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EACEA National Policies Platform: Youthwiki
Poland

Poland

7. Health and Well-Being

7.1 General context

On this page
  1. Main trends in the health conditions of young people
  2. Main concepts

Main trends in the health conditions of young people

Statistical information coming from surveys conducted as part of the Public Statistical Data Survey Programme (Program Badań Statystycznych Statystyki Publicznej) both by the Central Statistical Office and individual sectors (Ministry of Health, Ministry of Internal Affairs and Administration) is the most important source of statistical data relating to the health of the Polish population. Administrative data and collective publications obtained from institutions operating in the field of health care are an additional source.

Data from these sources outline the general health situation of the young generation. A number of elements can be regarded as satisfactory, because - among other things - they have improved over the last two decades. The positive changes include: "a decline in mortality rates, physical development of children and young people (increased body height), reduced prevalence of infectious diseases covered by the compulsory vaccination programme; significant improvement in treating cancer in children". Poles are in general satisfied with their health condition: according to a recent study, 60% of adults declare satisfaction with their health against 19% expressing dissatisfaction.

The authors of the survey, however, also indicate negative phenomena, such as being overweight or obese, declining physical fitness levels, mental health problems, allergies, consequences of risky behaviours. Therefore, decision-makers are still facing lots of challenges to ensure that young people have the best possible conditions in which to develop their physical and mental health, and the young generation is still struggling with a number of problems in this scope. It would be rather difficult to talk about stability in relation to a number of fields. The situation concerning vaccinations preventing infectious diseases is a good example thereof. Health and Healthcare in 2017, a report authored by the Central Statistical Office, sees it in a positive light: Free immunisation vaccines administered to Polish children and youth are still common. Infectious diseases, especially those affecting children, are no longer so dangerous and their prevalence has dropped. For example, since 2001 there have been neither diphtheria nor poliomyelitis cases caused by wild poliovirus. There have only been rare incidents of being infected by the virus contained in those vaccines (one case per year in 2009, 2010 and 2015).

The State of Health of Children and Youth in Poland (Stan zdrowia dzieci i młodzieży w Polsce) - a survey conducted by Barbara Woynarowska and Anna Oblacińska for the Bureau of Research (Chancellery of the Sejm) - confirms the above. "For many years now, the epidemiological status of infectious diseases in Polish children and young people has been no cause for concern. This refers to diseases covered by the compulsory vaccination programme. Within this group: (1) diphtheria and poliomyelitis have been totally eradicated, (2) the downwards trend in the prevalence of mumps, rubella, measles and hepatitis B has been maintained, (3) the prevalence of meningitis and/or encephalitis caused by Hemophilus influenzae type b has declined, (4) the prevalence of whooping cough is rising, persons over 15 years of age constitute half of all the registered cases, (5) the prevalence of tuberculosis in Poland remains stable and low when compared with cases registered across the EU".

However, specialists are seriously concerned about a growing anti-vaccination movement - data provided by the National Institute of Hygiene shows that in 2010 there were as many as 3 437parental refusals to have their children vaccinated, 16 689 in 2015 and up to 48 609 in 2019. Even at the moment the percentage of children receiving recommended vaccines (that is non-compulsory ones, for example against chickenpox) continues to be very low. The above report states that: "the prevalence of diseases not included in the compulsory vaccination programme is still high. In 2011, there were over 18,000 cases of scarlet fever and almost 163,000 cases of chickenpox (an upward trend) in the population aged between 0 and 19". Specialists say that it does not end there as lowered vaccination ratios, for example against measles, will cause a multi-fold increase in the number of cases. It is also possible that as a result of lowered immunity certain forgotten diseases might be back, such as diphtheria, tetanus, whooping cough and even polio. These concerned are confirmed by the National Institute of Public Health, according to which an increase in measles cases on Poland has been noticed since October 2018. In 2019, there have been 1492 diagnosed cases, a fourfold increase from 359 in 2018. communication from the Chief Sanitary Inspector: in 2018 in Poland (from 1st January to 30th November 2018) there were 220 cases of measels, whereas in 2017 - only 62. This means that the number of cases trippled in one year.

