THE CURRENT STATUS OF THE TOBACCO EPIDEMIC IN …

1 THE CURRENT STATUS OF THE TOBACCO EPIDEMIC IN poland The CURRENT STATUS of the TOBACCO EPIDEMIC in poland The WHO Regional 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. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan Original: English World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen , Denmark Tel.

2 : +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: Web site: 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.

3 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 , Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( ). World Health Organization 2009 All rights reserved.

4 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.

5 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.

6 I Executive summary ..ii 1 General .. 2 2 Administrative structure .. 4 Economic conditions .. 7 Health expenditure .. 8 TOBACCO -smoking and the health STATUS of the 9 Cigarette sales and consumption .. 9 Prevalence of smoking in the adult population ..10 TOBACCO -smoking among 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 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 TOBACCO cultivation ..37 Production and market share of TOBACCO Marketing strategies of the major TOBACCO companies.

7 38 Political commitments and priorities in TOBACCO control policy ..41 CURRENT legal and tax regulation ..41 Programmes for national 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 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 Annex 2.

8 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 Annex 6. Smoking-related Deaths per 100 000 Population, EU Countries, Russian Federation, Turkey, and Ukraine, 2004 2006 ..76 Annex 7. European Countries Ranked by Total TOBACCO Control Scale According to Progress in TOBACCO Control, 2005 2007 ..77 Annex 8. WHO Strategic Anti- TOBACCO Documents ..78 Acknowledgments This report is an element in the Biennial Collaborative Agreement between the WHO Regional Office for Europe and the Ministry of Health of poland 2008 2009, and is part of the process of implementing the Bloomberg Global TOBACCO Control Initiative to Reduce TOBACCO Use.

9 It was prepared at the turn of 2007 and 2008. The WHO Regional Office for Europe thanks the authors of their report, who have longstanding experience and expertise in the field: Mr Bogdan Bednarski, Ministry of Finance Dr Pawe Gory ski, National Institute of Public Health Mrs El bieta ata, State Sanitary Inspectorate Mr Tadeusz Parchimowicz, Ministry of Health Mr Krzysztof Przewo niak, Institute of Oncology in Warsaw Dr Bogdan Wojtyniak, National Institute of Public Health. Dr Micha Ambroziak and Ms. Anna Koziel, National TOBACCO Control Officers at the WHO country office in poland , coordinated the work and edited the Report. The Regional Office is grateful to the National Health Fund and the Ministry of Economy for their data. The data in the report draw on the official national statistics maintained by the Central Statistical Office, official and legislative documents relating to TOBACCO control, analyses and monitoring conducted by the Ministry of Health, the State Sanitary Inspectorate and the Ministry of Finance, systematic epidemiological studies carried out by the Cancer Centre and Institute of Oncology in Warsaw and the Cancer Epidemiology and Prevention Department, and information provided by institutions such as the Ministry of Agriculture and Rural Development and the National Health Fund.

10 The report is an attempt to present the data, covering all aspects of the spread of TOBACCO -smoking, in the light of the changes that have occurred in this area in past years. Its authors have sought to describe the areas where improvements are needed and to formulate the priority tasks for medium-term TOBACCO control. The CURRENT STATUS of the TOBACCO EPIDEMIC in poland page i Foreword TOBACCO -smoking is a serious threat to our civilization as a result of its prevalence and its detrimental impact on society and economic activity. In poland , the nicotine dependence EPIDEMIC kills thousands of people of productive age every year and permanently disables or hampers the early development of a much larger number of individuals.