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Health in the Polish People's Republic


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Before World War II (WWII) Poland was one of the countries with the poorest health in Europe. In the 1930s life expectancy in Poland was around 46 years in both sexes; in the same period in Germany it was over 61 years. Infant mortality was estimated at the level of 150 deaths per 1000 live births. The situation was exacerbated by WWII; between 1939 and 1945 life expectancy in Poland fell by 20-25 years. The health transformation that took place in Poland after WWII proceeded very rapidly. Control of infectious diseases and infant mortality became a state priority in the post-war Polish People’s Republic. The epidemiological transition that in the United Kingdom or Germany took almost a century, in Poland, and many other Central and East European (CEE) countries, occurred in the two decades following WWII. This process led the CEE region to almost closing the health gap dividing it from Western Europe in the 1960s. Life expectancy in Poland increased to 70 years and infant mortality decreased to 30 deaths per 1000 live births. However, simultaneously, after WWII the seeds of the epidemic of man-made diseases were sown in CEE. In Poland the consumption of vodka and smoking prevalence reached some of the highest levels in Europe. This dramatic increase in exposure to lifestyle risk factors (an increase in cigarette sale from 20 billion cigarettes per annum after WWII to around 100 billion in the 1980s, and an increase of alcohol consumption from 3 litres per annum to nearly 9 litres in the same period), led Poland and the CEE region to a health catastrophe caused by the rise of chronic diseases. Diseases such as lung cancer, laryngeal and oral cavity cancers, cardiovascular diseases (e.g. ischaemic heart disease and stroke), sudden deaths from external causes (e.g. accidents, injuries, poisonings etc.), and liver cirrhosis, all reached in Poland some of the highest levels observed globally. In contrast to most Western democracies, authorities in communist states of CEE were unable to cope with these new health challenges, which demanded comprehensive, also non-medical solutions. Health literacy was low, also among the better educated segments of population, including the political class.
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JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
REVIEW PAPER J Health Inequal 2016; 2 (1): 7–16
Submitted: 23.11.2015, accepted: 14.03.2016
Health in the Polish People’s Republic1
Witold A. Zatoński1,2, Mateusz Zatoński1,3
1Health Promotion Foundation, Nadarzyn, Poland
2Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
3London School of Hygiene and Tropical Medicine, London, UK
Before World War II (WWII) Poland was one of the countries with the poorest health in Europe. In the
1930s life expectancy in Poland was around 46 years in both sexes; in the same period in Germany it was
over 61 years. Infant mortality was estimated at the level of 150 deaths per 1000 live births. e situation
was exacerbated by WWII; between 1939 and 1945 life expectancy in Poland fell by 20-25 years.
e health transformation that took place in Poland aer WWII proceeded very rapidly. Control of infec-
tious diseases and infant mortality became a state priority in the post-war Polish Peoples Republic. e epi-
demiological transition that in the United Kingdom or Germany took almost a century, in Poland, and many
other Central and East European (CEE) countries, occurred in the two decades following WWII. is pro-
cess led the CEE region to almost closing the health gap dividing it from Western Europe in the 1960s. Life
expectancy in Poland increased to 70 years and infant mortality decreased to 30 deaths per 1000 live births.
However, simultaneously, aer WWII the seeds of the epidemic of man-made diseases were sown in
CEE. In Poland the consumption of vodka and smoking prevalence reached some of the highest levels
in Europe. is dramatic increase in exposure to lifestyle risk factors (an increase in cigarette sale from
20 billion cigarettes per annum aer WWII to around 100 billion in the 1980s, and an increase of alcohol
consumption from 3 litres per annum to nearly 9 litres in the same period), led Poland and the CEE region
to a health catastrophe caused by the rise of chronic diseases. Diseases such as lung cancer, laryngeal and
oral cavity cancers, cardiovascular diseases (e.g. ischaemic heart disease and stroke), sudden deaths from
external causes (e.g. accidents, injuries, poisonings etc.), and liver cirrhosis, all reached in Poland some of
the highest levels observed globally. In contrast to most Western democracies, authorities in communist
states of CEE were unable to cope with these new health challenges, which demanded comprehensive, also
non-medical solutions. Health literacy was low, also among the better educated segments of population,
including the political class.
KEY WORDS: epidemiological transition, Semashko model, Poland, infectious diseases, infant mortality,
premature mortality, chronic diseases.
ADDRESS FOR CORRESPONDENCE: Prof. Witold A. Zatoński, Health Promotion Foundation, 51 Mszczonowska St.,
05-830 Nadarzyn, Poland, phone: +48 22739 76 40, e-mail:
DOI: 10.5114/jhi.2016.61413
Both the scale and the pace of improvement of
human health in the 20th century are without historical
precedent. Within a century life expectancy has dou-
bled in many countries, increasing from 40 to 80 years.
However, while in most countries of Western Europe
this improvement has occurred in a harmonious and
balanced fashion, population health in countries of East-
ern Europe, including Poland, has been characterised by
rapid uctuations.
1 In the present study the authors have used mortality statistics from the World Health Organization Mortality Database [1].
Witold A. Zatoński, Mateusz Zatoński
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
From the end of the 19th century, steep rises in life
expectancy have been observed in the developed coun-
tries of Western Europe. Between 1870 and 1880 life
expectancy in Germany amounted to 37 years, in France
to 42 years, in England and Wales to 43 years, and in Swe-
den to 47 years. By the end of the 1920s it has increased
to over 61 years in Germany, 57 years in France, 61 years
in England and Wales, and over 64 years in Sweden. In
Poland, however, life expectancy in this period remained
low, with 1927 estimates being 46 years for both sexes.
is backwardness had also been conrmed by high
infant mortality rates, which during the interwar peri-
od were estimated to be over 150 deaths per 1,000 live
births. Similarly, 40% of infants died before 5 years of age
[2]. In comparison, in Sweden the infant mortality rates
before 5 years of age were around 15% in 1920 [3, 4].
World War II (WWII) further exacerbated this prob-
lem. e war le Polands infrastructure in ruins, and the
poor pre-war levels of sanitation and hygiene became
even worse. With famine raging in Poland, there were
severe shortages of medicines and basic medical sup-
plies, and epidemics of infectious diseases were breaking
out. It is estimated that in the catastrophic years 1939-
1945 life expectancy in Poland fell by 20-25 years2 [5].
