Environment and Health Performance Review

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The present report conveys a clear picture of the current environment and health
situation in Poland. It evaluates strong and weak points of environmental and
health status and policy making in Poland and brings recommendations from
independent experts.
C
Environment and health performance review
Following the decisions of the Fourth Ministerial Conference on Environment and

Health (Budapest, 2004), WHO Regional Office for Europe initiated a project to
ensure that environment and health policy making was more focused on the real
needs of the member states. This included providing country-specific advice in
order to better plan preventive interventions, and to tailor service delivery and
surveillance in the field of environment and health to those needs. Through detailed
Environment and Health Performance Reviews (EHPRs), WHO Regional Office for
Europe is continuing to provide a country-specific analytical description of the
environment and health situation in Member States. The major areas assessed
through this process include the countrys institutional set-up, the methods applied
when setting policy and the legal framework that is available to enforce environment
and health action. Also the capacity of the many sectors, partners and stakeholders
to establish national intersectoral collaboration and the related tools and resources
ensuring action are assessed.
Environment
and health
performance
review
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Scher
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Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18
E-mail: [email protected]
Web site: www.euro.who.int
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World Health Organization

Regional O ce for Europe
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Environment and health

performance review
Poland
Environment and health

performance review
Poland
ABSTRACT
This report describes and evaluates the current environment and health situation in Poland.
It evaluates the strong and weak points of the national environmental and health status
and presents recommendations from independent experts. The conclusions and
recommendations are based on the detailed environment and health performance review
carried out in the country. The review identified the most important environment and
health problems, evaluated the public health impact of environmental exposure and
reviewed the policy and institutional framework, taking into account the institutional setup, the policy setting and legal framework, the degree and structural functioning of
intersectoral collaboration and the available tools for action. This project was developed by
the WHO Regional Office for Europe to follow up the commitments made by Member
States at the Fourth Ministerial Conference on Environment and Health in Budapest in June
2004 to reduce childrens exposure to environmental hazards. The project was designed to
provide the evidence base for developing and implementing such actions. The environment
and health performance reviews are country-based interdisciplinary assessments the WHO
Regional Office for Europe carries out at the request of Member States. Through the
environment and health performance reviews, Member States receive support in reforming
and upgrading the overall public health system.
Keywords
ENVIRONMENTAL HEALTH
HEALTH STATUS INDICATORS
PROGRAM EVALUATION
HEALTH POLICY
PUBLIC HEALTH ADMINISTRATION
POLAND
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World Health Organization 2009
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Text editing: David Breuer

Cover design: Sven Lund
Printed in Denmark by Panthera Design
CONTENTS
Contributors ........................................................................vii
Abbreviations.......................................................................xii
Map of Poland..................................................................... xiii
Foreword.............................................................................xv
Executive summary: main conclusions and
recommendations .............................................................. xvii
Introduction.......................................................................... 1
1
Health characteristics of Polands population ..................... 8
Environment and health priorities ................................... 11
Institutional set-up ........................................................ 27

Socio-political situation, political system and
infrastructure ............................................................. 29
Health sector.............................................................. 31
Environment sector .................................................... 40
Other sectors ............................................................. 42
Tools for management: policy setting and legal

framework .................................................................... 50
Health policies related to environment and health ........ 53
Environmental policies ................................................ 57
Transport policies ....................................................... 60
Economics and funding ............................................... 61
Intersectoral collaboration ............................................. 65
Tools for action ............................................................. 69

Monitoring ................................................................. 72
Environmental impact assessment and health impact
assessment ................................................................ 76
Capacity-building........................................................ 79
Communication .......................................................... 79
References ......................................................................... 83
Annex 1. Additional information by regional priority goal ....... 91
Contributors
Project coordination
Nathalie Rbbel, WHO Regional Office for Europe
Lucianne Licari, WHO Regional Office for Europe
Authors
Nathalie Rbbel, WHO Regional Office for Europe
Dafina Dalbokova, WHO Regional Office for Europe
Reviewers
Lucianne Licari, WHO Regional Office for Europe
Paulina Miskiewicz, WHO Country Office for Poland
National contributors
Marek Bryx, Director, UN-HABITAT Warsaw
Alicja Chybicka, President, Polish Pediatrics Association, Head of
Department of Pediatric Bone Marrow Transplantation, Oncology and
Hematology, Wroclaw Medical University
Krystyna Czaplicka-Trojanowska, Department of Public Health,
Ministry of Health
Donata Czekaa, Manager, Health Programme and Health Promotion
Department, Mazovian Public Health Centre
Lucyna Dygas-Ciotkowska, Deputy Director, Chief Environmental
Inspectorate
Izabela Fengler, Director, Department of Environmental Hygiene,
Chief Sanitary Inspectorate
vii
Pawe Goryski, Head, Department of Medical Statistics, National

Institute of Public Health National Institute of Hygiene
Marek Grabowski, Undersecretary of State, Ministry of Health
Anna Huzior-Balajewicz, Environmental Medicine Unit, Institute of
Pediatrics, Collegium Medicum, Jagellonian University
Marek Jakubowski, Scientific
Occupational Medicine
Secretary,
Nofer
Institute
of
Krzysztof Jamrozik, Project Coordinator, National Road Safety

Council, Ministry of Infrastructure (formerly Ministry of Transport
and Construction)
Mirosaw Jarosz, Director, National Institute of Food and Nutrition
Robert Jeszke, Department of Public Health, Ministry of Health
Krzysztof Kafel, Adviser to the Minister, Department of General
Education and Special Education, Ministry of National Education
Marek Keller, Mayor, City of Bielany
Wojciech Kosinski, Deputy Director, Department of Public Health,
Ministry of Health
Agata Komisarz, Health Promotion Specialist, Mazovian Public
Health Centre
Barbara Krl, Public Relations, National Road Safety Council,
Ministry of Infrastructure (formerly Ministry of Transport and
Construction)
Dominika Krzemiska, Department of International Cooperation,
Ministry of National Education
viii
Zbigniew Kuaga, Head, Public Head Division, Hospital Memorial

Centre for Childrens Health
Krzysztof Kuszewski, Department of Organization and Economy of
Health Care and Hospital Management, National Institute of Public
Health National Institute of Hygiene
Elbieta ata, Director, Department of Public Health and Health
Promotion, Chief Sanitary Inspectorate
Jan K. Ludwicki, Head, Department of Environmental Toxicology,
National Institute of Public Health National Institute of Hygiene
Maria Machlarz, Senior Specialist, Department of Environmental
Hygiene, Chief Sanitary Inspectorate
Joanna Mazur, Unit of Research on Youth Health, Unit of Protection
and Health Promotion of Children and Young People, Institute of
Mother and Child
Krystyna Mikiel-Kostyra, Unit of Protection and Health Promotion of
Child and Young People, Institute of Mother and Child
Maja Muszyska-Graca, Department of Epidemiology, Institute of
Occupational Medicine and Environmental Health
Anna Oblaciska, School Medicine Unit, Unit of Protection and
Health Promotion of Children and Young People, Institute of Mother
and Child
Krzysztof Olszak, Director, Department of Public Health, Ministry of
Health
Katarzyna Paczek, Director, Mazovian Public Health Centre
Tadeusz Parchimowicz, Department of Public Health, Ministry of
Health
Monika Przygucka, Department of Public Health, Ministry of Health
ix
Janusz Popiel, Alter Ego NGO

Krzysztof Przewoniak, Research Director, Department of Cancer,
Epidemiology and Prevention, Institute of Oncology and associated
Health Promotion Foundation
Zbigniew Rudkowski, National CEHAP Programme Coordinator,
Institute of Occupational Medicine and Environmental
Magorzata Sadkowska-Todys, Unit of Zoonoses, National Institute of
Public Health National Institute of Hygiene
Wodzimierz Sekua, Deputy Economic Director, National Institute of
Food and Nutrition
Krzysztof Skotak, Department of Environmental Hygiene, National
Institute of Public Health National Institute of Hygiene
Joanna Skowron, Department of Public Health and Health Promotion,
Janus Sawomir, Director, Unit of Protection and Health Promotion of
Children and Young People, Institute of Mother and Child
Anna Starzewska-Sikorska, Institute for Ecology of Industrial Areas
Halina Strugaa-Stawik, Foundation for Children from the Copper
Basin
Janusz witczak, Head, Department of Environmental Hygiene,
National Institute of Public Health National Institute of Hygiene
Katarzyna Szamotulska, Head, Department of Epidemiology, Unit of
Protection and Health Promotion of Child and Young People, Institute
of Mother and Child
Tomasz Szkoda, Deputy Director, Department of Epidemiology, Chief
Sanitary Inspectorate
Lucjan Szponar, National Institute of Food and Nutrition

Jolanta Turek, Health Promotion Specialist, Mazovian Public Health
Centre
Iwona Traczyk, Deputy Director, National Institute of Food and
Nutrition, Warsaw
Poitr Turzanski, Chief Specialist, Department of International
Cooperation, Ministry of National Education
Anna Wajnbergier, Adviser to the Minister, Department of Global
Environmental Issues and Climate Change, Ministry of Environment
Miroslaw Wysocki, Director, National Institute of Public Health
National Institute of Hygiene
Andrzej Zieliski, Deputy Director, National Institute of Public Health
National Institute of Hygiene
xi
Abbreviations
APHEA
APHEIS
CEHAPE
COPHES
ECNIS
EHPR
ENHIS
ESBIO
GDP
INCHES
LEHAP
NEHAP
NGO
NIPH-NIH
OECD
PM
PPP
SCOEL
UNECE
UNICEF
WHO
xii
Air Pollution and Health A European Approach

