Does faith heal?

Certainly, it is not my intention to go into any theological considerations here. I can also reassure you that it will not be an essay about the links between politics and religion, albeit the issue remains valid and stirs up strong emotions (and guarantees to draw a larger number of readers). Nevertheless, religion and religious service attendance are an important part of social life, and as such are not without influence on the health of the public. A positive correlation between people’s health and their participation in the life of religious communities has been well documented. Not surprisingly, a closer look at the issue reveals a more complex picture.

The reasons for which ‘religiously active people’ are healthier (perhaps the term is not the best one to use, still it is true when it comes to actual activity and not mere declarations of the worshipers), have been generally identified and studied more or less deeply by various research teams. They include among others:

•  observing religious prohibitions and obligations related to various health risks, particularly alcohol and psychoactive substances abuse;
•  social involvement, which reduces risk of depression and psychosomatic diseases, with asthma and migraine, among others;
•  positive impact of meditation on heart rate and metabolism, which (regardless of the type of religious manifestation) has been well researched and proved;
•  approach to diet, although not all fasting brings positive health outcomes;
•  additional dose of physical activity if one does not go to the temple by car (and does not attempt to park as close to the entrance as possible).

Hence, can the social changes with regard to the religiosity of Poles have an impact on health? Did combating the ‘religious cult' have negative influence on health in the past? The state policy in the period of real socialism (in Poland, because the model did not necessarily work in other countries) was counter-effective and froze religious activity of Poles at a high level for many years. Policy has changed over the last 27 years and (despite this fact or perhaps just for this reason?), the process of decrease in the level of religiosity continues, although it has been very slow and with fluctuations. Although, if we consider the ‘social religiosity’ indicators for Poland, they still remain on a high level, however, for reasons being located in the areas I will not be referring to here, the picture has been undoubtedly changing. The pace of changes is expressed not in years in this case but rather in generations. I will not analyse here either, (although the issue is most interesting), if the current state policy, albeit near and dear to the hearts of the hierarchs of the Catholic Church, will cause this process to stop.

One aspect is certainly worth noting. As history shows that the attempts to replace religion with various forms of state cult have been unsuccessful. In a similar vein, it is hard to agree that the state should promote activities for the citizens aimed at replacing the benefits of their involvement in the activities of religious communities. But regardless of the above, creating safe areas for social life in general should be a permanent policy of the local authorities, especially those of the lowest level of municipalities and districts. It is beyond any doubt that such initiatives will turn out beneficial for both body and soul.

Recommendations for further reading:

• Religious service attendance and public health
• Is religion important in people’s lives?
• Religiosity of Poles in the light of social studies (published in Polish)
• Fruits of meditation – advanced reading ;)
• Asthma, migraine and hypertension – as ‘patient spirituality sensitive’ psychosomatic diseases, also for those who enjoy reading challenges.

What BREXIT means for patients and health care employees

Brexit continues to appear to be a future and uncertain event. Nevertheless, let us look at it from the point of view of Polish health care. Firstly, almost one-million- population of Poles in the United Kingdom, even after partial repatriation, will continue to live on the Isles. Up till now, due to EU regulations on coordination, while paying a visit to their old homeland they could use the English EHIC card in the event of sudden illness. In the grim scenario, without England and the European Union reaching agreement in the Norvegian style, it would be necessary to either conclude a bilateral agreement or issue relevant unilateral national regulations. Conclusion of a bilateral agreement might pose a challenge to any English government – as it was exactly the social and healthcare benefits offered to Poles starting work in the UK that were among the main causes for the decision of the British voters. Polish budget will have to come to the rescue, which will be actually in line with the announced transition from the health insurance system to budget funding of health care.

It would be worth mentioning here that the announced changes in Poland go further in the direction of the British NHS, thus taking a step back from the insurance models in Germany and France. In this respect, Poland may actually replace England and represent a centralised, health care system funded from the state budget, within the European Union.<br> The system has got two defining characteristics: lower financing in relation to the Gross Domestic Product (although the amounts are higher than in Poland) and lower level of meeting patient needs. The UK ranks 13th in the Euro Health Consumer Index, not only behind France and Germany but also … the Czech Republic.

