Alcohol as a public health threat in Poland: rising consumption, weakening policy, and increasing mortality

Introduction

Alcohol consumption is one of the most consequential modifiable risk factors to health worldwide. In Poland, alcohol-related diseases constitute one of the most significant public health challenges. Alcohol consumption leads not only to the development of addiction but also to a range of somatic and psychological complications, including liver damage, cardiovascular disease, cancer, neurological disorders, and dozens of other conditions, syndromes, and psychological disorders [1]. This problem is multidimensio­nal, affecting medical, social, economic, and legal spheres.
Alcohol remains one of the most commonly consumed psychoactive substances, with significant public health implications. Due to widespread acceptance of drinking and social norms that favour its consumption, negative effects are often downplayed, or obscured by beliefs about its supposed health and economic bene­fits. These conflicting messages can undermine efforts to reduce the health and social burdens associated with alcohol. Worldwide, alcohol consumption caused appro­ximately 2.6 million deaths (around 5% of all deaths) and 115.9 million disability-adjusted life years (DALYs) (around 5% of total) in 2019, mainly due to non-communicable diseases, injuries and mental disorders [2].
According to recent Polish epidemiological data, alcohol consumption is a significant risk factor for many diseases, responsible for tens of thousands of deaths annually, and a significant number of hospitalizations. According to data from the National Health Fund, in 2023 the number of patients hospitalized due to alcohol poisoning averaged 20,187 [3]. The World Health Organization (WHO) estimated the number of alcohol-related deaths in Poland in 2019 was 28,500 [2]. Considering the scale of this phenomenon, alcohol-related diseases must be considered in the context of broader health and social trends. At the individual level, all alcohol consumption is associated with short- and long-term health damage, although the extent varies and does not always become apparent during a lifetime.
At the population level, even light consumption typically worsens public health, primarily due to widespread harmful drinking patterns and alcohol-related disorders. Therefore, reducing consumption at the population level, measured as total pure alcohol consumption per adult yearly, is a legitimate and important public health goal. Alcohol per capita consumption (aged 15 years and older) within a calendar year in liters of pure alcohol is one of the indicators (no. 3.5.2) within the United Nations Sustainable Development Goals (SDGs) [4].
The aim of this short review is to summarise measures within the public health alcohol policy in Poland in last 25 years, on the background of historical and current levels of consumption, and the epidemiology of alcohol-related harm.

Alcohol is not an ordinary commodity. It causes health damage

To assess the scale of alcohol-related health damage, it is necessary to organize knowledge about its impact on the human body and emphasize the importance of consumption levels on a population scale for public health. Despite its widespread availability and popularity in European countries, alcohol is “not an ordinary commodity”, as reflected in the WHO slogan [5]. Ethyl alcohol, although perceived as an ordinary food product in many societies, is in fact a psychoactive, addictive, toxic, and carcinogenic substance. Despite this, its consumption is widely accepted, and promoted by the alcoholic beverage industry.
There is no safe dose of alcohol. In any form (spirit, beer, or wine), it has harmful effecs on the body [1]. It causes over 200 diseases and injuries, many of which have multifactorial aetiologies. It affects numerous structures and processes in the central nervous system; regardless of the dose, it causes brain damage, particu­larly the frontal lobe, responsible for thinking, planning, speech, personality, concentration, and motor coordination. Alcohol consumption is associated with the risk of developing mental disorders, addiction, and serious chronic non-communicable diseases, including alcoholic liver cirrhosis and cardiovascular diseases [6]. As a carcinogen, alcohol has a proven link to numerous cancers, including those of the head and neck, mouth, throat, oesophagus, larynx, liver, and breast [7]. It also acts as an immunosuppressant, increasing susceptibility to infectious diseases such as tuberculosis and AIDS. It is particularly toxic to the foetus and developing tissues, as well as to children. It’s worth noting that alcohol harms more than just the person consuming it. In 2019, nearly half of the 298,000 alcohol-related road fatalities were caused by someone drinking. Other consequences include injuries, violence, and suicide [8].
The risk of alcohol-related harm depends on many factors: quantity and frequency of consumption, age, gender, health status, and social context. The greatest risk is associated with heavy episodic and chronic drinking (even small amounts). In 2019, 52% of men and 35% of women drank alcohol, with men consuming on average four times more. The health consequences are also unequal, with alcohol accounting for 6.7% of all deaths in men and 2.4% in women [8].
Estimating the overall harm associated with alcohol (particularly non-communicable chronic diseases in adults) in Poland since the beginning of the 21st century has been a complex task. In contrast to most European countries, Poland experienced opposing trends in alcohol and cigarette consumption between 2002 and 2016 [9-11]. The increase in alcohol consumption contrasted with a significant decline in cigarette smoking, which translated into a reduction in deaths from tobacco-related diseases, such as cardiovascular disease, for which both smoking and alcohol consumption are risk factors. Mortality in these disease groups is primarily due to the decline in cigarette consumption, from approximately 80 billion cigarettes in 2002 to approximately 40 billion in 2014 [12-14]. This situation, with increased alcohol exposure and a simultaneous decline in tobacco consumption, complicates estimating their contribution to health indicators such as life expectancy and requires in-depth analyses.