In 1950, life expectancy in Poland was estimated at
56 years for men and 61 years for women. At the same
time, life expectancy for both sexes amounted to 71 years
in Sweden, 69 years in Great Britain, and 66 years in France.
Infant mortality in Poland was estimated at around 110
deaths per 1,000 live births, and 33% of children died
before the age of 5. In Sweden and England infant mor-
tality was at a level of about 20 per 1,000 live births, and
about 5% of babies died before the age of 5. e mortality
of perinatal mothers in Poland was also high at 100 deaths
per 100,000 births [3, 6].
One of the principal causes of mortality in Poland in
the 1950s were infectious diseases. In 1959 mortality due
to infectious and parasitic disease was nine times high-
er among Polish men (89/100,000) than among Swedish
men (10/100,000) [2]. In contrast, chronic non-infec-
tious conditions, such as cardiac failure and lung can-
cer (particularly pronounced in the UK and Finland) or
liver cirrhosis, oesophageal and laryngeal cancer (pro-
nounced in the Mediterranean countries), which became
the predominant causes of death in Western countries
aer WWII, were much less prevalent in Poland3 [7-9].
One of the most interesting accounts of the public
health situation in Poland aer WWII comes from ajour-
nalist, Aleksander Janta-Połczyński, who in 1948 report-
ed from Poland for the Parisian émigré monthly Kultura.
Poland emerges from his articles as acountry character-
ised by widespread alcoholism and venereal disease, dif-
cult conditions for medical treatment, tuberculosis, low
resistance to infections, shortages of medical sta and
medicines. He wrote that “If it weren’t for the sulfa drugs
and the dynamic activity of the Supreme Commission for
Fighting Epidemics, Poland would face the threat of wide-
spread infectious disease akin to the Middle Ages” [10].
In Poland, the epidemiological transition began in
earnest only in the 1950s, almost acentury later than in
Sweden or the United Kingdom. At this starting point,
health conditions in Poland were very poor and resem-
bled those in 19th century Western Europe. e health
improvement in Poland in the rst decades aer WWII
proceeded at an impressive pace (Fig. 1) [4, 11].
Soviet domination over Eastern Europe aer WWII
inuenced the development of new health policies
throughout this region. e so-called “Universal Health
System, or the Semashko model (named aer the Min-
ister of Health in Lenins government), which had its
origins in military medicine, was introduced in many
socialist countries and led to fundamental changes in
health policy, also in the newly formed Polish Peoples
Republic (PRL)4. Its basic tenets were that every citizen
2 ere are no mortality statistics in Poland for the period between 1939 and 1945. Estimates can be based on the health situation in the Soviet Union, Czecho-
slovakia and Western European countries such as the United Kingdom and Luxembourg.
3 In the early 1950s lung cancer was a major killer of middle-aged men in the UK.
4 e Semashko model was adopted from the Soviet Union by all satellite countries of the so-called “Soviet bloc” aer WWII.
FIG. 1. Life expectancy at birth in selected countries, both
1940 1950
Rep. of
1960 1970 1980 1990 2000
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
Health in the Polish People’s Republic
should have access to free medical care, and the so-called
“medicalisation of health5.
Avital ingredient of the Semashko model was the
creation of an eective system for mother and child
healthcare. A new scheme for the training of nurses,
midwives, and paediatricians was established, and spe-
cialised paediatric departments were funded at medical
schools6. is rapid post-war development of paediat-
rics was undoubtedly one of the most important reasons
driving the improvements to child health in Poland
[12]. Already in 1953, aDepartment of the Mother and
Child was established at the Ministry of Health and
Social Welfare. It coordinated the creation of a regis-
try of maternal deaths, supported the development of
perinatal medicine and amore eective communication
system which would allow for the better use of existing
human resources and infrastructure. e socialist sys-
tem brought with it some undisputable social gains, like
universal access to healthcare or free hospitalisation and
paediatric care, all of which helped to improve maternal
and infant health.
Dealing with infectious diseases was an even greater
strategic priority of the Semashko model than paediatric
care. e rst post-war decades were characterized by
the development of sanitary-epidemiological services in
Poland. In order to control infectious diseases the State
Sanitary Inspectorate was set up in 1954. Local sanitary-
epidemiological stations were created and vaccination
campaigns were rolled out, alongside educational cam-
paigns raising awareness of the importance of vaccina-
tion and personal hygiene. Disinfectants and pest control
chemicals also became widely available in this period [13].
ese favourable developments were aptly summa-
rised in a World Bank publication from 1996, which
stated that “rates of infant mortality in the former social-
ist countries are lower than one would predict based on
their income levels. is positive health development is
mainly attributed to the higher education levels among
women, the wide scope of prophylactic vaccinations
among children (> 90%), and environmental hygiene in
the former socialist countries” [14].
A good example of state involvement in public
health under PRL was the struggle against tuberculosis
[15]. Aer the war, the state took over all actions direct-
ed against this disease7. Already in 1945, aTuberculosis
Section of the State Health Board was established. In
March 1948, the director of the Polish Anti-Tuberculosis
Institute was appointed, and the Institute was allocated
signicant state funding. In 1951, by decree of the Pres-
ident of the Council of Ministers, an Institute of Tuber-
culosis was established as an independent research cen-
tre overseen to the Minister of Health. One of the aims
of the Institute, as described in its statute, was to best
utilise “the scientic achievements of pioneering Sovi-
et science”. In April 1955, by decree of the Minister of
Health, compulsory and free of charge BCG vaccinations
were introduced, and on 22 April 1959 the Polish Parlia-
ment passed the Anti-Tuberculosis Law. e conference
abstract titles of the 10th Polish Anti-Tuberculosis Con-
gress, held in September 1951, betray how politicised
the subject of tuberculosis had become in Poland. ey
included, “e struggle against tuberculosis in the 6-year
plan, or “Principles of dialectical materialism applied to
the ght against tuberculosis.
Another spectacular symbol of PRLs authorities’
commitment to ghting infectious diseases was Poland’s
pioneering role in the ght against polio (also known
as Heine-Medin disease). In the 1950s every year thou-
sands of children in Poland got the disease. Towards the
end of the 1950s Hilary Koprowski, a Polish virologist
working in the USA, and the creator of the rst polio vac-
cine, secured 9 million doses of the vaccine for Poland.