Air Pollution and Health: A European Information
System
Childrens Environment and Health Action Plan
for Europe
Consortium to Perform Human Biomonitoring on a
European Scale
Environmental Cancer Risk, Nutrition and
Individual Susceptibility
environment and health performance review
European Environment and Health Information
System
Expert Team to Support Biomonitoring in Europe
gross domestic product
International Network on Childrens Health,
Environment and Safety
local environment and health action plan
national environment and health action plan
nongovernmental organization
National Institute of Public Health National
Institute of Hygiene
Organisation for Economic Co-operation and
Development
particulate matter
purchasing power parity
Scientific Committee on Occupational Exposure
Limits
United Nations Economic Commission for Europe
United Nations Childrens Fund
Map of Poland
Source: United Nations Map, No. 3784 Rev. 4, January 2004.
xiii
xiv
Foreword
The purpose of this report is to convey a clear picture of the current
environment and health situation in Poland. It evaluates the strong and
weak points of environmental and health status in Poland. It also
brings recommendations from independent experts.
The process of preparing the environment and health performance
review began in March 2007. A Childrens Environment and Health
Action Plan for Europe (CEHAPE) workshop took place with the aim
of supporting the national counterparts in the development of a
national childrens environment and health action plan.
The evaluation mission took place from 2 to 6 July 2007 in Warsaw.
During this field visit, the WHO team met 54 representatives from 21
institutions from various sectors involved in environment and health.
The national contributors are acknowledged at the beginning of this
report.
The information included in this report is valid until the time of the
EHPR mission was completed, ie 6 July 2007. Since then, changes
have occurred in the structure of the various institutions. New staff
members now fill various positions.
The environment and health performance review for Poland was
carried out thanks to the efforts and support of Polands Ministry of
Health, under the supervision of the Undersecretary of State, Marek
Grabowski. Special thanks are due to Zbigniew Rudkowski, National
CEHAPE Programme Coordinator and Robert Jeszke, Department of
Public Health of the Ministry of Health, who organized the visit,
contacted all relevant sectors, provided background information and
shared their valuable time.
We are also grateful to the WHO Country Office for Poland and
especially the Head of the Country Office, Paulina Miskiewicz, for all
her assistance and support in the preparation and implementation of
the mission.
xv
We acknowledge Grant Agreement 2005156 from the European

Commission, Directorate-General for Health and Consumers for the
support in implementing this project and preparing this report.
Lucianne Licari
Regional Adviser for Environment, Health Coordination and
Partnerships
Partnership and Communications
WHO Regional Office for Europe
xvi
Executive summary: main conclusions and

recommendations
Main conclusions
The quality of the environment has improved.
The use of data is not sufficiently organized and institutionalized.
Environment and health are dealt with by two parallel systems: the
environment and sanitary inspectorates.
Intersectoral collaboration functions better at the level of institutes
and at the local level and with the private sector than at the
government level.
The responsibilities need to be clarified in health impact
assessment, environmental impact assessment and environmental
health impact assessment.
Children are well recognized as special target groups of policies
and programmes. Prevention is well focused on children.
Capacity-building, training in environment and health and
environment and health in the medical curriculum are not
sufficiently developed.
Environment and health are tackled predominantly from a research
perspective, but the translation of the research results into the
policy advisory function for the institutions is not clearly defined.
Many prevention activities focus on behaviour and less on
structural elements.
Related ministries (such as the Ministry of Finance) do not provide
any financial contributions.
Economic arguments and health costs are not used for setting
priorities or for informing or convincing policy-makers to take
preventive measures.
Recommendations
Research results need to be better translated into policy decisions.
Basic and supplementary training on environment and health for
general practitioners and paediatricians needs to be further
institutionalized.
xvii
A more concrete programme on health and environment should be

prepared as an integral part of the new National Health
Programme. Clear synergies need to be established between the
environment and health policy programmes.
Integrated economic analysis (such as costbenefit analysis) should
be used more systematically in environment and health policymaking.
A statutory framework should be developed for including the
European Environment and Health Information System (ENHIS)
and health impact assessment in planning, monitoring and
evaluating environment and health policy and action programmes.
An institutional entity should be designated as a formal body to
coordinate the implementation of environmental health impact
assessment in Poland.
The quality of the environment has steadily improved in Poland in the
past 15 years. However, there are still many environmental risk factors
to health. The main environment and health issues in Poland include
water and sanitation, exposure to environmental tobacco smoke and
urban outdoor air pollution, road traffic injuries and unintentional
injuries among children. Overall, transport is one of the major
problems at the urban level, resulting in high air pollution and
increased risk of road traffic injuries.
The National Health Programme reflects these priorities and also
emphasizes the need for protecting children and for giving priority to
socioeconomic inequality. Nevertheless, the priorities set by
environment and health activities and programmes do not often
explicitly reflect socioeconomic inequality.
Besides specific environment and health risks, there are concerns
regarding structural aspects of environment and health policy-making.
From an institutional perspective, many sectors and institutions are
tackling different aspects of environment and health and do not seem
to coordinate sufficiently. The Chief Sanitary Inspectorate is
responsible for environment and health from a sanitaryepidemiological perspective, while the National Institute of Public
xviii
Health National Institute of Hygiene is responsible for advising on

setting legal provisions but also for monitoring and risk assessment.
Environment and health is delegated to two institutes, which are also
in charge of monitoring, risk assessment and project implementation.
Although environment and health are tackled predominantly from a
research perspective, the policy advisory function for the institutions
involved is not very clearly defined.
Different administrative levels increase the difficulty in developing
and implementing adequate environment and health activities.
The role of physicians in the environment and health process needs to
be strengthened, thereby strengthening their role in disease prevention.
Adequate training and continuing education in environment and health
are required. Initial steps have been made by establishing an
Environmental Health Training Centre at the Institute of Occupational
Medicine and Environmental Health in Sosnowiec in 2001. However,
basic and supplementary training on environment and health for
general practitioners and paediatricians needs to be institutionalized
further.
Environmental health threats are clearly addressed and recognized in
political principles (the Constitution) and are acknowledged by both
the national health and environment policy programmes. However, the
two programmes need to be linked better. The Long-Term
Governmental Programme Environment and Health jointly
developed by the Ministry of Health and the Ministry of Environment
as an implementation programme of the national environment and
health action plan (NEHAP) was carried out between 2000 and 2004
and has not been renewed since.
The NEHAP has supported the establishment of synergies between
environment and health activities and the childrens environment and
health action plan (CEHAP), which is being prepared and is
considered to be an essential tool in guiding the national environment
and health process. It is recommended that the CEHAP be an integral
part of the National Health Programme. This Programme functions
through an interministerial coordination group. Poland has made
significant progress in developing an intersectoral approach in
environment and health policy-making. The National Road Safety
xix
Programme is a good example. Nevertheless, the intersectoral

collaboration in Poland is very different at different operational levels.
Generally speaking, it seems that the collaboration functions better at
the local or voivoidship level, where common activities and decisions
are often initiated and taken on a more personal basis than at the
national level.
An intersectoral approach is to be strengthened also from financial and
economic perspectives. Economic arguments and health costs are not
used enough for setting priorities or for informing or convincing
policy-makers to take preventive action when drafting regulations that
are relevant for preventing health risks due to environment.
Poland has made progress on compiling and providing access to
environmental information. The Act on Information on the
Environment and its Protection and on Environmental Impact
Assessment stipulates the right of access to information. A great
variety of institutions identify and monitor environmental hazards,
from both the health and the environment sides, resulting in a
scattered monitoring approach. There is considerable information but
not a uniform approach to preparing, analysing and reporting to
support health and environment policy action. The data are scarcely
shared between institutions. The National Institute of Public Health
National Institute of Hygiene routinely collects health indicators. But
monitoring focuses on either health or environment, and integrated
health and environment information is lacking.
This is also true for health impact assessment and for environmental
health impact assessment. The health component within
environmental impact assessment reports is still insufficient and
inappropriate. The national report prepared in 2002 on the impact of
the national environment and health action plan and the WHO
European environmental policy stressed the importance of upgrading
environmental health impact assessment and risk assessment
procedures. Although the national collaborating centre has
implemented activities in this regard, a national accreditation system
still needs to be established for experts on environmental health
impact assessment, and the methods of health impact assessment and
environmental impact assessment need to be developed further.
xx
Priority-setting in environment and health should be supported by the

use of standardized tools. The European Environment and Health
Information System (ENHIS) is a recommendable tool to be
implemented as a national environment and health information system
at both the national and regional levels.
Although access to information about environmental conditions and
the health status of the population is a basic right in Poland, society
still seems to be little aware of environmental risk factors. The
existing information is not systematically communicated to the public,
and the mass-media presence seems to be more present in specific
environment and health fields (nutrition and physical activity) than in
others. Disease prevention campaigns in the mass media are not
disseminated for free, adding to the difficulties of public or
nongovernmental institutions of disseminating information on
environment and health risks.
xxi
Environment and Health Performance Review Poland
Introduction
The main objectives of the environment and health performance
reviews are:
to assist Member States in building up a national institutional

