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Objectives: Oral health can affect quality of life in all course of life, which is a key factor of general health. Dental caries, periodontitis and oral cancer are of the highest burden of oral diseases. Rising prevalence of soft drinks and alcoholic beverages consumption due to easy access and socio-demographic altering has increased the concerns on oral health. In this review our purpose was to show effects of the most consumed beverages on oral health in people older than 15 years. Methods: The review was based on papers published in last 10 years, searched with combined key words related to types of drinks and specific oral health problems. We included 4 older studies due to lack of newer studies on subjected topics. Results: Sugar-free soft drinks are found less cariogenic and erosive than regular versions in limited number of studies. Alcohol consumption is shown as one of the risk factors of prevalence and severity of periodontitis and is proven to have synergistic effects along with tobacco on oral cancer risk. Consumption of soft drinks and alcoholic beverages was related with tooth loss whether dental caries or periodontal diseases. Conclusion: There is good evidence for association between soft drinks and oral health problems, but still no clear answer exists about strength of association between sugar-free soft drinks and dental caries. Also the knowledge about influence of alcohol is inadequate. Since consuming style affects erosive potential of drinks manufacturers should be required to add some recommendations on labels about drinking style.

Background Ukraine, one of the largest states formed on the rubble of the Soviet Union, is widely perceived as a country that has lost its opportunities. Being devastated by corruption, it shows incapable to modernize and enter the economic path of sustainable growth. Similarly in the health care system no deeper reform efforts have been taken in the entire post-soviet period, leaving the system in bonds of ineffective solutions taken out of the Soviet era. Main body The recent geopolitical and economic crisis seem to favor the introduction of radical solutions that might lead to a rapid change in the organizational paradigm of the economic system, as well as in health care in Ukraine. In this paper we aim to highlight the key features of the ongoing health reform in Ukraine, identify basic challenges for it, and assess rationality and feasibility of the reform. We found that the projected scope and schedule of changes in the Ukrainian health system give promising prognosis regarding its final effect. Conclusions The final success of health reform in Ukraine is dependent on a number of factors, including the financial foundation arising of economic stability of the country, balance assurance between public and private spending for health and ability to eliminate the long-lasting practices, particularly when they are connected with activities of lobbying groups occupying particular positions in the health system. A consequence of actions taken by the political decision-makers in the longer perspective are also to highly determine the reform’s chances for success.

Background European Union (EU) Member states' food environments are shaped by both national and EU policies. To date however, studies assessing food environment policies developed and set by the EU are scarce. The aim of this study was to assess the strength of EU policies to improve food environments as well as to assess the extent these policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. Methods We compiled evidence on the EU policies for each of the Food-EPI 47 indicators. A European panel of independent, non-government experts (N = 30) specialized in nutrition, obesity or chronic diseases, using the Food-EPI evidence, rated the strength of EU policies to improve food environments during an online survey in February-March 2020. The experts also rated to which extent policies could lead to a decrease or widening of socio-economic inequalities in dietary intake. In addition, experts formulated actions to improve EU food environment policies, which were prioritized during a follow-up online survey. Results The overview of EU-level policies resulted in a 79-pages document, describing policies (or the lack thereof) for each of the 47 Food-EPI indicators. This document has been verified for completeness and accuracy by EU governmental officials. The evidence document shows that the EU has mainly binding legislation on the food labelling whereas policies on the other Food-EPI domains are mostly voluntary. Results from the online survey and the formulated prioritized actions will be presented during the conference. The results will reflect the experts' ratings supported by documented evidence and will provide meaningful guidance to EU officials and public health advocates in their efforts to improve the food environment policies set by the EU.

