A fairly compelling example of the close connection between
government economic policy, business and health has just
come out of Poland. This time, unlike the examples of the
sales of cigarettes, alcohol and formula, its a positive
and healthy relationship.
The former Eastern European communist countries have been
having a difficult time making the transition from a centrally
planned, directed and controlled economy to the freewheeling
confusion of market forces.
In most of these countries, life expectancy, for example,
has fallen in the past ten to 15 years. Most of this decrease
has been due to coronary heart disease or heart attacks.
It had been thought that the transition would enable them
to keep the only good thing about the communist health system:
universal access to free healthcare, and lose the bad: authoritarianism,
poor equipment, out-of-date training, lack of drugs and
Were it not for the lack of access to healthcare and poor
salaries, that would be a penetrating and up-to-date description
of our health service, ie, were neither here nor there.
So many of their problems mirror ours. Corruption is endemic.
Health managers are inexperienced. There are frequent changes
of Ministers of Health, each one with their own ideas: one
anti-doctor, the other a patcher (patch here, patch there),
and yet another too timid to take any decisions.
In the midst of these challenges comes a success story.
Poland has reduced deaths from coronary heart disease by
over a third in the last 15 years, largely because of changes
to their national diet.
Thats like expecting Trinidadians to stop feting.
This has come at a time when many Polish doctors are emigrating
to other European countries because of the poor conditions
of employment, overwork, low salaries and difficulties in
specialising because of authoritative and unwieldy systems
dominated by older, senior and unmovable doctors.
Its interesting then, though hardly surprising, that
doctors have had little to do with this dramatic decrease
in coronary mortality.
Trinis, with their doctor going to save us attitude,
will be alarmed at that statement.
The decrease seems to be primarily due to changes in Polish
economic policy that led to improvements in the populations
diet. Essentially, these included reducing subsidies for
dairy and animal fats and subsidising fruits and vegetables
The effect of these government policies was that, after
the fall of communism in 1990, marked increases in the ratio
of polyunsaturated fat to saturated fat in peoples
diet was seen.
At the same time, with the opening up of the market to foreign
forces, and the growth of the local fruit industry, supported
by government policies, fruit consumption in Poland reached
an all-time high and has continued to the present day. Fruits
and vegetables are now available to consumers throughout
Increased intakes of polyunsaturated fat also explain most
of the major declines in coronary mortality in the United
States, United Kingdom, and Australia over the last several
Its well known that fruits and vegetables have significant
Despite initial resistance, no doubt from Polish men, the
wider availability and lower prices for unsaturated fats
and fruits and vegetables have caused rapid dietary changes.
Housewives, like water, flow to lower and cheaper places.
During this period, as anyone who has travelled to Eastern
Europe knows, despite intensive health promotion campaigns
there has been no change in smoking habits, drinking patterns
or exercise movements. Intensive health promotion campaigns
have failed to dent the growth in consumption of alcohol
and tobacco, which still enjoy liberal tax status.
Policies advocated by health ministries remain focused on
medical models of education and behaviour change, even though
these have had little impact on rising rates of unhealthy
diets and obesity.
The message that emerges is that improvements in health
cannot be expected from health reform or health promotion
No amount of old talk from overweight doctors with a glass
in one hand and a cigarette in the other can realise change.
Real improvements in health have to come from a combination
of health and political and economic reform.
You can tell people ad nauseam what healthy choices are
but unless you support them with tax incentives and make
it easy for them to make those choices, it fails.
Is anyone in government reading or listening these days
or is it true that governments save huge amounts of money
when citizens die prematurely?