A great deal has already been said and written about the health debt that the COVID-19 pandemic has thrust us into, but one can't help but recall that it has particularly weighed on the primary health indicators for men. Life expectancy for men in Poland in 2022 has fallen to 74 years, decreasing by 2.3 years compared to 2019. It is noticeably shorter than in the European Union (77 years). - When Sweden is taken as a reference point, men there live an average of 81 years, recalled Dr. Jakub Gierczynski, a health care expert. In Poland, the difference between the average life expectancy between men and women reaches eight years, and this "gender gap" is among the highest in the EU. In Sweden, it is half as long. But it is not only life expectancy that is a problem. No less important an indicator is healthy life expectancy. A blacksmith lives 60 years in health. The statistical EU citizen - 63.5 years. The statistical Swede enjoys good health as much as twelve years longer than a Pole.

Why? Here, lifestyle and the daily choices we make are crucial. Almost one in four Polish men smokes cigarettes, with more than half of them smoking more than a pack a day. Meanwhile, on the other side of the Baltic Sea, which Dr. Gierczynski said divides rather than unites in the area of health, 6 percent of men reach for cigarettes, and Sweden is on the final straight to announce that it is becoming a tobacco-free country. As for alcohol consumption, 28 percent of Poles risky drink (get drunk) once a month, and in this respect we are not far from the EU average. What sets us apart is what we drink - per capita consumption is 11 liters of pure spirit, when the EU average is 7 liters. Overweight and obesity affect 70 percent of men (obesity - 20 percent). During the pandemic, the problem has grown - the statistical Pole has gained 6 kg. Poland stands apart in this regard and from the EU (60 percent, of which 18 percent are obese) and from Sweden (58 percent, 15 percent obese). - Only one in ten men in Poland does any physical, athletic activity, Dr. Gierczynski pointed out. The EU average is 16 percent, but Sweden's rate is already 35 percent.

- We have a distance to cover in years, but also a distance in our approach to health. It would seem that in a pandemic, when there was so much talk about the risk factors for severe COVID-19, that smoking or obesity negatively affects the body's immunity, the importance of comorbidities, there would be a reflection. It turned out that COVID-19, looking globally, did not bring a change in health attitudes in Poland," concluded Deputy Health Minister Piotr Bromber. At the same time, he stressed that this change in attitudes is a necessity, but prevention requires patience, as it is not about spurts ("New Year's resolutions") only about consolidating good habits. According to Bromber, however, something is changing, as being healthy is becoming fashionable. - The fact that I am healthy gives me a completely different perspective.

The key, according to the deputy minister, will be the attitude toward health - their own health - of young people, who, he noted, face health problems earlier than previous generations, if only (but not only) in the area of mental health. They also reach for health-damaging stimulants earlier. - This is why prevention aimed at young people is so important," he concluded.

Dr. Radoslaw Sierpinski, president of the Medical Research Agency, also spoke about the fact that health must become "trendy" - and there is an opportunity for it to start being perceived that way. - The affluence of society is growing. Taking care of health and living longer in health in wealthier societies is more common, because, colloquially speaking, people want to enjoy life and its possibilities even after retirement. They want to be active, to be able to explore, to practice their passions," he explained.

However, the starting point, he admitted, is not favorable. Although the capabilities of Polish medicine are not fundamentally different - and in many areas not at all - from what the best hospitals in the US or Western Europe offer, there is a fundamental difference in treatment outcomes. The reason? Patients in the United States or "old EU" countries come forward with their health problems much earlier, thanks to widespread participation in, for example, screening tests. Meanwhile, a large proportion of serious diseases in Poland are diagnosed at such a stage that medical interventions are either impossible at all or bring much less benefit (although they generate enormous costs). - One in four men in Poland believes that preventive examinations are unnecessary," the ABM head stressed. In his opinion, the situation could be improved by strengthening the role of occupational medicine - if only because 9.5 million men are economically active, preventive examinations must be performed. Widening the panel of these examinations, combined with the mandatory, could have a positive effect. - At the moment, occupational medicine examinations are, to a large extent, a formality to be ticked off, he admitted.

The effects of such an approach to one's own health cannot be offset by restorative medicine, even if there are successes in this field. Such is, undoubtedly, the improvement of access to clinical trials - the segment of non-commercial, publicly funded trials in particular has been growing rapidly in recent years. Before the ABM was established, the share of non-commercial research in the clinical trials market in Poland oscillated around 2%. At the moment, as the Agency's president said, we are at the halfway point, as the share has increased to 10%, with a target of 20%, corresponding to the average for highly developed countries.