Demographic transitions that occur in decreased dynamics of natality and rising number of elderly in population structures constitute a challenge for all national economies. Another global phenomena are large-scale migration processes driven by intensification of globalization process, development of technologies, and telecommunications. Although both these phenomena were vastly addressed in many ways in scientific literature, a notifiable fact is that there are only few researches that would investigate them in connection and consider migration of older people and its consequences, especially for health systems. Despite the fact that generally the likelihood of migrations reduces along with age, in some countries a higher share of migrants older than 65 years in reference to the entire group of migrants are being observed. It is the more essential that groups of seniors represent an increasing percentage of people. There are also differences in between standard reasons for migrations in young people and the factors affecting migrations in elderly ones. Many variables can influence migration decisions among older people, and they can be affected by seniors' health conditions, levels of health care within the target countries they migrate to, and the living standards. Such factors as population aging, reduced fertility, and international migration have affected the changes in demographic profiles of many countries. The consequence of migration decisions in the group of seniors is, among others, the impact on health care systems of single nation states, which are more and more important elements of economic, social, and financial systems.

Background The implementation of public policies requires special attention from public authorities to ensure their transparency, effectiveness and efficiency. For this reason, efforts to evaluate the abovementioned politics gained attention and importance. Similar processes, by their very nature, are also noticeable in the area of health policy, however, the nature of the solutions used raises questions about the extent to which they allow to capture the assessed phenomenon in a holistic way. The current approach to the problem of evaluating health policy shows a tendency to break down this phenomenon into components including policies, programs or projects. The purpose of this publication was to assess the main methodological approaches used in evaluation studies in terms of their usefulness and limitations in conducting overall assessment of health policy. Main body The publication divides evaluation methods based on three main criteria identified in the literature—time, purpose and scope of evaluation. Methodological approaches to evaluation activities detailed on this basis are discussed from the point of view of their characteristics, usefulness and limitations in the creation of comprehensive health policy assessments. The growing awareness of the need for a different approach to evaluation, which was confirmed by the course of the discourse on evaluation in public health, was also pointed out. Conclusion Given the complexity of the matter making up the health policy, attempts aimed at its overall assessment should be based on an approach integrating many approaches, while ensuring coordination of evaluation activities that should be subject to common assumptions.

The aim of this article is to present the course of privatization of spa companies in Poland during the period 2001-2011. We discuss assumptions of the privatization process, as well as actual implementation, having identified the process as chaotic and inconsistent with prior legal provisions. We found that in its applied form the process resulted in limitation of the therapeutic potential of spas, and reduction of the State's ability to implement health policy in a legally determined form. We also found that privatization potentially improved spa infrastructure standards and increases the tourist potential of spa resorts. We recommend that clear eligibility criteria are applied to institutions in the privatization process, as well as the provision of legal guarantees for access to spa services financed from public resources. Such guarantees should be made a public obligation, to ensure the availability of services for insured persons, and there should be an obligation to maintain a specific part of a given institution's potential for the needs of patients funded by public health insurance.

The effectiveness of health systems is an area of constant interest for public health researchers and practitioners. The varied approach to effectiveness itself has resulted in numerous methodological proposals related to its measurement. The limitations of the currently used methods lead to a constant search for better tools for the assessment of health systems. This article shows the possibilities of using the health system synthetic outcome measure (SOM) for this purpose. It is an original tool using 41 indicators referring to the epidemiological situation, health behaviors, and factors related to the health-care system, which allows a relatively quick and easy assessment of the health system in terms of its effectiveness. Construction of the measure of health system functioning in such a way allowed its presentation in dynamic perspective, i.e., assessing not only the health system itself in a given moment of time but also changes in the value of the effectiveness measures. In order to demonstrate the cognitive value of the SOM, the analysis of the effectiveness of health systems in 21 countries of Central and Eastern Europe during the transformation period was carried out. The mean SOM values calculated on the basis of the component measures allowed to differentiate countries in terms of the effectiveness of their health systems. Considering the whole period, a similar level of health system effects can be observed in Slovenia, Croatia, Czech Republic, Slovakia, Poland, Macedonia, and Albania. In the middle group, Hungary, Romania, Latvia, Lithuania, Georgia, Estonia, Bulgaria, Belarus, and Armenia were found. The third group, weakest in terms of achieved effects, was formed by health systems in countries like Ukraine, Moldova, and Russia. The presented method allows for the analysis of the health system outcomes from a comparative angle, eliminating arbitrariness of pinpointing a model solution as a potential reference point in the assessment of the systems. The measure, with the use of additional statistical tools to establish correlations with elements of the external and internal environment of a health system, allows for conducting analyses of conditions for differences in the effects of health system operation and circumstances for the effectiveness of reform processes.