Despite coming from Wyeth, an American company,
the gi was accepted by the communist authorities. In
autumn 1959, under the leadership of Feliks Przesmycki,
the director of the National Institute of Hygiene (PZH)
in Warsaw, Poland became one of the rst countries in
the world to launch amass vaccination campaign against
polio. As aresult polio morbidity fell to just afew dozen
cases per annum at beginning of the 1960s [16].
As aresult of those changes infant and child mortality
rates in Poland rapidly declined (Fig. 2). Newborn mor-
tality rates were halved within adecade, from 109/1000
live births in 1950 to 55/1000 in 1960. By 1970 the new-
born mortality rates amounted to around 30/1000 live
births. At this time, the corresponding newborn mortal-
ity rates for the Federal Republic of Germany (West Ger-
many) were 23/1000 live births, Austria – 26, Italy – 29,
and Portugal – 53. Furthermore, the likelihood of child
mortality before the age of 5 in Poland decreased to 7%
from 33% in 1950. us, 25 years aer the end of WWII
the survival of infants and young children in Poland
had achieved asatisfactory European level. At the same
time, maternal mortality had dropped to 30/100,000 live
births in 1970. Mortality from infectious diseases was
also decreasing at an extraordinary rate e.g. for men it
declined from 99/100,000 in 1963, to 65/100,000 in 1970,
and to about 20/100,000 in 1985 [4].
5 In Poland the term medicalisation is oen positively perceived as providing easier access to medical care, hospitals and medicines. In some Western countries,
however, adebate over the negative inuence of over-medicalisation on society has been going on since the 1960s.
6 e importance of health within the political doctrine of the Polish state was underlined by the establishment of separate and autonomous higher education
institutions dealing with health.
7 Until 1948, medical treatment of tuberculosis had been of no avail. Only by introducing streptomycin was it possible to eectively treat this disease for which
incidence rates had signicantly increased during WWII and aerwards, as aresult of harsh living conditions and overcrowded housing. Aer the war,
the large scale battle against tuberculosis was organised and undertaken by the Institute of Tuberculosis, and in the following years has helped to signicantly
reduce tuberculosis morbidity rates.
Witold A. Zatoński, Mateusz Zatoński
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
All these favourable health developments led to
arapid increase of life expectancy rates in Poland in both
sexes. In the 1950s, life expectancy in Poland increased
1930 1940 1950 1960 1970
12 years
9 years
Germany Poland
FIG. 3. Life expectancy at birth in Poland and Germany, 1930-1970
1930 1940 1950 1960 1970
12 years
7 years
Germany Poland
FIG. 2. Percentage of deaths before the age of 5, Poland and
England and Wales
England and Wales Poland
by almost 9 years, whereas it only increased by 2.5 years
in West Germany over the same period (Fig. 3). Indeed
at the end of the 1960s, there was only 1 to 2 years dif-
ference in life expectancy at birth for both sexes between
Poland and developed market economy countries of
Western Europe (in Poland life expectancy was 70 years
whilst in England and Wales 72 years, and in West Ger-
many 71 years). e health gap between Poland and
Western Europe was almost closed [17].
Regrettably, this period of health improvement was
accompanied by many developments, which in the next
decades were to reverse this positive pattern. While in
western countries population health continued to improve,
Poland between the end of the 1960s and the end of the
1980s experienced an extremely rare occurrence in aperi-
od of peacetime – adecrease in the life expectancy of adult
males, and astagnation in the health of adult women.
At the heart of this health collapse lay the same
philosophy that had previously helped reduce infant
mortality and infectious disease in Poland, namely the
complete medicalisation of health resulting from the
Semashko model. e state, and not the citizen, was per-
ceived as being responsible for one’s health – as aresult
the Poles did not develop crucial health competencies
and remained in astate of health illiteracy. Every disease
or disease group had its own respective institute. Health
governance was dominated by doctors, who held all the
directorial positions at the Ministry of Health. In con-
trast to Western Europe, the concept of preventive med-
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
Health in the Polish People’s Republic
icine was not based on amultidisciplinary approach to
health in all policy, but only on strictly medical solutions.
Preventive medicine had been fully integrated with cura-
tive medicine, to which it was completely subordinated.
Public health was dened as social medicine, and was
seen as the remit of medical doctors [4, 18].
Epidemiology, the fundamental science of public
health, focused almost exclusively on infectious diseases.
Unlike the USA or the UK, the epidemiology of chronic
non-communicable diseases was poorly developed; lag-
ging 15-20 years behind English-speaking countries and
Scandinavia. In the absence of epidemiological informa-
tion and perspective, Poland, similarly to other countries
of Eastern Europe, did not take on board new develop-
ments in public health, such as identifying risk factors
impacting particular sections of the population, in which
mortality rates had risen. is situation was thus not con-
ducive to the dissemination of relevant health informa-
tion and expertise, nor to the mobilisation of adequate
means for the appropriate public health response. Medi-
cal doctors developed the tendency to focus on individ-
ual patient care, based on their experience with the suc-
cessful campaign to contain infectious diseases. Primary
prevention was considered from a medical standpoint,
and was focused principally on routine patient check-
ups. Health policy prioritised actions which aimed to
continue increasing the number of doctors, polyclinics
and hospital beds. An inordinately large clinical sector,
combined with passive curative medicine strategies and
long hospital stays, was unable to keep up with techno-
logical progress and devoured alarge part of the already
limited funds earmarked for healthcare [4].
e rapid development of evidence-based medicine
(EBM) which took place in the West in the 1960s and
1970s, was accompanied by research into the causes of
chronic non-communicable diseases, such as studies on
the causal relationship between smoking and lung can-
cer [19], the relationship between diet and cardiovas-
cular disease [20], or, as in the case of alcohol, between
the consumption of alcohol and liver cirrhosis or injury.
However, this went by unnoticed in Poland. ere were
no open public debates nor, except in the case of afew
infectious diseases, any large-scale public health inter-
ventions involving the state or society.
