Report from the 4th Calisia Conference on Family Health, Kalisz, Poland, 7-9 October 2024

INTRODUCTION

The 4^th Calisia World Conference on Family Health was organized by the Institute – European Observatory of Health Inequalities at the University of Kalisz, and by the Health Promotion Foundation (Fundacja “Promo­cja Zdrowia”). The conference took place in Kalisz, Poland, on 7-9 October 2024. It was co-financed by the Ministry of Science and Higher Education within the programme “Excellent Science”. Kalisz is the oldest city in Poland and provides a venerable context for an international public health conference.

PREVIOUS WORLD CONFERENCES ON FAMILY HEALTH

Three previous world conferences on family health were held in Kalisz in 2019, 2021, and 2023.
During the 2019 conference, the focus was on the state of health in Poland and serious health challenges for Poland as well as for Europe more broadly [1]. At this conference, more than 100 participants agreed upon a declaration which summarized such challenges that particularly confronted the countries in Central and Eastern Europe and the high levels of socioeconomic inequalities in Europe. Furthermore, the declaration emphasized the need for strong governance and comprehensive action for public health in all countries in order to prevent disease, promote health, and reduce health inequalities [2].
At the 2021 conference, the main theme was “Health at the time of crises and wars”, a topic of high relevance across Europe and beyond [3]. During the first day of this conference, Professor Theodor Meron, specialist in international criminal law and human rights, born in Kalisz in 1930, was awarded the title of Doctor Honoris Causa of the University of Kalisz. Theodor Meron was a victim of Nazi crimes when he was a child and a refugee in Poland in his adolescent years. Among the topics covered during this conference were family health care, the health situation in Central European countries, the COVID-19 pandemic, and human rights in the time of armed conflict [4].
In a separate paper from this conference, Aarø and associates summarized presentations on tobacco and alcohol policies and measures [5]. In addition to documenting inequalities in mortality across countries as well as inequalities in mortality related to alcohol and tobacco use within countries, the role of restrictive measures was addressed. It was concluded that comprehensive alcohol control policies contribute to reducing alcohol consumption and reduce the associated burden of disease.
During the 2023 conference, the main topic was the status of public health in Poland [6]. Similar to previous conferences, topics such as smoking, alcohol use, and health inequalities received attention. In addition, the recent trend towards reduced life expectancy was documented and discussed. The final session focused on the COVID-19 pandemic and the analysis of less-than-optimal policies of Polish authorities.

THE FOURTH WORLD CONFERENCE ON FAMILY HEALTH

The ceremony of the academic year inauguration at the University of Kalisz took place on October 7th. First-year students matriculated. By decision of the Senate of the University, Professor Witold Zatoński was awarded the Honorary Doctorate of the University of Kalisz during the ceremony that took place in the context of the academic year inauguration. The reviewers of the scientific achievements of Professor Zatoński were Sir Richard Peto, Emeritus Professor of Medical Statistics and Epidemiology, University of Oxford and Professor Marek Krawczyk, former Rector of the Medical University of Warsaw. In the acceptance speech, Professor Zatoński described his extraordinary, interesting life and an impressive scientific path, as well as important changes in the health of Poles that have occurred during the professor’s 60-year scientific career.
At the 4^th Calisia World Conference on Family Health in Kalisz in October 2024, challenges to public health were revisited. Furthermore, important themes were cancer, alcohol-related diseases, mortality due to the COVID-19 pandemic, and the increased use of novel nicotine pro­ducts in Poland. An overview of sessions and topics is shown in the programme outline (Box 1 below).

DAY 1: 7 OCTOBER 2024 – INAUGURAL CEREMONY

Meeting of the Senate of the University of Kalisz and the inauguration of the 4^th Calisia World Conference on Family Health.
Conferment of the Honorary Degree of Doctor Honoris Causa of the University of Kalisz upon Professor Witold Antoni Zatoński.

DAY 2: 8 OCTOBER 2024 – SCIENTIFIC MEETING

Opening session

Welcome addresses: Prof. Andrzej Wojtyła, Rector of the University of Kalisz; Prof. Witold A. Zatoński, Director of the Institute – European Observatory of Health Inequalities, University of Kalisz, Poland

Session 1: Public health challenges – panel discussion

Moderators: Professor Krzysztof Chlebus, Department and Clinic of Cardiology, Medical University of Gdańsk, Poland; Dr Kinga Janik-Koncewicz, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
Panel contributions: Introduction: Professor Witold A. Zatoński, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
Professor Krzysztof Chlebus, Department and Clinic of Cardiology, Medical University of Gdańsk, Poland
Professor Leif Edvard Aarø, Department of Health Promotion, Norwegian Institute of Public Health, Norway
Professor Andrzej Wojtyła, University of Kalisz, Poland
Dr Anna Harton, Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, Poland
Professor Katarzyna Zatońska, Division of Population Studies and Prevention of Noncommunicable Diseases, Wrocław Medical University, Poland
Professor Piotr Jankowski, Department of Internal Medicine and Geriatric Cardiology, Center of Postgraduate Medical Education, Warsaw, Poland

Session 2: Health, risk factors, cancer

Moderators: Dr Alicja Basiak-Rasała, Division of Population Studies and Prevention of Noncommunicable Diseases, Medical University of Wrocław, Poland; Professor Piotr Jankowski, Department of Internal Medicine and Geriatric Cardiology, Center of Postgraduate Medical Education, Warsaw, Poland
Halving premature mortality – Professor Richard Peto, University of Oxford, UK
Time trends in cancer mortality in Poland – Professor Witold A. Zatoński, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
History of exposure to cigarette smoking in Poland – Dr Kinga Janik-Koncewicz, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
half century of Polish-US cooperation in health and tobacco control – Dr Mark Parascandola, Center for Global Health, National Cancer Institute, USA
A half century of Polish-US cooperation in health and tobacco control – Professor Tom Glynn, Faculty of Medi­cine, Stanford University, USA
Eradication of cervical cancer in England – Clare Gilham, London School of Hygiene and Tropical Medicine, UK, Professor Julian Peto, London School of Hygiene and Tropical Medicine, UK
New directions in development of oncological therapy – lung cancer – Kamil Kuć, Oncology Department with Day Chemotherapy Subunit, Provincial Hospital St. Padre Pio in Przemyśl, Poland