Another two questions will be of larger significance: questions about patients and medical staff. This is a straightforward case as regards patients. Those who will remain British residents, will remain the beneficiaries of this system due to its form. What will happen to others will depend on the effectiveness of Polish diplomacy during divorce negotiations. The bar is set really very high – as the example of Norway will be the point of reference.

In the case of the NHS staff the situation is even simpler. Due to the shortage of staff they are not likely to have to look for a new job. On the other hand, it is quite difficult to assess the impact of recession that is likely to follow Brexit on the NHS finances. The chances that the funds saved in contributions to the EU will be spent on health care were questioned, despite campaign promises, by the leader of the anti-EU UKIP party, Nigel Farage himself . It could be interpreted as follows: despite obvious needs, there will not likely be funds for new posts for physicians and nurses …

Suggested further reading:

• The largest potential loss of coordination mechanisms
• European Medicines Agency not for the Islanders?
• NHS to weaken after Brexit?
• Uncertainty after the vote

Supporting a football team? Might be a bad idea.

I cannot be entirely impartial about watching football. Being a person, who even when made to watch a football match due to social expectations, rather pretends (out of courtesy but also to be honest, out of social conformism) to be interested than actually experiences emotions known to the true football fans, I certainly take a different point of view than millions of supporters living the UEFA European Championship to the full.

Nevertheless, the time of the games has come and opposing voices should also be heard. Including a voice which is not so much against the games themselves but against the context and the results. Let me adopt the perspective of public health here .
At first glance, it does not look bad. Theoretically speaking, football does not look so bad. The players enter the pitch, run, kick the ball, true - they occasionally suffer injuries, though incomparably less severe than in the case of boxing or weight lifting. It should be a good example for children, young people and adults. But is it really so?

Let us begin by stating the bare facts. Millions of bottles and cans of beer. Tonnes of chips, snacks, sausages and pizza. Hours spent in front of the television set, though watching the games at bars and pubs has been becoming a new Polish secular tradition. An additional cigarette smoked because of ‘the anxiety over the football match score’ …
Consumption is driven by a huge marketing machine, which entices millions of football fans into the sphere of its targets. Does it help to increase physical activity in the population? Any evidence? If yes, please share it with me. Will the games bring the result in the form of increased consumption of the mentioned products? Stock market reports directly show that – yes.

Pitifully, I have noticed not a single government communication or, more broadly speaking, a message from the politicians that would at least partially outweigh the negative impact of junk food and alcohol advertising. If any of you find an exception – then it is worth noting and popularising. I will be glad to admit that it escaped my attention… Perhaps we could find some positive psychological and emotional aspects of the phenomenon?
Shared emotional experiences, endorphins, mobilisation? Health has also psychological-social dimensions. Regardless of the funds spent on promotion, the European Championship would not be a success if it did not meet human needs. How does it work? Here we enter Terra ignota, though (for those more deeply interested in the topic) some results of psychological studies can be found, for example of studies on the differences between sport fans and the persons emotionally detached when it comes to sporting issues.

These emotions, even though engaging attention (and memory, here the link between emotions and memory has been quite well explored), seem to be risky too. Since the study of 2006 carried out on a group of German football fans (the study recalled during the Championship by the Polish Health Policy Institute*) shows that the risk of a heart attack is likely to be linked not only to bad diet but the very ‘adrenaline rushes’ while watching the match. Certainly it would be worth comparing the results of this study and the possible positive results of the ‘watching activities’… (perhaps someone will present them, on condition of providing reliable sources )

Regardless of the above: I think that from the point of view of public health the time of the games is actually the time lost. However, if the UEFA European Championship lasts for a few days longer, perhaps at least the journalists, not necessarily covering sports, will remind us that only watching sport will not make us any healthier…

And to end the post with a constructive proposal: the media covering sporting events (which is not a negligible sources of their income) would be obligated to advertise not only various products but also healthy lifestyle and to inform of the risks related to ‘emotions in sport’, alcohol, tobacco, and most snacks.

Original post in Polish

Strategy for PHC, strategy for patients

Strengthening the role of primary health care is one of the cornerstones of public health and the conditions for maintaining a stable, effective and safe health care system. Therefore, it is undoubtedly a positive phenomenon that works on development strategy for this sector are being continued. It is said that even a draft report has been prepared.