In contrast to many western countries, medicine in
Poland was more commonly dened as an art, the suc-
cess of which depends on the doctor’s skill, rather than
a science, whose methods should be based upon evi-
dence. Meanwhile, in countries such as the UK, large-
scale clinical studies had become astandard method for
dening the ecacy of drugs and medical technologies.
e growing importance of EBM manifested itself in the
use of experimental and observational studies as abasis
for clinical practice. is ensured that medical doctors
had access to knowledge derived from systematic sci-
entic studies8 [21]. ese advances had been largely
ignored in Poland and had little eect on broadly dened
clinical practice.
e development of health cultures and perceptions
also took dierent paths. In the West, the advent of large-
scale health campaigns, and health interventions based
on the results of scientic studies, allowed to build the
popular awareness that people themselves can inuence
and improve their own health (e.g. through physical
exercise or following the recommendations of so-called
“preventive medicine”). is stood in stark contrast with
the Soviet bloc, where health was dened primarily as
the business of the state and government.
e concept of “health elds, developed by Lalonde
in Canada in the 1970s, and subsequently modied and
dened in several documents9 was dicult to nd in
Polish health policy, where it was not the whole govern-
ment, but only the Health Minister who was responsi-
ble for health. is stood in contrast to, for instance, the
Scandinavian countries [22]. ere were no multi-disci-
plinary schools of public health (i.e. epidemiology, bio-
statistics, disease prevention, healthcare organisation,
environmental health, health education and health pro-
motion). e public health eld lacked representatives
of any professions other than medical doctors: hospital
administrators, health science lecturers, nutritionists,
biostatisticians, social scientists, epidemiologists, law-
yers, etc.
As aresult, the health awareness of Poles, as in the
other countries of the Soviet bloc, remained very low.
Aer WWII, tobacco and alcohol consumption in East-
ern Europe grew steadily (Fig. 4). Both these products
were readily available and their prices were maintained
8 Aer WWII, Austin B. Hill, aprofessor of applied medical statistics at the London School of Hygiene and Tropical Medicine, developed methodologies for
assessing and evaluating new treatments and medical interventions. He pointed out the need for making appropriate comparisons in modern epidemiology,
which would allow to avoid bias and to understand the role of probability (i.e. role of chance). He designed and conducted some of the rst randomised,
double-blind clinical trials, which were designed in a way which would minimise investigator bias. is method was rst used to test the eectiveness of
treating tuberculosis with streptomycin. Hill divided his tuberculosis patients into two groups; neither the physician (researcher), nor the patient (subject)
knew whether they are receiving placebo or streptomycin (hence the term “double-blind study”). In this way anew methodology arose for measuring ecacy
of treatment and the eectiveness of other medical interventions. Elements of this reasoning were then used to study the relationship between smoking and
lung cancer. Research designs such as the case control study, and the prospective and retrospective cohort studies, were created, and were used in research on
the role of smoking in causing lung cancer. e key moment when EBM became established in Western medical thinking was the 1972 publication by Archie
Cochrane entitled “Eectiveness and Eciency: Random Reections on Health Services”, which criticized the dearth of clinical experiments as the basis for
medical practice.
9 Published in 1974 by the Canadian Government, the Lalonde report was an inuential symbol of the Western countries’ departure from the medicalisation
of health model. It proposed aholistic approach to building population health, through focusing of four key “health elds” – people’s lifestyle, their living envi-
ronment, biology and genetics, and healthcare organisation (M. Lalonde, A new perspective on the health of Canadians; a working document, Ottawa, 1974).
Witold A. Zatoński, Mateusz Zatoński
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
at very low levels. In Poland, alcohol consumption per
capita increased from about 3 litres in 1950 to 8.4 litres
in 1980, and the dominant fashion of drinking became
the “Russian” model of binge drinking. Another good
example of alack of strong health policy was the states
dismissive attitude towards tobacco. Within the milita-
rised societies of Eastern Europe, cigarette production
and sale became a national priority. Everyone in the
army received acigarette allocation regardless of wheth-
er they smoked or not, and non-smoking among sol-
diers was frowned upon. Cigarette prices were low, and
cigarettes were widely available. Indeed, smoking was
allowed practically everywhere and at all times, except in
places where re safety could be compromised. Cigarette
sale increased from 20 billion cigarettes per annum to
around 100 billion in 1980. is state of aairs changed
very little until the end of the 1980s (Fig. 4).
Poland, and the other closed societies of the Soviet
bloc, were deprived of information about the harmful
eects of smoking. Paradoxically, the heaviest smokers
were the better educated (including physicians) and the
better-o. Such approaches to smoking, observed in the
countries of communist Eastern Europe, meant that
Poland became one of the global leaders in tobacco con-
sumption between the late 1970s and the end of the 20th
century [4, 23, 24].
Another important factor that can help account for
Poland’s health disaster was diet. e state heavily subsi-
dised certain basic foodstus. is meant that the prices
of meat and dairy products remained relatively low com-
pared to people’s incomes. is, combined with alack of
awareness about the adverse eects of certain diets on
the cardiovascular system, led to ahigh consumption of
saturated animal fats. Up until 1980, caloric intakes were
higher in Eastern Europe than in Western Europe (Fig. 4).
is was likely the reason that the onset of obesity
became aproblem rst in Eastern European countries.
Alack of diversity and innovation in eating habits meant
that in the northern part of Eastern Europe vegetable oil
consumption remained at very low levels, probably con-
tributing to the deciency of certain essential unsaturat-
ed fatty acids [4, 25].
Although high seasonal consumption of fruits and
vegetables from local markets was noted in many Soviet
bloc countries, such produce was practically unavailable
out of season; in contrast to Western Europe (including its
northern region). e low consumption of fresh fruits and
vegetables out of season was coupled with a reliance on
traditional methods of preparing food. is was connect-
ed with ahigh salt intake (15-20 g day) [26], which in itself
carried the risk of cardiovascular disease. Many vegetables
were consumed in marinated form, and meats were usual-
ly processed with large amounts of salt, potassium nitrate
(saltpetre), or were smoked (mainly sausages).
