SOCIAL AND ENVIRONMENTAL-FACTORS IN LUNG-CANCER MORTALITY IN POSTWAR POLAND

Poland and other Eastern European countries have undergone heavy industrial development with marked increases in air pollution and occupational exposure in the nearly 50 years since World War II. These countries have also experienced substantial increases in chronic disease mortality in the past three decades. While it is tempting to assume a direct association between these phenomena, more detailed-analyses are called for. Poland offers a potentially rich opportunity for comparing geographical patterns of disease incidence and of industrial change. In this paper we 1) elucidate the prospects for attributing lung cancer mortality to industrial emissions in poland, using an ecological approach based on the hitherto unaddressed geographic differences, and accounting for regional differences in cigarette consumption; 2) propose explanatory hypotheses for the observed geographic heterogeneity of lung cancer, 3) begin systematic testing of the widely accepted but not well-scrutinized notion that pollution in Poland is a major contributor to declining life expectancy. Regions with the highest fraction of cancer that cannot be explained by smoking appear to be highly urbanized, have high population exposure to occupational carcinogens, experience the highest rates of alcoholism and crime, and are associated with the post-World War II population resettlement. Although the analysis does not rule out pollution as a significant contributor to lung cancer mortality it indicates that other factors such as occupational exposures and various social factors are of at least comparable importance. We conclude chat the observed trends in life expectancy in poland should not be attributed primarily to pollution without careful attention to other contributing causes and that social factors, such as the major population resettlement, may have produced living conditions adverse to good public health. We argue that research on pollution and public heath should treat these topics in a broad context including bath technological and social change.