Introduction
Globally, tobacco use remains a major public health issue, impacting both individuals and societies in harmful ways. Poland is currently facing a crucial challenge due to the high level of tobacco consumption. Available data recently indicate an upward trajectory in the prevalence of smoking in the country [1]. As many as 28.8% of adult Poles (30.8% of men and 27.1% of women) admitted to smoking daily in 2022 [2]. Moreover, 26.2% of Polish youth admitted to smoking at least once in the previous 30 days [3].
Smoking negatively affects all organs of the human body, including the heart and circulatory system by increasing the risk of ischemic heart disease, among other conditions. It can cause incurable respiratory diseases such as chronic obstructive pulmonary disease (COPD), emphysema, asthma, or increase the risk of several cancers. It has been shown that smoking can cause the development of at least twelve different malignancies including lung cancer, laryngeal cancer, bladder cancer, and stomach cancer [4].
Insights from the Global Burden of Disease (GDB) study have unveiled the profound impact of tobacco-induced cancers on the Polish population. In 2019, tobacco-related neoplasms caused the deaths of about 39,816.79 people and accounted for 32.6% of all deaths from malignant neoplasms. Tobacco dependence caused 26.6% of all deaths among Polish men and 13.8% of all deaths among Polish women in 2019. It is also among the main factors responsible for lost healthy life years for Poles (17.2% of total disability-adjusted life years [DALYs] in 2019) [5]. The health status of the Polish population is profoundly affected by tobacco-related diseases, underscoring the need for proactive tobacco control measures which should be an indispensable part of cancer prevention strategies.
The urgency as regards comprehensive tobacco control in Poland is further compounded by the persistent activities of the tobacco industry. Despite the ban on advertising and promoting tobacco products in Poland, tobacco companies exploit legal loopholes and the weak enforcement of existing laws to carry out their marketing activities [6]. The industry continues to employ marketing tactics that target vulnerable populations. In order to target young adults, they strategically place advertisements in locations associated with social gatherings and entertainment [7]. What is more, the tobacco industry possesses the capacity to exert influence over tobacco control policies in Poland. This influence is achieved through a range of strategies, such as cultivating a positive image, demonstrating a willingness to engage in policy-making procedures, and employing various forms of pressure to exert influence and lobby those in power [8].
Even so, Poland has not yet established effective countermeasures. Besides the implementation of European directives and, to some extent, the World Health Organization’s Framework Convention on Tobacco Control [9], prevention efforts have been very scattered. A study by Balwicki et al. showed both inadequate planning of and funding for Polish the Tobacco Control Program in the years 2000–2018 [10].
The study aimed to develop an expert consensus statement on tobacco control sustainability in Poland. Expert opinions were sought from diverse fields encompassing public health, medicine, research, and policies to ensure a multidisciplinary approach that incorporates various perspectives.
Material and methods
An expert consensus hybrid meeting was held on November 4, 2022, in Warsaw in the Ministry of Health. Polish national tobacco control experts representing public institutions, academia, and civil society organizations were invited to participate in the meeting to discuss the sustainability of national tobacco control in Poland. The discussion was a part of global initiative of The International Union Against Tuberculosis and Lung Disease called The Index of Tobacco Control Sustainability (ITCS). ITCS is a tool to assess and guide national tobacco control programs to become more sustainable [11]. The open discussion was structured by 31 indicators that have a critical influence on the national capacity to deliver effective and sustainable tobacco control into the future. The ITCS identifies the structures, policies, and resources that a country already has in place, and thus its progress towards establishing a sustainable national tobacco control program. After the meeting, a first draft including a statement was circulated to the panelists, discussed and edited. The present document was formulated and agreed on by all attending experts in this field.
Results
Tobacco control strategy: the program and inter-governmental coordination
Poland lacks a tobacco control strategy and a comprehensive program. A tobacco control strategy should provide a roadmap for addressing smoking prevalence and nicotine addiction effectively. It enables the government to implement evidence-based policies and interventions, allocate resources efficiently, and monitor progress in reducing tobacco use. Without a clear strategy, efforts to control tobacco may lack direction and coordination, leading to suboptimal outcomes. A tobacco control program should be based on the above mentioned strategy, describing in detail the activities that lead to achievement of the goals. The program should be comprehensive, covering all aspects of tobacco control expressed in the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) and its guidelines [12] as well as aspects expressed in WHO MPOWER package [13]. Additionally, establishing a functioning inter-governmental coordination mechanism is vital for effective collaboration and cooperation among different government agencies and public institutions involved in tobacco control. This mechanism can facilitate the exchange of information, coordination of efforts, and alignment of strategies, thereby ensuring a cohesive and unified approach to reducing tobacco use. It is critical for the country to allocate designated government funding annually to support tobacco control strategies and activities, including capacity building.
Consensus statement
It is crucial for Poland to develop a comprehensive tobacco control strategy and a program in line with the WHO FCTC guidelines. The realization of the strategy and program should be warranted by a functioning inter-governmental coordination mechanism.
