ABSTRACT
Over the past two decades, divisions have taken shape in Poland that have given rise to high levels of social tension. Huge inequalities have been created, and health care changes have brought those inequalities very close to the bone. The raising of financial barriers to health care has made the lack of a sense of physical safety part of the ‘exclusion’ experienced by a large part of society. The corollary is the growth of the health care market, which has continued throughout the financial crisis – the pharmaceutical industry has been rated as a ‘high-potential foreign direct investment sector’ for the coming year. 2 The spirit of optimism that surrounds such well publicised predictions contrasts with the silence that accompanies the experience of absence of care. It is striking to note that, despite the massive insecurity that is being experienced in the face of Poland’s health care changes, there has been little discussion or research about what loss of health care safety, in tandem with other social changes, has meant in people’s lives. 3 Marketisers cite the growing health care market – the total amount of money spent privately on health care – as reassuring evidence that ‘Poles are better off’. A different story is told by national death rates. Mortality among men was 48 percent higher in Poland than in the countries of ‘old Europe’ in 1990 when communism ended; by 2009 that figure had risen to 58 percent. 4 This increase was largely because health improvements in the intervening period had not been shared equally across the population, but were limited to a relatively narrow affluent social group. 5 Health care changes have been hitting hardest where people need care the most.