Exposure

Data indicate that Poland is among the few European countries that experienced an increase in alcohol consumption between 2000 and 2020 [15]. Historically, Europe has been, and continues to be, the region with the highest alcohol consumption in the world [16, 17]. However, it is worth recalling that between 1950 and 1980, Poland was not among the leading countries in this regard. During this period, the highest levels of consumption were observed in the Mediterranean countries and the Balkans, where people aged 15 and over drank an average of 20-25 liters of pure alcohol per capita per year [15]. Such high consumption was associated with the highest rates of morbidity and mortality from alcohol-related diseases, including alcoholic liver cirrhosis, cancers of the oral cavity, larynx, and oesophagus, as well as alcohol-induced mental disorders [16]. In the first decades after World War II, the level of alcohol-related health damage in Mediterranean countries reached alarming, epidemic levels. During the same period, consumption of 6-7 litres of pure spirit per person per year was recorded in Poland [15, 18].
Given the alarming health situation in Europe, many countries have implemented measures to limit alcohol consumption since the late 20th century [19, 20]. The result: alcohol consumption and related mortality have declined significantly in recent decades. For example, in France, consumption fell to 10 litres of pure alcohol per person in 2020, and in Italy to 8 litres. This was accompanied by significant declines in morbidity and mortality, particularly in alcoholic liver cirrhosis and laryngeal and oesophageal cancers.
A different trend was observed in Poland, where the structure of alcohol consumption changed significantly in subsequent decades. In the late 1990s, vodka, which has long been dominant among alcoholic beverages, was replaced by beer. In 2022, beer accounted for 53% of total per capita alcohol consumption (in pure alcohol terms), and vodka for 39% [21]. At the turn of the second and third decades of the 21st century, registered alcohol consumption in Poland reached 10 litres per capita, the highest level in history [22].
The availability of alcohol in Poland, expressed in terms of the number of points of sale, has increased over the years. The 1982 Act on Promoting Sobriety and Counteracting Alcoholism [23] limited their number to approximately 30,000. However, in the late 1980s, as a result of political and economic changes, the opening of the market to foreign products, the development of free market mechanisms, and privatization, the number of points of sale rapidly increased, to nearly 200,000 retail outlets and approximately 60,000 restaurants and bars [18].
The removal of time restrictions further increased the physical availability of alcohol. It became a commodity available 24/7. It can now be purchased almost anywhere: in grocery stores, gas stations, and restaurants. In 2024 there were 119,5978 retail outlets in Poland (1 for every 302 residents) [24, 25]. In comparison, the number of Polish inhabitants per one pharmacy is many times greater: approximately 2,700 residents per pharmacy [26].
At the same time, the affordability of alcohol, measured by the number of half-litre bottles of 40% vodka that can be purchased with an average wage, has syste­matically increased. Between 2001 and 2021, it rose significantly. A person earning the minimum wage could buy 32 bottles of vodka in 2001, and more than triple that (107) just 20 years later [27].
This significant increase was primarily due to Poland’s excise tax policy. While in many European countries, excise tax rates on alcohol were systematically raised [28], in Poland, the tax rate on spirits was reduced by 30% in 2002 and then maintained unchanged for a long time. Increases in 2006 (3.4%), 2009 (15%), 2014 (10%), and 2020 (10%) were lower than inflation or the rate of minimum wage growth, further increasing the economic affordability of alcohol [29]. This failure demonstrated a deficit of health literacy among decision-makers at the highest levels of government, leading to important economic decisions being made without considering their potential impact on public health. As Madoń and Lewandowski wrote [30], excise tax is one of the main mechanisms shaping the prices of alcoholic beverages and tobacco products. The change in excise tax policy introduced by Leszek Miller’s government in 2002 contributed to increased economic access to alcohol. This resulted in the so-called “Kołodko alcohol epidemic,” a phenomenon demonstrating that fiscal policy without a health perspective can lead to serious social consequences.
In 2021, a roadmap for excise tax increases through 2026 was developed, assuming a 10% increase in 2022 and a 5% annual increase thereafter [29, 31]. However, due to high inflation and a rapid increase in the minimum wage, real alcohol prices began to decline. In 2022, with the minimum wage increasing by 7.5% and inflation reaching 14.4% year-on-year [32], the decline in the real price of alcohol deepened even further.
An additional factor driving the increase in alcohol consumption in Poland was the introduction of a marketing strategy by the spirits industry in 2008-2009 promoting so-called small bottles of vodka, typically 100 or 200 ml, most often flavoured. A report by research firm Synergion [33] indicate that over a billion such bottles are sold in Poland annually, and in 2018, their sales increased by nearly 10%. Approximately 3 million such bottles are sold daily, approximately 600,000 of which are sold between 6 AM and 12 noon. Currently, these bottles constitute 17% of the entire vodka market. Data show that alcohol consumption patterns in Poland have shifted from weekend binge drinking to daily consumption of small portions. This phenomenon has been widely discussed in the media but rarely analysed in public health studies. In recent years, there has been a lack of reliable, independent data to determine its actual scale [34].
The rise in alcohol consumption in Poland is fuelled by both its widespread availability and increasing affordability. An additional factor is aggressive marketing, including the popularization of small bottles, which can reinforce daily drinking patterns. Increased exposure to alcohol has led to dramatic increase in morbidity and mortality from alcohol-related diseases in Poland.