Session 3: Epidemiology of alcohol-related diseases in Poland at the beginning of the 2000s

Moderators: Dr Aleksandra Herbeć, University of Kalisz, Poland; Dr Krzysztof Przewoźniak, University of Kalisz, Poland
Exposure of the Polish population to alcohol – Dr Kinga Janik-Koncewicz, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
Alcohol-related health harm – alcoholic liver cirrhosis – Professor Witold A. Zatoński, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
Increasing alcohol exposure and CVD – Professor Piotr Jankowski, Department of Internal Medicine and Geria­tric Cardiology, Center of Postgraduate Medical Education, Warsaw, Poland
From online row to legislative changes – Krzysztof Nowiński, Jan Śpiewak, Safe Poland for All Foundation, Poland
Milestones in liver transplantation. How we obtained alcoholic liver cirrhosis as an indication for liver transplantation – Professor Marek Krawczyk, Clinical Department of General, Transplantation and Liver Surgery, Medical University of Warsaw, Poland
Alcoholic liver cirrhosis – current indications for liver transplantation – Professor Joanna Raszeja-Wyszomirska, Clinical Department of Hepatology, Transplantology and Internal Diseases, Medical University of Warsaw, Poland
Current possibilities and perspectives for liver transplantation in alcoholic cirrhosis in the face of progress made in the 21^st century – Professor Michał Grąt, Clinical Department of General, Transplantation and Liver Surgery, Medical University of Warsaw, Poland

DAY 3: 9 OCTOBER 2024 – SCIENTIFIC MEETING, CONT.

Session 4: Public health challenges associated with rising use of novel nicotine products in Poland (nicotine delivery devices)

Moderators: Dr Anna Harton, Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, Poland; Dr Mark Parascandola, Center for Global Health, National Cancer Institute, USA
Introduction – Professor Witold A. Zatoński, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
Can extremely effective marketing of e-cigarettes lead to inhibition of the tobacco endgame? – Professor Alan Brandt, Harvard University, USA
The US perspective on e-cigarettes and harm reduction – Mitch Zeller, Center for Tobacco Products, U.S. Food and Drug Administration, USA
Trends in use and regulations regarding novel nicotine products in the US – Dr Mark Parascandola, Center for Global Health, National Cancer Institute, USA
Tobacco endgame – UK perspective – Professor Martin McKee, London School of Hygiene and Tropical Medi­cine, UK
Tobacco industry “transformation” narratives: a barrier to the tobacco endgame – Dr Allen Gallagher, Hala Alaouie, Tobacco Control Research Group (TCRG), Department for Health, University of Bath, UK

Session 5: Excess mortality due to coronavirus – the biggest health catastrophe in Poland in the 21st century

Moderators: Professor Łukasz Gruszczyński, Department of International Law and European Union, Law Kozminski University, Poland; Professor Katarzyna Zatońska, Division of Population Studies and Prevention of Noncommunicable Diseases, Wrocław Medical University, Poland
Introduction – Professor Witold A. Zatoński, Institute – European Observatory of Health Inequalities, University of Kalisz, Poland
Excess mortality from COVID-19: a global perspective – Professor Prabhat Jha, University in Toronto, Canada
Summary of excess mortality across European Union 2020-2023 – Professor Carlo La Vecchia, Dr Gianfranco Alicandro, Department of Clinical Sciences and Community Health, University of Milan, Italy
Course of the coronavirus pandemic in Poland – Dr Alicja Basiak-Rasała, Division of Population Studies and Prevention of Noncommunicable Diseases, Wrocław Medical University, Poland
COVID-19 from the perspective of an infectious diseases expert – Dr Paweł Grzesiowski, Chief Sanitary Inspector, Poland
Regulating pandemics – experience of Poland – Professor Łukasz Gruszczyński, Department of International Law and European Union Law, Kozminski University, Poland
Inequalities in health behaviours and attitudes during the COVID-19 pandemic and their implications for public health – Dr Aleksandra Herbeć, University of Kalisz, Poland

Session 6: Challenges of medical education

Moderators: Professor Jacek Piątek, University of Kalisz, Poland ProPlastinated anatomical preparations – representative of Gunther von Hagen
The human body as an eternal source of horror and passion paving the birth of modern anatomy – Professor Michał Szpinda, Department of Normal Anatomy, Nicolaus Copernicus University in Toruń, Poland
Preparing nurses and midwives to implement new competences – Professor Mariola Głowacka, Mazovian University in Płock, Poland and Nicolaus Copernicus University in Toruń, Poland
Treating irritable bowel syndrome with a balanced multistrain synbiotic: results from the ViIBS Tria – Professor Henning Sommermeyer, University of Kalisz, Poland
Nanoplastic particles as a potential factor modulating the functioning of human body cells – Professor Ewa Pruszyńska-Oszmałek, Department of Animal Physiology, Biochemistry and Biostructure, Poznań University of Life Sciences, Poland
New peptides as a therapeutic target in obesity and type II diabetes – Professor Paweł Kołodziejski, Department of Animal Physiology, Biochemistry and Biostructure, Poznań University of Life Sciences, Poland
Metabolic fatty liver disease – Dr Szymon Suwała, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland, Professor Hanna Krauss, Institute for Preventive Research, University of Kalisz, Poland
Intestinal microbiota and dysbiosis in neurodegenerative diseases – Professor Hanna Krauss, Institute for Preventive Research, University of Kalisz, Poland

Session 7: Closing remarks

Rapporteur: Professor Leif Edvard Aarø
Vice-Rapporteur: Professor Łukasz Gruszczyński, Dr Kinga Janik-Koncewicz, Dr Mark Parascandola, Professor Jacek Piątek, Professor Katarzyna Zatońska
Brief CVs for all speakers included Box 2. In addition to the speakers from Polish universities and research institutes, a number of presenters were from the USA, Cana­da, the UK, Italy, and Norway. The presence of experts from countries other than Poland was important in order to talk about the situation in Poland in the context of experiences from these other countries. Dr Mark Parascandola from the National Cancer Institute in the United States and Professor Tom Glynn, Stanford University, described collaboration between Poland and the U.S. in the field of tobacco control.