The information on the content of this report which has thus far been available in a fragmented manner does not allow conclusions to be made about the direction and definitely it will be necessary to wait until the Health Minister discloses the report to fully assess its contents.
It is worth reminding briefly how we arrived at this point of PHC organisation and why we are here. It was only twenty years ago that the physicians working ‘in the district’ (what a terrible phrase, isn’t? ...) carried out their duties within the organisational framework of health care institutions.

However, it was not exactly an integrated form of care due to ineffectiveness and futility of various incentive mechanisms in a purely budgetary system. Introducing and developing a contract-based system that replaced budgetary planning led to rapid disintegration of forms of organisation, whereas in the few places where such organisations managed to defend themselves, their efficiency seems to be far from perfect. The former public health care institutions (Polish ZOZ) quite quickly underwent privatisation, entirely new entities were established, and currently privately owned entities constitute about 90% of the total potential.

At present several trends can be observed to have impact on the organisational forms. Firstly, large networks of health care providers are being developed, although their growth rate seems to be much lower than the growth that can be observed with regard to the pharmacy sector. The process of privatisation of the public entities supervised by the local authorities, especially by the local self- government, has been considerably slowed down. One might risk stating the opposite - that public hospitals began, sometimes successfully, to create their own PHC centres. At the same time, some of the slightly larger private entities started to grow ‘vertically’ by offering services within other scopes of health care benefits, such as advisory clinics, rehabilitation or one-day clinics.

Soon after privatisation took place, exceptionally rapid emergence of organisations defending the interests of these newly established entities could be observed, which was actually a result of the reform attempted in the very beginning of the existence of the Polish National Health Fund (NFZ).
These organisations were effective in attaining their goals, despite changing government coalitions and a wide range of concepts for health care governance – and they did it either by negotiation or by exerting public pressure, or resorting to strike action. Public funding of primary health care increased, not only in terms of absolute but also relative amounts, although, it is honest to say so, as a general rule the scope of responsibility was broadened too.

The announced document, therefore, will be of importance not only for the PHC entities and their staff. Preparing myself to do some research on the subject, I decided to make a checklist:

1. How will the PHC team be defined and will it still be a team? The possible role of a nurse is not the only challenge but certainly the first to be encountered.
2. How will implementing the strategy impact other segments of the health care system? Peer review is an essential part of functioning of every organisation and assessment of specialist care, hospital care or long-term care cannot be avoided.
3. Will development of prevention be included and how will it be done?
4. Will the role of the local self-government be recognised and, if yes, in what ways will it be done? Difficulty in accessing a primary care physician is a strongly diversified problem in terms of geographical location and it would certainly be more effective to support the self- governments on one hand and get them involved in problem solving on the other hand.
5. Will the possible organisational changes, which are likely to quite rightly highlight the need for greater coordination, not cause the competitiveness potential of PHC (possibly being the reason for quite good results obtained in patient satisfaction surveys) to be lost?
6. And the final question, linked to the previous questions, and a fundamental one: how will the new strategy affect the patients? How to convince them that within PHC it is really possible to obtain a majority of needed everyday health care benefits?

As the twig is bent…

I will begin by making an introductory remark that although my BMI remains within normal limits, I still should say good-bye to a few kilograms. As it is already known, the value of the index itself is not a problem, however, it indicates a possible problem or health risks.
The problem is not so much widespread among children as it is among adults, nevertheless, if it occurs, then it has more serious consequences and sometimes it also has more serious reasons that should not be ignored.

This issue came up visibly several times last year during the so-called ‘sticky bun debate’. The debate which was in some part informed, in some part amusing and spiced with demagogic objections, and during which the participants did not refrain from using stereotypes. The debate which was positive before the regulation came into force and negative after 1st of September (beginning of the school year in Poland). The Health Minister issued a regulation based on his legislative authority specifying which products can be sold in the shops located within the premises of educational institutions and which meals can be served in school canteens, which has been binding since the beginning of this school year. It should be also noticed that advertising and promotion of the products which are not in the list has been banned, therefore, the regulation has an intermediate educational effect.

