Przejście epidemiologiczne i przejście zdrowotne w Polsce w perspektywie długookresowej

Epidemiological Transition and Health Transition in Poland over Long-Time Perspective Longue durée demographic theories explain a drop of death rate accompanying the modernization process, first of all industrialization and urbanization. Demographic transition theory pertains to a long-term death rate drop; in the first place mortality of infants and older children, then mortality of the remaining segments of population. The epidemiological transition theory describes changes of the mortality rate structure on the basis of causes, shifting from dominant infectious and parasitic diseases towards the signifi cance of degenerative diseases and disorders that are human activity related, i.e., cardiovascular diseases, cancers or traffi c accident casualties. On the other hand, the health transition theory accounts for the mechanism of eliminating the most serious ‒ from the point of view of individuals, social groups and whole societies ‒ health risks by means of applying health innovations. This chapter has been focused on presenting the mortality rate evolution in Poland against the background of the above mentioned theories. A consistent death rate fall started in Wielkopolska (a region in Central Western Poland) in the last decade of the 19th century, what is more, the decrease in children death rate had a fundamental impact on the prolongation of an average life expectancy at birth. Infectious disease, in particular tuberculosis, smallpox and childhood diseases were the most critical death causes in the 19th century. Outbreaks of local epidemic hotbeds were observed till the twenties of the 20th century, first of all being related to marches of troops, war havoc and famine. A distinct fall of the impact of infectious diseases had started in the interwar period and continued in the first years following World War II, when immunization programs were initiated on a massive scale. A rapid growth of an average life expectancy at birth in Poland was recorded around 1965. As of this year one observed deterioration of health indicators in all population groups. The so called health crisis that lasted from around 1965 to 1991, hit mainly middle aged males for whom the mortality rate increased due to cardiovascular diseases, cancers and liver cirrhosis. This phenomenon has been attributed to an unhealthy way of life, in particular poor diet, alcohol and tobacco abuse, lack of leisure and physical exercise, stress and frustration as a result of social and professional alienation. Health care system that proved highly effective in the early postwar years with regard to massive immunization and education campaigns have not adapted to chronic disorders prevention. The turn of 1989 brought a reversal of previous negative health trends. A few health innovations contributed to this shift: modified and varied diet; in particular replacement of animal fats with plant fats and an increase in fruits and vegetables consumption, a drop in tobacco consumption, healthier way of life accompanied by physical exercise. Last but not least, one should mention the institutionalized health care system reshuffle, growing expenditure on this sector and thus resultant improvement of sanitary and care standards in health service centers, as well as state-of-the-art techniques to treat cardiovascular diseases. The case of Poland illustrates that, in contrast to the postulates of the epidemiological transition theory, modifi cations in the mortality rate are not of unidirectional nature. Unfavorable social and economic conditions might bring to a halt death rate fall, as it happened in the 1965‒1991 period, nevertheless solely the improvement of these conditions enables implementation of health innovations and a comeback to the growing trend of an average life expectancy at birth.