Leif Edvard Aarø, PhD, senior researcher at the Norwegian Institute of Public Health, Department of Health Promotion, located in Bergen. Professor of social psychology at the University of Bergen 1987-2014. In the early 1980s, Aarø contributed to the establishment of the WHO collaborative study on Health Behaviour in School-aged Children (HBSC). Aarø established the Research Centre for Health Promotion at the University of Bergen in 1988 and was its first director. Most of his career he has carried out studies on health-related behaviour, large scale surveys among adolescents, and evaluation of interventions. His present research is focussed on methodological challenges in surveys on distress and quality of life. Aarø has coordinated EU-funded studies on HIV/AIDS prevention among adolescents in South Africa, Tanzania, and Uganda.

Alicja Basiak-Rasała, PhD, Postdoctoral Research Associate in the Division of Population Studies and Prevention of Noncommunicable Diseases at the Wrocław Medical University. She is engaged as a researcher in seve­ral population studies, including the Polish cohort of the Prospective Urban and Rural Epidemiological Study (PURE) and Population Cohort study of Wrocław Citizens (PICTURE). Her work, both scientific and didactic, focuses on epidemiology and prevention of noncommunicable diseases, nutrition and public health.

Allan M. Brandt, the Amalie Moses Kass Professor of the History of Medicine, and Professor of the History of Science at Harvard University, where he holds a joint appointment at the Faculty of Arts and Sciences and Harvard Medical School. Brandt is the author of No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (1987, 2020); and co-editor of Morality and Health (1997). His book on the social and cultural history of cigarette smoking in the U.S., The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Pro­duct that Defined America, was published by Basic Books in 2007 (paperback, 2009). He has written on the social history of epidemic disease; the history of public health and health policy; and the history of human experimentation, among other topics. Brandt is currently serving as the interim chair of the Department of Global Health and Social Medicine at Harvard Medical School.

Krzysztof Chlebus, Professor at the 1st Department and Clinic of Cardiology of the Medical University of Gdańsk. He completed postgraduate studies in “Management in Healthcare Facilities” at the University of Gdańsk, as well as prestigious Executive MBA studies (Carlson School of Management, University of Minnesota, and Warsaw School of Economics). He is the National Coordinator of the National Health Program Project “Clinical and Genetic Diagnostics of Patients at High Risk of Familial Hypercholesterolemia, including Cascade Screening of their Relatives.” He is also a member of the Program Council of the Ministry of Health’s KORDIAN Project “Prevention of Arterial Atherosclerosis and Heart Diseases for Residents of the Northern Macroregion”. He is the Coordinator of the National Center for Familial Hypercholesterolemia in Gdańsk and the creator and coordinator of the National Registry of Familial Hypercholesterolemia, which records new diagnoses of FH in probands and their family members.

Allen Gallagher, PhD, a research fellow within the Tobacco Control Research Group within the University of Bath. While his initial research focus was investigating the illicit tobacco trade and the relationship that major transnational tobacco companies have with it, in recent years he has expanded his research focus to explore tobacco industry influence on tobacco control policy, more broadly. Dr Gallagher has presented his work to both the European Parliament and at various high-profile tobacco control conferences, including the European and World Conferences on Tobacco or Health. His work has been mentioned in UK Parliamentary debates and has been cited in numerous policy documents including by the World Health Organization, Pan American Health Organization, and the United Nations, among others.

Clare Gilham, an assistant professor at the London School of Hygiene and Tropical Medicine. She is a statistical epidemiologist who has worked in the field of human papillomavirus (HPV) and cervical cancer screening for 25 years. She is the principal investigator for the long-term follow-up of the ARTISTIC trial cohort, which recruited around 25,000 women in 2002, collecting further samples for HPV testing from 10,000 women in 2018-22. Since January 2024 she has also been the principal investigator of the Catch-up Screen Project, which will evaluate the impact of offering an at-home urine HPV test to women now aged 65-79 who left the cervical screening programme before the introduction of primary HPV testing.

Thomas Glynn, PhD, currently on the faculty at the Stanford University School of Medicine. His career, which includes tenures at the U.S. National Institute on Drug Abuse, U.S. National Cancer Institute, and the American Cancer Society, has focused on cancer prevention and control, both in the U.S. and internationally, with a parti­cular interest in eliminating the harms from tobacco use.

Mariola Głowacka, PhD, currently a professor at the Mazovian Academy in Płock, where she also acts as Vice-Rector for Collegium Medicum and lecturer at the Collegium Medicum of the Nicolaus Copernicus University in Toruń. She serves as the chair of the National Accreditation Council for Nursing and Midwifery Schools, is a member of the National Council of Nurses and Midwives (NRPiP) and is part of its Presidium. She also chairs the Education Committee and the Legal and Legislation Committee of the NRPiP. Her professional and academic areas of interest include geriatrics and geriatric nursing, the quality of undergraduate and postgraduate nursing education, nursing autonomy and professional competencies, international and European nursing, and the use of simulation in nursing education at both the undergraduate and postgraduate levels.

Łukasz Gruszczyński, PhD, Professor at Kozminski University, where he heads the Department of International Law and European Union Law. His research focuses on international economic law, global health law and international risk regulation. He earned his doctorate at the European University Institute in Flo­rence and spent the next stages of his scientific career at the Institute of Law Sciences of the Polish Academy of Sciences. A winner of six National Science Centre (NCN) competitions. His scholarly achievements include three monographs published by Oxford University Press and numerous publications in leading international scientific journals. Professor Gruszczyński is the editor-in-chief of the English-language yearbook Polish Yearbook of International Law. He currently serves as the President of the High Council of the EUI.

>Paweł Grzesiowski, MD, PhD, paediatrician, Chief Sanitary Inspector, expert in immunology, prevention and therapy of infections. Consultant for hospitals on hospital infection control, antibiotic therapy. Trainer in hospital accreditation. President of the Polish Medical Hygiene Association. A graduate of the Medical Faculty of the Warsaw Medical University. Academic lecturer, author or co-author of scientific abstracts, 280 scientific publications and chapters in textbooks on vaccinology, infectious diseases, immunology, prevention, therapy of infections and hospital-acquired infections. A populariser of medical knowledge, recipient of the ”Great Educator” award from the Association of Journalists for Health and the Health Manager’s Success of the Year award and the honorary title of ”Friend of the Media”. In 2022, granted the main prize in the 18th edition of the PAP Foundation’s Populariser of Science.