framework that will make it possible to draft national action
plans addressing childrens health and environment;
to provide a country-based analytical description of the

environment and health situation; and
to determine whether health policies are well designed to

prevent ill health caused by environmental determinants.
Background
Preventing disease and injury is at the heart of public health and health
systems. The environment is responsible for as much as 24% of the
total burden of disease (1).
Environmental health comprises the aspects of human health and
disease that are determined by factors in the environment. It also
refers to the theory and practice of assessing and controlling factors in
the environment that can potentially affect health. According to the
definition used by the WHO Regional Office for Europe,
environmental health includes both the direct pathological effects of
chemicals, radiation and some biological agents and the effects (often
indirect) on health and well-being of the broad physical,
psychological, social and aesthetic environment (2). In this report, the
relationship between environment and health is denoted as
environment and health. This covers all human health issues that are
related to environmental factors and all environmental factors that
may (possibly) affect health (either negatively or positively).
In 1989, the WHO Regional Office for Europe launched the European
Environment and Health Process through a series of ministerial
1
conferences, with the aim of eliminating the most significant

environmental threats to health as rapidly as possible, based on the
premise that prevention is better than cure.
Environment and health issues are essentially cross-sectoral, and
human health can only be protected from the risks posed by a
hazardous or contaminated environment through the coordinated input
of different sectors and greater capacity on the part of the health sector
to enlist the support of these actors to develop a high level of targeted
activities and to ensure consistency and synergy with other relevant
commitments made by Member States (3,4).1 The importance of
coordinated input from different sectors was recognized by the
ministers attending the Second Ministerial Conference on
Environment and Health in Helsinki (5) and endorsed in the
commitments of the framework action plan the Environment and
Health Action Plan for Europe (EHAPE). This plan called for the
development of national environment and health action plans
(NEHAPs). The theme of the Third Ministerial Conference on
Environment and Health held in London in 1999, Action in
Partnership (6) continued to promote this key message and relevant
commitments. Following the Fourth Ministerial Conference on
Environment and Health in Budapest in June 2004, the Member States
refined their action plans to addressing vulnerable populations, most
especially children and committed to reducing childrens exposure to
environmental hazards, countries are now seeking support for
1
The Budapest Declaration (4):

recognizes the relevance of national environment and health action
plans (NEHAPs) and commend the continuing efforts to implement
and evaluate them (paragraph 6);
calls on organizations to establish mechanisms for coordinating
technical and financial assistance to the newly independent states and
countries of south-eastern Europe, in order to stimulate legislative and
institutional reforms, strengthen countries capacities and effectively
reduce exposures to environmental hazards and their health impacts
(paragraph 20c); and
invites the WHO Regional Office for Europe to support the
initiative of the newly independent states and some countries of southeastern Europe to reform and upgrade their sanitary/epidemiological
services and set up public health systems (paragraph 20d).
implementation work. To provide assistance to member states, the

WHO Regional Office for Europe ensured implementation of a DG
Sanco funded project that would provide the evidence base for
developing and implementing such actions.
Objectives
Through detailed environment and health performance reviews
(EHPRs), the WHO Regional Office for Europe provides countrybased analytical descriptions of the environment and health situation
in Member States. The major areas of this strategic analysis are the
institutional set-up, the policy setting and legal framework, the level
and structural functioning of intersectoral collaboration and the
available tools for action. This interdisciplinary assessment
objectively examines the relevant policy and institutional framework
and gives guidance for strengthening environment and health policymaking, planning preventive interventions, ensuring service delivery
and conducting surveillance in environment and health. The most
important environment and health problems in the country are
identified and the public health impact of environmental exposure is
assessed. The national performance review is conceived as an integral
part of the planning and management of environment and health
services and is performed at the request of the Member State
concerned.
The EHPR process

The EHPRs are based on a programme of Environmental Performance
Reviews (EPRs) launched in 1991 by the Organisation for Economic
Co-operation and Development (OECD) to help OECD member
countries improve their individual and collective performance in
environmental management. The programme was mandated to the
United Nations Economic Commission for Europe (UNECE) in 1993
to ensure coverage of the whole region of Europe (7,8). In the period
19972004, the WHO Regional Office for Europe contributed to the
3
EPRs, providing a review of the health aspects related to the

environment.
Since the EPRs focus on environmental management, WHO Regional
Office for Europe recognized the benefits of using this existing tool
and developing its analysis to cover the relationship between human
health and the environment and between the environment and health
policy management (911).
The EHPRs are in line with and draw on the national profiles of
childrens health and environment developed by WHO headquarters
(12) and are strongly linked to ongoing Regional Office environment
and health programmes. The ENHIS records information about the
national approach to linking environmental conditions and public
health, its importance for healthy environmental policy and
measurement of the countries progress towards the targets set in the
Europe-wide action programmes (13). The ENHIS provides reliable
and standardized information about the health status of children, its
determinants and its trends. It uses internationally available data
sources and monitors and evaluates the effectiveness of policies.
The ENHIS is a standardized approach within the EHPRs to make a
situation analysis from a WHO European (Region-wide) perspective.
The analysis is then further complemented with the information
gathered in the review process.
As in the case of ENHIS, the EHPRs focus on risk factors that most
affect the health of European children. At the Fourth Ministerial
Conference on Environment and Health in 2004, ministers agreed to
give priority to four regional priority goals for Europe (3):
regional priority goal 1: prevent and significantly reduce the

morbidity and mortality arising from gastrointestinal disorders
and other health effects, by ensuring that adequate measures are
taken to improve access to safe and affordable water and
adequate sanitation for all children;
regional priority goal 2: prevent and substantially reduce health

consequences from accidents and injuries and pursue a decrease
in morbidity from lack of adequate physical activity, by
promoting safe, secure and supportive human settlements for all

children;
regional priority goal 3: prevent and reduce respiratory disease

due to outdoor and indoor air pollution, thereby contributing to
a reduction in the frequency of asthma attacks, to ensure that
children can live in an environment with clean air; and
regional priority goal 4: reduce the risk of disease and disability

arising from exposure to hazardous chemicals (such as heavy
metals), physical agents (such as excessive noise) and
biological agents and to hazardous working environments
during pregnancy, childhood and adolescence.
The implementation of EHPRs is made possible by the European

Commission through its Directorate-General for Health and
Consumers. In support of the European environment and health
process, the European Commission has identified the need to develop
and strengthen policy actions to reduce the risk of disease and
disability arising from agents in the environment in Europe and is cofunding this activity of the WHO Regional Office for Europe.
Methods
A team of WHO technical experts carries out each EHPR at the
request of the health ministry of the country concerned. It takes the
form of semi-structured interviews with national technical
representatives and policy-makers. Two series of reviews are
conducted; one is part of the project funded by the European
Commission, and the second results from the bilateral Biennial
Collaborative Agreements (BCA) between WHO and the various
health ministries. Polands EHPR is part of the former.
The EHPR comprises the steps described below.
1.
The standardized method for the review developed at the

beginning of the process is applied to all Member States.
2.
Consultations are held with the head of the WHO country office
and assistance and advice are sought on timing and the
personnel involved.
3.
Prior consultations are held with the environment and health

focal point or project counterpart within the Member State.
4.
Relevant policies, information, evidence and data are collected

and analysed; and the national counterpart organizes the WHO
field visit.
5.
The field trip by the WHO technical team to the country takes
place; interviews are conducted with preselected representatives
of sectors and institutions.
6.
A draft report is compiled, summarizing the information

collected during the field visit.
7.
A final report with recommendations for action is submitted

back to the counterpart, the head of the WHO country office
and interviewees.
8.
Final conclusions are presented to policy-makers at a national

workshop.
All the EHPR final reports will be collated into a single global report
to be presented at the WHO Fifth Ministerial Conference on
Environment and Health to be held in Parma, Italy in 2010.
Structure of the report

The status of the environment and health situation in Poland
summarized in this report, reflects the situation in the first decade of
the 21st century and can be considered as a national baseline analysis
after the commitments made at the Fourth Ministerial Conference on
Environment and Health in Budapest in 2004. The information and
data summarized in this reported is valid till its final collection and
collation ie 6 July 2007, which is the last day of the EHPR in Warsaw.
The report is made up of six chapters. The first two chapters describe
the health characteristics of Polands population and the major
environment and health risks in Poland. The following chapters
describe the institutional set-up in environment and health, the legal
framework under which environment and health policy is
implemented, the degree and functioning of intersectoral collaboration
mechanisms and the tools available for the operation of environment
and health services (such as: monitoring, environmental health impact
assessment and health impact assessment, capacity-building and
communication). Recommendations are formulated depending on the
background situation and are clearly set out at the beginning of each
chapter.
1 Health characteristics of Polands

population
Conclusions
Main causes of death: cardiovascular diseases and cancer
High mortality rate for road traffic injuries in children and young
people
WHO estimate of the environmental burden of disease for Poland:
17%
Life expectancy at birth in Poland in 2005 was 71 years for men and
79 years for women (14). In comparison to the other new European
Union (EU) members, Poland is in the middle of the range. The life
expectancy is above the average for the WHO European Region,
particularly for women.
In 2004, cardiovascular diseases accounted for 46% of all deaths and
cancer for 25%. They were followed by external causes, respiratory
diseases and diseases of the digestive system (7%, 5% and 4%) (15).
Cardiovascular diseases and cancer are the leading causes of death in
most countries in the WHO European Region, although the percentage
vary between the countries.
Fig. 1. Leading causes of death in Poland, 2004
Cardiovascular diseases
Cancer
External causes
Respiratory diseases
Diseases of the digestive system
0
10
20
30
40
50
Source: Concise statistical yearbook of Poland (15).
WHO estimates on the burden of disease in Poland show that

environmental risk factors accounted for 17% of the total burden of
disease in 2004 (16).
Childrens health overview according to the regional

priority goals
The standardized mortality rate for road traffic injuries among people
aged 024 years is 9.3 deaths per 100 000 population and is above the
average for the European Region. Road traffic injuries contribute
significantly to the overall burden of mortality among people younger
than 25 years in Poland. Mortality among children (119 years old)
due to unintentional injuries (drowning and submersion, poisoning,
falls and exposure to smoke, fire and flames) is also slightly above the
median range compared with other countries in the European Region
(17).
The rate of postneonatal deaths from respiratory diseases is 0.20 per
1000 live births (17); Poland is in the middle group of countries.
Nevertheless, the European Region still differs between the western
and eastern countries. Asthma and allergies are the most common
9
chronic diseases in children reported by Poland to the International