Meanwhile, in Western Europe in the 1960s and
1970s anew public health philosophy was being devel-
oped. Health policy was to be carried out by the entire
state apparatus – and with asignicant role of the Min-
istry of Finance – and not just by the Ministry of Health.
e so-called “Health in All Policies” approach was suc-
cessfully carried out by countries such as Finland, which
underwent the transformation from acountry with poor
health indicators in the 1960s, to aEuropean leader in
health [22]. Another example was the UK, aworld power
in the trade, sale and consumption of tobacco (in the late
1940s 80% of adult males in Britain smoked, and lung
cancer became the number 1 killer of middle-aged men).
e British initiated an anti-smoking crusade using all
FIG. 4. Cigarette sale, alcohol consumption, and caloric intake in Poland
Billions of cigarettes
1935 1950 1965 19801920
Cigarettes sales in Poland,
1923-1980 10
Liters of pure alcohol/per capita/year
1955 1960 1965 1970 1975 19801932
Alcohol consumption in Poland,
1950-1980 3600
Kcal/per capita/day
1940 1948 1956 1964 1972 19801932
Total energy intake in Poland,
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
Health in the Polish People’s Republic
possible means; with economic and educational meas-
ures being paramount. For example, huge taxes were set
on tobacco products, and until now the UK is the country
where cigarette prices are among the highest in Europe
(four times higher than in Poland). is helped to reverse
the trend of lung cancer incidence, which decreased
threefold. British scientists estimate that the declining
smoking prevalence rates are also responsible in 50%
for the decrease in the incidence of cardiovascular dis-
eases in the UK [27]. e unprecedented health growth
in western European democracies (which is continuing
in the 21st century) has been possible thanks to chang-
ing the way their citizens think about health (not just
as amatter of curative medicine), building their health
competencies and reducing health illiteracy, building
healthy lifestyle models, and the active participation of
state and society in public health programs (“health is
too important to be le to doctors”) [28].
Despite the low mortality rates from chronic dis-
ease in post-WWII Poland, followed initially by only
modest increases (keeping in mind the long period of
disease development in the case of many chronic diseas-
es), already around the mid-1960s increases in mortality
began to be observed, particularly in the group of young
and middle-aged men. Among adult women (aged
20-64), mortality rates were stagnant. As aresult, at the
same time as arapid improvement was occurring in the
control of infectious diseases and child health, an equal-
FIG. 5. Life expectancy at age 20, Poland, men
1950 1960 1970 1980 1990 2000
FIG. 6. Mortality of men aged 20-64, selected causes, Poland
1962 1967 1972 1977 1982 1987 1992
CVD Cancer Injuries Infectious
ly rapid deterioration of adult health could be observed.
Life expectancy at 20 years of age was decreasing (Fig. 5).
Myocardial infarction sharply rose. Lung cancer rates
soared for men, breaking world records, especially in
young and middle-aged adults. Morbidity rates of liver
cirrhosis also rose. Almost one in ve adult men suered
premature death from injury (Fig. 6).
is deterioration in population health in Poland
was not aresult of any shortage of doctors or hospitals.
In fact, this dramatic decrease in health occurred at the
same time as the number of doctors in Eastern Europe
signicantly increased (in 1990 the number of doctors
per 1000 inhabitants in Eastern Europe was 4.7, while
in market economy countries it was just 2.5), and their
level of education was improving. Similarly, the number
of hospital beds increased (in 1990 there were 11 hospi-
tal beds per 1000 inhabitants in Eastern Europe, versus
just 8 beds per 1000 inhabitants in developed countries).
Access to new drugs and medical technologies also con-
tinued to improve in Eastern Europe [17].
While mortality rates in the UK and Finland have
decreased by over 30% between 1965 and 1990, in
Poland they have increased by almost 40%. Life expec-
tancy among males at age 20 decreased by 2.3 years, and
in women it increased by just 1.1 years. During this same
time, life expectancy at age 20 in western countries such
as France and Finland had increased by more than 4 years
in men and more than 5 years for women.
Stand. mortality rates per 100,000 population
Witold A. Zatoński, Mateusz Zatoński
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
FIG. 7. Risk of dying by world region, 1990
Males aged 15-60 years Females aged 15-60 years
Non-communicable diseases
Communicable diseases
Non-communicable diseases
Communicable diseases
Males aged 0-15 years
Non-communicable diseases
Communicable diseases
Females aged 0-15 years
Non-communicable diseases
Communicable diseases
Males aged 60-70 years Females aged 60-70 years
Non-communicable diseases
Communicable diseases
Non-communicable diseases
Communicable diseases
EME – Established Market Economies; FSE – Former Socialist Economies; CHN – China; LAC – Latin America and the Caribbean; OAI – Other Asia and Islands;
MEC – Middle Eastern Crescent; IND – India; SSA – Sub-Saharan Africa.
JOURNAL OF HEALTH INEQUALITIES 2016 / Volume 2 / Issue 1, June
Health in the Polish People’s Republic
e main reason for this growing gap in health, espe-
cially for young and middle-aged men, were cardiovascu-
lar disease, especially coronary heart disease. e increase
in cardiovascular disease mortality for men aged 20-64
in the years 1965-1990 in Poland amounted to 83%,
while in the same period in Belgium or Finland adecrease
of around 50% was observed. e second principal rea-
son for the growing East-West gap was an increase in
mortality due to sudden external causes. is rate grew
by 57% among Poles aged 20-64, while it decreased by
25% in Austria, and 37% in the Netherlands [4].
Until the 1980s, cancer mortality in Poland was low-
er than in Western Europe. However, while in the 1980s
Western Europe experienced for the rst time adown-
ward trend in cancer mortality, in Poland this rapidly
grew. is was primarily due to lung cancer incidence, as
well as other tobacco-related cancer locations [4].
Another health development typifying this period
in Poland, as well as other countries of the Soviet bloc,
were the growing dierences in health between men
and women; the so-called “excess male mortality”. is
was particularly pronounced in the 20-64 age group.
e dierence in life expectancy between men and wom-
en increased throughout the period of PRL. In 1960 the
gap was 6 years, at alife expectancy of 71 years for wom-
en and 65 for men. When the communist regime was
collapsing in 1989, life expectancy was almost 9 years
higher for women, at alevel of 75 years, compared to just
66 years for men [29].
Before the economic and political transformations of
the 1990s, the health status of adults in Poland, and in
the rest of the Soviet bloc, diered dramatically from the
western countries [4, 30].
e untrammelled rise of adult premature mortality
in Poland has demonstrated the inability of communist
countries to eectively respond to the new health challeng-
es. Chronic diseases among adults were becoming an ever
greater burden for the economy. Human capital was wast-
ed and economic development retarded. ese failures in
public health were part of a larger pattern of Polands ina-
bility to compete eectively in the globalising economy.
At the end of the 1980s the health of adult Poles was
in a catastrophic state. Premature mortality among mid-
dle-aged Poles, lung cancer mortality, cardiovascular dis-
eases, sudden deaths from external causes (i.e. accidents,
injuries, poisonings, etc.), and liver cirrhosis, had achieved
in Poland (and other CEE countries) levels that were not
observed anywhere else in the world. is epidemic of
“man-made diseases” became one of the main challenges
facing Poland at the end of the PRL period. According to
10 At the end of the PRL years, premature mortality rates of adult Poles, especially men, had attained disastrously high levels. In 1990 almost 30% of the male
population aged 15-59 years were dying; this being higher than levels seen in India and China [30].