It is worth recalling that the regulation met with some objections on the part of the former Minister of Education and fundamental criticism coming from the Minister currently in power.
Nevertheless, in this case the Polish legislator has vested all the legislative power in the hands of the residents of Miodowa Street 15 (the seat of the Ministry of Health) and up till now no changes have emerged on the horizon. So, it seems, health wins?

And here we should stop. As it is expected that the regulation will last the whole school year, it would be a good idea to assess its effectiveness already in May. It is not about media reports in the ‘children continue to buy chips’ sensational style but actual, in-depth studies on the attitude change of teachers, children, parents and local authorities.
Without involving all these groups the regulation will be only halfway to success, and a ridiculed and dead letter in the worst case. To end on a positive note, I would like to draw your attention to the programme that is carried out in my former workplace - at the University Clinical Centre in Gdańsk. One can only regret that in few cities in Poland similar effort was made.

Further reading:
Which strategies to employ to tame childhood obesity epidemic are evidence based - as one of the topics for the future debate and decisions.

Czym skorupka za młodu

Od razu zastrzegę się, że chociaż mój BMI mieści się w granicach normy, to powinienem jeszcze z kilkoma kilogramami pożegnać się. Jak już wiadomo to nie sam wskaźnik jest problemem. Zgodnie z nazwą po prostu wskazuje na możliwość problemu czy ryzyka zdrowotnego i w pewnym zakresie to ryzyko mierzy.
Wśród dzieci problem nie jest tak rozpowszechniony jak wśród dorosłych, nie mniej jeśli już występuje ma poważniejsze konsekwencje a czasami także przyczyny, których nie powinno się ignorować.

Temat pojawił się dość mocno w ubiegłym roku w czasie tzw. „debaty drożdżówkowej”. Debaty miejscami merytorycznej, miejscami zabawnej, z domieszką demagogii, w której uczestnicy nie stronili od posługiwania się stereotypami.  Pozytywnej przed wejściem w życie, negatywnej po 1 września. Minister Zdrowia na podstawie delegacji ustawowej wydał rozporządzenie, określające co wolno sprzedawać w sklepikach na terenie placówek oświatowych i podawać w stołówkach szkolnych, które obowiązuje od początku bieżącego roku szkolnego.

Trzeba zwrócić uwagę, że zakaz obejmuje także reklamę i promocję produktów spoza listy, zatem regulacja ma także wymiar, w pośredni sposób, edukacyjny. Warto przypomnieć, że przy pewnym oporze ze strony byłej i totalnej krytyce ze strony obecnej minister edukacji.

Ustawodawca jednak dał w tym przypadku całą władzę w ręce Miodowej (siedziba MZ) i na razie zmian w tym zakresie na horyzoncie (czyli projektu przekazanego do konsultacji społecznych) nie widać. Czyli, wydawałoby się, zdrowie górą?
Tu należałoby chwilę poczekać. Skoro wygląda na to, że regulacja przetrwa cały rok szkolny, to warto w pierwszej kolejności, jeszcze w maju, sprawdzić jak ona działa. Nie chodzi tu oczywiście o doniesienia medialne w stylu „dzieci i tak kupują chipsy” ale realne, pogłębione sprawdzenie, na ile zmieniło się nastawienie nauczycieli, dzieci, rodziców i samorządów. Bez zaangażowania tych wszystkich grup regulacja administracyjna okaże się co najwyżej połowicznym sukcesem, w najgorszym zaś wyśmianym i martwym zapisem.

Dla pozytywnego zakończenie wpisu chciałbym polecić uwadze program, w który jest realizowany w moim byłym miejscu pracy, Uniwersyteckim Centrum Klinicznym. Szkoda, że w niewielu miastach w Polsce podjęto podobny wysiłek.

Dla ułatwienia przekazuję zainteresowanym linki do dwóch jeszcze dodatkowych materiałów

• Rozporządzenie "drożdżówkowe", czyli o czym była cała ta dyskusja...
• Jakie strategie walki z otyłością dzieci działają a jakie nie - jako podstawę do dalszej dyskusji i działań, w tym ważnym przecież obszarze.

The Shape of Polish Healthcare – a Decision Yet to Be Made.