Epidemiology of alcohol-related diseases

According to the WHO, in 2019, alcohol was responsible for 2.6 million deaths worldwide (2 million men, 0.6 million women), of which 1.6 million resulted from non-communicable diseases, 700,000 from injuries, and 300,000 from infectious diseases. In 2019, there were 474,000 deaths from cardiovascular diseases and 401,000 cancer deaths attributed to alcohol consumption. The highest alcohol-related mortality rates were recorded in Europe and Africa. Globally, approximately 400 million people over the age of 15 struggle with alcohol-related disorders, more than half of whom suffer from addiction [8].
The best indicator for estimating alcohol-related health damage in a population is the mortality rate from alcoholic liver cirrhosis. This condition is 100% alcohol-attributable and is easily diagnosed. The increase in alcohol consumption in Poland has led to a sharp increase in mortality from alcoholic liver cirrhosis [35].
Between 1999 and 2022, Poland experienced a mani­fold increase in mortality from alcoholic liver cirrhosis among both men and women across all adult age groups. In the youngest adult group (20-44 years), the standardized death rate (SDR) increased from 2.7 to 10.5 per 100,000 in men (fourfold) and from 0.5 to 4.2 in women (eightfold). In the 45-64 age group, the SDR increased from 10.4 to 52.7 in men (fivefold) and from 1.4 to 18.9 in women (thirteenfold). Among the oldest adults (65 years and older), the increase was even more pronounced: from 4.6 to 49.3 (tenfold) in men, and from 0.5 to 11.7 (twenty-threefold) in women. Analysis of mortality from alcoholic liver cirrhosis in Poland indicates that although mortality is higher in men, a more dynamic rate of increase was observed in women during the study pe­riod. Furthermore, the increase in mortality was relatively greater in older age groups than in younger ones [35].
Even more pronounced changes were observed in the absolute number of deaths due to alcoholic liver cirrhosis. Between 1999 and 2022, this number increased among young adults (20-44 years old) – fourfold in men (from 227 to 870) and eightfold in women (41 to 341). Among those aged 45-64, it increased sixfold in men (436 to 2,583) and fifteenfold in women (65 to 985). Among persons aged 65 and over, it increased seventeen­fold in men (79 to 1,384) and fortyfold in women (11 to 436). In total, between 1999 and 2022, over 79,000 people died of alcoholic cirrhosis in Poland: 60,562 men and 18,764 women [36]. The disease, which was a rela­tively rare cause of death in the late 1990s in Poland, especially among women, became one of the most common in the 2020s.
As mortality from alcoholic liver cirrhosis increased, its share of all-cause death increased as well. The largest jump was observed among young adults (20-44 years of age): the percentage of deaths due to alcoholic liver cirrhosis increased between 1999 and 2020 from 1.2% to 6.7% in men and from 0.7% to 6.3% in women. For comparison, in 2020, in the same age group, the share of deaths due to cardiovascular diseases was 10% in both men and women [36].