Study of Asthma and Allergies in Childhood study, but the prevalence
of asthma (10%) is relatively low among children aged 1314 years.
Poland reported a high and rising rate of allergic rhino-conjunctivitis
symptoms among children 67 years old and 1314 years old.
10
2 Environment and health priorities

Conclusions
Environment and health risks and major determinants of health
The environment and health situation has improved overall.
Health risks arise from water and sanitation.
Exposure to environmental tobacco smoke and particulate matter
(PM10) are high.
The rates of road traffic injuries and unintentional injuries among
children are high.
There is little awareness of health risks deriving from climate
change, both in civil society and government institutions.
Public health
Children are well-recognized as a key priority of the public health
system.
Preventing environment and health risks is often not explicitly
considered a public health priority.
Socioeconomic inequality is reflected in the objectives of the
National Health Programme but is not often explicitly reflected in
the priorities set by environment and health activities and
programmes.
Structural concerns
The role of the built environment in public health is mostly
acknowledged from a pollutant perspective and not from an
integrated health-centred perspective.
Actions and programmes are fragmented amongst different
stakeholders, resulting in lower efficiency.
Priority-setting in environment and health should be supported by
the use of standardized tools. ENHIS is a recommendable tool to
be implemented at both the national and sub-national levels.
11
Recommendations
Policy measures on preventing exposure to harmful environmental
risk factors have to be strengthened both by actions reducing the
level of pollutants and risk factors and behavioural changes within
the population.
The identification of environment and health priorities should be
strengthened at the national and sub-national levels.
Efforts should be directed towards identifying all data sources
according to the methods underlying the ENHIS.
With the support of the European Commission and in collaboration
with partners from 18 Member States, including Poland, the WHO
Regional Office for Europe developed the ENHIS (13), which has
enhanced the availability and comparability of information on
environment and health across the Region.
The system focuses on the health issues identified in the CEHAPE as
priorities for pan-European action, particularly its four regional
priority goals. The information covers health issues related to
environment, environmental issues affecting childrens health and
actions aimed at reducing or preventing health risks (13).2
12
For all information and data quoted in this section, unless not specified
differently, see the country profile of Poland (17) and the ENHIS fact
sheets (18).
Access to safe and affordable water and adequate

sanitation
Access to a regular, clean and safe drinking-water supply, improved
wastewater and sanitation and safe bathing water are essential factors
in public health. The ENHIS analysis shows that water management is
one of the greatest challenges in Poland.
According to the official data reported by Poland to the
WHO/UNICEF (United Nations Childrens Fund) joint monitoring
programme and used in an ENHIS fact sheet, 96% of the population in
rural areas had access to an improved water supply in the home, and
85% of the population was connected to a public water supply (19).
The percentage of the population served by a sewerage system
connected to a wastewater treatment facility and a safe wastewater
disposal system assesses the potential level of pollution from domestic
point sources entering the aquatic environment, which may adversely
affect the health of the inhabitants. Although significant progress has
been made since 1995, only 58% of the population is connected to
wastewater treatment facilities and only 14% of the population is
connected to sanitation facilities in the home in rural areas (20). This,
in turn, affects the quality of recreational waters.
Compliance with the mandatory requirements for water quality were
fulfilled in only 11.9% of the bathing areas in freshwater zones and
35.3% of the bathing areas in coastal zones. In 2005, Poland had one
of the lowest compliance rates in the framework of the European
Commission bathing water quality directive both in terms of
compliance with standards and insufficient sampling (21). The noncompliance most likely reflects the initial difficulties of new EU
countries in implementing the monitoring schemes. Given the
developments in the implementation of directive 76/160/EEC until
2006, when it was repealed by the new directive 2006/7/EC,
progressive implementation and enforcement can be expected
resulting in improved water quality in European recreational water
environments.
13
Fig. 2. Percentage of the population connected to wastewatertreatment facilities in Poland, 19952003

70
60
50
%
40
30
20
10
0
1995
1998
2001
2003
Source: Wastewater treatment and access to improved sanitation (20).
14
Fig. 3. Percentage of the population connected to sanitation facilities

in urban and rural areas in selected countries in the WHO European
Region, 2004
Source: Wastewater treatment and access to improved sanitation (20).
15
Fig. 4. Bathing water quality in freshwater zones in the EU, 2005
Source: Bathing water quality (21).
16
Fig. 5. Bathing water quality in coastal zones in the EU, 2005
Source: Quality of bathing water, 2005 bathing season (22).
Reduce health consequences from accidents and injuries

and enhance physical activity
As mentioned in the previous chapter, unintentional injuries are a
leading cause of morbidity and mortality among children and
adolescents in the WHO European Region. In Poland, the mortality
rates due to road traffic injuries among people aged 024 years (9.28
17
per 100 000 population) and the mortality rates due to unintentional
injuries among children 119 years old (3.38 per 100 000 population)
are only slightly above the European average but still unacceptably
high.
18
Fig. 6. Standardized mortality rates for road traffic injuries among

people aged 024 years in the WHO European Region, averages for
20022004 or the most recent three years
Source: Mortality from road traffic injuries in children and young people (23).
The ENHIS analysis shows that the high prevalence of unintentional

injuries and road traffic injuries has increasingly been recognized as a
19
priority at the European level, and country efforts should be further

strengthened and improved. The indicator summarizing the
implementation of 12 policies towards injury prevention (excluding
road traffic injuries) based on the information from 23 WHO
European Member States shows that Poland is within the range of
moderate to low commitment towards injury prevention.
A safe environment that encourages personal mobility and physical
exercise is important for health and preventing obesity and excess
body weight. Although the prevention of injuries does not seem to be
commonly promoted in Poland, policies to reduce and prevent excess
body weight and obesity in children and adolescents have been
steadily improved. With a score of 19, Poland is above the mid-point
of the scoring scale, which is 12. Self-reported data from the countries
participating in the Health Behaviour in School-Aged Children survey
show that Poland ranges in the average of countries with 11-year-old
boys who were physically active at the level recommended by the
moderate-to-vigorous physical activity guidelines. Further, the
prevalence of excess body weight (including obesity) among 13-yearold boys in Poland is lower than the average in the European Region.
20
Fig. 7. Percentage of children and adolescents undertaking sufficient

physical activity in selected European countries, 2001/2002
Source: Percentage of physically active children and adolescents (24).
21
Ensure environments with clean air to reduce respiratory

diseases
Multiple factors interact to determine respiratory health, including
indoor and outdoor air pollution. With a rate of 0.20 postneonatal
deaths per 1000 live births due to respiratory diseases, Poland is in the
overall range of countries with low levels of mortality but still greater
than those in western European countries. The asthma prevalence in
Poland is below or at the average of countries most affected by these
types of health risks, although asthma symptoms are increasing among
children 67 and 1314 years of age. For allergic rhino-conjuctivitis,
Poland has the highest prevalence of the countries participating in the
International Study of Asthma and Allergies in Childhood, and the
prevalence is rising.
About 88% of children 1315 years old are exposed to environmental
tobacco smoke at home and 90% outside the home. Environmental
tobacco smoke is by far the most important indoor air quality issue in
health terms, and Poland is strengthening its policies to reduce
childrens exposure. The WHO tobacco control database (25) and the
information summarized in an ENHIS fact sheet (26) show that
smoking is prohibited in every means of public transport, educational
facilities, workplaces and public places (with special smoking areas).
The high level of environmental tobacco smoke exposure at home
shows the need for further strengthening health promotion and raising
awareness centred on activities and programmes aiming at behavioural
changes among the population.
22
Fig. 8. Proportion of children 1315 years old exposed to

environmental tobacco smoke in their homes, 20022005
Source: Exposure of children to environmental tobacco smoke (27).
23
The mean concentration of particulate matter with an aerodynamic