Anna Harton, PhD, Assistant professor at the Department of Dietetics at the Institute of Human Nutrition Sciences at the Warsaw University of Life Sciences, member of the Polish Society of Dietetics. Author of about 100 scientific articles. Author, co-author and consultant of educational programmes and popular articles in the field of human nutrition and dietetics. Scientific interests: dietary prevention and therapy of diet-dependent diseases.

Aleksandra Herbeć, holds a PhD in Health Psychology, Behavioural Science and Digital Health from University College London (2019). She specialises in mixed-methods research, public health, tobacco control and smoking cessation, digital interventions, and behavioural change among healthcare professionals, patients, and the general public. Since 2020 she has been co-leading the Health Behaviours during the COVID-19 (HEBECO) pandemic epidemiological study in the UK. Aleksandra currently heads the Secretariat for the Independent Review on Equity in Medical Devices at the Medical Technologies Directorate at the Department of Health and Social Care in the UK and is a Research Fellow at University of Kalisz. Since 2009 she has been affiliated with the Health Promotion Foundation in Poland.

Kinga Janik-Koncewicz, PhD, researcher at the Institute – European Observatory of Health Inequalities, University of Kalisz, Poland. Her main interest is monitoring consumption of tobacco and alcohol and epidemiology of tobacco- and alcohol-related health burden in Poland. She is a Lead Assistant Editor at the Journal of Health Inequalities.

Piotr Jankowski, MD, PhD, professor at the Centre of Postgraduate Medical Education in Warsaw, head of the Department of Geriatric Cardiology and Department of Epidemiology and Health Promotion CMKP, until 2020 professor at the Jagiellonian University in Kraków (Poland), cardiologist. Secretary (2017-2019) and member of the Board (2011-2015) of the Polish Cardiac Society, chairman of the Health Promotion Committee of the Polish Cardiac Society (2011-2017 and from 2021). Author of over 450 scientific contributions, co-author of a number of scientific and clinical statements and guidelines. Laureate of numerous scientific awards. President of the Board of the “Zdrowie Publiczne” Foundation.

Prabhat Jha, PhD, Professor at the University of Toronto, and the founding director of the Centre for Global Health Research. His work includes the Million Death Study in India, the Action to Beat Coronavirus study in Canada, and the Healthy Sierra Leone project. His research on tobacco control enabled a global treaty signed by over 180 countries.

Paweł Kołodziejski, PhD, received his PhD degree in biological sciences and in 2022, a habilitated doctorate in agricultural sciences, both from Poznan University of Life Science, Poland. Currently he is an assistant professor at the Department of Animal Physiology, Biochemistry and Biostructure, serving as the Head of the Department. His research focuses on hormonal regulation of metabolism and endocrine function of peripheral tissues related to carbohydrate and lipid metabolism, with particular emphasis on adipose tissue, pancreas, liver, and muscles. Author and co-author of over 100 articles published in journals from the JCR list. Principal investigator of research projects financed by the NCN, NCBiR, Poznań University of Life Sciences and contractor in several projects financed from national and European sources (e.g. 7th Framework Programme). Laureate of scholarships from the Ministry of Science and Higher Education, ESF Scholarship and awards of the Rector of the Poznań University of Life Sciences for scien­tific activity.

Hanna Krauss, Director of the Institute of Preventive Research and Director of the Doctoral School at the University of Kalisz. A specialist in paediatric diseases, the Chair of the Poznań Branch of the Polish Physiolo­gical Society and a member of the Society’s Main Board. She has co-authored over 450 scientific publications and conference materials and is the scientific editor of academic textbooks. Her main scientific research focuses on the regulation of energy metabolism in both physiological and pathological conditions, as well as the impact of microbiota and selected hormones on children’s development.

Marek Krawczyk, MD, PhD, Professor at the Department of General, Transplant and Liver Surgery (formerly the 2^nd Surgical Department) at the Medical University of Warsaw. A specialist in general surgery, clini­cal transplantology and oncological surgery. European expert in Hepato-Pancreato-Biliary Surgery (FEBS). Professor Krawczyk studied at the Surgical Department of the University of Heidelberg (1978/1979), the Surgical Department in Mannheim of the University of Heidelberg (1989/1990), the Surgical Department of the University of Dundee (1991), the Surgical Department of the University of Cambridge (1991), the Saint Joseph Hospital in Charleroi (1991), the Surgical Department in Villejuif – University of Paris (1993/1994), the Surgical Department in Strasbourg (1995) and the Department of Surgery and Liver Transplantation in Bordeaux (1999). Between 1996 and 2002 he was the Vice-Dean, and from 2002 to 2008 the Dean of the 1^st Faculty of Medicine. He served as Rector of the Medical University of Warsaw (2008-2016). Honorary member of 8 foreign scientific societies and 5 Polish scientific societies. He was the President of the Polish Transplantation Society (2001-2003), the President of the Association of Polish Surgeons (2011-2013), the President of the European Surgical Association (2016-2017). He is an author or co-author of 571 scientific contributions, editor or co-editor of 70 books.

Kamil Kuć, MD, a specialist in clinical oncology, the head of the Oncology Department with a Day Chemotherapy Unit at the Provincial Hospital of St. Father Pio in Przemyśl. He also serves as the Coordinator of Medyk Oncology at CM Medyk in Rzeszów. He is an initiator and executor of numerous educational and preventive projects for cancer patients. As a principal investigator, he has led numerous clinical trials in the field of oncology. He was a recipient of the Minister of Health’s scholarship for students with significant achievements. In 2023, he was awarded the title of “Doctor of the Decade” for his dedication to cancer patients by the Alivia Foundation.

Carlo La Vecchia, Professor of Medical Statistics and Epidemiology at the School of Medicine at the University of Milan. Dr La Vecchia serves as an editor for numerous clinical and epidemiologic journals. He is among the most renowned and productive epidemiologists in the field, with over 2,090 peer-reviewed papers in the lite­rature and is among the most highly cited medical researchers in the world.

Martin McKee, Professor of European Public Health and Medical Director at the London School of Hygiene and Tropical Medicine. He is also Research Director of the European Observatory on Health Systems and Policies and past President of the European Public Health Association. He is trained in medicine and public health and has written extensively on health and health policy, with a particular focus on countries undergoing political and social transition.

