Three forms of oral history were used in the data collection process between December 2014 and December 2016: interviews, witness seminars, and a conference whose participants also supplied witness testimonies. All recordings and transcripts of the interviews, seminars, and conference were saved electronically in a password-protected folder at the London School of Hygiene and Tropical Medicine, and were only accessible to the author.
Interviews
The bulk of oral history research conducted during the data collection period came in the form of semi-structured in-depth interviews with key informants. These were conducted by the author in English or in Polish, depending on the first language of the interviewee. The interviews had open- ended questions and were tailored to the individual interviewee (see Appendix A for interview schedule). The interviews took place in the participant’s home or a location that was convenient for them. The need for privacy guided location choice. Interviews were digitally recorded and transcribed verbatim. Interviews lasted between 30 and 120 minutes.
The interviewees were individuals involved in health policymaking, advocacy, or in the tobacco industry between the 1970s and 1990s. This included ministers and parliamentarians, civil servants, anti-tobacco activists (Polish and western), religious leaders, researchers and scientists, and tobacco industry executives. The initial pool of interviewees was identified from secondary literature and the subsequent interviewees by respondent-driven sampling, or by them being identified as key stakeholders in the archival materials. In total, 15 interviews were carried out in Poland, UK, Italy, and the USA between December 2014 and February 2017 (see Appendix B for list of interviewees, excluding interviewees representing the tobacco industry who chose to remain anonymous, Appendix C for participant information sheet, Appendix D for informed consent form, and Appendix E for LSHTM Ethics Approval). In fourcases, follow-up interviews were conducted. Five other informants were approached for an interview but declined due to advanced age and health concerns or, in the case of tobacco industry representatives, a lack of interest.
The interviews posed some methodological and practical challenges. While a broad spectrum of key stakeholders was interviewed, yielding a wide range of data about tobacco policy in Poland, it proved difficult to identify interviewees holding critical opinions of the developments in the 1990s. An attempt was made to elicit dissenting views by recruiting persons associated with the
101 tobacco industry. However, only two individuals agreed to participate, under the condition of remaining anonymous, and both declared that in retrospect they evaluated the anti-tobacco efforts of the post-communist period positively, perhaps indicating a courtesy bias.
Another limitation was that most of the interviewees only began their involvement with health and tobacco policymaking, advocacy, or public health, in the late 1980s. Only a handful could provide data regarding the late 1970s, and none regarding the earlier period. Recruiting individuals who might provide such information was unsuccessful, as they were either unavailable due to poor health or had passed away before the interviews could take place. Witness conference and testimonies
The second oral history data collection method was a fully recorded and transcribed witness conference – the Conference on Smoke-free Poland – organised on 18 May 2016. The conference was organised by the Ministry of Health of Poland in collaboration with the Health Promotion Foundation (Image 1). It marked the 20th anniversary of the enactment of the Polish Anti-tobacco
Law by the Polish Parliament in May 1996. The conference was attended by over 100 participants representing the health advocacy movement in Poland. The participants originated from a wide variety of backgrounds – physicians, politicians, civil servants, artists, journalists, and many others – in order to reflect the diverse nature of the anti-tobacco movement in Poland. Several of them held senior governmental positions in the present government, including the Minister and Vice-minister of Health. The participants discussed the key developments in tobacco control in Poland in the last 30 years and were asked four broad questions:
What was your contribution to the anti-tobacco movement and to advocacy in favour of smoke-free lifestyles in Poland?
How to you explain the success of the health advocacy in Poland in the 1990s? How did the Anti-tobacco Law and the decrease in popularity of smoking in Poland
impact your personal and professional life?
Is there any distinctive, personal story connected with your involvement in health advocacy in Poland?
Ten formal presentations addressing these questions were given, and 5 other participants in the conference submitted written witness testimonies (see Appendix B for list of conference participants and contributors of witness testimonies).
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Image 1. Photographs from the Conference on Smoke-free Poland, 18 May 2016
Clockwise from top: participants of the conference in the Column Hall of the Ministry of Health, presentation by Iwona Schymalla, presentation by Andrzej Pągowski.
Source: M. Zatoński, "Report from the Conference on Smoke-Free Poland, Ministry of Health, Warsaw, Poland, 18 May 2016," Journal of Health Inequalities 2, no. 2 (2016). The format of a ‘witness conference’ carried with it several challenges as a tool for data collection. Many of these challenges were associated with the fact that, as a substantial
organisational undertaking, it had to be organised with the help of a major institutional partner, the Ministry of Health of Poland, which hosted the event. In order to obtain support, the conference theme had to be framed in an attractive way. The tagline of ‘20th anniversary of the
introduction of the Polish Anti-tobacco Law’ was used for this purpose. The discussion points of the conference, as well as the list of presenters, had to be agreed with the Ministry. This shifted
103 the programme from being purely focused on history to being partly devoted to present and future tobacco control policy. Therefore, out of the 150 minutes allocated to presentations, the first 90 minutes were devoted to historical reminiscences, while the last 60 minutes to the current political agenda, in which the Vice-Minister of Health laid out the new government’s plan for tobacco control in the coming years. Finally, the conference invitations and the outline of discussion topics framed the Polish Anti-tobacco Law and its legacy in a very positive way, thus perhaps discouraging potential dissenting voices.
