Question

Create a case study "Curbing tobacco use in Poland" with the info below.

Health Condition: Tobacco is the second deadliest threat to adult health in the world and causes 1 in every 10 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 1.2 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 10 people. In the 1980s, Poland had the highest rate of smoking in the world. Nearly three-quarters of Polish men aged 20 to 60 smoked every day. In 1990, the probability that a 15-year-old boy born in Poland 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.

Intervention or Program: In 1995, the Polish parliament passed groundbreaking tobacco-control legislation, 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 advertisement; 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 10 percent between 1990 and 1998, and the number of smokers declined from 14 million in the 1980s to under 10 million at the end of the 1990s. The reduction in smoking led to:

10,000 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.

Answer 1

Cigarettes are smoked by over 1 billion people, which is nearly 20% of the world population in 2014. About 800 million of these smokers are men. While smokingrates have leveled off or declined in developed nations, especially among men, in developing nationstobacco consumption continues to rise. According to 2016 (https://tobaccoatlas.org/topic/consumption/) the rate of cigarette consumption per year per person 1363.1 cigarettes.According to an article on Tobacco control in Poland -successes and challenges in NCBI for many years, tobacco smoking was the major single avoidable cause of premature mortality in Poland. In the 1970s and 1980s, Poland was a country with an extremely high prevalence of smoking and lung cancer mortality among men in the world. By 1990, over 40% of Polish men died prematurely from smoking-attributed diseases.

Smoking leads health and wealth related consequences.Education and preventive measures is needed against tobacco use.

Since the 1960s, smoking rates and its health consequences have gradually decreased in rich countries and have rapidly increased in developing countries, including the region of Central and Eastern Europe . Poland, being at the time part of the communist bloc, was among countries with particularly high tobacco consumption. In the mid-1970s and early 1980s, 65% to 75% of Polish men aged 20 to 60 smoked cigarettes every day .By 1990, over 40% of Polish men died prematurely from smoking-attributed diseases.

As Poland was one of the largest producers of Tobacco in Europe ,the people were used up to tobacco use very easily. Smoking had severe impact on health causing cancer,cardiovascular diseases ,respiratory diseases, premature deliveries , abortions and decreased life expectancy. The Polish smokers were less informed about the dangers of smoking than most of their European neighbors due to uneducated groups of people in society and low economy.

When laws were  against tobacco were rarely enforced, and stronger tobacco-control legislation introduced in the early 1980s was rejected by the government because it was seen as a threat to government revenue during an economic downturn.

According to data of the World Health Organization (WHO) and the Polish Central Statistical Office, Poland reached an average cigarette consumption of over 3,600 cigarettes per adult person per year, thus zooming from 11th place in 1972 to the first in the world in 1992 . Heavy smoking was taking a deadly toll in high rates of lung cancer and cardiovascular diseases. The estimated number of deaths in Poland caused by tobacco smoking in 2000 reached approximately 69,000, of which 43,000 occurred prematurely i.e., between the ages of 35-69 . Around 43% of all deaths in males aged 35-69 were caused by smoking; middle aged adult smokers lost nearly 22 years of life and smokers aged 70 and older lost an average of 8 years of life . Lung cancer killed half of all Polish men who died before reaching 65 years.(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367772/#idm139771723038928title)

Creation of health-focused non-government organizations (NGOs), such as the Health Promotion Foundation and the Polish Anti-Tobacco Society, which emphasized the devastating effects of smoking and the need for comprehensive tobacco-control legislation.Nationwide actions included an annual campaign entitled “Let’s Stop Smoking Together” .

Nation-wide surveys estimated that over 4 million smokers decided to give up smoking between 1992 to 2008 as a result of the Great Smoke-Out campaign(http://www.who.int/tobacco/surveillance/en_tfi_gats_poland_report_2010.pdf)

In November 1995, the Polish Parliament with an overwhelming majority from all political parties, passed new tobacco-control legislation, the toughest in any of the former communist countries of Eastern Europe. Its main provisions and subsequent amendments in 1999 and 2002 included:

• A ban on smoking and the sale of cigarettes in health care centers, schools and enclosed workplaces;
• A ban on the sale of tobacco to minors (under 18) and by vending machines;
• A ban on electronic media advertising, including radio and television (in 1999 extended to all media);
• A ban of tobacco promotion and sponsorship;
• 30% textual health warnings on cigarette packs (one of the largest in the world at that time);
• Free provision of treatment for smoking dependence;
• The gradual reduction of tar, nicotine and carbon monoxide according to the European Union (EU) standards;
• Developing the government program aimed at reducing health and socio-economic consequences of smoking in Poland;
• Establishing a tobacco-control fund comprising of a levy of 0.5% from the excise tobacco tax .

Since the beginning of the 1990s, excise tax for cigarettes sold in Poland has increased over four times and now constitutes around two-thirds of the weighted average price, following the EU’s excise tax rules. This led to a substantial increase in tobacco prices in Poland, especially for manufactured cigarettes . However, cigarette prices are still low when compared to other EU countries, especially in Western Europe. Additionally, Poland’s rapidly growing economy has resulted in higher affordability of tobacco products. Hence, increases in excise duties and prices of cigarette and other tobacco products should be steadily continued.(Czart-Ciecierski C, Cherukupalli R, Weresa MA. 2011).

With proper planning and prevention measures and keeping in mind the current state of healthcare system in Poland the Tobacco use can be reduced .So the cause of tobacco use in Poland is they are one of the largest producers of Tobacco and lack of awareness.

Rigorous monitoring of tobacco use is critical for the implementation of effective tobacco control strategies.