EJEMpLOs DE sECuENCIAs DIDáCTICAs CON pIZArrA INTErACTIvA

If Europe was the continent of smokers for much of the 20th _{century, Eastern Europe was the}

region where the problem reached epidemic proportions. This has not always been the case; in the immediate years after WWII smoking prevalence in the CEE was at a low level in comparison to western countries.74 _{More broadly, the advances in medical care and public}

health in the region in the 1950s and 1960s led to an unprecedented rate of health

improvement, principally connected to reductions in infectious diseases.75 _{The domination of}

the Soviet Union influenced the development of health systems across CEE. The satellite states of the USSR committed to achieve universal free health care, one of the key promises of Communist leaders, in a matter of a few years. For many of these countries, where before WWII access to the hospital was often a privilege afforded only to the urban rich, this was a veritable revolution.76 _{In addition, well-resourced, comprehensive campaigns were run with}

the aim of reducing the high levels of child and maternal mortality .77 _{An extensive system of}

public health infrastructure and institutions known as the Sanitary Epidemiological Service (Sanepid) was set up.78 _{Mass vaccination programmes to curb infectious diseases were}

70 _{European Commission, "Tobacco or health in the European Union - Past, present and}

future,"(Luxembourg: Office for Official Publications of the European Communities, 2004). P. 42.

71 _{WHO, "European Tobacco Control Status Report,"(Copenhagen: World Health Organisation, 2013).}

P. 8.

72 _{M. Ng et al., "Smoking prevalence and cigarette consumption in 187 countries, 1980-2012," JAMA}

311, no. 2 (2014).

73 _{J. Mackay, M. Eriksen, and O. Shafey, The Tobacco Atlas, 2nd edn. (Atlanta: American Cancer Society,}

2006).

74 _{B. Forey et al., International Smoking Statistics: A Collection of Historical Data from 30 Economically}

Developed Countries, 2 ed.(Oxford: Wolfson Institute of Preventive Medicine, 2002).

75 _{Mateusz Zatoński, Witold A. Zatoński, and Andrzej Wojtyła, "Premature mortality: Europe’s}

persisting Iron Curtain?," Journal of Health Inequalities 2, no. 1 (2016).

76 _{J. Figueras et al., eds., Health systems in transition: learning from experience(Copenhagen: European}

Observatory on Health Care Systems, 2004).

77 _{T. Maciejewski, "Rozwój opieki perinatalnej na przełomie XX i XXI wieku," Perinatologia,}

Neonatologia i Ginekologia 6, no. 3 (2013).

78 _{George Gotsadze et al., "Reforming sanitary-epidemiological service in Central and Eastern Europe}

43 launched.79 _{The results came very quickly. Infant mortality fell in the countries of the Soviet}

bloc by 50%.80 _{Life expectancy increased by an average of 5 years in the 1950s, with the}

improvement in Poland as high as 9 years.81 _{By the mid-1960s the difference in life}

expectancy between CEE countries and Western Europe was down to just 1-2 years (Figure 4).

Figure 4. Life expectancy at birth in Poland and West Germany, 1930-1970

Source: Witold A. Zatoński and Mateusz Zatoński, "Health in the Polish People’s Republic," Journal of Health Inequalities 2, no. 1 (2016).

However, the Communist authorities of CEE, successful in their fight against infections, did not manage to replicate these achievements in dealing with chronic diseases. High alcohol consumption, poor diets, and the surge in smoking, characterised the countries of the Soviet bloc throughout the second half of the 20th _century.82 _{Preventive medicine was fully}

subordinated to curative medicine, public health was seen as being solely in the competence

79 _{M. L. Grabowski, "Rys historyczny Służb Sanitarno-Epidemiologicznych i Państwowej Inspekcji}

Sanitarnej," Przegl Epidemiol 59, no. 1 (2005).

80 _{Feachem, "Health decline in Eastern Europe." P. 314.}

81 _{W.A. Zatoński and M. Zatoński, "Sytuacja zdrowotna [Health situation]," in Dzieje Medycyny w Polsce}

- lata 1944-1989, ed. W. Noszczyk(Warsaw: Wydawnictwo Lekarskie PZWL, 2016).

82 _{M. McKee and V. Shkolnikov, "Understanding the toll of premature death among men in eastern}

44 of medical doctors, and epidemiological research was focused almost exclusively on

infectious diseases.83 _{With the emphasis on medicalisation of health, not much effort was}

made to give the population the necessary tools to exert agency over their own wellbeing. Communist countries saw little public education on smoking harm, and western studies of the relationships between smoking and diseases such as cancer often struggled to penetrate the region.84

Cigarettes were one of the cheapest consumer goods and anti-tobacco legislation was weak throughout the Soviet bloc.85 _{Cigarette sales in most CEE countries had been increasing}

rapidly in the decades following WWII.86 _{Mortality attributed to smoking doubled in the male}

population of CEE countries from 15% in 1955 to 29% in 1985.87 _{Meanwhile, western}

countries with traditionally high smoking prevalence rates have been experiencing the

opposite trend, as tobacco consumption in their male populations was decreasing throughout the 1960s and 1970s.88 _{As a result, by the 1980s countries such as Hungary and Poland had}

some of the highest annual per capita sales of cigarettes in Europe, as well as the highest lung cancer rates among males.89 _{In the wake of the opening of the Iron Curtain, the former}

Communist states of CEE had a 70% higher probability of people dying before the age of 65 than in the Western European countries.90 _{The risk of death for a male aged 15 to 59 in}

Hungary was higher than in Zimbabwe and higher in the Czech Republic than in Vietnam (Figure 5).91

83 _{M. Terris, "Restructuring and accelerating the development of the Soviet health service: preliminary}

observations and recommendations," Journal of Public Health Policy 9, no. 4 (1988).

84 _{European Commission, "Tobacco or health in the European Union - Past, present and future." P. 42;}

Zatoński, "Tobacco Smoking in Central European Countries: Poland." P. 236.

85 _{Connolly, "Tobacco, Trade and Eastern Europe."}

86 _{A.K. Kubik et al., "Patterns of cigarette sales and lung cancer mortality in some central and eastern}

European countries, 1960-1989," Cancer 75, no. 10 (1995). P. 2454.

87 _{R. Doll, "Evolution of knowledge of the smoking epidemic," in Tobacco: Science, policy and public}

health, ed. P. Boyle, et al.(Oxford: Oxford University Press, 2010). P. 12.

88 _{J. E. Tyczynski et al., "Lung cancer mortality patterns in selected Central, Eastern and Southern}

European countries," International Journal of Cancer 109, no. 4 (2004). P. 598.

89 _{Kubik et al., "Patterns of cigarette sales and lung cancer mortality in some central and eastern}

European countries, 1960-1989."

90 _{McKee and Shkolnikov, "Understanding the toll of premature death among men in eastern Europe."}

P. 1051.

45

Figure 5. Risk of dying by world region, 1990

EME – Established Market Economies; FSE – Former Socialist Economies; CHN – China; LAC – Latin America and the Caribbean; OAI – Other Asia and Islands; MEC – Middle Eastern

Crescent; IND – India; SSA – Sub-Saharan Africa

Source: Witold A. Zatoński and Mateusz Zatoński, "Health in the Polish People’s Republic," Journal of Health Inequalities 2, no. 1 (2016). (Data derived from R. Feachem, "Health Decline

in Eastern Europe," Nature 367 (1994)).