CHANGES OF MORTALITY IN POLAND, IN THE YEARS 1988-2004, IN THE LIGHT OF THE EPIDEMIOLOGICAL TRANSITION
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Changes in mortality, observed in Poland in the years 1988-2004, are analysed in the light of the epidemiological transition i.e. the study focuses on symptoms, characteristic for the fourth phase, and concentrates on mortality patterns by age, sex and selected causes of death (cardiovascular diseases, malignant neoplasms, external causes of death, respiratory diseases, digestive diseases and infections and parasitic diseases). The data comes from the current mortality statistics and life tables, both prepared by the Central Statistical Office. In 1988-1991 disadvantageous trends in mortality carried on, i.e. the health crisis in Poland still persisted. Improvements in mortality, observed since 1992, confirm the hypothesis that in the years 1992-2004 the third phase of the epidemiological transition in Poland came to an end and the age of delayed degenerative diseases started. Mortality changes characteristic for the forth phase of the epidemiological transition in Poland were as follows: decreases in overall mortality, which resulted in the systematically increasing life expectancy at birth; declining mortality rates almost at all ages, especially at working-age, a remarkable decrease of infant mortality, a still persisting gender gap in mortality and an increasing excess in male mortality at age 20-39; remarkable decreases in mortality from cardiovascular diseases combined with a differentiation of death rates by selected malignant neoplasms, decreasing male mortality from external causes, and increasing female mortality from respiratory diseases. Besides a detailed description of changes in mortality, in the light of the epidemiological transition, the article also presents an attempt to identify their determinants. The approach applied, is based on a conceptual framework of health domains. To explain decreases in mortality, factors related to individual behaviour, environment and health care are discussed. Undoubtedly, crucial determinants of mortality improvements in Poland are, on one hand, a strong promotion of a healthy life style and increasing knowledge of health risks, remarkable diet changes, curbed smoking, and appreciation of the role of physical activity, and on the other hand improvements in medical treatment in terms of technologies, the availability of medicines and their quality. Especially, the progress in cardiology and cardio-surgery along with changes in life styles, contributed to the mortality declines due to circulatory diseases. Also, during the period of transformation, Poland experienced positive changes, in the broadly defined environment - a remarkable reduction of environment pollution might be attributed to changes in economy (collapse of heavy industry and declines in the traditional branches of industry, the shift to modern technologies in manufacturing, development of services), and to the implementation of regulations and procedures in the area of environmental protection, accompanied by promotion of environment friendly behaviour.
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