In addition, due to the current political polarisation in Poland, the choice was made not to invite several individuals whose contribution might have been valuable for the purpose of research, but could be unfavourably received by the hosting institution. Several other invitees refused to attend for political reasons. Others still attended, but were not provided with space in the programme to make oral contributions (although in a number of instances they still took the floor impromptu). In particular, key informants with known broadly defined left-wing views, or political affiliations, were underrepresented during the event. This meant that greater effort had to be made to elicit data from these individuals using different methods, including interviews and the witness seminars.
Despite those limitations, the format and prestige of the event provided a unique opportunity to obtain data from several respondents who were not interested, or not promptly available, to take part in individual interviews or in witness seminars. In addition, it enhanced the public engagement and impact dimension of the research. The conference was reported in several media outlets and it was used by the Ministry of Health to announce the government’s new proactive position in regard to implementing European Union Tobacco Products Directive provisions, as well as regulating electronic cigarettes.
Witness seminars
The third oral history data collection method was centred on two fully recorded and transcribed witness seminars. The format of the meetings was modelled on the witness seminar programme organised by the Wellcome Trust Centre for the History of Medicine at University College London and the London School of Hygiene and Tropical Medicine History Centre.6 It has been
6 E.M Tansey, "Witnessing the witnesses: potentials and pitfalls of the witness seminar in the history of
twentieth-century medicine," in The Historiography of Contemporary Science, Technology and Medicine: Writing Recent Science, ed. R. Doel and T. Soderqvist(Abingdon: Routledge, 2006).
104 characterised as ‘a particularly specialised form of oral history, where several people associated with a particular set of circumstances or events are invited to come together to discuss, debate, and agree or disagree about their memories’.7 While care was taken for the topics discussed at
the meetings not to be completely pre-determined, a semi-formal structure was adopted in order to ensure that key points were covered by the participants, while allowing them to use them as a springboard to explore other, related issues. A briefing paper that included short biographies of participants, a brief historical background to the topic discussed, and a set of guiding questions, was prepared ahead of the meeting (see Appendices G and H). These were sent to the participants before the seminar (see Appendix B for list of participants). A suitable moderator was also identified in each case. The moderators were individuals who knew most of the seminar participants through professional connections, who had an understanding of tobacco control and the issues surrounding it, and who were held in high esteem by the other ‘witnesses’, allowing them to act authoritatively and probe them even on more controversial topics. After the seminars, the transcripts were made available to the participants who had the opportunity to edit or redact any statements, which none of them chose to do.
The first seminar was the Witness Seminar on Tobacco Control Policy in Poland, which took place on 31 May 2016 (Image 2). The seminar was organised by the Health Promotion Foundation and hosted by the Polish Chief Sanitary Inspectorate. Nine participants took part – politicians, civil society activists, journalists, and public health specialists – who have been involved historically in Poland’s anti-tobacco advocacy and policymaking. The seminar provided an opportunity for an in-depth, moderated discussion on the past, present, and future of tobacco control in Poland, with a particular focus on the introduction and impact of the Polish Anti-tobacco Law of 1995 and its amendment of 1999. The briefing paper received by the participants ahead of the meeting included a timeline of key milestones in tobacco control in Poland, and a series of guiding questions centred around four key topics. The moderator was encouraged to make sure that at least 40 minutes were devoted to each of the sections.
This first section focused on the question of why tobacco control policy progress only took place in the 1990s. What were the obstacles such policies faced in the 1980s? How did the political discussion on health change in the 1990s? How did the anti-tobacco movement evolve in this period? Who were the key individuals and institutions?
7 S.M. Crowther, L.A. Reynolds, and E.M Tansey, The Medicalization of Cannabis: The Transcript of a
Witness Seminar conducted on 24 March 2009 (London: Wellcome Trust Centre for the History of Medicine at UCL, 2010).
105 In the second section the participants reminisced on the parliamentary debate over the
Anti-tobacco Law in the Polish Sejm and Senate. What lobbies were involved and in what way? What was the stance of the different parties? What were the key arguments used? What were the key milestones leading to the introduction of the 1995 legislation and the later amendments?
The third section tackled the implementation and enforcement of the Anti-tobacco Law. How useful was the Law in supporting the activity of the health advocacy movement? What were the roles of different civil society groups in implementing the regulation? How did the legislation impact the life of Poles? How did it affect attitudes towards smoking in the country?
