State, society, and the politics of smoking in Poland, during and after communism (1960-2000)

The Polish Communist authorities declared an ideological commitment to population health. They maintained control over the political and economic levers necessary to shape the demand for, and the supply of, cigarettes. And yet, by the 1980s cigarette consumption in Poland reached the highest level in the world. Cigarettes were cheap and easily accessible, and tobacco control laws lax. Less than half of all Poles believed that smoking constituted a serious health hazard. Between 1989 and 1991 Poland underwent a political and economic overhaul as the Communist regime lost power. Transnational tobacco companies (TTCs) entered Poland, kept cigarette prices low, lobbied politicians, built state-of-the-art factories, and invested in marketing. Despite these efforts, by 2000 cigarette consumption in Poland significantly declined. Progressive anti-smoking laws were introduced, banning tobacco advertisement and introducing the largest health warnings on cigarette packs in the world. The aim of this thesis is to understand why post-communist Poland was able to adopt effective tobacco control policy responses rapidly in the 1990s, even though it had failed to do so earlier, despite the increasing power of the TTCs at that time. It also aims to investigate the importance of civil society actors in this process. This thesis demonstrates that the collapse of communism in 1989 was a political caesura which opened the health policy landscape in Poland, empowering anti-tobacco civil society groups and public health-oriented politicians. Simultaneously, however, it highlights the continuity in tobacco control policy debates before and after 1989, showing that the professionalization and coalition-building of the anti-tobacco movement began already in the communist period. It also points to the importance of cultural change and of the shifting social attitudes towards smoking, to the centrality of the agricultural lobby in tobacco policy formation, and to the delayed privatisation of the tobacco industry as a factor weakening the lobbying efforts of the TTCs.