The epidemiological situation in Poland is a classic example of the so-called “reservoir effect”, an immediate change in mortality in response to a sharp increase or decrease in alcohol consumption at a population level. This phenomenon was first described during the German occupation of Paris during World War II, when an 80% decline in alcohol consumption was observed between 1942 and 1947, accompanied by an immediate decline in mortality from alcoholic liver cirrhosis, by over 50% in the first year and by over 80% after five years. In recent decades, similar relationships have also been observed in Russia and Poland. For example, in the USSR, during Mikhail Gorbachev’s anti-alcohol campaign of 1984-1987, alcohol consumption fell by approximately 25%, and mortality from alcoholic liver cirrhosis immediately decreased by over 40% in men and by 35% in women aged 20-64. By comparison, the collapse of the USSR between 1992 and 1995 brought sharp increases in alcohol consumption in many countries, immediately followed by a rise in mortality from alcoholic liver cirrhosis. In Russia alone, mortality increased by 140% during this time. A similar phenomenon occurred in Poland between 1989 and 1992 [37].
As demonstrated in numerous epidemiological studies, alcoholic cirrhosis develops at the individual level after years of heavy alcohol consumption. The risk of its occurrence increases exponentially, although it is charac­terized by significant individual variability. However, in individuals with a long history of excessive alcohol consumption and chronic liver damage, sudden changes in alcohol exposure lead to immediate changes in mortality from alcoholic cirrhosis at the population level. In Poland, the increase in mortality from alcoholic cirrhosis was observed immediately following changes in alcohol consumption since the early 2000s, and its scale was many times greater than in other countries [37].
Developments in Poland since 2002 offer an opportunity to observe an epidemiological phenomenon, a so-called “natural experiment”, that is still not fully understood. However, it is increasingly clear that in many European countries, even those with well-developed public health strategies, such as Finland, alcohol is not treated as a common commodity.
Of particular note is the fact that the International Agency for Research on Cancer (IARC) classifies alcohol as a Group 1 substance with proven carcinogenicity in humans [7]. There is little knowledge in society, not only Polish, that the risk of cancer increases with a single alcoholic beverage and increases with the amount consumed [38]. Alcohol damages DNA through acetalde­hyde, causes oxidative stress, alters hormonal balance (increasing estrogen levels), and facilitates the absorption of other carcinogens, such as those from tobacco smoke. The combination of alcohol and tobacco has a synergistic effect, increasing the risk of cancers of the oral cavity, pharynx, and oesophagus by up to 30-fold. Alcohol-related cancers include cancers of the oral cavity, pharynx, larynx, oesophagus, colon and rectum, and liver, but alcohol is also a significant risk factor for breast cancer [1]. In Poland, in 2016, 7,252 cancer cases (approximately 4.4% in women and 5.8% in men) were attributable to alcohol consumption [39].

