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

Poland and other Eastern European countries have undergone heavy indus trial development with marked increases in air pollution and occupatio nal exposure in the nearly 50 years since World War II. These countrie s have also experienced substantial increases in chronic disease morta lity in the past three decades. While it is tempting to assume a direc t association between these phenomena, more detailed-analyses are call ed for. Poland offers a potentially rich opportunity for comparing geo graphical patterns of disease incidence and of industrial change. In t his paper we 1) elucidate the prospects for attributing lung cancer mo rtality to industrial emissions in poland, using an ecological approac h based on the hitherto unaddressed geographic differences, and accoun ting for regional differences in cigarette consumption; 2) propose exp lanatory hypotheses for the observed geographic heterogeneity of lung cancer, 3) begin systematic testing of the widely accepted but not wel l-scrutinized notion that pollution in Poland is a major contributor t o declining life expectancy. Regions with the highest fraction of canc er 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 mo rtality 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 p opulation resettlement, may have produced living conditions adverse to good public health. We argue that research on pollution and public he ath should treat these topics in a broad context including bath techno logical and social change.