Achievements, needs, development, or public health for the next 4 years

- Everything cannot be justified and explained by the pandemic. On the contrary, the pandemic mercilessly exposed our realities, highlighted the problems. Also that we don't really have a system. That we need to build a health care system from scratch," said Dr. Beata Małecka-Libera, chairwoman of the Senate Health Committee, in an introductory lecture, while pointing out that the foundation, the basis, must be public health, prevention, health education.

Małecka-Libera, who in 2015 was responsible in Ewa Kopacz's government for passing the Public Health Act and preparing the new edition of the National Health Program (unlike the previous ones, as she stressed during the Congress, it had guaranteed funding), did not hide her disappointment with what happened in the following eight years. In her opinion, the Public Health Law was practically not implemented, while the "best" summary of the approach to the NHP is that its latest version, on the one hand, is completely out of step with current challenges, and on the other hand, its funding has been cut by half. - Let's not explain that alongside the NPZ there are still programs addressed to oncology, cardiology or rare diseases, because the National Health Program is the only one intended for the entire population, it is supposed to help keep them healthy for as long as possible," she pointed out.

Citing the latest OECD report published in November, she recalled that life expectancy in Poland is currently 75.5 years, five years shorter than the OECD average. - It is somewhat of a paradox that despite the dismal health indicators, only 10 percent of Poles rate their health badly or very badly. We should think about why this is so," she commented.

On the list of problems pointed out by the Civic Coalition senator is the high percentage of preventable deaths (44 percent could be avoided through prevention or early access to treatment), and - no surprise - demographics. - We pointed this out back in 2015. Now we need to bet on fertility growth on the one hand, and on the other, urgently, on building a health care system for seniors, because there is no senior policy in health care at all," she explained. Other issues include mental health and the massive epidemic of overweight and obesity, especially among children and adolescents. - Eight years ago, we assumed in the goals of the NHP to stop this trend. We have had an increase. This is also because there has been no emphasis on health education. We need to educate the public, show the benefits of a healthy lifestyle.

A powerful cause of shame for Poland is air pollution. - That's 53,000 deaths due to smog," Małecka-Libera said. It is worth recalling: in the OECD report, Poland ranks first in the ranking of countries with the highest number of deaths per population due to smog. The pandemic should also be a reason for shame, with a massive number of excess deaths, but also - with a lack of willingness to learn and learn lessons. - Again we have an increase in infections, again we are unprepared. The vaccination campaign is powerfully late and taking off in chaotic conditions," the politician scored.

One of the topics discussed was also the staffing crisis, which, according to Beata Małecka-Libera, should be solved primarily by making better use of the skills of those medical professionals who are already working in the system (and not by multiplying places educating, for example, doctors without controlling the quality of this education). This part of the speech was referred to by Prof. Zbigniew Gaciong, rector of WUM, who stressed that when it comes to the number of doctors per population, Poland is practically at the level of the EU and OECD average. The problems we have are not about the sheer number of specialists. - 28 percent of doctors work in five cities, so the problem is one of concentration. 9 percent of doctors work in primary care, while the average is 20 percent. And finally, doctors are not "encapsulated" with support staff, certainly not to a sufficient degree, he pointed out. This, in turn, generates problems: the lack of support staff and, above all, the lack of an idea to manage and coordinate the work of medical professionals causes, for example, a large scale of non-cancellation of appointments in the public system. - It is very often simply difficult for the patient to do this, and there is no one on the provider's side to remind the patient about the appointment or to check whether he or she will make it to the appointment.

Prof. Gaciong also advocated moving from announcements and decisions, and introducing solutions that would induce more Poles to behave more responsibly. - Lack of preventive examinations should translate into either higher health premiums or the need to cover the costs of extended hospitalizations, he said.

The topic of senior policy raised by Senator KO was, in turn, referred to by Professor Boleslaw Samolinski, head of the Department of Public and Environmental Health at Warsaw Medical University. - Senior policy is lifelong, he pointed out, confirming that the lack of education from early school years, even pre-school, entails problems in senior age, especially since this education - as well as the emphasis on prevention - is also lacking in working age. This applies to all areas of health, from physical to mental. - In the peri-retirement age, we have a huge increase in suicides at the moment. Many people at the end of their working lives face the prospect of losing the basis of their livelihood, and not just in economic terms, he reminded.

The expert pointed out that lack of education translates very clearly into bad choices and decisions. - Against COVID-19 in some countries more than 90 percent of the population has been vaccinated. In Poland - about 60 percent. The authority of public authorities, the authority of the state proved too weak to curb the influence of anti-vaccine movements, he assessed.

Prof. Jaroslaw Pinkas, national consultant in public health, also spoke about anti-vaccinationists and their influence, lamenting that more deputies who preach such views have entered the Sejm in this term than in the previous one (however, it is worth noting that in the previous term, deputies with anti-science views were also on the side of the government majority, now - not). - Broadcasts of the parliament are very popular, such parliamentarians will preach their views and spread the virus of denialism," he lamented, citing the experience of Romania, which declared an epidemic state on December 5 due to numerous measles cases.

Prof. Pinkas also stressed that citizens should be told the truth, that they are most responsible for their own health, which "requires sacrifices, time, determination, consistency."

Dr. Marek Rutka of the Department of Organization and Management of the Faculty of Management at the University of Gdansk, a representative of the left, also spoke about the co-responsibility of patients for the system. - Prevention is necessary so that if a patient gets sick, he or she gets to the doctor in the best possible shape. We may have great oncology departments, but they don't have miracle workers," he said, referring to the fact that by avoiding preventive examinations, Poles report to specialists in advanced stages of the disease (not only cancer, by the way). According to Mark Rutka, a round table would be needed to move away from the strategy of covering up problems. An example? - Half of S ambulances have no doctors. The system, on the one hand, requires, on the other, allows them to be absent. Evidently, we can't afford to have so many specialists working in the system, or there simply aren't any, but we have this duality.

Dr. Tomasz Latos, a representative of the Law and Justice party and former chairman of the Health Committee, also spoke about patients' shared responsibility. He recalled that the Prevention 40 Plus program benefited a small percentage of those eligible. - Perhaps some way would be to financially incentivize PCP clinics for high rates of preventive examinations, he wondered, stressing that he is keeping his fingers firmly crossed for the new Health Minister to succeed "at least one step" in the desired direction. Among other things, Latos recalled the sugar tax, which was introduced in 2020, and assessed it as one example that positive things have also been happening in public health over the past eight years.

Public Health Priorities:

• The most important thing should be population-based control of risk factors. The urgent task for today is to rationalize health care spending (Prof. Zbigniew Gaciong).
• Building a national strategy that would take into account all stages of life and be prevention-oriented. This strategy would integrate all the activities of the ministries that have an impact on health security (Prof. Boleslaw Samolinski).
• Wise health education as a multi-decade investment and treated not as a cost. It is necessary to appeal to people through a health gain account (Dr. Marek Rutka).
• Fighting alcohol and tobacco consumption. Right now we are drinking more than in the People's Republic (Dr. Tomasz Latos).
• Institutionalization of public health. Work for all graduates in this field (Prof. Jaroslaw Pinkas).
• Building a nationwide prevention program for children - everything starts with them, with their knowledge, awareness, choices (Dr. Beata Małecka-Libera).
• Program to combat overweight and obesity (Prof. Mariusz Gujski).