How does health status affect men's productivity? Prof. Gertruda Uścińska, president of the Social Insurance Institution, pointed out that when it comes to spending on disability pensions, the situation has improved dramatically over a dozen years. - The disability contribution practically balances expenses, there is even a surplus in the budget, she revealed. This is the result, on the one hand, of the disability regime, developed - as the head of the Social Insurance Institution said - with tremendous effort, and on the other, of the increasingly better organization of disability prevention, targeted expenses incurred in restoring employees' ability to work. Over the course of a dozen years or so, it has been possible to reduce the number of pension recipients from 2.3 million to several hundred thousand. Things are slightly different with short-term sick leave. Their cost to the Social Insurance Fund is PLN 28 billion (of which PLN 9 billion comes from subsidies from the state budget), while another PLN 10 billion is contributed by employers. The pandemic has clearly increased the frequency of use of the popular "sick leave." At first glance, women are more often the beneficiaries. - However, if one were to subtract exemptions for pregnancy and maternity, it would turn out that it is men who use sick leave more often," admitted Prof. Uścińska, while noting the huge "advance" in the list of reasons for which exemptions are issued, mental health problems. - Just a few years ago they were in tenth place, today they are already in fifth place, she stressed.

- In psychiatry, male gender is a risk factor for non-cooperation with chronic disorders, stressed Professor Piotr Galecki, national consultant in psychiatry. This is why, among other reasons, it is primarily men who account for the lion's share of those successfully taking their own lives. Last year's figures show more than 5,100 successful suicide attempts, 83 percent of which involved men. - Men do not come forward with mental problems, they are also more impulsive and suffer from addictions more often than women, Prof. Galecki enumerated the reasons for this. When they collide with crises in their personal or professional lives - especially when the crises occur simultaneously - they are more likely to decide to end their lives.

The expert stressed that the reform of adult psychiatry, i.e. shifting the burden from inpatient treatment to community-based treatment, in mental health centers, is at least partially responsive to these problems. In his opinion, the effects can already be seen. - Where the centers have been operating for quite a long time, both the number of hospitalizations and their average length have fallen. This is the result of systemic changes, certainly not the state of the population's mental health, he stressed.

Dr. Krzysztof Łanda, founder of the Watch Health Care Foundation, president of HTA FORMEDIS and former deputy minister of health, pointed out that while men's health is primarily due to neglect of prevention and healthy lifestyles, problems with access to health services are not insignificant. - Men do not wait in queues of months or years. "Patient" means "patient" in English. In this sense, women are ideal patients, they can wait. Men - do not," he stated.

Can something more be done systemically to ensure that poor health choices do not harm Polish men so much? Łanda took a swipe at one of the most serious public health problems, namely smoking, which is the cause of a huge percentage of diseases of civilization, from respiratory diseases through the cardiovascular system to cancer - not just lung cancer. He pointed out that the guidelines of scientific societies for treating tobacco dependence include behavioral interventions, nicotine replacement therapy, pharmacotherapy, while harm reduction products are missing. - Many people try to quit smoking a dozen or more times. To no avail. They can be saved by offering them less harmful products, such as tobacco warmers, e-cigarettes or nicotine pouches. In the Polish guidelines, we are dealing with an orthodox approach, meanwhile there are examples of countries such as Sweden and the UK where the use of such products has yielded results. The harm reduction strategy is working, as a reduction in the problem of lung cancer is already being observed, he pointed out.

Łanda said that Poland should not implement an anti-smoking strategy that was outdated because it was prepared a decade earlier. - When the European Commission was working on it, it had research results of very poor quality. Between 2007 and 2013, moreover, many products were not yet on the market. There are new studies, from 2014, which can be described as a mine of knowledge. The anti-smoking directive should be updated and then it will make sense to implement it," he said.

The former deputy head of the Health Ministry stressed that as a doctor he believes it would be better if people didn't smoke, but if quitting smoking proves impossible, harm reduction is the only sensible solution. The challenge, on the other hand, is to find a way to ensure that products such as e-cigarettes and tobacco warmers are not reached for by children and teenagers. Although, he reminded, the ban on the sale of tobacco products to minors has been in place for many years, only it is completely dead, because young people (and even children) find ways to get cigarettes anyway.