diameter of less than 10 m (PM10) calculated for cities in Poland is
30.6 g/m3; Poland thus has a relatively high level of outdoor air
pollution in urban areas among the countries of the European Region
for which data are available. However, outdoor air pollution is
declining in Poland, and urban air quality monitoring and reporting
has improved significantly (28).
Poland has low radon gas concentrations in dwellings.
Reduce disability and disease arising from exposure to

hazardous chemicals, physical and biological agents and
hazardous working environments
Leukaemia is the most frequent type of malignancy among children in
industrialized countries. It is a subject of considerable public concern,
especially in the areas perceived as having excessively high incidence
and in relation to putative environmental causes such as radiation and
chemicals. In Poland, the standardized incidence is 32.3 per million
population per year, one of the lowest in the European Region.
Lead concentrations in the blood of children, which constitute a
credible biomarker of exposure to lead, have declined since unleaded
fuel was introduced. Nevertheless, exposure of children remains
higher near industrial emitters of lead than in other areas. Geometric
mean concentrations of lead in the blood of children living near
copper and zinc smelters in 20022007 ranged between 5.5 and 7.7
g/dl. The geometric mean concentrations of lead in the blood of
children living in control group areas in 20042007 were about 3.0
g/dl.
Children are particularly vulnerable to damage related to ultraviolet
radiation. Much exposure to ultraviolet radiation occurs in childhood
and thus determines the risk for severe diseases such as malignant
melanoma and skin cancer. It is particularly important to increase the
promotion of sun protection behaviour and to ban the use of sun beds
by young people. The age-standardized rates of melanoma among
24
people younger than 55 years in Poland are lower than in many other
countries, especially the northern part of the European region. Poland
is showing a low degree of implementation of action to reduce the
exposure of the population to ultraviolet radiation.
Summary
Summarizing the results obtained from the overview provided by the
ENHIS indicators according to the four regional priority goals defined
in the CEHAPE, water and sanitation, exposure to environmental
tobacco smoke and urban outdoor air pollution, road traffic injuries
and unintentional injuries among children are the main health and
environment concerns in Poland.
The National Health Programme reflects these priorities. They are also
very much in accordance with the priorities and concerns expressed by
public health professionals during the review. Water and air quality
are perceived as being major risk factors for the health of Polands
population. The review shows that water contamination occurred more
often in small water supplies and more rarely in the medium-sized
ones. About 10% of the samples taken did not comply with the
standards. The non-compliance mainly referred to the levels of iron,
manganese, turbidity, less often to the level of ammonia, and in 2% to
other analysed water parameters.
Closing many industrial plants has steadily improved air quality. In
consequence, the quality of the environment has improved in the past
15 years, and the concentration of total suspended airborne particles
(industrial dust) declined by two orders of magnitude. Air quality is
still considered to be a major environmental risk factor to health.
Transport is seen as a major problem at the urban level, resulting in
high air pollution and noise and an increased risk of road traffic
injuries.
In addition to the results of the ENHIS, according to the opinion of the
public health professionals the review underlines additional
environment and health risks relevant for Poland. The most frequent
25
food outbreaks were Salmonella and Campylobacter, with general

patterns changing to more nora viruses and rotaviruses.
Besides specific environmental health risks, concerns focus on
structural aspects. The new National Health Programme specifically
declares children to be a national priority and at the core of several
activities initiated in the health sector. The National Health
Programme stresses the need for giving priority to reducing
socioeconomic inequality, but the priorities set by environment and
health activities and programmes often do not explicitly reflect this.
Socioeconomic inequality is still a major determinant of exposure to
environmental health risks in Poland.
Distributed EU funds mostly support the structural development of the
country (European Investment Bank, EU revitalization programmes
etc.) with a specific focus on revitalizing the urban and built
environment. Nevertheless, the review has shown that the effect of the
built environment on public health has been recognized only in the
context of emission risks arising from construction materials. The role
of home safety measures in injury prevention still needs to be
developed further.
The identification of environment and health priorities should be
strengthened at the national and sub-national levels. Most of the
information used by the ENHIS is available within Poland. Efforts
should be directed towards identifying all data sources according to
the methods underlying the ENHIS. The establishment of a framework
for accessing and exchanging this information to ensure its use for
assessing health needs would strongly support public environment and
health policy-making. The cost-effectiveness of such an intervention
can be considered very high.
26
3 Institutional set-up
Conclusions
Different levels of administration create difficulty in developing
and implementing adequate environment and health activities.
At the government level, the environment as an explicit
determinant of public health is covered through the Department of
Environmental Hygiene of the Chief Sanitary Inspectorate.
Nevertheless several governments, quasi-governmental and
research-oriented institutions are responsible for managing
environment and health risk factors, actions and programmes.
Environment and health are tackled predominantly from a research
perspective. The policy advisory function of the institutions
involved in environment and health is not very clearly defined.
Environment and health are predominantly covered through an
occupational health approach.
Many different institutions tackle different aspects of environment
and health and do not seem to coordinate sufficiently.
Many institutions dealing with environment and health issues do
not seem to be involved in the work of the public health
institutions.
Local governments are given the responsibility to implement
environment and health measures, but insufficient resources
(capacity and expertise as well as financial resources) are allocated
to them.
No nongovernmental organizations (NGOs) focus on environment
and health; single NGOs tackle environment and health relevant
issues individually.
The role of physicians in the environment and health process is not
well defined; they are mainly seen as the interface with civil
society but have no specific involvement in or awareness of
environmental health.
27
There is considerable high-quality expertise in environment and

health, and it effectively contributes to implementing European
programmes and projects. However, the expertise is not
sufficiently used in national programmes. The collaboration and
transfer of the good practice within the country is rather limited.
Recommendations
Physicians should be more actively involved in preventive action
better information generated by government authorities dealing
with environment and health and direct collaboration with medical
societies would help in this task.
Improved and stable employment opportunities should be created
for environment and health professionals.
Environment and health NGOs representing public and
professional interests in environment and health policy- and
decision-making should be strengthened.
Efficiently allocating the available financial resources requires
coordinating the responsibilities among all the institutions
involved.
Setting up an operational mechanism integrating the existing health
and environment information and ensuring involvement of
different stakeholders dealing with public health and
environmental monitoring will facilitate sharing information and
experience, using the national expertise and evaluating ongoing
programmes and projects. For the integrated information
mechanism, an infrastructure of distributed data systems and a
network of institutions with mandates for environmental and health
monitoring and assessment should be established.
This chapter gives an overview of the political system and
infrastructure of Poland. It outlines the institutions involved in
environment and health policy-making, both in the health sector and
in all other relevant sectors. The environment is especially
emphasized. The following list is not exhaustive, as not all sectors
28
could be reached or approached during the review. Little information

is available on the Ministry of Agriculture and Rural Development. In
addition, Poland has a variety of small institutes and local or regional
research centres that might have some activities in environment and
health. For the scope of this review, the only institutions mentioned
and described are those outlining environment and health activities as
specific objectives of the institution.
Socio-political situation, political system and

infrastructure
Poland is the largest country in central and eastern Europe in both
population (38.1 million) and area (312 685 km2) (2931). Poland
entered the EU in May 2004. It is a social democracy, with a president
as a head of state, and the current constitution dates from 1997. The
government structure centres on the Council of Ministers, led by a
prime minister. The president appoints the cabinet according to the
proposals of the prime minister, typically from the majority coalition
in the Sejm (parliament). The president is elected by popular vote
every five years.
The country is divided into 16 provincial administrative units called
voivodships. The central government appoints the voivod, the
administrator of each voivodship. At a third level of public
administration, since 1990, local government councils are set up as
independent legal entities. A gmina (commune) is an elected council
representing the district population. There are now 2478 gminas of
varying sizes. An intermediate fourth level, the powiat (county), was
added in the elections in October 1998. Since 2008 there have been
378 powiats (including 65 cities with powiat status) covering several
gminas.
Poles make up 98% of the population, with Belarusian, German,
Lithuanian and Ukrainian minorities accounting for the remainder.
Ninety-five per cent of the population is Roman Catholic. In terms of
29
ethnicity, language and religion, Poland is more homogeneous than

most countries in the European Region.
Economic problems through the 1980s led to the rise of a strong
independent trade union, Solidarnosc, which forced elections in 1989.
After democratic rule was re-established in 1989, Lech Walesa was
elected President in 1990 and the first full parliamentary election was
held in October 1991.
By 2004, the gross domestic product (GDP) per capita of US$ 12 974
(adjusted for purchasing power parity (PPP)) had more than doubled
in real terms compared with 1991 (14,19).
Table 1. Macroeconomic indicators, 19912005
Indicators
Unemployment
rate (%)
Annual rate of
inflation (%)
GDP per capita in
US dollars
Real GDP per
capita in US
dollars
(purchasing power
parity)
1991
1995
2000
2001
2004
11.8
15.2
15.1
17.4
19
17.7
70.3
27.3
10.1
5.5
3.5
2.1
2 184
3 611
4 475
4 981
6 607
7 932
4 500
7 703
9 529
9 450
12 974
Source: European Health for All database (HFA-DB) (14).
Health expenditure comprised 6.2% of GDP in 2005 (14).
30
2005
Health sector
The main health institutions in Poland responsible for health risks
related to environmental factors are the Department of Public Health
of the Ministry of Health, the Chief Sanitary Inspectorate with its
Department of Environmental Hygiene, the National Institute of
Public Health National Institute of Hygiene (NIPH-NIH), the Nofer
Institute of Occupational Medicine and the Institute of Occupational
Medicine and Environmental Health.