The condition of teeth is an important element of young people’s health. In this respect, young Poles rank very low, also in comparison with the rest of Europe. The survey conducted by Woynarowska and Oblacińska proves that tooth decay is the most prevalent chronic disease in children and youth. It can start as early as in the first year of life and its prevalence and intensity will grow with patients’ age. In 2012, only 14% of six-year-olds and 4% of eighteen-year-olds were free from tooth decay. The prevalence of tooth decay in Poland, when compared with many EU countries, is still high. No comprehensive solutions are being applied to this important health issue (bad teeth constitute a significant risk that the whole body will be affected by more infections). For many years now, there has been no medical care (including dental care) provided in schools. There was, however, an unsuccessful attempt to solve this problem by introducing so-called dentobuses (dental van units). The Ministry of Health bought 16 specialist vehicles (one for each province, which cost in total PLN 24,000,000). They were supposed to provide dental care to children and young people under 18 years of age, thus facilitating the youngest children’s access to that kind of service even in the most remote or deprived neighbourhoods. Unfortunately, it turned out that the conditions offered failed to satisfy dentists and as a result, mobile dental surgeries did not significantly improve young people’s access to dental care.

Any medical problems become much more compounded when they refer to young people with disabilities. Apart from various defects - congenital or acquired - rehabilitation and care costs as well as architectural barriers significantly hinder development. The report prepared by Woynarowska and Oblacińska states: On the basis of the disability criteria adopted by the Central Statistical Office in 2009, the percentage of persons with a disability was 3.5% in the 0-14 years of age group; 4.4% in the 15-19 years of age group. Children with disabilities are a group with special and diverse health and educational needs, depending on the type and degree of disability.

The system of health care for young people with mental problems leaves a lot to be desired. Most of the facilities where young people can get help are situated in big cities. There are fewer psychiatrists and psychologists than necessary, the effectiveness of prevention is poor, and the extent of the problem still fails to be reliably recognised: "in Poland, data concerning disorders affecting the social and mental health of children and young people over 15 years of age is fragmented. According to the Institute of Psychiatry and Neurology, in 2011 treatment was received by: 10,040 people in 24-hour psychiatric wards, 100,659 people under 18 years of age in mental health clinics for children and youth. The number of people affected by disorders is much higher, many of them do not receive professional care mainly because of  poor access to that kind of care but also for fear of stigmatisation. It is estimated that such disorders affect 10-20% of the whole population. In the group of children and youth under 18 who are patients of mental health clinics and addiction treatment centres (588 out of 100,000 people), the most common mental disorders are: emotional and behavioural difficulties (including ADHD) usually starting in childhood and adolescence, neurosis as well as stress-related disorders. Emotional and behavioural difficulties remain the first cause of psychiatric hospitalisation (45 out of 100,000 persons). Disorders caused by psychoactive drug abuse rank second".

The situation from 2014 has not improved, and may have even deteriorated. At the end of 2019, there were - depending on the source - between 379 and 441 practicing child psychiatrists in Poland. The population of children up to age of 18 in Poland is approximately 7 million (6 949 000 by the end of 2019). Therefore, there are 5 to 6 child psychiatrists per 100 000 minors in Poland, when the WHO standard is 10. Hospital admission takes at least a few months, hospital beds are being reduced, the hospitals themselves are overburdened and it is not uncommon for minors to be admitted to the so called “add-ons” (beds in hospital corridors). The situation is described by a report by the Citizen Network Watchdog Poland: Minor Psychiatry in Poland (Psychiatria Dzieci i Młodzieży w Polsce). This state of affairs has been confirmed in the Ombudsman’s statements and interventions. In response, the Ministry of Health presented, at the start of 2020, a new model of minor psychiatric health protection, introducing a three-tier care system. Its basic assumption is to attempt to diagnose minors in sites located as close to the patient as possible: in Local Psychological and Psychiatric Care Centers (which are to be established in every district), and only afterwards in Local Psychic Care Centers and Urgent Psychiatric Care Centers (hospital units). 