11 is paper is based on the authors’ forthcoming chapter in the Polish-language publication by Noszczyk W (ed.). Zarys dziejów medycyny wPolsce – tom III.
[History of medicine in Poland – vol. 3]. PZWL, Warszawa 2016.
WHO estimates in 1990, the chances of a15-year-old boy in
Poland (along with his peers in other former socialist coun-
tries) to survive to 60 years of age was lower than that of
ateenager living in China, Latin America, or India10 (Fig. 7).
As the PRL was collapsing in 1989, the predictions
for the future of the country were dire. e uncertainty
about what the collapse of socialist economy will bring,
the impoverishment of society, the return of unemploy-
ment (inexistent under communism) – all of this augured
very poorly for the health of Poles. Forecasts indicat-
ed that infant and child mortality rates will increase.
e tobacco industry predicted further increases in ciga-
rette sales. Polands looming food shortage and malnutri-
tion crisis were widely debated11.
e authors would like to thank Kinga Janik-Kon-
cewicz, Urszula Sulkowska and Piotr Hołownia for their
help in the preparation of the manuscript.
Authors report no conict of interest.
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income in Europe, 1900-2008: an update of Prestons analysis.
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7. Doll R, Hill AB. Smoking and carcinoma of the lung; prelimi-
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... One of the main challenges of the newly established communist Polish People's Republic after World War II was the catastrophic health state of its population. Fifteen percent of newborns did not survive the first year of life, and life expectancy stood at about 50 years [2]. This was largely due to the high rates of infectious diseases in the war-torn country. ...
... A centralised health system was introduced, where infectious diseases and the health of children and women became priorities, in line with the Soviet Semashko model. 2 All these changes brought about a rapid improvement in population health. Epidemics of tuberculosis and other infectious diseases, including childhood diseases, were brought under control. ...
... Between 1950 and 1960 life expectancy increased almost by 9 years. By 1960, public health indicators in Poland came close to those in Western Europe: the average life expectancy in Britain was 72 and in Poland 71 [2]. ...
Full-text available
In the late 1980s, Poland was one of the countries with the highest per capita cigarette consumption, smoking prevalence, and lung cancer morbidity and mortality in Europe. After the political and economic transformation of 1989, transnational tobacco companies (TTCs) entered the market. The TTCs expected the cigarette sales in Poland to increase by at least 10% in the 1990s. Unexpectedly, the opposite happened. In the 1990s, the social attitudes towards smoking began to change, spurred by the involvement of civil society, the medical community, religious institutions, as well as national and local administration in developing and conducting a comprehensive tobacco control programme. For the first time since World War II, cigarette consumption in Poland began to decline. As a report by Fagerstrom et al. published in 2001 in a renowned medical journal showed by the end of the 1990s Poland had one of the best anti-smoking climates in Europe. Between 1990 and 2015 tobacco sales in the country fell from 100bn cigarettes to 40bn. This was accompanied by a decrease in lung cancer incidence and mortality. This paper discusses the factors underlying these positive developments.
... At the beginning of the 1960s, many Western European countries introduced population-based organised cervical cancer screenings for women. At the same time, countries of the communist Eastern Bloc attempted to solve the problem of cervical cancer with methods based on the clinically-focused Semashko model, with deep medicalisation and an assumption that every citizen should have access to free medical care [11]. Cervical cancer control through early diagnosis (Pap test) and treatment became part of the gynaecological routine, becoming the domain of highly specialised gynaecologists. ...
... Remnants of this system, as well as a culture of public health overemphasising the importance of clinical medicine, survived in many Central and Eastern European countries, including Poland, after the fall of the Eastern Bloc in the early 1990s. This applies not only to the way of thinking about patients and healthcare providers, but also public health administration officials [11,14,15]. ...
At the beginning of the 21st century, our knowledge on the biology, etiology, diagnosis, prevention, and treatment of cervical cancer is close to complete. Essential tools for effective screening of cervical cancer already exist and are improving each year. Deaths from cervical cancer have become very rare in many parts of the world. Despite this, there are still countries, in which cervical cancer mortality levels have increased in the last decades. This is partly because the implementation of an effective cervical cancer programme is an extremely complex undertaking, from the organizational, medical, social, and economic points of view. Finland is one of the European countries, which have been able to develop some of the most optimal cervical cancer screening programmes. On the other hand, some countries of Central and Eastern European region have not been able to overcome the substantial challenges involved in building such a programme, and struggle with persistently high and often growing cervical cancer rates. In Poland, cervical cancer mortality rates have been declining since 1990s, but new challenges have emerged. Significant differences in mortality levels between social groups have arisen, as have the first symptoms of a lack of a sustainable population-based cervical cancer screening strategy in Poland.
... Enriching the diet with vegetable products, changing drinking patterns, taking actions limiting the exposure to carcinogens at work and, above all, decreasing tobacco consumption by men and women, have all been described in Poland since the 1990s, and the scale of these changes has been increasing. 24,[38][39][40][41] It therefore seems clear that younger people are the main beneficiaries of the changes described. ...
Full-text available
Introduction: Although in Poland at the turn of the 20th and 21st centuries, tobacco consumption per capita was one of the highest in the world as a result of specific political and social conditions, nicotinism was the most common preventable cause of death that reduced life expectancy by 10 years on average. The aim of this study is to determine the level of premature mortality and its trends by age and sex for tobacco-related malignancies in Poland in the years 2008-2017. Methods: The standardised premature mortality rates as well as mortality rates for five-year age ranges according to the patients' sex were used. The Joinpoint model was used to determine the time trends. Results: Premature mortality due to all tobacco-dependent cancers analysed decreased in Poland throughout the analysed period in both male (2.5% per year) and female (1% per year) populations. A detailed analysis of individual diseases showed that a decrease in premature mortality was observed for almost all malignancies with the exception of malignant liver cancer among males, malignant oesophageal cancer among females and malignant lip, oral cavity and oropharyngeal cancer in both sexes. The reduction in mortality from all tobacco-related cancers in the male population was greatest between 40 and 44 years of age, reaching 5.6% year on year. Similarly, in the case of females, the decline in mortality was greater in the younger age cohorts and decreased in those aged over 50. Conclusion: The favourable phenomenon of decreasing the level of premature mortality caused by tobacco-related malignancies may be associated, among others, with the policy of primary prevention of these diseases in the form of a widespread ban on smoking in public places, intensive information campaigns on the harmfulness of tobacco smoking and increasing taxation on tobacco products.