The Chief Sanitary Inspectorate (32) is a body of the central
administration appointed by the Prime Minister and subordinate to the
Minister of Health and it manages the State Sanitary Inspection. There
are 334 sanitary epidemiological stations (318 at the county level, 10
at the borders and 16 at the voivodship level). The responsibilities of
the Inspectorate are established by the Act on State Sanitary
Inspection from 1985. The Inspectorate performs sanitary controls and
is organized in the following departments:
environmental hygiene (municipal, occupational, etc.);

communicable disease control (epidemiology);
public health and health promotion; and
nutrition and food safety.
The Inspectorate has laboratories belonging to sanitaryepidemiological stations that perform analyses in the following areas:
municipal hygiene;
food, nutrition and consumer articles hygiene;
epidemiology;
work hygiene; and
radiation protection.
31
Through a network of institutions at the voivodship and poviat levels

and their own laboratories, the State Sanitary Inspection implements
the above tasks within the framework of:
infectious disease prevention and control;

preventive surveillance licensing permits on project
documentation in relation to sanitary and health requirements,
including conditions concerning construction or change in the
use of buildings; and
running surveillance control of compliance with regulations
concerning environmental health (including water intended for
human consumption, air quality, soil, water, control of
maintaining proper sanitation in buildings, workplaces,
educational facilities and public places, means of transport,
checking conditions of food production, transport, storage and
sale and health conditions of the working environment).
The State Sanitary Inspection is mainly responsible for monitoring the

quality of drinking-water and bathing water. It is in charge of creating
an electronic database on water quality and prepares the annual report
on the state of the country. The Chief Sanitary Inspectorate is
participating in several international projects aiming at strengthening
the monitoring of water quality (such as the PHARE Programme of
the EU). In addition, it informs the population about the quality of the
environment, organizes and carries out educational activity aimed at
health promotion and developing desired attitudes and behaviour
concerning health.
National Institute of Public Health National Institute of

Hygiene
The NIPH-NIH (33) is an applied research institution implementing a
wide range of activities concerning public health, including above all
the evaluation of population health (routinely collected health
indicators). The NIPH-NIH has also a policy advisory function in the
process of preparing laws.
32
It assesses threats to health arising from the exposure to harmful

biological, chemical and physical agents in food, drinking-water and
indoor and outdoor air. The NIPH-NIH provides health risk
assessment and management expertise and elaborates preventive
environmental measures. Particular attention is paid in this respect to
pesticides, polychlorinated biphenyls and mercury.
The NIPH-NIH supports the Chief Sanitary Inspectorate through
specialized training for employees and postgraduate training for
specialists on epidemiology and public health. Training can be
expanded to representatives of industry.
In environment and health, the NIPH-NIH is responsible for
supervising the laboratories in charge of environmental health
monitoring (water quality and air quality laboratories managed by the
Chief Sanitary Inspectorate). It has two accredited laboratories for
physical-chemical and for microbiological parameters.
The NIPH-NIH has four types of environment and health activities. It
has been responsible for setting up all legal provisions for drinkingwater quality and has been involved in collecting data on air quality.3
It tests and assesses the quality of construction materials and deals
with urban noise.
The monitoring and risk assessment of chemicals is a major priority of
the NIPH-NIH.4 Toxicological activities focus on risk assessment
mainly of pesticides (risk assessments for occupational health risks of
pesticides and biocides started recently by using a standardized
computerized program, the same procedures as used in Germany and
the United Kingdom). Besides having the national reference
laboratory for pesticides residues, the NIPH-NIH Department of
Toxicology evaluates the toxicological dossiers for pesticides, food
contaminants, food additives and monitoring of chemical hazards in
3
The Department of Medical Statistics of the NIPH-NIH participated in

implementing European multicentre research on how air pollution
affects human health.
The NIPH-NIH is taking part in the EU programmes (within research
Framework Programmes 5 and 6) on human biomonitoring of persistent
organic pollutants in blood, milk and semen.
33
drinking-water and outdoor air in the context of the state monitoring

such as heavy metals, polycyclic aromatic hydrocarbons,
trihalomethane, bromates and chlorine screening and prepares an
annual report for drinking-water.
Finally, it conducts risk assessment mainly for food safety risks, such
as Salmonella for the rapid alert system of the Ministry of Health.
The NIPH-NIH provides significant expertise in health monitoring
and information systems, health risk assessment and health impact
assessment of air quality and health and contributes to several
European programmes.
Two other institutions deal with environment and
predominantly from an occupational health perspective.
health,
Occupational medicine and environmental health

The Institute of Occupational Medicine and Environmental Health
(34) focuses on research. It is in charge of health promotion at the
workplace through educational activities and for treating diseases
caused by exposure to biological, chemical and physical factors.
Besides the occupational setting, the Institute also analyses
environmental health hazards. It focuses on indoor air quality, noise
levels, electromagnetic fields and ionizing radiation. It is involved in
health impact assessment of industrial plants, sewage-treatment plants,
highways and landfill sites.
Since 1990, the Institute has collaborated with WHO in the process of
developing and implementing the NEHAP, several collaborative
projects between the European Commission and WHO (such as
ENHIS) and has actively participated in the implementing the EU
Strategy on Environment and Health.
34
Nofer Institute of Occupational Medicine

The Nofer Institute of Occupational Medicine (35) is one of the
leading centres in occupational medicine. It has been a WHO
Collaborating Centre for Occupational Health since 1975. Since 2008
it has also been a WHO Collaborating Centre for Environmental
Health. Its activities focus on scientific research and education as well
as international cooperation in occupational medicine, environmental
medicine, public health and epidemiology. It assesses exposure to and
treatment of harmful chemical, physical, psychosomatic and
biological agents in the work environments. The tasks of the Institute
include aspects of occupational physiology, psychology and
sociology, ergonomics, diagnostics and treating acute poisoning. The
Institute measures noise levels at work, vibration, electromagnetic
fields and ionizing radiation and evaluates the harmfulness of
chemical substances and preparations, including the development of
safety cards.
The accredited laboratory of the Chemical Hazards Unit of the
Institute monitors biological exposure to heavy metals (lead, mercury,
arsenic and cadmium), volatile organic compounds, long-lasting
organic contamination and environmental tobacco smoke. Staff
members took part in the process of drafting WHO documents on
long-range transboundary transport of metals and persistent organic
pollutants in the context of the Convention on Long-Range
Transboundary Air Pollution.
The Institute is involved in WHO air quality activities and is a partner
in several large EU projects, such as the Environmental Cancer Risk,
Nutrition and Individual Susceptibility (ECNIS) project (36), and
participates actively in the Consortium to Perform Human
Biomonitoring on a European Scale (COPHES) project as part of the
ESBIO (Expert Team to Support Biomonitoring in Europe) project
under the EU European Environment and Health Action Plan. This
project aims at implementing a system for monitoring the biological
exposure of women and children to chemical factors in EU countries.
The project will probably start being implemented in 2009. The
Minister of Health supported the national participation in the project.
35
In the context of a twinning project co-funded by the EU, the Institute

undertook actions aimed at establishing three national centres focusing
on health and the environment and on environmental health impact
The Institute is cooperating with a large variety of partners: NGOs
(Foundation for Children of the Copper Basin and hosting the
International Network on Childrens Health, Environment and Safety
(INCHES) secretariat), industry (performing training for
representatives of the industry on two systems for registering and
evaluating hazardous substances: derived no-effect level and Scientific
Committee on Occupational Exposure Limits (SCOEL).
Several other health institutions cover activities aiming at preventing
environmental health risks as defined by the WHO environment and
health process and the four regional priority goals despite not having a
specific mandate in environment and health.
Department of Public Health of the Ministry of Health

Within the Ministry of Health (37), the Department of Public Health
covers disease prevention activities related to environment and health.
In relation to the priorities set by the WHO regional priority goals for
the CEHAPE, the most noteworthy activities are in physical activity
and nutrition, road safety, anti-tobacco campaigns and respiratory
diseases (asthma). Prevention activities mainly focus on childrens
health and are often implemented in cooperation with other
institutions (including Keep Fit (38), Road Safety Week and
Freedom to Breathe). However, the Department of Public Health is
mainly responsible for drafting legislation and policy-making, while
the Chief Sanitary Inspectorate is responsible for implementing
prevention activities.
36
Institute of Mother and Child

The Institute of Mother and Child (39) provides health services and
carries out scientific work and research related to protecting children
and youth from environmental health risks. Research carried out
focuses on the impact of endogenous and exogenous factors on the
development and state of health of children and youth including:
biological (newly developing infectious diseases), chemical, including
exposure of children to environmental tobacco smoke, and physical,
including factors contributing to road crashes and accidents occurring
at home and in school. Childrens health is tackled from a social
inequality perspective. The Institute is a partner of the Health
Behaviour in School-Aged Children study, a large multinational,
multi-centre study conducted regularly involving more than 43
countries in the WHO European Region. The study gathers
information on a range of aspects of health among children and
adolescents such as overweight and obesity, physical activity,
smoking and injuries. The Institute has coordinated the information
collected on injuries.
Mazovian Public Health Centre