Funding of tobacco control
Currently, no specific, annual funding is allocated for tobacco control activities, highlighting the need for sustainable financial support. The Polish government should allocate specific funding on an annual basis to support the implementation of tobacco control strategies and activities. These finances should encompass capacity-building activities, both
at governmental and civil society levels, necessary for effective tobacco control. Money could come from the deduction of excise tax on tobacco products as recommended by the World Health Organization [14].
Consensus statement
Poland should allocate designated, annual government funding for tobacco control operations and capacity building for tobacco control personnel and organizations.
Coordination of tobacco control
Poland does not have a properly functioning Tobacco Control Unit nor coordination mechanism for tobacco control activities. As a result campaigns and activities are scattered with no long-term plan or evaluation. It is also not clear who oversees the implementation of tobacco control law, tobacco industry activities, as well as tobacco and new nicotine product use. Establishing a Tobacco Control Unit in Poland is crucial to coordinate national tobacco control activities. It facilitates collaboration, strategic planning, data analysis, advocacy, and public awareness. By coordination of efforts and utilizing evidence-based approaches, the unit could enhance the effectiveness of tobacco control measures and contribute to reducing smoking prevalence and related harms.
Consensus statement
It is crucial for Poland to establish a Tobacco Control Unit and coordinating mechanism to manage tobacco control activities nationally.
Civil society in tobacco control
A civil society tobacco control network does not exist in Poland. Strengthening the civil society community and forming a national advisory committee with civil society representatives is crucial for supporting the implementation of tobacco control strategies and programs across Poland. This approach ensures inclusivity, taps into specialized knowledge, mobilizes grassroots support, and enables independent monitoring and evaluation, leading to more effective and accountable tobacco control efforts. Civil society is also needed for communication and advocacy efforts for stronger tobacco control.
Consensus statement
Poland should strengthen its civil society community and form a national advisory committee with civil society representatives to support strategy and program implementation.
Monitoring and evaluation of tobacco control
Monitoring and evaluation play a vital role in effective tobacco control programs. While Poland lacks a comprehensive mortality and morbidity recording system, the incidence of lung cancer serves as a vital indicator of the actual and prevailing tobacco-related situation. Poland’s involvement in the GDB initiative allows for the provision of data that helps assess the extent of DALYs lost due to tobacco use. Nevertheless, it is noteworthy that Poland currently lacks a national evaluation framework, and the integration of evaluation practices into major policy implementation plans remains limited. Data on economic and social tobacco costs are not calculated regularly for Poland. Establishing a robust monitoring and evaluation system is imperative in tracking the impact of tobacco control efforts accurately, guiding evidence-based policymaking, and effectively addressing the challenges posed by tobacco-related mortality and morbidity in the country.
Consensus statement
Monitoring and evaluation should be a part of Polish tobacco control.
Resistance to tobacco industry interference
Poland has a weak organizational resistance to tobacco industry interference. A report of the Global Tobacco Industry Interference Index 2021 shows many examples of unnecessary interaction and collaboration between the Polish government and the tobacco industry [15]. Tobacco industry Interference results in insufficient legal regulations, lowering the quality of decisions made and reducing the effectiveness of tobacco control. The Act of 16 September on government employees establishes general policies governing the duties and performance of government officials and staff. It explicitly prohibits officials from engaging in activities that could be perceived as conflicting with their duties or raising suspicions of partiality or self-interest. However, the Ministry of Health has yet to adopt a specific policy aligned with Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. Moreover, there is currently no comprehensive adoption of the WHO FCTC Article 5.3 policy across all other ministries in Poland. Further progress is still needed to ensure robust measures are in place to counteract the influence of the tobacco industry at both the ministry level and throughout various government bodies in the country.
Consensus statement
Poland should strengthen organizational resistance to tobacco industry interference implementing WHO FCTC Art 5.3 provisions.
Conclusions
In order to effectively push out tobacco control in Poland, the country needs to build institutional capacity and address sustainable financial resources on an annual basis. A Polish tobacco control program should address all aspects of preventive measures described in the WHO FCTC which Poland is a party to. Lack of organized efforts can worsen the epidemiological situation and have a profound impact on tobacco related diseases, including cancer.
Funding
The International Union Against Tuberculosis and Lung Disease (The Union) with support from Bloomberg Philanthropies has funded the expert meeting costs.
Acknowledgements
We want to thank Mr. Dariusz Poznański and Mr. Jakub Szymański from the Department of Public Health, the Ministry of Health, Poland, for their valuable input.
Conflict of interest: none declared
Marta Miller
Medical University of Gdansk
ul. Marii Skłodowskiej-Curie 3a
80-210 Gdańsk, Poland
e-mail: mmiller@gumed.edu.pl
Received: 30 Jun 2023
Accepted: 12 Jul 2023