The unexpected consequences of the pandemic
The life expectancy of Poles has fallen sharply. Currently, serious questions need to posed about how health policy was implemented in the context of the pandemic and whether it did more harm than good
For decades, it seemed that the average age of life expectancy of Poles would only increase. Of course, the belief that this would happen was utopian in nature, as humans cannot extend their existence indefinitely. Nonetheless, it persisted throughout the years of the Polish Third Republic, because it was a marker of another belief – the possibility of unlimited development of our country. Unfortunately, today we can clearly see that the circumstances surrounding the COVID-19 pandemic, as well as the sanitary regime that was introduced alongside of it, have shaken Poland’s path to longevity. We are told about this in detail in a recent report published by the National Institute of Public Health (NIPH) entitled, “The health situation of the Polish population and its determinants, 2022.”
Let us add right away that the NIPH is the oldest state research institute dealing with public health. It was established as early as November 1918 and, especially during the Polish Second Republic (1918-39), constituted a unique expert community. It survived the communist era and was renewed in the Third Republic by a decree of the Minister of Health and Welfare at the end of October 1992. It regularly publishes important analyses on public health in Poland.
CONTINUOUS GROWTH AND SHARP DECLINE
The NIPH report in question focuses primarily on the national health consequences in the years of the COVID-19 pandemic, and how they have caused a reduction in life expectancy in Poland between 2019 and 2022. It should be noted that we are dealing with an unusual phenomenon on the scale not of recent years, but of long decades. In 1991, the average life expectancy of a woman in our country was just over 75 years. The situation for men was – in comparison to modern times – much worse, as the average life expectancy of Poles then was less than 66.
The 1990s were a time of good dynamics of life expectancy extension for Poles of both sexes. At the beginning of the new century, the life expectancy of men reached 70, and women approached 80. Men’s lifespans lengthened until the pandemic itself and reached 74. Women’s life expectancy was almost 82 around 2016, only to falter and shorten slightly thereafter. However, it was not until the pandemic that the situation worsened significantly. It is worth noting that in 2016, Polish women were closer to the average life expectancy in the European Union than men – 83.6 and 78.2 years of age, respectively. According to the NIPH analysis, published in early 2019, the main problem burdening the health of Poles then started to become, especially in men, overweight and obesity, and in women the still poor results of breast and cervical cancer treatment. In 2015-2016, breast cancer mortality rates were higher in as many as 13 more provinces than five years earlier. It is most likely that these factors caused the process of life extension of Poles to almost stop, and in the case of Polish women even a regression could be noticed.
Meanwhile, as early as the summer of 2022, the first results appeared, showing that each Pole gained an average of four kilograms during the pandemic. It is calculated that being overweight shortens one’s life span by as much as 14%, which for men, whose average survival age is currently calculated at 72, means a loss of as much as 10 years of life.” According to the 2022 National Health Test of Poles, only 28% of men are still of normal weight (between 18.5 and 24.9 points on the BMI scale). As many as 43% are overweight (25-29.9 points), and 27% are obese (over 30 points). In the case of women, the situation is slightly better: 45% of Polish women have maintained a normal body weight, 29% are overweight and 21% are obese,” indicates a study on the health of Poles, prepared by PAP [national press agency, Ed.] on the basis of research conducted by Professor Piotr Jankowski of the Department of Epidemiology and Health Promotion at the Medical Center for Postgraduate Education in Warsaw.
According to the NIPH report from January this year, there was even a collapse in the life expectancy of Poles between 2019-2021. Women’s lives shortened by 2.3 years, and men’s by 2.1 years. “If, for men as a whole, one were to take into account the fact that life expectancy had trended upward in the preceding years, the difference in observed life expectancy in 2022 relative to the value expected based on the trend to date would increase to 2.5 years,” – the authors of the report state. This means that the pandemic has further exacerbated the over-mortality of men relative to women. “We estimate that while in 2019, the most recent year before the pandemic, 68.3% of the difference in life expectancy between men and women was due to higher mortality among men aged 40-74, by 2021 this percentage had increased to 70.4%.” – the report reads.
The pandemic also hit men and women unevenly in hindsight. Its first impact was much worse for men, as their life expectancy was reduced by as much as 1.46 years in 2020, while in 2021 it was already “only” 0.86. The losses suffered by women were evenly distributed: in 2020 it was a loss of 1.04 years of life expectancy, and in 2021 – 1.03. An important point, which should be a premise for some kind of evaluation of the government’s pandemic policy, is the opinion of the report’s authors, stating, “that the higher number of deaths was related both to COVID-19 cases and to the overloading of the health care system, disruption of its operational capability, and avoidance of its use by patients.” This conclusion, while in no way surprising when it appears in a report by a state institute such as the NIPH, takes on a different stature than journalistic analyses, even those by public health specialists.
“The pandemic caused by the SARS-CoV-2 virus caused huge losses in the health of the population and contributed directly and indirectly to a large increase in mortality and consequently shortened life expectancy of the Polish population,” the authors of the NIPH report write. Moreover, “the COVID-19 pandemic caused an unprecedented reduction in the life expectancy of the Polish population in 2020-2021,” the report reads elsewhere. These changes are not uniform; for example, life expectancy for men in Podlaskie Voivodeship has shortened by as much as 3.6 years, and in Małopolska region “only” by 2 years. As for women, they lost 2.9 years in life expectancy in the Lubelskie and Podkarpackie provinces, and 1.7 years in Małopolskie.
The recorded changes mean that once again we have provinces in Poland – especially along the eastern border, but also in the northwest and central Poland – where the life expectancy for men has slipped below 70. In the record-breaking Kamieński district, men’s life expectancy was shortened by as much as 4.27. The worst situation for women is in the Grajewski district, where the loss in life expectancy was 3.95. The data that can be extracted from the report clearly shows the worsening situation for men, who lived significantly shorter lives than women even without the pandemic. However, the dynamics of pandemic-related losses also indicate that the male part of the population was more affected.
The reasons for the decidedly shorter life expectancy of men are many and cannot be reduced to genetic issues alone. The inferior social situation of men in many aspects is relatively rarely noted in analyses, and even more rarely becomes the subject of state or local government policy. There is still an over-mortality of men in various age groups. This is due to the overrepresentation of men among victims of car accidents, but not only. Men are overrepresented among suicide victims, and they are also far more likely to be in jobs with a higher risk of loss of health or life. Unfortunately, they are also more likely to drink alcohol or smoke cigarettes and take less care of their health. The latter phenomenon may also have translated into the fact that they endured the pandemic less well.
A NIPH report released in 2019 shows that Poles, as well as Polish women, are very unaware of risk factors for diseases such as heart attack, coronary heart disease, stroke, and cancer. “What is surprising is that not only those with lower education, but also those with higher education were unaware of what these risk factors are,” Professor Bogdan Wojtyniak, co-author of the report, said for the law.pl portal at the time.” This shows how systematic education about global diseases is desperately needed. Only when people know the risk factors will they be able to avoid them or modify their lifestyles to a more health-oriented approach,” he added.
These issues are still important, but at the beginning of 2023, one must also ask about something else – political responsibility for how health policy has been implemented in recent years, especially in the context of a pandemic. Whether it did more harm than good remains an open question. The data from the NIPH report should not be passed over in silence. Unfortunately, so far there is hardly any serious debate about how the Polish state has dealt with the pandemic and whether its consequences have been properly limited.
This article was published in January 2023 in “Do Rzeczy” magazine.