© Borgis - Postępy Nauk Medycznych 5/2016, s. 308-315
*Jacek J. Pruszyński1, Jacek Putz1, Dorota Cianciara2
Demographic changes in Poland in relation to changes in other countries of the European Union. Challenges for health policy
Zmiany demograficzne w Polsce w porównaniu do krajów Unii Europejskiej. Wyzwanie dla polityki zdrowotnej
1Department of Geriatrics and Gerontology, School of Public Health, Centre of Postgraduate Medical Education, Warsaw
Head of Department: Jacek Putz, MD, PhD
2Department of Epidemiology and Health Promotion, Centre of Postgraduate Medical Education, Warsaw
Head of Department: Dorota Cianciara, PhD, Associate Professor
Obraz współczesnej Polski w znaczący sposób kształtowany jest przez zmiany demograficzne spowodowane postępującym starzeniem się społeczeństwa, wydłużeniem przeciętnego czasu trwania życia, spadkiem przyrostu naturalnego oraz zmianą modelu rodziny. Zjawisko to nie dotyczy tylko Polski, ponieważ prognozy zakładają, iż odsetek osób w wieku emerytalnym do 2050 roku w skali światowej wzrośnie z 11 do 25%, natomiast w Europie (znacznie starszej niż reszta świata) z 27 do 51%. W Polsce i niektórych innych krajach zjawisko starzenia się populacji ma być połączone dodatkowo ze zmniejszaniem liczby całej populacji. Różnorodność czynników wpływających na przekształcanie demograficznego oblicza Polski powoduje, iż obserwowane przemiany zachodzą na wielu płaszczyznach, z których najistotniejszymi są poziomy: społeczeństwa, podstawowych grup społecznych (rodzina, para) oraz jednostek. Postępujący proces starzenia się populacji Polski, jak i całej Europy stwarza liczne wyzwania dla polityki zdrowotnej, której głównym celem jest zaspokojenie narastających potrzeb zdrowotnych osób starszych. Aby sprostać tym wymaganiom, niezbędna jest między innymi odpowiednia liczba personelu przygotowanego do rozwiązywania tego rodzaju wyzwań. W świetle powyższych danych, kluczowym zagadnieniem wydaje się odpowiednie przygotowanie do starości, które powinno być realizowane przez różne podmioty społeczne i zawodowe oraz samych zainteresowanych, czyli starzejące się społeczeństwa.
The image of contemporary Poland is significantly shaped by the demographic changes caused by the progressive aging of the population, lengthening of the average duration of life, falling birth rate and changing family model. This phenomenon is not only visible in Poland, prognosis assume that the percentage of people aged over 65 till year 2050 will increase from 11 to 25% worldwide, while in Europe (much older than the rest of the world) from 27 to 51%. In Poland and some other countries, the phenomenon of population aging is to be further combined with the reduction of the population. The variety of factors affecting the demographic transformation of Polish population causes changes taking place on many levels, of which the most important are the level of society, basic social groups (families, couples) and individuals. The progressive aging of the Polish population and the whole of Europe creates numerous challenges for health policy, whose main objective is to meet the growing health needs of the elderly. To meet this requirement, an adequate number of staff prepared for dealing with these challenges, is necessary. In light of these data, the key issue seems to be adequate preparation for old age, which should be carried out by different social and professional subjects and the interested parties, namely the aging population.
The image of contemporary Poland is largely shaped by demographic changes caused by the ongoing aging of the society, a shifting family model, and longer average life expectancy combined with the drop in the rate of natural increase. The forecasts assume that the percentage of people of retirement age will grow from 11 to 25% globally, with Europe (already older than the rest of the world) set to experience a 27 to 51% increase (1). In Poland, and in certain other countries, the aging of population is to be coupled with its shrinkage. GUS (Central Statistical Office of Poland) predicts that the population of Poland, which stood at 38,461,752 in 2014, will fall to 33,950,569 in 2050 (2).
The Eurostat data from 2014 show that 16 EU countries had a positive natural increase, while 12 EU members, including Poland, ended the year having a negative natural increase. What it means is that the death rate of these countries was higher that their birth rate (tab. 1).
