One hundred years of health in Poland

Life expectancy is the best synthetic indicator for measuring the improvement or deterioration of a country’s health across time. This article charts the life expectancy trends, and their underlying factors, in Poland in the last one hundred years. The process of health gain in Poland has seen much fluctuation. Periods of health convergency with Western Europe have been intertwined with periods of divergency and crisis. The social and economic watershed of 1989 has been followed by a rapid improvement in health indicators. However, the last fifteen years have seen a stalling of the health growth in Poland. Key wOrds: life expectancy, epidemiological transition, Poland, public health, tobacco control, alcohol diseases, diet. Address for correspondence: Witold A. Zatoński, Health Promotion Foundation, 51 Mszczonowska St., 05-830 Nadarzyn, Poland, phone +48 22 378 00 22, e-mail: wazatonski@promocjazdrowia.pl Supplementary materials (slides) are available in Webappendix 2 at the journal’s website: https://www.termedia.pl/Journal/Journal_of_ Health_Inequalities-100. DOI: https://doi.org/10.5114/jhi.2019.87816 IntroductIon The last century has seen a rapid improvement of health indicators around the world. Life expectancy has been historically the best and most useful measure for charting health developments across time and space. This paper analyses the health trends in Poland in the last century through the lens of life expectancy. After World War II we have seen a global convergence of life expectancy trends (see slide 6 in Webappendix 2). In most high-income, politically and economically stable countries a steady increase in life expectancy has been observed. In Poland, and the neighbouring countries of Central and Eastern Europe, the trends in life expectancy have seen much fluctuation. Periods of quick health growth have been intertwined with periods of stalling health improvement, or even its freezing (see slide 6 in Webappendix 2). HumAn development Index Since the early 1990s the United Nations have been using a synthetic measure called the Human Development Index (HDI) to classify the degree of socio-economic development and quality of life in different countries. The HDI allows to make comparisons across countries, and track development through time. The index is composed of three elements – per capita Gross Domestic Income, a measure of education combining average adult years of schooling with expected years of schooling for children, and life expectancy (see slide 6 in Webappendix 2). In the hundred years since Poland regained its independence in 1918 the country has experienced significant improvement in economic and educational attainment [1]. The Polish economists Paweł Bukowski and Wojciech Paczos estimated that in this period Polish GDP rose from EUR 4,000 to EUR 24,000 [2]. They argue that ‘despite wars and crises we are today six times wealthier than our great-grandparents were in 1918 [1]. Most striking are the last three decades, in which Poland developed not only without interruption, but also significantly faster than the West’ [1, 2]. Similar trends were observed in measures of educational development [3, 4]. In the last century Poland underwent an educational revolution. In 1919 illiteracy