the reasons for its decline are not fully understood, the lung cancer epidemic has been thoroughly explained and could be prevented by the eradication of smoking from the human population. The experience of Poland has also confirmed this phenomenon.
A careful analysis of the epidemiologic cancer trends must become a key component in the preparation of a cancer control strategy in Poland.