Krzysztof Nowiński, a criminal law attorney. Since 2011, he has been representing clients in criminal cases on both the defence and prosecution sides. He has extensive experience in representing clients in cases related to corruption, bond issuance, money transfers, mismanagement, acting to the detriment of businesses, fraud, embezzlement, as well as failure to perform or exceeding corporate duties.
/>Mark Parascandola, PhD, MPH, Director of the Research and Training Branch in the Center for Global Health at the National Cancer Institute (NCI). He received his Doctorate in Philosophy of Science from Cambridge University and his Master of Public Health degree in Epidemiology from the Johns Hopkins University School of Hygiene and Public Health. He has authored over 75 published articles on global cancer prevention, implementation science, tobacco control, and epidemiologic research methodology. He served as an editor for the NCI/WHO report The Economics of Tobacco and Tobacco Control (2016), the NCI/CDC report Smokeless Tobacco and Public Health: A Global Perspective (2014), and the two-volume encyclopaedia Tobacco: Its History and Culture (2005). Dr Parascandola has served as an Embassy Science Fellow and expert advisor on tobacco control, air pollution and health at the U.S. Embassies in Beijing and Warsaw.

Sir Richard Peto, FRS Emeritus Professor of Medical Statistics and Epidemiology, University of Oxford, UK. Richard Peto has collaborated for decades with major epidemiological studies in China, India, the Americas, and Europe, with close attention to the details of how epidemiological evidence and trial evidence should be interpreted. This has substantially increased the estimated importance of major avoidable causes of cancer and of vascular disease such as tobacco, blood pressure, blood lipids, adiposity, and diabetes.

Jacek Piątek graduated from the Faculty of Medicine at the Poznań University of Medical Sciences in 1985. From 1985 to 2018, he worked in the Department of Physiology at the same university. Between 2011 and 2013, he was a visiting professor at the Institute of Rural Health in Lublin. Since 2018, he has been a professor at the University of Kalisz, where he serves as the Dean of the Faculty of Medicine and Health Sciences. In recent years, his research interests have focused on gut microbiota, probiotics, and synbiotics. He is the author of several books and numerous articles published in peer-reviewed scientific journals.

Ewa Pruszyńska-Oszmałek, a Polish scientist specializing in animal physiology, biochemistry, and endocrinology. Her research focuses on the regulation of appetite, metabolism, and hormonal mechanisms that influence digestive processes and energy metabolism in humans and animals. She has a particular interest in the effects of bioactive compounds, such as probiotics, peptides, and other metabolic factors, on bodily functions, especially in the context of weight regulation, digestion, and energy homeostasis of peripheral tissues such as fat tissue, liver, and muscle. Pruszyńska-Oszmałek has authored or co-authored over 130 scientific publications in indexed journals, exploring the interplay between metabolism and the hormonal system, as well as mechanisms affecting the health of livestock animals. She is affiliated with the Poznan University of Life Sciences, where she combines her research work with teaching responsibilities, sharing her expertise in physiology and molecular biology with students.

Krzysztof Przewoźniak, doctor of medical sciences, sociologist of health and medicine, specialist in the field of epidemiology and prevention of civilization diseases as well as health promotion. Researcher at the National Research Institute of Oncology in Warsaw and University of Kalisz. Lecturer at the University of Southern Cali­fornia in Los Angeles and Johns Hopkins University in Baltimore. Associate of Collegium Civitas in Warsaw. President of the “Smart Health – Health in 3D” Foundation and member of the board of the European Network for Smoking and Tobacco Prevention. Coordinator, main researcher or manager of over 160 investigative, research and development, educational and intervention projects. Author or co-author of 339 articles and scientific monographs, research reports and expert opinions as well as popular scientific publications.

Henning Sommermeyer, from 1982 to 1987, Henning received his academic training at the University of Hanover and the Medical School Hanover in Germany, graduating with a degree in biochemistry. He specia­lized in immunology with his doctor thesis covering research about early signal transduction processes during the activation of T-cells. From 1990 to 2010 Henning held several leadership roles with major international pharmaceutical companies in Germany, Portugal, Poland, the Czech Republic, and the Slovak Republic. He restarted his scientific research activities in 2017 through cooperation with Prof. Jacek Piątek. In 2019, they together founded the Microbiota Research Group of the University of Kalisz. Their research focuses on characterizing the therapeutic effects of probiotic bacteria and covers preclinical as well as clinical research. The work has resulted in a number of scientific publications and, so far, two books. The most recent research has focused on clinical trial research with newborns suffering from infantile colic and patients with irritable bowel syndrome.

Szymon Suwała, a graduate of the Faculty of Medicine at the Medical University of Łódź, he is a specialist in endocrinology and diabetology, currently working at the Department of Endocrinology and Diabetology at the Ludwik Rydygier Collegium Medicum in Bydgoszcz, part of Nicolaus Copernicus University in Toruń. His current scientific and professional focus lies in the interdisciplinary aspects of endocrine diseases (including thyroid disorders), metabolic dysfunction and liver structure abnormalities, the bidirectional relationship between obesity and type 2 diabetes (diabesity), and the application of artificial intelligence in medical education.

Andrzej Wojtyła, MD, PhD, paediatrician, professor in medical sciences, former Minister of Health and Social Welfare, Deputy Minister of Health, and Chief Sanitary Inspector in Poland. He was a visiting Professor at Georgetown University and secretary general of the World Organization of Rural Medicine. Since 2018, he has served as Rector of the President Stanisław Wojciechowski University of Kalisz, Poland.

Katarzyna Zatońska, MD, PhD, Professor of Medical Sciences at Wrocław Medical University, specializing in population health and the prevention of noncommunicable diseases. During her career, she has completed specializations in internal medicine, diabetology and public health. Prof. Zatońska has directed a number of important research projects, both national and international, focusing on the epidemiology of chronic diseases, obesity and the metabolic syndrome. Her most important achievements include leading the Polish cohort participating in the Prospective Urban and Rural Epidemiological Study (PURE) and the PICTURE study. In her clinical work, she specializes in the management of patients with diabetes and metabolic disorders. Her main areas of scientific and didactic interest include population health, epidemiology, public health, and health promotion.