... The first NRT treatment was produced in the form of a "chewing" gum and was sold under the trade name "Nicorette®". It was introduced to the market in the early 1980s by the Swedish pharmacological company "Leo" [23]. ...
... During this period, disinfectants and pest control chemicals became widely available as well. 25 Direct data on 20th-century helminthic infection rates in Poland are difficult to find. The IARC database shows that from 1960 to 1990, Poland's PC mortality rate increased fourfold (Figure 7). ...
Full-text available
In this descriptive epidemiological study, the soil-transmitted helminth (STH) burden and pancreatic cancer (PC) mortality rates of different countries and peoples are compared to demonstrate an inverse correlation. Formerly ubiquitous helminth infection possibly played a significant role in defending the human host against PC until the advancement of modern hygiene, with helminth eradication in recent times in developed countries and urban centers. It is posited that a high rate of infection by STH in developing countries and rural areas protects the human host from the development of PC, possibly by immune modulation. This hypothesis is used to explain increased PC rates in minority groups in the United States who had decreased helminth exposure in the late 20th century.
... Furthermore, the importance of clinical medicine had begun to be emphasised regarding public health. It survived the collapse of the Iron Curtain in many central and eastern European countries [4][5][6]. However, at that time, important population-based and organised early-detection programmes for cervical cancer were not undertaken, as was the case in numerous western European countries [7]. ...
Full-text available
Changes that took place in Europe in the early 1990s had an impact on health-associated issues. They were an impulse for the changes in healthcare systems and, consequently, also for the changes in cancer control programmes. Those changes also had an effect on mortality rates due to cervical cancer (CC). Therefore, the aim of this study is to analyse CC mortality trends in east-central Europe after 1990. Data on deaths due to CC were retrieved from the WHO Mortality Database. Trends in east-central European countries between 1990 and 2017 were assessed using Joinpoint Regression Program software. CC mortality decreased in the majority of analysed countries. However, an increase was observed in Latvia and Bulgaria. Despite decreasing mortality in the majority of the analysed countries, significant differences were observed. In order to improve the epidemiological situation, effective early detection programmes for cervical cancer ought to be rearranged and based not only on pap smears but also on molecular methods, as well as on introducing widespread programmes of vaccination against HPV.
... During his lecture, Witold Zatoński recapped the recent history of smoking in Poland -the country's record smoking rates in the 1970s and 1980s, the rapid decline in smoking in the 1990s, and the resulting reversal of the country's catastrophic health trends. These changes were described in-depth in the previous issue of the Journal of Health Inequalities [5,6]. ...
Full-text available
The conference, organised by the Ministry of Health of Poland in collaboration with the Health Promotion Foundation (Fundacja “Promocja Zdrowia”), was attended by over 100 participants representing a wide variety of backgrounds – physicians, politicians, civil servants, artists, journalists, and many others. This breadth was characteristic of the diverse nature of the anti-tobacco movement in Poland. It was this extensive coalition that helped to bring the Polish Anti-Tobacco Law to be accepted by the Polish Parliament in 1995 and enacted in May 1996.
Background: The process of social, political and economic transformation, which took place in Central and Eastern Europe in the early 90's, has affected many spheres of Europeans' lives, including health-associated issues. These changes also had an impact on mortality rates due to cervical cancer (CC). Therefore, the aim of this study was to analyse CC mortality trends in Europe after 1990. Methods: Data on death due to CC, uterine cancers and unspecified uterine cancers, in women aged 20-44, were taken from the WHO Mortality Database. Trends in European countries between 1990 and 2017 were assessed using the Joinpoint Regression Program. Results: Most of the countries experienced a decrease in CC mortality. Although the lowest rates were observed in EU15 Member States, the highest decreases were observed in Central and Eastern Europe. However, there are still differences in mortality in these countries. There are also a few countries like Belarus, Latvia and Ukraine, which experienced an increase in mortality. The range of mortality across Europe in 2017 was between 0.6 and 5.2/100,000 women. Conclusions: It is essential to introduce well-organised screening programmes for early detection of CC with coverage of a correspondingly high percentage of the population, particularly in East-Central Europe, as well as to introduce high-coverage HPV vaccination in all European countries.
Full-text available
In the past, upward shifts of the so-called Preston curve, which relates life expectancy to national income, have contributed importantly to worldwide increases in life expectancy. These shifts were due to rapid diffusion of knowledge and technology for infectious disease control from high-income to low-income countries. We assessed to what extent life expectancy growth in Europe has been accompanied by upward shifts in the relation between national income and life expectancy in later parts of the 20th century, when progress in cardiovascular disease control was the main driver of life expectancy growth. Data on national income (gross domestic product per capita, in 1990 international dollars), life expectancy and cause-specific mortality covering the period 1900-2008 were extracted from international data banks. (Change in) life expectancy and age-standardized mortality was regressed on (change in) national income, and the regression parameters were used to estimate the contribution to rising life expectancy and declining mortality in Europe as a whole of changes in national income vs shifts in the relation between national income and health outcomes. Large upward shifts in the relation between national income and life expectancy only occurred before 1960, and were due to rapid declines in mortality from infectious diseases which were independent of rises in national income. These shifts account for between two-thirds and four-fifths of the increase in life expectancy in Europe as a whole during this period. After 1960, upward shifts in the relation between national income and life expectancy were much smaller, and contributed only between one-quarter and one-half to the increase in life expectancy in Europe as a whole. During the latter period, declines in mortality from cardiovascular disease were mainly attributable to increases in national income. In contrast to earlier periods, recent life expectancy growth in European countries appears to have been dependent on their economic growth. More rapid diffusion of knowledge and technology for cardiovascular disease control from higher- to lower-income countries in Europe may be needed to close the East-West life expectancy gap, but it is unlikely that this can be achieved in the absence of more equal economic conditions.