Public health policy towards alcohol

The Polish example in the first 20 years of the 21st century shows that the weakening of previously effective strategies to limit the availability of alcohol, combined with intensive promotion by the alcohol industry, can lead to a serious health crisis [40].
Between 1985 and 2002, alcohol consumption in Poland remained relatively stable, below the Euro­pean average [15]. This was the result of effective alcohol control policy, based on the Scandinavian model and introduced by the 1982 Act, adopted at the initiative of the Solidarity movement [23]. A comprehensive analysis of alcohol control policy in 30 OECD countries showed that in the early 2000s, Poland, alongside Norway, was among the countries with the most developed and effectively implemented alcohol control regulations [41]. This was reflected in the relatively low number of alcohol-related deaths during this period [37, 42].
Unfortunately, since the beginning of the 21st cen­tury, Poland has seen a marked weakening of public health policies regarding alcohol. In 2001, the ban on advertising and promoting alcoholic beverages, in force since 1982 [23], was loosened, allowing, among other things, beer advertising. Initially, these could be broadcast only via television, radio, cinemas, and theatres between 11:00 PM and 6:00 AM [43]. A year later, the excise tax on spirits was reduced by 30% [44], and in 2003, regulations were liberalized again, particularly regarding advertising and sponsorship of events, including sporting events. The broadcast time for beer ads was then extended to 8:00 PM and 6:00 AM [45]. In 2010, an intensive marketing campaign promoting small bottles of alcohol was launched, as mentioned earlier [34].
It is difficult to find a rational justification for such passive public health policy in this area. Analysis of actions taken between 2000 and 2020 in the Baltic states shows that Lithuania, Latvia, and Estonia have consistently introduced severe sales restrictions, repeated tax increases aimed at reducing the affordability of alcohol, and marketing restrictions [46]. In Poland, however, excise tax increases were less frequent and insufficient, and the 2002 tax reduction on spirits resulted in particularly strong increases in affordability and consumption [44]. Furthermore, no regulations limiting the physical availability of alcohol have been introduced in the last two decades [47-49].
The WHO confirms [50] that Poland has experienced a significant weakening of health policy in this area and a lack of regulatory action to limit alcohol availability. It also notes that since the early 2000s, there has been a steady increase in recorded alcohol consumption in Poland, while Estonia and Lithuania have seen declines since 2008 due to effective regulations. The WHO concludes that the lack of decisive action in key areas of public health policy in Poland contributes to the increase in morbidity and mortality from alcohol-related diseases.
The most effective strategies [51] for reducing the health and social harm associated with alcohol consumption involve multi-factorial actions implemented at multiple levels. Fiscal policy plays a key role, with regular increases in excise taxes and other taxes directly limiting the affordability of alcohol. Restrictions on advertising and marketing, including bans on the promotion of alcohol products in mass media or at sporting events, as well as regulations regarding availability, such as limiting the number of retail outlets and shortening their opening hours, are also crucial. These actions are complemented by broad-based educational initiatives that increase public awareness and help shape healthy consumer attitudes.
However, research shows that knowledge about the link between alcohol consumption and diseases such as breast cancer in women remains very low. In many countries, including Poland, less than half the population is aware of this risk [38]. This ignorance contributes to the perpetuation of myths, such as the popular notion that modest consumption (e.g. a glass of wine a day) has health benefits. Debunking this narrative and promoting abstinence, or significantly reduced consumption, are among the main elements of contemporary public health initiatives.
At the same time, it is necessary to intensify scientific research into the biological mechanisms of alcohol’s effects, consumption patterns, social factors contributing to drinking, and the effectiveness of various preventive and regulatory interventions. Only a combination of strong legal regulations, economic policy, educational activities, and scientific research can yield lasting results in reducing alcohol-related harm.

Conclusions

Alcohol remains one of the most significant modifiable health risk factors worldwide. From a public health perspective, it is crucial not only to treat addiction but also to reduce consumption across the population, as most health harms affect non-dependent indivi­duals who drink alcohol regularly, or in large quantities on occasion. Only a comprehensive approach, including legislation, education, and research, can effectively reduce the burden of alcohol-related diseases.
In Poland, it is urgently necessary to restore the alcohol-related harm control program, which has been significantly weakened in the 21st century. A key step should be the development and implementation of a national strategy, encompassing, among other things: adequately funded and effective educational campaigns, restrictions on the availability of alcohol, regular and significant increases in excise taxes that account for rising inflation, the introduction of a complete ban on alcohol advertising, and constant monitoring of health and social harm. An effective health policy must be based not only on restorative medicine but, above all, on the pillars of public health, in line with standards applied in many European countries, including our closest neighbours. It is crucial to restore population-level educational activities and emphasize primary prevention. Evidence-based programs addressing all major health risk factors should be implemented as soon as possible.

Disclosures

The authors report no conflict of interest.

References