Witold Zatoński, MD, Professor of Medical Sciences, Honorary Doctor of the University of Aberdeen in the United Kingdom. Between 1966 and 1979 he worked as an internist (post-doctoral degree) and as a biochemist at the Medical Academy in Wrocław, Poland. Then, until 2016 he was the director in the Division of Epidemiology and Prevention at the Maria Skłodowska Curie Memorial Cancer Centre and Institute of Oncology in Warsaw. Professor Zatoński is the founder and president of the Health Promotion Foundation. Since 2016, Director of the Institute – European Observatory of Health Inequalities at the University of Kalisz and Scientific Editor-in-Chief of the Journal of Health Inequalities.

Mitch Zeller, J.D., retired from federal service in April 2022. He was the director of the FDA’s Center for Tobacco Products from March 2013 to April 2022. As Center Director, Zeller led the FDA’s efforts to use the tools of product regulation to reduce disease and death from tobacco use and bring previously unavailable information about its dangers to light. He created a comprehensive regulatory programme encompassing application review, innovative regulatory policy, compliance and enforcement, public education, and regulatory science research.
Several speakers mentioned the important contributions in the field of public health and public health research of Dr Mateusz Zatoński, son of Professor Witold Zatoński and partner of Dr Alexandra Herbec. Mateusz sadly passed away in January 2022. Allan M. Brandt, Harvard University, expressed his thoughts on this as follows:
“I have grieved his loss. It’s a loss to the world of global health and the thinking of global health equity and fairness that he and so many of you have been so deeply committed to”.

HIGHLIGHTS

Brief summaries and conclusions from the five main sessions are included below.

Summary of session 1: Public health challenges in Poland

There has been a decrease in cardiovascular mortality in Poland since around 1990. At the same time, cardiovascular diseases (CVD) are still dominant in the Polish context and cardiovascular mortality is higher than the average for EU countries.
Cardiovascular mortality can be reduced by improved lifestyles and use of medication. Lifestyle changes, especially changing structure of consumed fat and compensation of alpha-linolenic acid deficiencies, contributed substantially to declining trends of CVD mortality in the 1990s in Poland.
Behavioural risk factors dominate the list of factors contributing to reduced life expectancy (smoking, diet, alcohol use). Social and contextual factors (family, school etc.) influence our health behaviour.
Many, perhaps all sectors of society have their roles to play in public health. Availability and prices in grocery stores are one important example of an area influencing the health behaviour of children and adolescents. The architecture of buildings influences our physical activity (stairs, not elevators). Decision makers in all sectors should be educated in public health.
Obesity among children and adolescents is a major problem; one in five teenagers is obese. This is related to the traditional as well as “Western” food habits. Comprehensive prevention programmes, including health education, are needed.
Experimentation with alcohol use and tobacco smoking is widespread among 15-year-olds in Poland and the Baltic countries. Regular use of tobacco-free nico­tine delivery devices is more prevalent in this age group than regular tobacco smoking and regular use of alcohol.
The increasing proportion of elderly people in Poland represents a serious challenge to the health care system.
It is necessary to prepare a comprehensive national strategy of public health including alcohol and tobacco control policy for the next 20-30 years, with measurable and achievable goals.

Summary of session 2: Health, risk factors, cancer

In 2023, cardiovascular diseases and cancers caused more than 60% of all deaths in Poland. Cancers are the cause of about 25% of all deaths and should be considered separately in regard to their location/type and require an individual approach in treatment. Trends in mortality due to lung cancer and stomach cancer have shown an impressive decline in recent decades. However, neoplasms still remain one of the biggest challenges for public health. Novel treatments, some already in use and others being researched, give hope for remission and longer survival rates. In some types of cancer, immunotherapy is currently a first line of treatment, which is a big improvement.
Death is inevitable, but premature death is not. Worldwide (with the exception of countries affected by HIV and war) the mortality decreased substantially from 1970 to 2010. The decline is especially prominent in infant mortality rates, in deaths due to communicable perinatal, maternal, and nutritional causes. Although premature cardiovascular mortality has decreased in Poland in recent decades, the rates are still higher than the average for EU countries.
Despite declining trends in tobacco smoking, its cessation remains the most important challenge to reduce cancer mortality, especially lung cancer.
Properly conducted primary prevention can completely change the picture of mortality from cancer – which is clearly shown by the example of cervical cancer. There is still a tremendous gap in HPV-vaccination coverage between UK and Poland. The school-based vaccination programme in the UK had an 80% coverage, while in Poland only 10% of the eligible population benefits from free vaccination. As a result, the incidence rate is visibly higher in Poland. Analyses of birth cohorts are extremely helpful in presenting the epidemiological picture of cancer mortality.
While preparing the strategy and policy aimed at improvement of the population’s health, one should try to achieve a balance between primary prevention, secondary prevention, and treatment. In recent decades, we have met the goals for treatment (e.g. in the case of cardiovascular care), but primary prevention has been underfinanced and neglected.

Summary of session 3: Epidemiology of alcohol-related diseases in Poland at the beginning of the 2000s

In 2002 the Minister of Finance of Poland decreased the alcohol tax by 30%, which contributed to the substantial increase in registered alcohol per capita consumption in Poland from 8 to 11 litres per capita (age 15 years or more) per year between 2002 and 2021. The provisions of the Act on Education in Sobriety and Counteracting Alcoholism from 1982, at that time one of the best alcohol control legislations in the world, has been dismantled.
Rising alcohol consumption has led to dramatic increase in mortality from alcohol-related diseases, especially alcoholic liver cirrhosis. It is estimated that around 30 000 deaths were caused by alcohol consumption in Poland in 2021. Mortality from alcoholic liver cirrhosis (one among dozens of diseases which are 100% caused by alcohol consumption) increased dramatically in both men and women and in all age groups. Standardized mortality rates increased in the oldest age group (65 years and more) 8-fold in men (from 6.3 to 49.3 per 100,000) and 20-fold in women (from 0.7 to 11.7 per 100,000) between 2002 and 2022.
Unlike other European countries (e.g. the Baltic States), Poland has not introduced any alcohol control measures to reduce alcohol consumption since the beginning of the 2000s. On the contrary, the dismantling of the national alcohol control law led to loopholes and introduction of products (such as small vodka bottles) and marketing campaigns which significantly increased the consumption of alcohol. The need for action in this area is so enormous that civil society initiatives have been launched to reduce the availability of alcohol.
We are faced with new scientific evidence that alcohol consumption has no protective role in cardiovascular diseases. Indeed, alcohol consumption increases the risk of cardiovascular diseases and cancer. This evidence is especially important in a country where cardiovascular diseases and cancers are the two main causes of mortality.
In recent decades, there has been unprecedented development in transplantology. Currently, one of the indications for transplantation is alcoholic liver cirrhosis. According to transplant experts, while transplantation for alcoholic liver cirrhosis saves lives, public health policies should aim to reduce exposure to alcohol and prevent people from needing a transplant.
The development of the health situation in Poland and the epidemiology of mortality due to alcohol consumption should constitute a basis for ceasing treating alcohol as an ordinary commodity (as has been implemented in many European countries). The aim should be to denormalize alcoholic beverages as economic goods, which could be achieved through various types of legal regulations and educational campaigns.

