© Borgis - Postępy Nauk Medycznych 4/2009, s. 319-320
„Health is the greatest treasure; the joy of life, energy, self-confidence, cheerfulness and satisfaction results from it. It is a weapon giving us the possibility of fruitful work and service for family, for society, and for humanity.”
The author of this in-depth, multifaceted, complex concept of health, still relevant today, is the great Polish doctor, philosopher and thinker, for many years Professor and Rector of the Medical Academy of Warsaw, Marcin Kacprzak (1888-1968).
The ideas encapsulated in this definition can be found in all definitions of health that would appear later, including the most well-known: „a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO Constitution, 1948).
The authors of numerous modifications and descriptions of the term „health” have a common aim: to show the complexity of determinants of this desired state. Economic, legal, axiological, spiritual and other aspects appear, and the list still remains open.
Of huge significance for the performance of actions for health is the acknowledgement that „...enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being” (WHO Constitution).
Health as the right of everyone explicitly establishes the need for actions supporting health in the functioning of each democratic law-governed state.
The articles included in this issue of Postępy Nauk Medycznych (Progress in Medical Science) present selected examples of issues within public health that are carried out in the CMKP School of Public Health.
In the article by Maria Miller and Janusz Opolski, an outline of public health as a field of knowledge, science and practice is presented – its scope and also the dependence of the scope and directions of research on the health situation of societies. Particularly essential seem to be the references to the recommendations of the World Health Organization. The concept of the essential public health functions is presented, which as a result of the broad context of health factors means that the most characteristic feature of public health is its multisectoral and interdisciplinary nature.
The authors identify with the opinion that in public health the strategy of action and problem solving is health promotion, and the basic tool is epidemiology.
The next studies by Maria Miller and Anita Gębska-Kuczerowska present epidemiology as a method of measurement of the state of health of the community, and also a method enabling decisions concerning the choice of health priorities. Also an assessment of the epidemiological situation in Poland and some other countries relating to the main health problems is presented. A comparative analysis of the mortality rates which are its main cause, i.e. diseases of the circulatory system, cancers and so-called external causes of deaths, was carried out by taking into consideration also the variability of the demographic situation of Polish society, the most characteristic feature of which is aging.
We have observed in the space of several years an improvement in the most presented indicators of the health status of the Polish population. We live longer and longer, society grows older, and together with this process the structure of chronic diseases changes, the contribution of diseases of the circulatory system decreases in the structure of mortality, and the importance of cancers increases. Not all of them are characteristic for advanced age (cervical cancer, breast cancer, lung cancer). Together with the change of the structure of age and distribution of chronic diseases the problem of disability arises; the number of people incapable of an independent existence increases.
The article by Anna Wilmowska-Pietruszyńska is devoted to social protection against the risk of disease and its results. Apart from presenting the protection system with particular emphasis on the role of doctor´s certification and rehabilitation, also results of the reforms of the system in the previous years, and proposals for the next changes are described.
In the next article by Anna Wilmowska-Pietruszyńska and Jacek Putz the concept of nursing care social insurance as a solution of the needs of those incapable of independent existence is described in detail.
In the public health sphere there are also issues concerning access of societies to appropriate, in terms of quality and availability, health benefits, organized in an efficient and effective way.
In the next articles (Alicja Sobczak and Janusz Opolski) health services and health insurances are described. The paper discusses the dilemma: health – a public or a private good? By adopting the fundamental values concerning health there follow broad consequences concerning among other things the insurance system and the „basket” of health services.
The organizational systems of health care throughout the world are undergoing changes; a continuous process of their mutual merging can be observed. The fashion for „one-size-fits-all” is gone, and solutions best fitting individual countries, possible to use in a particular society, are being sought. These processes have a continuous character. It is also apparent today that the time of revolution in the health systems has passed; just as their objective feature is variability, so their praxeological requirement is calm reflection and gradual change.
With this in mind the examples of two health systems – the Danish and Irish – are presented in the paper by Marek Sanecki and Janusz Opolski.
The Danish model did not undergo within the last quarter of a century any serious changes, and the Danish citizens show a high level of satisfaction with its functioning. The Irish model meanwhile may be interesting not only because of the great interest of Ireland in Poland, but for many people due to a different reason. Namely, in spite of the officially declared principles of the budget model, it fundamentally diverges from the prototype (i.e. the British solutions) through the permanent symbiosis between the systems of insurance and public and private health care, the advanced stratification of patients, and also extended co-payment for the health benefits.
Each system of health care has certain characteristic solutions, frequently occurring exclusively in a particular country. Such a solution is for example a legal-organizational construction: an independent public health care establishment. The construction, regarded in the past as an important element of reform, is frequently assessed today as not adapted to the current social and economic reality. It is thought most often that the independent public health care establishment units are badly managed, and their effectiveness is very low.
The paper by Alicja Sobczak is devoted to an analysis of selected financial indices for the evaluation of management effectiveness of independent health care establishments. A study of 1555 subjects was carried out, based on the calculation and analysis of the gross financial result and indices: net profitability, profitability of operational activity and relation of costs of operational activity with the income from sales. Such a broad comparative analysis, not made before, verifies the thesis on diversified financial effectiveness, simultaneously showing detailed situations in the individual categories of the establishments.
A very important element conditioning health is food safety, including food obtained by the methods of genetic engineering.
GM food is currently the subject of a real social debate, which is a result on one hand of the popularization of GM cultivations and their commercialization, and on the other hand the anxiety of the risk which the popularization of using techniques of genetic engineering brings in such a sensitive area for human health.
In the article by Iwona Wrześniewska-Wal legal aspects of marketed genetically modified food in the context of consumers´ safety are described.
Regulations determining the post-graduate education of doctors introduced a duty to undergo a specialization course within the public health for doctors specializing in clinical fields. In the CMKP School of Public Health a uniform syllabus of this course was co-created; in the CMKP the first classes were organized; the School of Public Health is the biggest individual training base.
The article by Janusz Opolski et al. presents an assessment of a course within public health made by the participants – doctors specializing in various fields of medicine – the syllabus, organization and lecturers.
Since the dawn of time, from the time people were first aware of the biological limitations of their existence, numerous factors shortening life or bringing suffering and threat of life provoked consideration and reflection, and also actions directed towards the prevention of diseases and maintenance of health.
The scope of these actions resulted from the state of knowledge of the time, the way of understanding and explaining the environment of human existence, and also various concepts of organization of social life.
The place of public health in the actions for health is rendered best by the statement of Dr. C. Everett Koop: „health care is vital to all of us some of the time, but public health is vital to all of us all of the time”.
Dr med. Janusz Opolski,
Prof. dr hab. med. Maria Miller