In 1991 Poland's overall mortality rate increased to 10.6 deaths per 1,000 persons, from the 1990 figure of 10.2 per 1,000. In the same period, infant mortality remained constant at 15.9 per 1,000. About 50 percent of the 405,000 deaths in 1991 were attributed to circulatory diseases, and another 20 percent were caused by malignant tumors. Poland's communist regimes partially or completely ignored a number of major health problems, including acquired immune deficiency syndrome (AIDS), drug addiction, and alcoholism. Only with the open discussion that began in 1989 did the extent of these problems become clear. Solutions, on the other hand, were often blocked in the postcommunist years by popular distrust of state authority, controversy between church and state, and lack of resources.

AIDS

AIDS emerged as an issue in Poland later than in the West-- partly because of communist suppression of statistics, partly because the epidemic apparently reached Poland later. In 1991 the government officially estimated that 2,000 Poles had been infected with the human immunodeficiency virus (HIV), whereas an independent health expert put the figure at 100,000. This statistical discrepancy reflected Poland's late start in testing the groups at highest risk of infection. Narcotics addicts were endangered particularly because the drug in widest use in Poland was administered and distributed by syringe, one of the most potent means of HIV transmission. Early efforts to control the spread of HIV were hampered by public ignorance and superstition; in 1992 about 70 percent of Poles believed they could not be infected, while many believed that water and mosquitoes were carriers. The total lack of sex education programs in the schools (the Polish Catholic Church forced their removal after the communist era) and the disinclination of political and religious leaders to address the issue publicly further hindered prevention efforts.

Twice in 1991, World Health Organization (WHO) teams evaluated the Polish situation and proposed a program to combat the spread of AIDS. The teams advised that, to prevent the disease from spreading from high-risk groups to society at large, information on the epidemic be given maximum dissemination to certain less visible groups that were likely victims of the second phase of the disease. The most urgent target groups were the prostitute community--whose numbers in 1992 were estimated to be as high as 180,000--and their potential customers. At that point, however, a comprehensive information program was impossible because the country lacked trained workers and money for training programs. Other obstacles were lack of modern diagnostic technology and poor hygiene in public health facilities. In 1991 WHO allocated a small fund for a three-year education and prevention program in Poland.

Narcotics

As in the case of AIDS victims, communist regimes denied the existence of drug addicts. The first private drug treatment center opened in 1970, and in the 1970s health and legal professionals discussed the drug problem guardedly. Not until the 1980s were organizations founded to combat drug addiction, and they were harassed and limited by government agencies until 1989. In 1992 between 4,000 and 5,000 Poles dependent on narcotics were being treated at facilities of the national health service or social organizations. The Ministry of Health and Social Welfare estimated that 200,000 to 250,000 persons were taking drugs at that time, however. In 1991 some 190 deaths were attributed to drug overdoses. Addicts under treatment were predominantly from the working class and the intelligentsia, male, and younger than thirty years of age (nearly half were under twenty-four). The most commonly abused substance, kompot, was a powerful and physically devastating drug readily produced from the poppy plants grown widely in Poland. The drug was injected intravenously. Kompot moved through society via informal networks operating independently of the international drug market.

In the period from 1986 to 1992, drug abuse in Poland remained stable despite declining standards of living, rising unemployment, and a rising overall crime rate. As barriers to the West fell, however, amphetamine manufacture and trafficking introduced a new threat. By 1992, amphetamines from Poland were considered as serious a threat in Germany and Scandinavia as imported cocaine and heroine; at that time, an estimated 20 percent of amphetamines in Western Europe originated in Polish laboratories. The confiscation of 150 kilograms of cocaine in Poland in 1991 also indicated that domestic narcotics production was diversifying, and local authorities feared that Colombian drug cartels were investing in that activity. To counter criminal drug producers, who also were involved in other types of crime, Poland established a National Drug Bureau in 1991. Because kompot remained much cheaper and more accessible in the early 1990s, however, the Polish market for amphetamines remained very small. Meanwhile, a 1990 law made illegal the cultivation of poppies without a government permit, and a new, morphine-free poppy species was introduced in 1991 to enable farmers to continue poppy cultivation.

In 1992 nineteen of Poland's drug rehabilitation centers were operated by the Young People's Movement to Combat Drug Addiction (known by its Polish acronym, MONAR). Although hundreds of people were cured in such centers in the 1980s, the severe treatment methods of MONAR's two-year program caused controversy in the Polish health community. For that reason, in 1990 the Ministry of Health and Social Welfare began opening clinics that emphasized preparing individuals for life after treatment.

Alcoholism

The older generations of Poles escaped narcotics addiction, but alcoholism is a problem in all generations. Alcohol consumption is an integral part of Polish social tradition, and nondrinkers are relatively rare. Per capita consumption increased significantly after World War II, however, and consumption remained above the European average throughout the communist period. Children often began drinking when still in primary school. Government programs nominally discouraged excessive drinking, but the importance of revenue from the Polish alcohol industry restricted their activity. Throughout the 1980s, the percentage of strong alcoholic beverages in overall consumption rose steadily, putting Poland near the top among nations in that statistic. In 1977 an estimated 4.3 million Poles consumed the equivalent of more than 48 liters of pure alcohol per person per year; of that number, about 1 million were believed to be clinically alcohol-dependent. In 1980 the average male Pole over sixteen years of age consumed the equivalent of 16.6 liters of pure alcohol per year.

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Source: U.S. Library of Congress