Institutions acting at the subnational level monitor and promote public
health. The Mazovian Public Health Centre (40) is funded by the
Voivodian Government of Mazowieckie and collects and processes
data on the health status of the population and evaluates the
effectiveness of health care system performance at the regional level.
The Mazovian Public Health Centre is responsible for determining
health promotion priorities and implementing health promotion
programmes. Action for health promotion includes tackling
educational, living and working environments. The overview of the
major projects carried out in the past years shows that priority is given
to health promotion in the school environment targeting children (such
as noise at school and musculoskeletal disorders at school through the
Lighten the Load programme).
37
Childrens Memorial Health Institute

The Childrens Memorial Health Institute (41) covers the food and
environmental situation of schools in Poland. The Institute primarily
focuses on research and provides the highest standard of scientific
evidence. It is actively involved in the Polish Society of Paediatrics. A
Public Health Department was established within the Institute with the
specific task of communicating to the mass media. Next to foodrelated priorities in collaboration with the National Food and Nutrition
Institute, the Childrens Memorial Health Institute is currently
developing a registry of childrens injuries. The Institute collaborates
with the Public Health Institute of the Jagellonian University in
Cracow, a partner of the EU Child Safety Action Plan activities.
National Food and Nutrition Institute

The National Food and Nutrition Institute (42) is a leading scientific
and research institute in preventing non-communicable diseases
related to inappropriate diet and insufficient quality of food and
nutrition. The most important achievement in the 45 years of the
Institute is the dissemination of the nutrition rules and tables of the
nutrition composition of food. The Institute performs research on food
and nutrition for the population and takes part in the activities
preparing Poland for transposing EU regulations and directives on
food management and control into national legislation. It participates
in international projects, in particular EU framework programmes.
A reference laboratory of the Institute conducts research on nutrition
and selected parameters of food safety. In addition, it carries out
educational activities by publishing a bimonthly magazine on human
nutrition and metabolism and a series on works of the Institute as well
as guidelines for physicians, dieticians and patients in the framework
of a series of recommendations from the Institute. It organizes
courses, training, scientific conferences, post-graduate training on
food and nutrition safety as well as dietary counselling.
38
The Minister of Health has nominated the Institute as the responsible

institution for implementing the WHO Global Strategy on Diet,
Physical Activity and Health at the national level. The Global Strategy
is implemented through the national programme for preventing
overweight, obesity and non-communicable diseases through diet and
improved physical activity (20072011).
Other institutes
Finally, two additional institutes cover environment and health. The
Institute of Agricultural Medicine has the main goal of
comprehensively assessing the health status of Polands rural
population in the context of environmental conditions. Its particular
aim is to analyse the occurrence and harmfulness of factors that may
become a hazard for the health of the population and are specific to
the rural environment.
The Interdepartmental Institute of Maritime and Tropical Medicine
(43) analyses how the environment affects the safety of life and work
at sea. The Institute focuses on the environment of marine waters,
inshore and inland waters, assesses the emission of volatile organic
compounds produced by synthetic materials, particularly furnishings,
and analyses the toxicity of heavy metals. Nevertheless, due to the
very specific nature of their mandate, the major actors involved in
environment and health have not mentioned these institutions as
collaborators in any specific project.
Health care workforce

The professional profiles on environment and health are not
sufficiently developed. The role of physicians in the environment and
health process is not adequately defined; they are mainly seen as the
interface to the society but with no specific environment and health
responsibility. Such a view is largely sustained through a lack of
continuing professional development on environment and health,
enabling them to function effectively in the constantly changing world
of environmental threats. This results in little awareness about
environmental health risks.
39
Environment sector
Ministry of Environment and Chief Environmental
Inspectorate
The Ministry of Environment has core responsibility for protecting the
environment in Poland (44). The Chief Environmental Inspectorate
under the Minister of Environment is responsible for monitoring
compliance with environmental protection requirements, assessing the
state of the environment and preventing severe accidents (45). The
Chief Environmental Inspectorate is headed by the Chief
Environmental Protection Inspector and 16 voivodship (provincial)
inspectors operating within the combined central and sub-national
government administrations headed by voivods. Several regulations
specify the tasks in this respect, including: the Environment Protection
Act, the Water Act and the Act on Environmental Protection
Inspection. The main responsibilities of the Inspectorate are
monitoring the implementation and enforcement of regulations
respecting environmental protection and the use of natural resources
and assessing the impact of the adopted environmental protection
policies, plans and programmes. The Inspectorate also monitors the
state of the environment and prepares reports focusing predominantly
on air quality, inland surface water and groundwater, soil and land,
noise, hazardous waste, electromagnetic fields and ionizing radiation.
The monitoring process is in accordance with EU regulations. The
Inspectorate reports to the European Environment Agency and the
European Commissions Directorate-General for Environment. It is in
charge of assessing the environmental effects of policies, plans and
programmes.
Cooperation takes place with the sanitary inspectorates. The
cooperation seems to be functioning better at the regional level than at
the national level. Despite a written agreement between the Chief
Sanitary Inspector and the Chief Environmental Inspector, cooperation
40
is not always straightforward. Collation of health data and

environment data and integration of information is not sufficient.
Institute for Ecology of Industrial Areas

The Institute for Ecology of Industrial Areas conducts research on
appropriate measures for environmental protection (46). The Institute
performs environmental health risk assessment with special emphasis
on how investment, products and waste affect the environment.
Moreover, the Institutes activities cover research on environmental
pollutants and developing technologies for rehabilitating degraded
areas. A priority area of the Institute is waste management, including
municipal waste management.
Institute of Environmental Protection

The Institute of Environmental Protection appointed by the Minister
of Environment conducts research on environmental protection (47).
The Institute is mainly in charge of developing principles and
strategies for environmental protection and for performing integrated
environmental studies, air quality protection, climate protection,
abatement of noise and vibration and the protection of water resources
and waste management. The Institute covers a wide range of activities
including setting standards, environmental monitoring, environmental
education, design of management plans for protected areas and
environmental impact assessment of substances, products and
installations. The Institute of Environmental Protection disseminates
information on the state of the environment.
As the responsibilities in environmental protection are spread among
different institutions, international experts in the pre-accession phase
recommended establishing a national environmental agency to
overcome the organizational difficulties. The agency is currently
being established. In July 2007 a draft was prepared and comments
41
made on the structure based on the water management system

organized across seven regions.
The new institution should not add to the list of existing stakeholders
involved in environmental management but should rather guarantee
the overall coordination in environmental protection activities.
Other sectors
Environment and health issues are essentially cross-sectoral, and
human health can only be protected from the risks posed by a
hazardous or contaminated environment through the coordinated input
of different sectors. The following section analyses the responsibilities
and tasks of ministries and stakeholders relevant for environment and
health policy-making and covering the risk factors emphasized by the
regional priority goals.
Building and infrastructure

Since 2003, the Ministry of Infrastructure (formerly Ministry of
Transport and Construction) has been responsible for regulating the
quality of buildings and urban planning (48). Since 2007, the Ministry
has been organized in three departments: Transport, Construction and
Marine Economy. A specialized Department of Construction and
Architecture mostly implements EU directives.
The Polish Building Research Institute (49), through a specialized
department, prepares expert opinions and provides training on the
quality of the environment, buildings and building products with the
aim of ensuring adequate hygienic and health conditions for the users.
It is in charge of testing the emission of harmful substances from
building products and their influence on the indoor living
environment, workplaces, industrial protection zones and the natural
environment.
42
Transport
The Ministry of Infrastructure takes action to prevent road crashes.
The National Road Safety Council (50) was established in 2002 under
the Ministry. Based on the National Road Safety Council, 16 regional
road safety councils were set up in each region. The Council is an
interdisciplinary body comprising representatives of government
departments and central bodies, voluntary organizations and scientific
experts that meets twice a year.5
Experience shows that, although the Council is meant to be an
interdisciplinary body, not all sectors are equally involved. The
educational sector has dropped out from the process, mainly due to
financial reasons, while the health sector seems to carry out
independent preventive actions on road safety measures. The Ministry
of Infrastructure has a coordinating function but has no legal authority
over the other sectors involved.
The Council nevertheless shows strong cooperation with the private
sector. The automobile industry has been involved in numerous
campaigns, as have the police (which provide the data used by the
Council on morbidity and mortality due to road traffic injuries), NGOs
and religious institutions. Campaigns have been carried out through
the support of churches.
The National Road Safety Council guides and coordinates activities
taken by the central government in road safety: developing road safety
programmes and guidelines and initiating and providing opinions on
legislative acts and regulations. It promotes safe behaviour in road
traffic: cycling licences, producing safety kits for cyclists and
preparing advertisements on road traffic injuries.
5
The members are representatives of regional government authorities

