A common enemy: half a century of US/Poland cooperation and tobacco control

Both Poland and the US have made tremendous progress over the past several decades in reducing both tobacco use and lung cancer mortality. However, this victory was not easily won. The outcome was the result of substantial effort over decades, requiring multi-sector collaboration and countering of competing interests. The US and Poland also share over 50 years of formal cooperation in health, with a continuous bilateral agreement in place since 1974. Beginning in the 1960s, the US government, particularly the National Cancer Institute, supported biomedical research projects in Poland under the Foreign Assistance Act. However, the bilateral relationship around tobacco control was more complex, with competing economic and foreign policy interests. During the 1970s and 1980s, Poland was among the highest smoking nations in the world. Smoking prevalence had risen to around 80% among men and 50% among women. The fall of Communism, Poland’s transition to democracy during 1989 to 1991, and the move towards a capitalist market also had implications for the tobacco market, as multinational tobacco firms raced into Central and Eastern Europe. During the 1990s, US tobacco companies were rapidly expanding their markets abroad and the US government was actively promoting greater exports of US tobacco products and subsidizing sales of US tobacco to Poland. However, the enactment of a comprehensive national tobacco control law in Poland 1995, after years of hard fought efforts, finally began to drive down cigarette smoking. This success was largely a result of efforts from journalists, voluntary organizations, and activists, part of a growing civil society movement in newly-democratic Poland. The international community, including the US, had an important role in bringing tobacco control experience to Poland, but this assistance came not from government but from voluntary and advocacy organizations. These collaborative efforts turned Poland into a tobacco control success story.