Tab. 1. Demographic balance, 2014 (thousands)
| ||Population, 1 January 2014||Live births||Deaths||Difference||Net migration and statistical adjustment||Population, 1 January 2015|
|EU-28||506 857.5||5108.4||4947.0||161.4||951.9||508 191.1|
|Belgium||11 204.0||125.0||104.8||20.2||34.2||11 258.4|
|Czech Republic||10 512.4||109.9||105.7||4.2||21.7||10 538.3|
|France||65 835.6||820.8||556.1||264.7||31.9||66 352.5|
|Germany||80 767.5||700.0||875.0||-175||581.5||81 174.0|
|Greece||10 903.7||92.1||113.9||-21.8||-69.4||10 812.5|
|Italy||60 782.7||502.6||598.4||-95.8||108.7||60 795.6|
|Netherlands||16 829.3||175.2||139.2||36||35.5||16 900.7|
|Poland||38 017.9||375.2||376.5||-1.3||-10.9||38 005.6|
|Portugal||10 427.3||82.4||104.8||-22.4||-30.1||10 374.8|
|Romania||19 947.3||183.8||253.3||-69.5||–16.4||19 861.4|
|Spain||46 512.2||426.0||396.1||29.9||-102.3||46 439.9|
|United Kingdom||64 351.2||776.4||570.3||206.1||210.0||64 767.1|
Based on Eurostat data (online data code: demo_gind), date of access: 11th November 2015
Fertility and demographic transformation
The transformation in human reproduction from its initial period (characterized by high death rate, short average life expectancy, high fertility and birth rate) to the current period (characterized by low and stable mortality rate, low and relatively stable fertility rate, and low birth rate) constitutes the foundation of demographic transition theory. According to this theory, demographic transformation occurs in stages and the final stage should yield balance between births and deaths, and consequently, stabilize the population numbers. The predictions regarding demographic changes in European countries having a well-developed market economy were off the mark. At the turn of the 1960s, the principles of starting and disbanding a family, and the family model itself underwent changes, which, for some European countries, resulted in a decline in population, caused chiefly by the drop in fertility rate that no longer guaranteed generation replacement. This phenomenon is presented in table 2, which shows the changes in total fertility rate from 1960 to 2013 in EU countries.
Tab. 2. Total fertility rate, 1960-2013 (live births per woman)
n/a (Data not available)
Based on Eurostat data (online data code: demo_frate), date of access: 11th November 2015
The changes at the turn of the sixties that occurred in the Western and Northern Europe have lead to, generally speaking, the lack of continuity in human reproduction. In an attempt to explicate the origins of these changes, the theory of Europe’s second demographic transition characterized by the deficits in the long period of generation replacement (meaning the number of children is not high enough to replace the parents), and unorthodox family forms (cohabitation, LAT relationships, homosexual relationships, monoparental families, married couples who chose not to have children, etc.) has emerged. The demographic changes in Poland occurred in a similar fashion to those of the Western and Northern Europe, however, they did transpire in a relatively shorter period of time (3). Regardless of the rapidity of changes, a shift in the family model was observed in Poland that reduced the significance of marriage as a form of starting a family, and weakened the durability of marriages. This phenomenon is illustrated in the table 3, which depicts the changes in the amount of marriages and divorces in EU countries.
Tab. 3. Crude marriage and divorce rates, selected years, 1970-2013 (per 1000 inhabitants)
n/a (Data not available)
Based on Eurostat data (online data codes: demo_nind and demo_ndivind), date of access: 11th November 2015
*Divorce was not allowed by law in Italy until 1970, in Spain until 1981, in Ireland until 1995, and in Malta until 2011
The increased popularity of cohabitation (living together, informal relationships), LAT relationships (Living Apart Together), higher number of couples with only one or without any children are all signs of the abovementioned changes. The delay in both getting married and giving birth to a first child is also of significance. All these changes result in the sharp fall in the number of births. The causes arise from the processes of socio-economic transformations, which in turn are the reasons for the shift in economic relations between the country and the households or companies, as well as the radical changes on the labor market, which subsequently lead to the rise of importance of education and left many people feeling socially insecure. One may identify other causes that involve the rise of opportunity costs (alternatives excluded because of a particular choice) of marriage and/or motherhood, as well as heightened difficulty of combining the roles of a partner and parent (4). Moreover, people face more varied, growing demands (like the need for being mobile and having flexible working hours) which are hard to meet, and tend the family at the same time.
The swings of hitherto established value system and rules, less cohesion in groups that set up norms, the growth of responsibility in regards to one’s career, and greater social acceptance of childlessness all contribute to the situation. Furthermore, one has to mention the spread of knowledge regarding possibilities of effective pregnancy prevention methods, which foster the decision of having an active sex life without having a baby. One cannot omit the notion that multi-child families tend to be perceived as defective families, and associated with poverty and low social status of the parents.
The variety of factors that shape the demographic transformation in Poland is the reason behind the changes transpiring and affecting multiple areas, the most important of which are the happiness of the society as a whole, its basic social groups (families, couples), and individuals. Certain decisions made by Poles stem not only from the living conditions, but also from the transformation of attitude and behavior model of contemporary Polish society (5). The changes in this model are responsible for the decreasing number of people getting married, the higher age at which people get married, increase in the number of divorces, drop in the number of people remarrying after a divorce or spouse’s death, lower fertility rate caused by postponing first pregnancy and the overall higher age at which women give birth for the first time, devaluation of parenthood, and treating children as a commodity that stands in opposition to a career and material wealth. One can also notice the belief among people that children are a threat to parents’ personal freedom.
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