The final section discussed the present and future of tobacco control in Poland.
In many ways the challenges and opportunities associated with this seminar were similar to those of the witness conference. The agenda of the host, the Chief Sanitary Inspectorate, had to be taken into account both in drafting the agenda and in the choice of participants. The entire final section of the discussion was devoted to the present and future of tobacco control in Poland, rather than its history. It was also necessary to emphasise the role of the Chief Sanitary
Inspectorate in tobacco control developments. However, in this case the choices of guests faced less political scrutiny, representatives of movements from across the ideological spectrum (including very senior left-wing politicians) were represented, and an attempt was made to encourage them to speak candidly about their views.
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Image 2. Photograph from the witness seminar on tobacco control policy in Poland, 31 May 2016
Witness seminar participants, from left to right: Józef Kozioł, Włodzimierz Cimoszewicz, Jan Kopczyk, Andrzej Wojtyła, Witold Zatoński, Grzegorz Hudzik, Jan Bondar. Not on the picture:
Krzysztof Kuszewski, Elżbieta Łata, Aleksandra Lusawa, Marek Posobkiewicz, Krzysztof Przewoźniak, Mateusz Zatoński.
Source: M. Zatoński, "Report from the Witness Seminar on Tobacco Control Policy in Poland, Chief Sanitary Inspectorate, Warsaw, Poland, 31 May 2016," Journal of Health Inequalities 2, no. 2
(2016).
A specific challenge arising from the witness seminar format is that some of its participants might try to dominate the discussion, leaving others less time to contribute. This fortunately only happened to a small extent in this case and the moderator made sure everyone got a voice. Another related limitation of this format is that little can be done about participants unwilling to contribute during the seminar, or ‘determined to have their say with little regard to the rest of the meeting’.8 This was fortunately not the case for this research, and all the participants
8 Tansey, "Witnessing the witnesses: potentials and pitfalls of the witness seminar in the history of
107 engaged willingly in the discussion. The participants also came well prepared for the discussion, having received the briefing papers and list of topics in advance. The seminar was organised on 31 May 2016, the World No Tobacco Day, in order to make it an attractive event both for the host institution, and for the participants. As a result, it managed to draw a very high calibre of participants, especially politicians and civil servants, including a former Prime Minister, Ministers and Vice-ministers of Health, and present and former Chief Sanitary Inspectors. Many of these individuals would not be available for individual interviews.
Witness seminars also share the limitations of oral history more broadly – inaccurate recall, the temptation to grandstand, or a tendency to view the past through a ‘golden age’ lens.9 During the
witness seminar and conference, however, the scope for immediate scrutiny by other participants might have prevented some of the speakers from inflating their historical role, as they could have done during the face-to-face interviews. The group setting of the witness seminar provided a window into the shared discourse of its participants. In addition, the participants could prod each other’s memory, allowing for the emergence of data that would otherwise not be accessed through individual interviews.
The second witness seminar took place on 27-28 October 2016 and was hosted by the Harvard University Department of the History of Science in Cambridge, Massachusetts. This seminar had a more international outlook than the first one and had the broad remit to tackle the ‘past,
present, and future of tobacco control’, but nonetheless the history of tobacco policy in Poland featured prominently as one of the key case studies discussed, and was set in the context of tobacco control in other regions. In total 14 participants were involved, ranging from health scientists, economists, and health historians who have conducted research on Poland in the past, through American health advocates who were involved in supporting Polish anti-tobacco efforts in the 1990s, to a senior US politician who in the past have also provided health policy advice to the CEE region. The key topics discussed were harm reduction approaches to tobacco control, the use of litigation and lawsuits, targeted promotion of tobacco products, the impact of tobacco taxation, the role of social, religious, and business lobbying groups, as well as the importance of addiction treatment.10
9 M. Gorsky, "'Searching for the people in charge': appraising the 1983 Griffiths NHS management inquiry,"
Med Hist 57, no. 1 (2013).
10 M. Zatoński and M. Stokłosa, "Report from the seminar on the past, present, and future of tobacco
control, Harvard University Department of the History of Science, Cambridge, Massachusetts, October 2016," Journal of Health Inequalities 3, no. 1 (2016).
108 In the entire data collection process, this was the event in which the history of tobacco control in Poland was treated most tangentially. The principal interest of most participants lay in tobacco control in the international and American context. The seminar also came in the wake of rising interest in electronic cigarettes and next generation tobacco and nicotine products – this meant that it naturally veered towards those contemporary topics. Nonetheless, the moderator of the meeting did his best to ensure the case of Poland was kept prominent throughout the discussion. The conversation about modern products was couched in the context of more general and timeless tobacco control debates, such as the tension between harm reduction approaches and the precautionary principle, or the challenges posed by disruptive innovation to anti-tobacco advocacy efforts.
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