Mirosław Wysocki, national consultant in the area of Public Health, professor at the National Institute of Public Health (NIH), the research institute responsible inter alia for health promotion and disease prevention, discusses the overwhelming challenge of shifting the nation’s healthcare mentality from a curative approach, to a prevention lifestyle system. Furthermore, he gives statistical insights into the health of Polish people and points out the importance of education in establishing a healthy nation.
As the national consultant, could you introduce the National Institute of Public Health (NIH) to our international readers?
The NIH, the oldest health research institute in Poland (100 anniversary in 2018), has many different roles, but in principle is focused around health promotion and disease prevention within the Polish population. This prevention is both in non-communicable and communicable diseases and as an organization we are implementing a range of activities and initiatives to drive forward our agenda as we understand the public health of a nation is dependent on the involvement of society. Therefore, we are educating Poland through different activities and projects as well as an array of platforms, such as TV, radio and publications to get our message across.
When you look at the epidemiological landscape of Poland it is similar to other parts of Europe. Cardiovascular disease is the main killer causing 45 percent of all deaths, then cancer at 25 percent and accidental deaths at six percent. Crippling conditions, that can also lead to death though generally lead to impairment, are an important factor in Polish health. This includes mental disorders, such as depression, dependencies and Alzheimer disease, rheumatic diseases, mainly arthrosis of the spine, knees and hips, and chronic obstructive pulmonary diseases (COPDs), namely asthma, chronic bronchitis and emphysema.
Furthermore, we see an increase of people affected by diabetes with around three million cases, mainly type-2, though many patients are still undetected. This is driven by the problematic global trend of obesity that is an issue in both adults and children.
Is Poland doing enough in regard to prevention?
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No. Public health and epidemiology for the average person is still perceived as less important that a clinical approach. There is a mentality to focus on curative medicine, and then the question is always asked: why is the primary healthcare system ineffective and why are waiting lists for hospitals and specialists so long?
Everybody who has a chronic or acute disease wants to be treated quickly, effectively and in a comfortable atmosphere. It is often overlooked that all these concerns can be overcome with effective prevention solutions by the health education of the Polish population to change their mentality, from only a curative approach to preventive approach and a healthy lifestyle.
Nevertheless, results are improving and as we look at the problem of smoking, 8 million Poles have stopped in the last two decades. Furthermore, since the fall of communism in the end of 80’s, the current life expectancy of woman is 82, and men, 72, a rise of eight years. Equally, the average of healthy life-years has encouragingly increased. Infant mortality, a comprehensive indicator of standard of living, health knowledge and the effectiveness of health system, has also greatly improved, with the present rate of 4 deaths per every 1000 live births being in line with developed healthcare nations across the globe.
How important is education and health awareness for improving public health?
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Incredibly important! For most areas, besides some mental disorders such as Alzheimer disease, prevention is a key step in combating conditions. There are movements to educate people and we are conducting initiatives, that are funded by international organizations, the Polish government and local authorities.
A good example would be Hepatitis C, that until 1991 we did not know was caused by a virus; therefore, we were unknowingly infecting people via blood. In Poland there are estimated to be around 160 to 180 thousand cases of Hepatitis C, that in the long-term may lead to liver cirrhosis and eventually cancer – although – the concern is that only around 15 percent of the affected patients actually know they carry the disease.
Another key factor is that we have no vaccine against Hepatitis C, unlike Hepatitis B; meaning, education to the public and especially well-defined risk groups is crucial having them understand they should be tested to prevent the chronic effects of the condition. Thus far, this campaign is becoming a success and many people have been correctly diagnosed and treated by innovative non-interferon hepatitis C drugs that have at least a 95 percent success rate.
What role does the retail aspect of the healthcare industry play in pushing the case of public health?
Companies allocate a certain proportion of funds to support our operations, such as conferences and events, though perhaps we must do more to convince them to assist our cause on a larger scale.
In which areas does Poland excel from a treatment perspective?
Within cardiology in the treatment of the acute coronary episodes the hospital fatality rate hovers around 4-6 percent, which is one of the lowest in Europe. This is due to the fact Poland has a system throughout interventional cardiology that allows most of the patients to be effectively treated within one hour of the condition occurring. The only concern is patients are discharged so quickly that in-turn the physicians lack a sufficient period of time to properly educate them on how to live a healthier lifestyle. As a result, many patients become repeat victims and experience long-term chronic issues like heart insufficiency.
Oncology is a different story. In adults, Poland has one of the worst five-year survival rates in Europe, 30 percent worse in males compared to Iceland and Belgium, and 15 percent in woman. This is not because they are treated badly, but rather they are diagnosed late in the cancer cycle. This is an area in Poland we must see drastic improvement in the future.
How efficient is Poland in vaccinations?
95 percent of children up till two years old are vaccinated according to calendar requirements, which is a very high rate. In fact, if children do not receive the vaccinations, the parents are fined. There have been a number of cases of measles recently, mainly due to people coming from eastern Europe. Unfortunately, at present there are groups and individuals spreading false news about vaccines, and this anti-vaccine movement should stop. The dialogue with this people is extremely difficult.
What are they key strategic steps for public health in the future?
The institute must continue what we are doing, and I believe we must inter alia have a better interaction with the retail sector, acting more in a partnership. This is important as the government with its restricted financial means is very often looking to focus on curative medicine, and working with other players will broaden our approach and ensure we can drive forward the institute’s objective of a healthy Poland.
The optimistic fact is that since 2015 we have the Public Health Legal Act approved by parliament and signed by President of Poland. The important tool of this act is the National Health Program 2016 – 2020, financed by Ministry of Health and focused on the six important health areas. Our institute is an active partner in implementation of the National Health Program activities and tasks.