Purpose: To investigate whether the Polish Marshal Offices use instruments for social media marketing activities in the field of health promotion. Methodology: Fourteen Polish Marshal Offices participated. The Computer-Assisted Web Interview and Computer-Assisted Telephone Interview were used along with a proprietary questionnaire. Standard statistical methods were employed. Findings: The number of people using the Internet and social media in Poland is steadily growing. The majority of the offices (93%) performed health promotion activities. The authorities collaborated with other units of local government and non-governmental organizations in these activities. According to respondents, the most convincing form of health promotion is direct communication (46%). More than half of the surveyed offices (56%) did not use portals or social networking sites in health campaigns. The rest of the offices indicated using Facebook (25%) or YouTube (6%). Half of them did not apply the tools of social media marketing. The other half was involved in discussions on health-related online forums (moderation or consulting). Relatively few offices use social media and social media marketing in health promotion campaigns. Value: The use of social media by the Marshal Offices may result in a potential increase in effectiveness of the pro-health campaigns. It is recommended that Polish Marshal Offices recognize the potential benefits of social media marketing campaign instruments in the field of health promotion in order to reach out the digital recipients.

The main aim of the paper is to outline the perspective for future developments of the spa treatment in light of demographic transitions characterized by the increasing number of seniors, as well as changing expectations and health needs of younger population. We made a systematic review of literature referring to the experience of Poland, and similar experiences of other countries in Central Europe. Based on the existing knowledge we conclude that spa treatment should become one of the preferred directions of development of health systems in European countries. Moreover, we state that a desirable direction to modify the therapeutic paradigm used in spa treatment is to put a far-reaching greater emphasis on the provision of innovative health promotion, which is justified by both its effectiveness, and strongly good foundation for its provision in spas. For this purpose it is necessary to extend the specialized health sector personnel with qualified health educators, which will enable an effective implementation of health promotion actions and their proper alignment to the specific target groups. Developing this category of specialists will also enable other professionals to concentrate on therapeutic activity fitting their competence.

Primary health care is an important part of any health care system. In highly developed countries it secures the population's most elementary health needs, with particular emphasis on preventive care and early intervention. Polish PHC model is currently undergoing a thorough transformation, associated with the need to adapt to standards designated based on the WHO's criteria, and with reference to the experience of other European countries. The paper describes the process of changes being carried out, in the context of previous experiences of reform relating to the sphere of organization, processes and efficiency. A review and systematization has been made, with regard to the undertaken activities in the field of deregulation and change of legal provisions, which are aimed at achieving the improvement of the efficiency of treatment and resource allocation. A set of recommendations based on expert's discourse have also been provided, with respect to future directions of Polish PHC transformation.

The issue of clusters as a form of organization of market entities has recently attracted an increasing attention of health care management theoreticians and practitioners. In our opinion the existing theoretical basis gives a foundation for considering clusters as a source of potential for increasing the effectiveness of health policy and health care organizations. It can be assumed that in case of health care clusters there is a possibility of interregional diffusion of innovation, based on ventures undertaken on the health care market, increasing not only the potential of the entities in the cluster, but also of its surroundings and subcontractors. It is possible to realize the idea of a flexible health care implemented regionally with the use of modern techniques of communication, knowledge transfer and high specialization. Nonetheless, in case of Poland the potential of clustrification remains untapped, being characterized by a limited actions of public and private bodies, marginal role of non-profit sector organizations and limited engagement of R&D sector. This is because a general distrust in the cluster formula, and the lack of relevant knowledge among local officials and health business leaders. For this reason the process of clustrification among health care entities requires external support through the increased efforts to create a system of legal and tax preferences for cluster initiatives and provision of organizational support in terms of know-how, targeted particularly at bodies and individuals, who may act as cluster leaders.

