Modern-age diseases are widespread

Over half of Poland’s population grapples with overweight or obesity, while at least a quarter of individuals still indulge in traditional cigarette or e-cigarette use. Additionally, two million people struggle with alcohol abuse, with over 800,000 facing dependency. Lifestyle-related diseases are a significant concern, and the fiscal measures implemented thus far may prove insufficient in curbing them, despite their necessity.

– “As much as 10–15% of our overall health hinges on a well-functioning healthcare system. For the most part, whether we are healthy or sick depends on each and every one of us — our everyday choices and the way we live”, reminds Prof. Andrzej Matyja, former president of the Supreme Medical Chamber.

He then wonders, “Why is it that we don’t take care of our health, and who should guide us in prioritising it?” In his opinion, the medical community and regulatory bodies responsible for allocating resources to the healthcare system, including prevention efforts, should play a pivotal role. They can employ appropriate fiscal policies, such as tax rates, to discourage the consumption of health-detrimental products.

Professor Matyja was among the participants in the debate titled, “The Influence of Fiscal Policy on Public Health: Lifestyle Diseases as an Urgent Challenge for Authorities”, at the Economic Forum in Karpacz. Alongside fellow experts, they explored effective strategies aimed at reducing the prevalence of lifestyle-related diseases.

A series of actions is needed

– “The most common and severe diseases in Poland include respiratory cancer, heart failure, and chronic obstructive pulmonary disease, with smoking being the primary contributing factor to their development”, pointed out Prof. Andrzej Fal, President of the Polish Society of Public Health. He also acknowledged that addiction, including nicotine addiction, is among the most challenging conditions the human body can face, affecting both mental and physical well-being. – “Also, it’s important not to categorise addiction management tools as better or worse, or more or less effective, or claim that education or the tax systems are more important. Instead, we should advocate for a comprehensive and coordinated approach involving various activities implemented systematically”, the doctor and economist added.

He listed four key elements of a health policy aimed at reducing addiction and, consequently, the incidence of lifestyle-related diseases. First of all, it is education that should begin in early childhood and continue throughout life to raise awareness about the dangers of addiction. It is also crucial to eliminate the presence of harmful substances in public areas and levy higher taxes on harmful products; implementing measures such as higher excise taxes can deter the consumption of harmful products. And last but not least, we should introduce solutions and substitutes for addicts as providing support and alternatives to help individuals cope with their addiction is essential. – “We need to take measures to minimise the prominent visibility of harmful substances, ensuring that cigarettes are concealed beneath the counter and that alcohol is not displayed next to mineral water”, prof. Fal recommended as an example of cleaning up the public space. Together with Prof. Andrzej Matyja, they emphasised that while harm reduction strategies are necessary (introducing less harmful alternatives, albeit still harmful), these measures should be accessible only to individuals suffering from addiction-related illnesses, not to the general population. They highlighted the concerning trend of e-cigarettes becoming increasingly common among young people.

– “Sometimes even their parents allow them to vape because they believe e-cigarette nicotine is not harmful”, the medics explained.

Media impact

Barbara Dziuk, Member of Parliament and Vice-Chair of the Parliamentary Health Committee, emphasises the significant role of prevention and education, which she believes cannot be overstated. She highlighted that the removal of stimulant-related information from public spaces should extend to advertising and electronic media content. – “If we fail to implement preventive measures that can influence lifestyles, it may lead us to a health crisis.” She also recalled the introduction of the Sugar Act or the roadmap for excise duty increases. – “Really, as much sugar as there used to be in drinks is not needed. Predictions of a huge decline in the production and sales of these drinks did not materialise”, she added. Furthermore, she reminded that the tax system is also needed to provide funds to the healthcare system in addition to the contributions of the insured.

Should the roadmap be changed?

Both she and Wojciech Bronicki, a tax adviser and former director of the Excise Duty Department at the Ministry of Finance, pointed out that the “roadmap for excise rates” was established two years ago. An amendment to the Excise Duty Act was approved at the end of 2021. This amendment encompasses the gradual elevation of excise duty rates on ethyl alcohol, beer, wine, fermented beverages, as well as cigarettes, smoking tobacco, novel tobacco, and nicotine products, up until 2027.

– “The fact that this is a five-year timeframe has a major impact on the market for these products. Companies are not taken by surprise, and this is also part of a policy against the spread of stimulants”, noted Wojciech Bronicki.

He added that research shows that fiscal tools are the best mechanisms to influence the reduction of stimulants. – “They cannot be eliminated, but a direction for change can be set”.

The debate participants unanimously concurred on the principle that the most detrimental substances should bear the heaviest taxation burden. They expressed favourable opinions about the existing “roadmap” concept. However, they did not reach a consensus regarding whether the roadmap established two years ago should undergo amendments or remain unchanged until 2027. Wojciech Bronicki emphasised the importance of maintaining predictability in tax adjustments and argued against immediate changes, acknowledging, however, that inflation had influenced the context of these changes. – “The price of beer, which is largely unaffected by tax rates, has gone up, while the price of stronger spirits has not.”

The panellists, who are medical professionals, suggested that it may be worthwhile to contemplate adjusting the rates. – “This roadmap, like any map, should be changed according to the current needs”, Prof. Andrzej Matyja referenced findings from research conducted within the framework of the Polish Health 2.0 project, overseen by the Public Health Committee of the Polish Academy of Sciences. These studies reveal that approximately 30% of the population engages in daily cigarette smoking. – “This is the first such high level in decades”, he added. In his view, this is reason enough to consider the level of excise duty on stimulants. – “We need to define public accountability precisely. If one has rights, one should have duties; does the patient have duties?” – he asked his interlocutors. – “We need to convince patients to take care of the duties that serve them”, he explained. He mentioned the obligation to ride a motorbike wearing a helmet as an example. – “A similar approach should be extended to other societal behaviours. When considering mandatory preventive examinations, it becomes necessary to contemplate response strategies tailored to patients’ behaviours. There is the possibility of implementing either punitive measures or incentives. Many countries have adopted such practices, where a reduced health rate can be offered as an incentive or, conversely, imposed as a consequence”, explained prof. Andrzej Matyja.

Participants in the debate pointed out that there is no network of anti-smoking counselling centres (reportedly treating around 800 people a year) in the health system as there is for other addictions (e.g., alcohol).

Proven solutions

– “We shouldn't dismiss the possibility that increased pricing on certain products may lead to reduced consumption. Balancing two essential factors is crucial, i.e., education and fiscal measures”, emphasised Prof. Halina Car, Head of the Department of Experimental Pharmacology at the Medical University of Białystok. She also acknowledged that the cost of treating addiction-related diseases is not balanced against health excise tax revenues. But she also pointed to another element of public policy that has been introduced in many other countries: – “If a patient cannot stop smoking, an alternative should be offered to them, which is a less harmful substance”. The doctor stressed the importance of reliable education, emphasising that it should not rely solely on fear-based approaches.

Professor Car also believes that it is necessary to implement standards for dealing with people who are addicted. – “First, they should concentrate on harm reduction and then on recovery. It would also be useful to have information in the medical records that the patient is addicted to nicotine, for example.”

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