Summary of session 4: Public health challenges associated with rising use of novel nicotine products in Poland (nicotine delivery devices)

The tobacco and nicotine product market is diverse and rapidly changing, with new products (electronic cigarettes, heated tobacco products, nicotine pouches) being introduced and widely marketed. Yet data on the characteristics, use, and health impact of these products remain limited.
Survey data indicate that use of novel tobacco and nicotine products predominantly impacts adolescents and young adults. In Poland in 2016, 32% of boys and 22% of girls aged 11-17 years were current users of electronic nicotine delivery devices. The widespread availability of inexpensive, disposable products with attractive fruit and sweet flavourings, along with marketing through social media, has contributed to the popularity of these products among youth.
Novel nicotine products present additional challenges for regulation. In some cases, these products may fall outside existing tobacco control laws, and enforcement agencies may be limited in their ability to control sales of unlicensed products through informal markets and online. There is a need for a comprehensive regulatory approach for all tobacco and non-medicinal nicotine products.
Multinational cigarette manufacturers have developed or acquired alternative nicotine delivery devices and are actively marketing them in many countries. A review of internal documents and public statements by tobacco industry actors reveals how they have co-opted the language of “harm reduction” to serve their own interests. This has caused the epidemic of electronic nicotine delivery system use among youth in Poland and some other countries.
While public health aims to reduce the harm associated with tobacco products, debates around the potential role of electronic nicotine delivery devices in reducing harm from cigarette smoking have polarized the tobacco control community. Although there may be a continuum of risk associated with different tobacco and nicotine products, it is essential to consider their long-term impact on population health, including patterns of youth uptake and dual use.
A number of countries have implemented or proposed policies and regulations to address adverse impacts of novel nicotine products on youth and population health, including banning the use of non-tobacco flavourings in products, restricting advertising and sale of products on the internet or through social media, and developing innovative cessation and counter-marketing programmes targeted at youth.
Several countries and jurisdictions have proposed or implemented tobacco “endgame” strategies, such as prohibiting tobacco sales to anyone born after a particular date as a way to phase out tobacco products over time. While such strategies have promise to dramatically reduce the public health impact of tobacco use, their implementation is complicated by tobacco industry opposition and divergent views over the role of novel nicotine delivery devices.
It must be emphasised that conventional cigarette smoking is still the leading cause of preventable morbidity and premature mortality in Europe and beyond. This should be addressed in public health policy.

Summary of session 5: Excess mortality due to coronavirus – the biggest health catastrophe in Poland in the 21^st century

The COVID-19 pandemic was clearly one of the most important challenges to the public health in the last 100 years. Number of excess deaths and excess mortality are the best measures to evaluate the course of the coronavirus pandemic and enable comparison of data between countries.
There were huge differences between European countries with respect to excess deaths. Central and Eastern European (CEE) countries were most affected, and Poland is among the countries with the highest rates of excess mortality. One of the most important factors affecting excess mortality was the level of vaccination in the population.
There is a huge difference between officially registered COVID-19-related deaths and excess deaths (6 million reported vs. 15-20 million excess deaths globally). In Poland there were approximately 250,000 excess deaths between 2020 and 2023 (officially approximately 120,000 COVID-19-related deaths).
The development of the COVID-19 pandemic was different in Poland in comparison with other EU countries. The course of the pandemic in Poland showed how the introduction of restrictions by the state administration, and their timing, as well as compliance with them (including their premature loosening) can have a decisive impact on the number of infections and deaths related to COVID-19, especially in the phase when vaccines were not yet available.
COVID-19 led to serious disruptions in health behaviours that affected different social groups in different ways, with certain groups (e.g. migrants, poor, people with pre existing health conditions) being affected the most.

POSTER SESSION

In the poster session, 57 summaries of research were presented. The competition commission selected the following as the best ones:
First place: “Chlorpyrifos impact on the development of obesity and insulin resistance – study on 3T3-L1 model” by Lucyna Kapka-Skrzypczak, Paulina Wojtyła- Buciora, Magdalena Matysiak-Kucharek, Krzysztof Sawicki and Magdalena Czajka.
Second place: “Effect of GLP-1 therapy and a low calorie diet on weight reduction. An in-house study” by Zuzanna Chęcińska-Maciejewska, Andrzej Ciborek and Hanna Krauss.
Third place: “Obesity and overweight among rural residents as a health problem on the example of patients from the KRUS Farmers’ Rehabilitation Center in Jedlec” by Marek Przybył, Andrzej Wojtyła, Ewa Wojtyła, Przemysław Biliński and Jędrzej J. Ksepka.
The following works received distinctions: “Diagnosis and treatment of melanoma: personal experience” by Anna Browicz, Andrzej Ciborek and Hanna Krauss, “Evaluation of selected health-promoting behaviours of students of the University of the Third Age Calisia” by Elżbieta Konieczna, Agnieszka Nowak, Violetta Jachimowicz, Paulina Wojtyła – Buciora and Jacek Piątek, “Debonding of porous coating: a late failure mode of uncemented, partially threaded acetabular components – retrieval analysis” by Łukasz Łapaj, Joanna Sulej-Chojnacka, Justyna Rozwalka, Abdulrahim Alaouir, Tomasz Markiewicz, Paweł Chodór, Jan Kiryluk, Adrian Mróz and Jan Zabrzyński, and “Radiophobic detection of ionizing radiation” by Dominik Łapa, Marta Podwapińska and Stanisław Mitura.