Background After the fall of communism, the countries of Central and Eastern Europe started the process of political, economic, and social transformation. In health system the reform directions were often similar, despite differences in transition dynamics and the degree of government determination to implement reforms. Nonetheless, for most post-communist countries, there is a gap in evidence regarding the effectiveness of implemented reforms and their impact on health system performance. The presented study attempts to analyse and evaluate the results of health reforms in CEE countries with regard to their influence on health system outcomes. We also analysed the external and internal health system environments during the transition period to determine the factors affecting the effectiveness of health reforms. Methods We compared the indicators of population health status, lifestyle, occupational safety issues and health system resources in 21 post-communist countries between sub-periods across the entire transition period at the aggregate level. The dynamics of change in health system outcomes in individual countries, as well as between countries, was also compared. Finally, we analysed the correlations between health system outcomes gathered into one synthetic measure and factors considered as potential determinants affecting the effectiveness of health reforms. The analyses were performed based on one-dimensional, two-dimensional and multidimensional statistical methods. The data were retrieved from the international databases, such as WHO, World Bank, International Labour Organization, World Value Survey and the European Social Survey. Results Among the factors positively stimulating improvements in health system outcomes were the total expenditure on health and a lower financial burden on patients, but primarily they were determined by the broader economic context of the country. Another finding was that better initial position positively determined health system outcomes at later stages, but did not affect the degree of improvements. Countries that embarked on comprehensive reforms early on tended to achieve the greatest improvements in health system outcomes. Conclusions Poorer countries may have only limited ability to improve health system outcomes by committing more financial resources to the health system. Progress can still be made in terms of health behaviours, since policies to address these have so far been insufficient or ineffective.

Armenian healthcare reforms have been carried out since independence in 1991, but achieved their full scale starting in 1995–1996. Although the healthcare system has already been modified and changed for 10 years, there is a lack of research in this regard. This paper aims to present the organization of the healthcare system in Armenia, its changes and challenges throughout the reform process. This paper is mainly based on a review of the relevant professional literature, a review and interpretation of legal acts in the healthcare field, and a review of research and assessment works done by several international and local organizations. There are still large numbers of elements typical for the Soviet Semashko model in Armenian healthcare structures. Implemented reforms have separated the institutions of the public payer and the providers, but did not manage to change the model of financing to be based on compulsory insurance. The level of financing is similar to the average in Central and Eastern Europe, but is based mainly on out-of-pocket payments contributing to about 80% of all system resources. The informal payments reach even 45% of expenditures. The structure of hospital beds remains ineffective, and there are still no mechanisms of increasing the quality of services. Privatization has been applied, but the role of private providers is still limited. The reforms have not caused satisfactory improvement in healthcare performance, although the health indicators are better than at the beginning of the transformation period. The stability of the reforming processes in previous years as well as the engagement of international institutions is a chance for positive changes in the near future.

The paper discusses the question of privatisation of the in-patient care sector in Poland. The references to the general reforming processes are made, as well as the legal context of ownership changes is presented. First part of the article describes the forms of privatisation applied in Poland, such as privatisation of the management, partial privatisation, functional privatisation and total privatisation. The basic data concerning legal regulations currently being in force is also included. Legal status is an important obstacle for the process of privatisation, since the regulations are incoherent and ambiguous. The project of Commercialisation and Privatisation of Independent Public Health Care Facilities Law was presented in 2001, but the political situation was unfavourable for such a regulation. The paper discusses also the potential profits that may be gathered during the privatisation, which may be proved by the experiences in the field of out-patient care, as well as the examples of other countries. It is stated that success of privatisation depends on changes in the structure of sources of financing health care system. The last part of the article describes the previous course of privatisation processes of in-patient sector. Presently about 18% of hospitals in Poland are private facilities, but their role in the system is marginal. The case of hospital in Wiecbork, which was the first bankrupt private hospital in Poland, is presented as the example of dangers caused by the invalid law. The final conclusion is that there is an urgent need in Poland to create clear and coherent legal frames for the privatisation of hospitals, as well as harmonisation of the changes with general reforms of the health care system.

The paper refers to the problem of emergency medical service in Poland, which is the only European Union Member State not having activated the emergency phone number 112. This fact has caused the threat of European Union sanctions. In this context, we try to discuss the chances of finalizing reform of the dramatically inefficient Polish emergency services. Except for the lack of the integrated emergency call centres, there is no appropriate network of emergency hospital departments in Poland and no clear regulations concerning emergency professions. The necessary law was enacted in 2001, but it did not come into force. The threat of European Union sanctions may hasten its implementation; however, the weak position of the present government may cause a further delay of the reform.