The Working Group on ‘the health care system’ set up by the Minister of Health has not completed its mission yet, however, some initial, leaked, information seems to confirm what was generally expected.

This includes health insurance contribution deducted from Personal Income Tax to be replaced by … a share of personal income tax. The special-purpose assets remain, however, it is still unclear whether the Central Office of the National Health Fund will be functionally replaced by appropriate departments in the Ministry of Health or by specialised agencies established for this purpose. As it may be concluded from other announcements made, entitlement to health care is to be linked to the place of residence under the so-called citizenship entitlement to healthcare benefits.

It is not an entirely new idea for those following the state’s healthcare policy. In 1998 Professor Leszek Balcerowicz, the then Deputy Prime Minister and the Finance Minister from the liberal Freedom Union (Unia Wolności, UW- a liberal democratic political party in Poland no longer existing but many of its former members are in opposition parties now) proposed such a path for one of the four memorable reforms of the government led by Professor Jerzy Buzek. However, another concept prevailed – that of the right-wing Solidarity Electoral Action (Akcja Wyborcza Solidarność, AWS), from which at least some politicians of the Right and Justice party (Prawo i Sprawiedliwość, PiS), currently in power, belong and which consisted of establishing Sickness Insurance Funds – 16 funds dependent on provincial self-government authorities and a central entity for the officers and employees of the Ministry of the Interior and the Ministry of National Defence.

It seems, however, that at least in the current parliamentary term the concept of a health insurance institution independent from the government has not come back together with the people who built the system not even two decades ago. It is worth noticing that since the beginning of the National Health Fund’s existence each successive government reduced the powers of the public payer, consistently limited its competences and centralised decision making in the hands of the Minister of Health. The current proposal should be perceived rather as ‘dotting the i’s and crossing the t’s’ in the process begun 13 years ago by the government of Leszek Miller.

Problems and challenges:

• In order to maintain the current level of revenue it will be necessary to increase the nominal value of personal income tax by at least 1%, which despite being only an accounting operation will be difficulto implement on a political level. An alternative solution would be to include the changes in a broader reform of the tax and insurance system reform (encompassing contributions paid to the Social Insurance Institution (Zakład Ubezpieczeń Spolecznych, ZUS) and increasing progression in the personal income tax.
• The tax administration’s efficiency in Poland is amongst the lowest in OECD countries with its current cost reaching 1.6% of the amount of the tax collected. It will be necessary to improve the quality of the tax offices’ work in order to ensure sustainable tax revenues in the medium-term.
• Replacing the entitlement to healthcare based on the insurance with one based on citizenship and place of residence is more likely to discourage participation of the potential employees in the labour market. It also poses serious technical challenges resulting from quite high migration and mobility of Polish citizens.
• Increasing dependence on the state budget may have even further consequences. So far the Fund’s distinct legal personality and its own financial plan have acted as a specific buffer in the context of the macroeconomic situation of hospitals and primary health centres. In the time of acceleration of economic growth the increase of the funds was spread over the period, whereas during the economic downturn the reserve funds served as a cushion. The funds that were not used in a given year were not lost but could be used in the following year. These elements that allow the flexible management of the funding system may be now lacking, and, moreover, a considerably greater pressure may be exerted by other ministries, especially those dealing with social issues, when it comes to financial planning. As long as we are enjoying satisfactory economic growth, the threats mentioned above remain purely theoretical. Nevertheless, should the Polish economy slow down or, even worse, fall into recession, then the Minister of Health may be in an even more difficult and weaker position than he is now.

Jaki system – decyzje przed nami

Praca Zespołu „systemowego” powołanego przez Ministra Zdrowia jeszcze trwają, ale są już pierwsze przecieki, zgodne zresztą z oczekiwaniami. Oto składkę ubezpieczeniową odliczaną od podatku (PIT) ma zastąpić … udział w podatku od osób fizycznych. Fundusz celowy pozostaje, jakkolwiek czy Centralę NFZ zastąpią w funkcji stosowne departamenty w Ministerstwie Zdrowia czy też specjalne agencje powołane w tym celu, nie jest jeszcze jasne. Uprawnienie do świadczeń, co wynika także z innych zapowiedzi, ma być oparte na zasadzie miejsca zamieszkania, jako tzw. obywatelski tytuł do świadczeń.