The National Mental Health Protection Programme for 2017-2022 (Narodowy Program Ochrony Zdrowia Psychicznego na lata 2017-2022) includes a diagnosis which contains data referring to the 18-29 age group. The diagnosis shows that 2.1% of people from this age group (1.7% of males and 2.6% of females) have had a depression episode at some point in their life, and a total of 0.4% have been affected by persistent depressive disorder called dysthymia. However, it is quite likely that the data quoted is significantly underestimated, because police data shows that the highest percentage of suicidal attempts is in the group of 20-24-year-olds. In the same way, data referring to the percentage of people receiving treatment ought to be treated very cautiously. The Polish system of psychiatric care is quite imperfect, especially in relation to child and adolescent psychiatry. Although in recent years there has been a growing number of children and young people receiving specialist care related to their mental disorders (...), over 3/4 of people from this group live in cities and the differences may result from difficulties when accessing specialist support in rural areas. The general stigmatisation of mental disorders is also a significant factor. That is why those really needing support in this field do not report such needs - psychiatric hospitalisation is generally treated as a last resort and decisions to hospitalise mainly refer to those seriously ill. According to the diagnosis, between 2011 and 2014 there was a slight  increase in the percentage of children and young people with mental disorders (no addictions) receiving treatment in psychiatric hospitals and outside (data refers to outpatient care, day wards, 24-hour wards and care wards); there was neither a significant growth nor a drop: for example, in 2011, 96,183 children and young people were treated as outpatients and in 2014 – 105,123 (9.3% growth). The diagnosis of schizophrenia in children and youth is made relatively rarely - in 1 to 1.5% of cases in outpatient and day care and in 5% of cases treated 24 hours a day - which is about 5% of all patients. The diagnosis which is contained in the Programme of Preventing Depression in Poland for 2016-2020 (Program zapobiegania depresji w Polsce na lata 2016-2020) indicates that depression in young people may affect from 4-8% to 20% of their population.  Depression in children and young people is still less clear than adult depression. In addition to that, a high Charlson Comorbidity Index is an additional characteristic of childhood and puberty – from 30 to 75% of children with depression meet the diagnostic criteria for anxiety disorders. Therefore, it is not surprising that Polish school children quite frequently go for psychotropic substances not prescribed by doctors (for example sleeping pills or calming tablets). It refers to about 17% of 15- and 16-year-olds and about 18% of 17- and 18-year-olds.  Girls are likely to use such substances twice as often as boys. The characteristics of youth depression are worth noticing. "It is inextricably linked to the difficulties of adolescence and development tasks of that phase (...) the clinical picture of the disease is often masked by tantrums, boredom and tiredness, as well as disruptive behaviour such as escaping from home, truancy as well as self-destructive and antisocial behaviour. The symptoms of depression are frequently accompanied by difficulties at school, cutting ties with peers, worse relationships with the loved ones and withdrawal. Growing depression symptoms in adolescents require special attention as they may lead to suicidal attempts or to suicide." In Poland, the rate of suicidal attempts among children and young people significantly increased over the last few years.  2015 marked its highest level in many years - 481 attempts, including 12 by children under 12. In 2016 this rate was slightly lower - 475 attempts. The number of suicide attempts among minors was 772 for 2018 (including 26 for children age 7-12) and in 2019 there were 951 such attempts (including 46 by children age 7-12). 

