Tobacco and Public Health - TCSC Indonesia

Chapter 13
Tobacco smoking in central European
countries: Poland
Witold Zatoński
Two simultaneous health phenomena developed in eastern and central Europe after
World War II. On the one hand, the incidence of infectious diseases and perinatal/
neonatal mortality fell abruptly. However, at the same time the incidence of and mortality
from man-made diseases began to rise rapidly. In the 1970s and 1980s, the incidence
of lung cancer, liver cirrhosis (especially in south-eastern Europe), cardiovascular
diseases and injury-related mortality (especially in the then Soviet Union) in young and
middle-aged adults (particularly among men) reached levels never previously recorded
in the world (Feachem 1994; Zatoński and Jha 2000). As a result of the above, at the end of
the 1980s the levels of mortality due to infectious diseases and mortality among infants
or children and youth before age 20 were comparable to Western standards (World
Bank 1996; Zatoński and Jha 2000). At the same time, adult health represented a public
health catastrophe. Premature mortality, especially among young and middle-aged
adult men had reached the highest level in the developed world. The WHO report from
1990 showed that fewer 15-year-old boys from Poland and other CEE countries would
reach the age of 60 than their peers not only in western Europe but also in Latin
America, China or even India (Murray and Lopez 1994). Very high premature mortality
in Poland and other eastern European countries is mainly due to man-made diseases:
nearly 50% of this burden is attributable to cigarette smoking (Peto et al. 1994). The
incidence of lung cancer (a disease that almost exclusively effects cigarette smokers) in
Poland (and other central European countries) had reached a level not seen anywhere
else in Europe (Zatoński et al. 1996). The heath, economic, and social costs of smoking
became a major challenge facing Poland and eastern Europe (Zatoński and Boyle 1996).
Introduction
The adult health catastrophe, unusual in peacetime, cannot be understood without
first tracing the history of exposure to tobacco smoke in EE populations.
Before WWII tobacco consumption in EE countries was lower than in most western
European countries (Forey et al. 2002). There was some diversification and tobacco
was mostly consumed as hand-made cigarettes, most smokers being males.