Introduction: The political preference of voters has been shown to be associated with their health status. We investigated the relationship between political preferences and mortality in Poland around the time of the last three general elections.Methods: We used the electoral data from the general elections held in 2001, 2005 and 2007. Indicators of political ideological preference were constructed based on the percentage of votes gathered by each party. Data on mortality, education and income level were obtained from 2002-2007 from the Polish Central Statistical Office. Pearson correlation was computed between standardised mortality ratios (SMR) and political preference. Finally, the influence of political preference on SMR was examined in a multivariate analysis controlling for socio-economic factors.Results: SMR was positively correlated with liberal political views (0.26; pConclusion: Our findings are consistent with earlier studies conducted in western countries showing a positive correlation between liberal political ideology and SMR, but differ in that an inverse relationship was found between conservative political orientation with education and income. The importance of socioeconomic and geographical factors in relation to political affiliation and health inequalities in Poland should be further explored.

The recent, tragic disaster at the pigeon fancier's fair in Katowice, which claimed 65 victims and injured 200 others, has left Poland in a state of shock. At the same time everyone was amazed at the efficiency of the rescue efforts, which stood out in sharp contrast to the chaos characterizing the Polish health care system and its emergency services. The implications of this accident merit consideration for the organisation of emergency services in Poland. Witnesses confirmed that the first ambulance arrived at the site just 4 min after the accident occurred. Well-equipped rescuers—firemen, soldiers, physicians, paramedics, mining rescuers, mountain and NGOs volunteers—quickly streamed into the disaster area. The injured were swiftly transported to nearby hospitals, which had …

The paper is an effort to find what determined the success of Polish health reform implemented in 1999 in the Silesian Voivodeship. The problem has been referred to "social capital" proposed by R. Putnam; the first part of the article contains a short description of this approach. Then data concerning health insurance performance in Poland are presented, which confirm that the Silesian Regional Sickness Fund functioned most effectively. As a possible factor influencing present decentralised institutions performance, the situation of the Silesian Region during the mid-war period was described. Autonomy of the region, as well as tradition of social voluntary activity may be a source of "social capital" in Putnam's meaning. Besides, continuity of the Prussian bismarckian health insurance system is presented as a potential source of "institutional memory" also increasing the present reform's chances for success. In the last part of the paper, limitations of applying the "social capital" approach to the Silesian case are presented, such as shortness of the mid-war autonomy period and changes in the cultural structure of Upper Silesia caused by migrations after World War II. Other factors, which could increase the efficacy of the health insurance system, such as relatively high incomes of the region's inhabitants, are also described. Nevertheless, the final conclusion is that social and cultural conditions deriving from historical traditions could have had a significant influence on the process of implementing health reform in 1999.

Background Migration and ethical recruitment of health care workers is receiving increased attention worldwide. Europe’s aging population is creating new opportunities for medical doctors for finding employment in other countries, particularly those of a better standard of living. Methods We conducted a survey among 1214 medical students in five out of eleven universities in Poland with medical schools in October 2008. A series of statistical tests was applied to analyse the characteristics of potential migrants. Projections were obtained using statistical analyses: descriptive, multifactorial logistic regression and other statistical methods . Results We can forecast that 26–36% of Polish medical students will emigrate over the next few years; 62% of respondents estimated the likelihood of emigration at 50%. Students in their penultimate year of study declared a stronger desire to migrate than those in the final year. At the same time, many students were optimistic about career opportunities in Poland. Also noted among students were: the decline in interest in leaving among final year students, their moderate elaboration of departure plans, and their generally optimistic views about the opportunities for professional development in Poland. Conclusions The majority of Polish students see the emigration as a serious alternative to the continuation of their professional training. This trend can pose a serious threat to the Polish health care system, however the observed decline of the interest in leaving among final year students, the moderate involvement in concrete departure plans and the optimistic views about the opportunities for professional development in Poland suggest that the actual scale of brain drain of young Polish doctors due to emigration will be more limited than previously feared.