Main concepts

Young people’s health is significantly influenced by how they take care of themselves. Education, upbringing and information campaigns able to instil a kind of behaviour resulting in fewer health problems in young people may be of key importance in this respect. The report prepared by Woynarowska and Oblacińska reveals that the awareness of health-improving steps "among young people aged 11-18 is poor, for example among 15‑year-old girls: 31% do not have breakfast every day, 74% of cases do not have fruit and 70% - vegetables, low level of physical activity in 90%, while 20% are on a slimming diet without any reason. Teenagers take up lots of activities that are dangerous for their health, for example in the group of 15-year-old boys 17% regularly smoke cigarettes, 15% regularly drink beer, 20% have got drunk 4 times or more and 12% have used marijuana or hashish in the last 30 days. Such behaviours frequently cumulate and create a risky behaviour pattern exposing health and social functioning to a serious risk." More data concerning improper health-improving behaviour (coming from the 2019 report prepared by the Centre for Public Opinion Research and entitled Young People 2018 (Młodzież 2018) indicates that the percentage of youth age 18-19 that does not smoke tobacco is, as of many years now, stable and holds at around 60%. 18% of youth of that age smokes regularly. Alcohol is far more popular as a psychoactive substance than tobacco and narcotics. In the month preceding the research date, 74% of youth age 18-19 had drunk beer at least once, 62% vodka and other high proof spirits, 43% wine. In comparison to 2016 the percentage of youth drinking beer and wine increased (the last one is the only kinds of alcohol where a long-term increase trend in consumption since 2008 is visible), while the percentage of youth drinking high-proof spirits remained the same. A concern is the number of youth who in the month preceding the research had gotten drunk at least once - 44% (13% had gotten drunk at least three times in that period.  

The report does not confirm young people’s using drugs on an allegedly large scale -  83%  said that within the year preceding the survey they had not experimented with drugs - on the other hand, it should be stressed that 38% of young people admitted to having ever used some kind of a drug. The most common ones are marijuana and hashish, as well as amphetamine and tranquilisers used without prescriptions from a physician. The number of young people experimenting with designer drugs decreased. The research shows that in 2018, 2.6% of youth declared having contact with those substances, indicating a rate similar to 2008, when they first appeared on Polish market.

The situation of young people being overweight or obese is not good, although better than in Europe still a short while ago: "in EU countries every fourth child has been diagnosed with being overweight and obese; whereas in Poland in 2009 - only 16.4% of children aged 6-19. However, this percentage grows by about 2-3% every decade. The prevalence of being overweight or obese is greater in boys than in girls." In 2018, up to 22% children of school age were overweight, and Polish children are among " the most quickly becoming overweight in Europe.  Among other things, this situation is caused by bad eating habits. The 18-24 age group stands out by the largest percentage of those having their breakfast more rarely than every day. They are the ones that are most likely to have sweets in between their meals and use diets not verified and not recommended by medical circles (40% in the 18-24 age group). The lifestyle of young people is favourable to eating "junk food" (food without nutritional value and very often detrimental to one's health). According to WHO research show that 30% of children in Poland eat fruit daily, almost 30% for vegetables, 28% for sweets, 25% for carbonated soft drink. 

Low level of young people’s physical activity is another factor influencing the risk of obesity and the prevalence of other conditions:  Even though recent study from 2018 shows that some 31% (fewer than twoj years ago) of surveyed young people declared to spend their free time practicing sport, still 25% prefers to play video games and 25% surfing the internet. "Doing nothing" was a favourite passtime for 29% of the surveyed youth and it is an activity chosen by increasingly large percentage of young people (a growing trend from 2013). On the other hand, 72% of boys and 55% declare physical activity (beside PE classes) at least once a week (mainly biking and individual exercise at home). WHO research shows that in 2014 40% of students in Poland performed some form of physical activity a few times a week. 

Young people struggling with other difficulties such as attention deficit disorder, thought disorder or aggressive behaviours are much more likely to have problems with abusing the Internet. Young people’s low level of physical activity is confirmed in a report prepared by the Institute of the Mother and Child for the Ministry of Sports and Tourism and entitled the Physical activity of school children aged 9-17 (Aktywność fizyczna młodzieży szkolnej w wieku 9-17 lat). The report provides examples of poor levels of Polish school children’s physical activity: Only every tenth person meets both physical activity criteria: VPA (vigorous physical activity, usually additional activity treated as a hobby and a way to spend free time) and MVPA (moderate to vigorous physical activity. Total physical activity is understood as a number of days within the last seven days where young people are engaged in physical activity for at least 60 minutes per day). It is additionally shown that Polish young people’s physical activity level decreases with age.