Dla śledzących politykę zdrowotną państwa pomysł nie jest do końca nowy. W 1998 roku, prof. Leszek Balcerowicz, ówczesny wicepremier i minister finansów z liberalnej Unii Wolności proponował taką właśnie ścieżkę dla jednej z 4 pamiętnych reform rządu premiera prof. Jerzego Buzka. Zwyciężyła jednak koncepcja prawicowego AWS, z którego wywodzi się przynajmniej część polityków Prawa i Sprawiedliwości (obecnej partii rządzącej), budowy Kas Chorych – 16 zależnych od władz samorządów wojewódzkich i jednej centralnej dla funkcjonariuszy oraz pracowników resortów spraw wewnętrznych i obrony narodowej.

Wygląda jednak na to, że przynajmniej w obecnie rozpoczętej kadencji parlamentu idea niezależnych od rządu instytucji ubezpieczenia zdrowotnego nie wróciła wraz z osobami budującymi ten system niecałe 20 lat temu. Warto przy tym zauważyć, że od samego momentu powstania Narodowego Funduszu Zdrowia, każdy kolejny rząd zmniejszał uprawnienia płatnika, konsekwentnie ograniczał jego kompetencje i centralizował decyzje w rękach Ministra Zdrowia. Obecna propozycja to raczej postawienie kropki nad „i” w procesie rozpoczętym 13 lat temu przez rząd Leszka Millera.

Problemy i wyzwania :

• W celu zachowania poziomu obecnych przychodów konieczne będzie nominalne podniesienie podatku (PIT) o co najmniej 1%, co mimo, że jest jedynie operacją księgową będzie trudne politycznie do przeprowadzenia. Alternatywą jest włączenie zmian do większej reformy podatkowo-składkowej (obejmującej też składki na ZUS) i zwiększenia progresji w podatkach osobistych.
• Efektywność administracji skarbowej jest w Polsce jedną z najniższych w krajach OECD, która kosztuje już obecnie 1,6% zbieranych w podatkach pieniędzy. W celu średnioterminowego zapewnienia przychodów konieczne też będzie poprawienie jakości pracy urzędów skarbowych.
• Zastąpienie ubezpieczeniowego tytułu do świadczeń obywatelskim, opartym na miejscu zamieszkania, w większym stopniu może zdemotywować potencjalnych pracowników do aktywności zawodowej. Powoduje także poważne wyzwanie techniczne z powodu dość dużej migracji i mobilności obywateli naszego kraju.
• Pogłębienie zależności od budżetu państwa może mieć jeszcze dalsze konsekwencje. Do tej pory odrębna osobowość prawna i własny plan finansowy zapewniały swoiste buforowanie sytuacji makroekonomicznej szpitali i przychodni. W przypadku przyspieszeń wzrostu przyrost środków był rozłożony w czasie, spowolnienia zaś były łagodzone środkami rezerwowymi. Środki niewykorzystane w danym roku nie przepadały, tylko mogły być wykorzystane w kolejnym okresie. Tych elementów uelastyczniających zarządzanie finansami może zabraknąć a dodatkowo może pojawić się znacząco większa presja przy planowaniu finansów ze strony innych, zwłaszcza społecznych resortów w rządzie. Dopóki przyzwoity wzrost gospodarczy trwa, powyższe zagrożenia pozostają teoretycznymi, jednak w przypadku pojawienia się spowolnienia gospodarczego lub w jeszcze gorszej ewentualności, recesji, pozycja Ministra Zdrowia może być jeszcze trudniejsza i słabsza niż obecnie.

And another vodka for me, luv …

Alcohol, quite wrongly, remains outside the mainstream of public health in Poland. Whereas, despite the fact that alcohol consumption fell slightly soon after democratic changes had taken place, we have been watching another regression since 2001.

Not only for health reasons but rather thanks to local self-government activists, the issue of limiting access to alcohol through laws has surfaced up again. The presidents, the mayors and the members of the city councils are not so much motivated by potential health benefits but the pressure exerted by the citizens who experience the disadvantages resulting from 24 hours a day alcohol sale or too close proximity of alcohol outlets to schools. The authorities and the opposition quite unanimously agree that local self-governments should be given larger powers to decide on the number of outlets in the area.