DISCUSSION, COMMENTS, AND CONCLUSIONS

People’s health and quality of life are influenced by chains of interrelated processes involving genetic, biolo­gical, psychological, and behavioural factors [7]. People live their lives in social, physical, organizational, societal, and political contexts [8]. Behavioural risk factors such as tobacco use, use of alcohol, food habits, and physical activity may at a first glance appear to be under the individual control of each citizen. Decades of research have, however, shown that health-related behaviour to a large extent is shaped by contexts and circumstances.
According to the late Stanford University professor Lee Ross, most human beings tend to perceive fellow humans’ behaviour as caused by inner dispositions, neglecting the impact of situational or contextual influences. We tend to see other people as internally motivated and in control of their own behaviour. Ross called this the fundamental attribution error [9]. In public health it is important not to allow one’s understanding to be distorted by the fundamental attribution error and realize that health-related behaviours actually, to a large extent, are moulded by contexts and circumstances.
Health education as a tool in the promotion of po­pulation health is important and should not be neglected. Relying solely on health education approaches is, however, counterproductive. Health education as a way to influence health behaviour rests on the assumption that behaviour change takes place as a result of cognitive and affective processes leading to decisions made by individuals, and over time changes in social norms. This is a process which takes time, and which tends to function better among highly educated population segments, thus contributing to increasing socioeconomic differences in health behaviour and health [10]. A wider set of tools needs to be utilized, perhaps first of all use of legislation, taxation, and physical planning.
During the 4^th World Conference on Family Health in Kalisz, the importance of health behaviour such as tobacco smoking, alcohol use, and food habits for understanding population health was well documented. In Poland, cardiovascular mortality is declining. This decline is not only caused by changes in behavioural risk factors. Improved medication and treatment have contributed substantially. Nevertheless, cardiovascular mortality in Poland is still higher than the average for EU countries. The second largest cause of death is cancer. Cardiovascular diseases and cancer were responsible for more than 60% of all deaths in Poland in 2023.
In order to further reduce the burden of disease caused by cardiovascular disease and cancer, smoking of tobacco and consumption of alcohol need to be reduced. There was a decline in smoking in Poland during the period 2000–2018, but this decline has been weaker since 2018 [11, 12]. The average consumption of alcohol in Poland increased sharply between 2002 and 2008, and has continued increasing, although less markedly in recent years [13] (data from Statistics Poland).
However, mortality due to alcoholic liver cirrhosis, considered as the best indicator of alcohol harm, has been steadily increasing since the beginning of the 2000s (data from the WHO Mortality database). As documented at this conference, as well as at the 2nd Calisia World Conference on Family Health [5], comprehensive smoking control and alcohol control programmes which include use of legislation and taxation approaches are effective in reducing the tobacco- and alcohol-related burden of disease. There is an urgent need to strengthen these policies in Poland. Primary prevention has been underfinanced and largely neglected.
Scientific evidence has confirmed that alcohol consumption has no protective role in cardiovascular diseases [14, 15]. It is well documented that alcohol consumption increases the risk of cardiovascular diseases and cancer. In addition, alcohol use has more specific consequences, for instance the major role it plays in the development of liver cirrhosis [16]. Mortality from liver cirrhosis increased dramatically in Poland between 2002 and 2022 [17-19]. Transplantology has improved substantially and saves lives. A much better solution is, however, primary prevention through a reduction of alcohol consumption. The serious challenge of increased alcohol use can no longer be ignored.
A wide range of novel tobacco and nicotine edited wording here to be consistent with language in session and summary above products have been developed and are actively marketed in many countries. The multinational producers and distributers of these product in their marketing efforts describe them as less harmful alternatives to tobacco smoking. Non-combustible pro­ducts may serve a harm reduction purpose if replacing tobacco smoking among established smokers. According to the World Health Organization, e-cigarettes with nicotine have negative health consequences [20]. When young people start using these products, there may be additional negative health impacts not yet fully known. And since they can serve as a gateway to smoking tobacco, this may have serious negative effects on population health.
Worldwide, over the last 30 years, mortality among children and adolescents has decreased substantially, the only exception being adolescents living in sub-Saharan Africa [21, 22]. Still, it is important to include policies and programmes targeting and involving children and adolescents in the context of the promotion of public health. In Poland, since 2002, tobacco smoking among adolescents has decreased [23]. Experimentation with tobacco smoking, tobacco-free nicotine delivery devices, and use of alcohol is, however, still widespread among 15-year-olds. Regular use of tobacco-free nicotine products in this age group is more prevalent than regular smoking, and regular use of alcohol may potentially serve as a gateway to tobacco smoking. More research to examine this assumption more closely is needed.
Obesity among children and adolescents is presently a major problem. One out of five teenagers is obese – a problem related to physical inactivity and unhealthy food habits. It is necessary to develop programmes promoting healthy lifestyles targeting the adolescent population in Poland, particularly emphasizing prevention of obesity.
Use of HPV vaccination in order to reduce the incidence of cervical cancer has been shown to be effective [24]. There is, however, a huge gap in coverage across countries. In the UK, the coverage of school vaccination programmes has been shown to be around 80%. In Poland, only 10% of the eligible population has benefited from HPV vaccination. When the solution to a challenge of this magnitude is so obvious, we have every reason to ask for strong action from politicians and health authorities.
The COVID-19 pandemic was one of the most serious challenges to public health in Europe in the last 100 years [25]. The risk of a fatal outcome was particularly high among elderly people. Central and Eastern European (CEE) countries were most affected, and Poland was among the countries with the highest rates of excess mortality [26]. The pandemic also had negative consequences for health behaviour as well as social life [27, 28]. Efforts should be made to build preparedness for new pandemics. This should include nation-wide vaccination programmes.
The increasing proportion of elderly people in many countries of Europe, including Poland, represents a serious challenge to the welfare and health care systems [29]. Promotion of health across the life span, starting with the youngest and continuing into old age, will contribute to a healthy, active, and vital elderly population, important for the individual, for families, and for society as a whole.
In short: in Poland, behavioural risk factors domi­nate the list of factors contributing to reduced life expectancy (smoking, alcohol consumption, food habits, physical inactivity). Health information and health education approaches are important, but insufficient, and should be accompanied by programmes aimed at changing contextual factors through legislation, taxation and price regulations, and physical and community planning. There is an urgent need for developing and implementing a national strategy and strengthening of governance for public health in Poland. Real progress in public health may be difficult to achieve unless this sector is adequately organized and strengthened at all levels (central, regional, local). This should include organization of preparedness for new pandemics.

DISCLOSURE

The authors report no conflict of interest.

References