Full-text available
A feature of the health of men across Europe is their higher rates of premature mortality and shorter life expectancy at birth than women. Following the publication of the first State of Men's Health in Europe report, we sought to explore possible reasons. We analyzed trends in life expectancy at birth in 19 European Union member states (EU19) between 1999 and 2008 using mortality data obtained from Eurostat. We then used Pollard's decomposition method to identify the contribution of deaths from different causes and at different age groups to differences in life expectancy. Between 1999 and 2008, life expectancy at birth in the EU19 increased by 2.74 years for men and by 2.09 years for women. Most of these improvements were due to reductions in mortality at ages >60, with cardiovascular disease accounting for approximately half these improvements for men. In 2008, life expectancy of men in the EU19 was 5.92 years lower than that of women. Deaths from all major groups of causes, and at all ages, contributed to this gap, with external causes contributing 0.96 years, cardiovascular disease 1.80 years and neoplasms 1.61 years. Improvements in the life expectancy at birth of men and women have mostly occurred at older ages. There has been little improvement in the high rate of premature death in younger men, suggesting a need for interventions to tackle their high death rate.
The story of mankind's struggle against polio is compelling, exciting and full of twists and pardoxes. One of the grand challenges of modern medicine, it was a battleground between good and bad science. Gareth Williams takes an original view of the journey to understanding and defeating polio.
This book covers the science and policy issues relevant to one of the major public health disasters of modern times. It pulls together the aetiology and burden of the myriad of tobacco-related diseases with the successes and failures of tobacco control policies. The book looks at lessons learnt to help set health policy for reducing the burden of tobacco-related diseases. It also deals with the international public health policy issues which bear on control of the problem of tobacco use and which vary between continents. New chapters in this edition cover subjects such as market manipulation, the ways in which the tobacco industry recruits and retains smokers, and how product design is manipulated in order to maintain addiction.
One of the greatest challenges in Europe at the beginning of the 21st Century is the wide east-west health gap. In 2008, the difference in life expectancy between men in some Western European countries and Russia was 20 years. Whilst trends for life expectancy at birth have improved in many areas around the world, those for Russia, as well as those for some other former Soviet Union countries, have fluctuated greatly and have not shown signs of growth since the middle of the 20th Century. This problem is most acute in Russia and former Soviet Union countries, but is also far from being solved in the states that have made significant progress since 1990 and joined the European Union in the 21st Century. One of the priorities of the Polish presidency of the European Union, which began in July 2011, is the call for a European solidarity for health that could help to close the health gap dividing Europe.
The enormous health gap between the 'new' (eastern) and 'old' (western) parts of the EU has evolved over many decades. The epidemiological transition - that is the decrease in the relative importance of infant and early child mortality and the shift in the composition of mortality risks from communicable to non-communicable diseases - which started in the western part of the region at the beginning of the 20th century, was substantially delayed in most of eastern Europe. However, after the World War II, health improvement in the east initially out-paced the west, such that, by the mid-1960s, only 1-2 years separated the average life expectancy for both sexes between the east and west. This convergence was short-lived and it reversed dramatically between the mid 1960s and 1990. During this period, adult health status in the east stagnated or deteriorated, whereas in the west it improved steadily: by 1990, life expectancy at the age of 20 years was more than fi ve years shorter in the east for men, and more than four years shorter for women. The biggest contributors to the health gap were cardiovascular diseases and injuries. A substantial fraction of the gap can, with confidence, be attributed to the higher volume and more irregular pattern of alcohol consumption in the east, and to the delayed onset of the tobacco smoking epidemics. Much of the remainder of the gap is likely to be attributable to the composition of the diet, but the contribution of different dietary factors cannot be estimated with confidence. Leading candidates are a high consumption of saturated animal fats, a low consumption of fresh fruit and vegetables (especially in winter and spring), a very low consumption of fats supplying omega 3 fatty acids – both vegetable oils and fi sh oils rich in alpha-linolenic acid – and a high consumption of salt. Behaviours unfavourable to health did not change in the east, as they did in the west in response to the credible dissemination of scientific findings linking disease and injury risks both to individual behaviours and to the social and economic circumstances that fostered those behaviours. The eastern countries failed to equip themselves with the science and with the forms of social organisation that were needed to effectively counter epidemics of chronic disease and injury. The poor health-related behavioural determinants resulted from the institutional infrastructures based on an authoritarian, conservative and medicalised model of health, which inhibited modern approaches to social problems, an almost exclusive focus of epidemiology on communicable as opposed to non-communicable diseases, a lack of understanding and access to modern epidemiology and public health, a lack of understanding and access to evidence-based medicine, and a lack of public health education and health promotion.
The Framingham study was a landmark study that, already in the 1960s, gave strong evidence as to the likely causal role of several lifestyle-linked factors in the development of cardiovascular diseases (CVDs). Men in Finland had at that time the highest mortality rates of coronary heart disease in the world, a finding that raised much local concern. In 1972, a pioneering project by a young leadership team and with many partners, including World Health Organization, was started to change the situation. The project was based on the results for Framingham and some other classical studies to carry out a comprehensive prevention program to reduce the risk factor levels in the population through general lifestyle changes in the pilot area of North Karelia. Later on, the work was transferred to national level. Over the years, great reductions in the population levels of the risk factors took place, associated with dramatic reduction in age-adjusted CVD mortality rates and improvement in public health. The experience of diminishing the prevalence of risk factors in the population is a powerful demonstration of how the CVD epidemic can be successfully confronted-thatis, how the Framingham results can effectively be used for major progress in public health.
Over the last decades, Europe has experienced dramatic changes in the geographical variation of liver cirrhosis rates. We attempt to provide a comprehensive analysis of patterns and trends in liver cirrhosis mortality in European countries and regions. Age-standardized (world standard) liver cirrhosis mortality rates per 100,000 person-years at ages 20-64 for 35 separate countries were computed using the World Health Organization Mortality Database. In the analyzed period (1959-2002), a very strong East-to-West gradient in mortality rates was observed. An increase of the burden of mortality due to liver cirrhosis appeared in Eastern Europe in two specific areas: South-eastern Europe and North-eastern Europe. In the first group of countries, liver cirrhosis mortality was 10-20 times higher than in most other European states, levels never before observed in Europe. In the countries of North-eastern Europe (former Soviet Union countries) liver cirrhosis mortality was characterized by dramatic changes (both positive and negative) in specific periods of time. Despite the fact that the etiology of liver cirrhosis is multifactorial, it seems that alcohol drinking is the factor that best explains the observed patterns in frequency of this disease in Europe. Alcohol control policies in Central and Eastern Europe could lead to an appreciable reduction of premature mortality from liver cirrhosis.