This solution is bound to be resisted by salespeople as their budget relies on alcohol sale. Certainly, some consumers will object too. At the same time, the goal of reducing alcohol consumption, which would be undoubtedly achieved (numerous studies and observations have been conducted to prove this argument), is most legitimate and laudable.

It is my view, however, that the draft act is too administrative in its nature. Honourable Members and the Association of Polish Cities, being the co-originators of the changes, should consider a larger contribution of the economic factors. I particularly mean increasing the fee for issuing an alcohol license (generally known as the ‘cork’ tax) and providing its flexibility depending on local conditions. Especially the sales during the evening and night hours, and during the holidays should be taxed much more heavily than in the case of ‘regular’ outlets open, for instance, till 6 p.m.

This is the way not to make alcohol business a part of the underground economy as it took place during the communist era, to maintain or even increase the municipal financing of prevention programmes while the salespeople will still have a choice and carry out calculation whether to continue sales, increase prices or give up on these products. Either way, the consumption of alcohol will fall - thus benefiting the health of Polish citizens.

I jeszcze wódeczkę Pani poda łaskawie …

Alkohol, zupełnie niesłusznie, pozostaje poza głównym nurtem zainteresowania zdrowia publicznego w Polsce. Tymczasem, mimo, że zaraz po przemianach demokratycznych konsumpcja alkoholu lekko spadła, od 2001 roku obserwujemy ponownie regres (statystyki OECD).

Z przyczyn nie tylko zdrowotnych a raczej za sprawą działaczy samorządowych powrócił temat ustawowego zmniejszenia poziomu dostępności alkoholu. Prezydenci, burmistrzowie czy radni nie tyle są motywowani względami zdrowotnymi co presją mieszkańców, odczuwających niedogodności nocnej sprzedaży alkoholu czy zbyt bliskiego sąsiedztwa punktów sprzedaży ze szkołami. Rządzący dość zgodnie z opozycją (za Głosem Wielkopolskim) chcą dać większe uprawnienia samorządom w określaniu liczby miejsc sprzedaży.

Rozwiązanie takie z pewnością wzbudzi opór ponieważ dla handlowców jest to jeden z istotnych punktów w ich budżetach. Także część konsumentów będzie zapewne protestować. Jednocześnie cel, jakim jest ograniczenie spożycie alkoholu, który niewątpliwie (na poparcie tej tezy przeprowadzono szereg badań i obserwacji) zostałby osiągnięty, jest jak najbardziej słuszny.

Uważam jednak, że sam projekt ustawy ma charakter zbyt administracyjny. Szanowni posłowie a także Związek Miast Polskich, jako współinicjator zmian, rozważyć powinni większy udział czynników ekonomicznych. W szczególności mam na myśli zwiększenie opłaty za prowadzenie sprzedaży (znanej powszechnie jako podatek „korkowy”) i jej uelastycznienie, w zależności od lokalnych uwarunkowań. W szczególności sprzedaż w godzinach wieczornych, nocnych i dni świąteczne powinna być zdecydowanie wyższa od „zwykłych” punktów, działających np. do 18:00.

W ten sposób sprzedaż alkoholu nie zejdzie, jak w PRL, do gospodarczego podziemia, gminy utrzymają lub nawet zwiększą środki na profilaktykę a handlowcy będą mieli wybór i przeprowadzą kalkulację: utrzymać sprzedaż, podnieść ceny sprzedawanych wyrobów czy zrezygnować z tego asortymentu. W każdym przypadku konsumpcja spadnie, z pożytkiem dla zdrowia Polaków.

Good morning, Dzień dobry,

The idea to start a blog on public health has been ‘percolating through my cortex (neocortex ;) )‘ for a long time. The first day of spring, Palm Sunday and the first week of being released from the burden of ‘a bit’ limiting public duties seem to be the best moment to start writing.
I invite those who are interested in broadly understood public health, health policies and health care organisation, and promise posts that will be quite regular, not too long and up-to-date . I am not afraid of criticism, I even invite it as it will help me to develop myself and develop this blog.