(voivodes) designated by the Prime Minister, the Minister of National
Defence, Justice, Interior and Administration, State Treasury, Finance,
Economy, Regional Development, National Education, Environment,
Infrastructure and Labour and Social Policy as well as the Police
Commander-in-Chief, the Fire Brigade Commander-in-Chief and the
General Director for National Roads and Motorways.
43
Activities are carried out at both the national and local levels. The
local governments are responsible for campaigns focusing on
infrastructural activities. The European Investment Bank is supporting
these initiatives. The estimated budget of the Council for 2007 was
Zl 6 million (about 1.6 million) to be used to assist in infrastructure
development and to develop information material (brochures, leaflets
etc.).
Road safety and the environmental impact of road traffic are at the
core of the activities of the Road Traffic Safety Centre and the
Environmental Protection Centre under the national Motor Transport
Institute. Both centres are technologically oriented as they carry out
research on equipment, methods and systems for reducing vehicle
emissions and testing vehicles fuel consumption.
The activities of these two centres include conducting and
coordinating scientific research and disseminating results on optimal
technical, organizational and economic solutions for enhancing the
safety of road users. The centres collect data on vehicle emissions and
on data on road crashes, which have been recorded here since 1990.
Nevertheless, stakeholders in other sectors do not seem to use or know
these data.
Labour
The Central Institute for Labour Protection (51) is the main scientific
and research institution in Poland comprehensively dealing with issues
related to adjusting working conditions to human mental and physical
abilities.
The Institutes activity covers research and development work leading
to new technical and organizational solutions in labour protection
related to health and safety at work and ergonomics. The Institute is
formulating educational curricula and delivers training and
postgraduate education courses in health and safety at work and
ergonomics.
44
The Institute is also involved in policy-making by preparing and

providing expert opinions on standard-setting in labour protection and
for setting norms for complying with these standards.
Education
The Ministry of National Education (52) develops projects on
environmental and health education (physical, mental and social
health). The main focus is developing and funding projects aimed at
environmental protection or health promotion campaigns at the school
level. Sustainable development and the role of schools in promoting
sustainable development are anchored in the Constitution and in the
Educational Act. The health effects of environmental hazards and
environmental developments are not addressed explicitly.
However, the Ministry of National Education is indirectly involved in
numerous activities that cover the regional priority goals set at the
WHO Fourth Ministerial Conference on Environment and Health. In
injury prevention, the Ministry of National Education has initiated
programmes on safe cycling (cycling licence). Violence prevention at
school is a priority of the educational sector. A government
programme for the improvement of security in schools and
educational institutions (zero tolerance for violence at school) has
been set up for this purpose.
To support the implementation of nutritional policies and physical
activity in schools, beside separate subjects such as physical activity,
cross-curricular themes have been introduced:
primary school (grades 46): health education, ecological
education, education for society and education for family life;
gymnasium (lower secondary school): health education and
ecological education; and
upper secondary school: health education, ecological education and
preparation for family life.
The school principal is responsible for including these themes in the

school curriculum; teachers are responsible for implementation (in the
45
framework of their subjects or during separate lessons). Although

efforts are being made to increase the level of physical activity in
school and to promote healthy lifestyles, the sale of food and
beverages in schools is still not well controlled.
Local governments
The municipalities primarily fund their activities by their own funds
and by national subsidies. Municipalities do not own all their revenue
sources and must therefore fulfil specific expenditure obligations
decided by the central government. For example, drinking-water
supply has been delegated to the local level. The local governments
have to implement the basic requirements stipulated by the law and
have to respond to the Ministry of Health on the improvement of
drinking-water (in the framework of the new National Health
Programme).
Alert systems for pollution incidents (gas, chemicals and fire) are
organized at the level of the city of Warsaw and the districts.
At the municipal level, work mainly focuses on environmental
considerations, such as creating or retaining green spaces in urban
areas, construction of cycling lanes and waste management.
Municipalities support energy-saving insulation activities (households
can apply to the municipality for receiving funds); the same applies
for funding changes in the heating system or the rehabilitation of
panel block buildings.
Local governments are nevertheless very much involved in the local
implementation of prevention programmes, such as the road safety
week or the implementation of the National Road Safety Programme.
They cooperate with NGOs.
From a communication perspective, local governments are raising the
awareness of the population on environment and health, most
specifically on the state of the environment. The Warsaw communal
46
gazette, for example, reports on the air quality in the different districts.
Some have real-time information about air quality (28).
Two pilot local environment and health action plans were set up
within the implementation programme of the NEHAP: Lodz and
Olkusz. To implement the local activities, a Local Environment and
Health Action Plan (LEHAP) Task Force was established for the area
of Lodz comprising representatives of local health and environmental
administration, sanitary and environmental protection inspection as
well as representatives of ongoing programmes related to environment
and health, such as Agenda 21, Healthy Cities and others. One key
objective was to develop an integrated approach to environment and
health issues and capacity needed for developing and planning a pilot
LEHAP. The Ministry of Environment supervised the activities and
the Environmental Protection Department of the Regional
Government in Lodz coordinated them on a daily basis.
47
Nongovernmental organizations
Public participation in the development and policies related to
environment and health services can be channelled through the
involvement of NGOs. Since children are particularly vulnerable to
environmental pollution, they are at the focus of advocacy efforts for
greater protection from health risk factors.
Poland has many NGOs across the country. Nevertheless, no NGO
focuses directly on environment and health. Nationally, the role of
NGOs is mostly seen in raising awareness rather than influencing the
change of regulations related to environment and health. Generally
this is felt to be the responsibility of other associations or institutions.
One major NGO in Poland is the Foundation for the Children of the
Copper Basin (53). They strongly cooperate with the Nofer Institute of
Occupational Medicine. This NGO is supported by local authorities,
enterprises and environmental funds and has the main objective of
monitoring the concentration of heavy metals in children and curing
the results of chronic metal toxicity. It carries out various forms of
preventive, treatment and therapeutic work with children, young
people and their families to reduce the consequences of broadly
understood harmful environmental effects, especially the
consequences of industrial contamination and socio-psychological
harm. The Miasteczko lskie Foundation for Children plays a
similar role.
The Health Promotion Foundation (54) has the objective of reducing
the incidence of cancer primarily by promoting favourable changes in
lifestyle. Special emphasis is put on reducing and eliminating tobacco
smoking and exposure to environmental tobacco smoke. The
Foundations activities focus on the annual campaign Quit smoking
with us, as a result of which 2.5 million people in Poland have quit
smoking.
Finally, Alter Ego is another NGO whose main focus is preventing
road crashes. They are cooperating in the framework of the National
48
Road Safety Programme and are particularly interested and engaged in

supporting victims of road crashes.
Although the NGOs mentioned are highly recognized and cooperating
with national institutions, ministries do not fund NGOs, and
collaboration clearly depends on the type of project.
49
4 Tools for management: policy setting

and legal framework
Conclusions
The countrys basic policy act (the Constitution) acknowledges the
necessity of preventing ill health arising from environmental
factors.
The authority to tackle environment and health is legally ensured
only at the municipal level.
The most comprehensive and targeted policy on environment and
health has been the long-term programme on health and
environment.
The National Health Programme covers many priorities defined by
the regional priority goals.
The environment policy programme tackles the relationship
between environment and health. Nevertheless, there is no link to
the National Health Programme.
The existing health prevention and promotion programmes focus
mainly on behavioural changes, such as the National Road Safety
Programme.
The National Health Programme acknowledges the role of NGOs
in public health.
The NEHAP has enabled synergies to be established in
environment and health activities and defines clearly the roles and
responsibilities of the actors involved.
As a government act, all ministries have approved the NEHAP. In
practical terms, not all relevant sectors are represented.
Policy actions in environment and health are not regularly funded.
Only the NEHAP and the National Road Safety Programme have
had clear sources of funding. When the government adopts an
environment and health programme it does not automatically
allocate a budget.
50
Related ministries (such as the Ministry of Finance) do not provide

any money.
Health outcome priorities (such as injury prevention) are not
automatically distributed in budget allocation.
Structural funds from the EU are mainly allocated to the built
environment sector.
Financial support for public awareness is not foreseen.
Economic arguments and health costs are not used for setting
priorities or for informing or convincing policy-makers to take
preventive measures.
Economics at the personal level is used as an argument, whereas
the public health economic arguments are not.
There is no comprehensive policy related to transport emissions.
Health cost arguments are not used in setting local priorities.
Recommendations
A more concrete programme on health and environment should be
prepared as an integral part of the new National Health
Programme.
Active involvement in the relevant international conventions is
recommended by, for example, ratifying the UNECE/WHO
Protocol on Water and Health to the 1992 Convention on the
Protection and Use of Transboundary Watercourses and
International Lakes.
Clear synergies need to be established between the environment
and health policy programmes.
Funding mechanisms and institutionalized mechanisms for
supporting partnerships in public health should be created.
A national childrens environment and health action plan, with its
regional priority goals, is a tool to support and help guide national
processes. It should be prepared as an integral part of the National
Health Programme.
51
Institutional and human resources should be allocated to

implementation of Polands NEHAP and CEHAP, both in the
relevant sectors and institutions and to ensure coordination in the
health sector.
Extend the use of economic instruments.
Make more systematic use of integrated economic analysis (such
as costbenefit analysis) in environment and health policy-making.
Review existing environmentally related taxes from the perspective
of health expenses.
The protection of public health should figure more prominently in
legislation related to both the environment and economic
development.
Economic instruments should be applied to encourage enterprises
to observe health and safety standards and to report all
occupational disease.
Environment and health policy in Poland is implemented under the
umbrella of several national acts and policy programmes. The new
Constitution, introduced on 2 April 1997, covers environment and
health issues under Article 68. Under this article, the Constitution sets
the obligation for public authorities to combat epidemic diseases and
to prevent negative health effects from environmental degradation.
The same article emphasizes the right to health protection, access to
equal health care services and the relevance of giving special health
care to children, pregnant women disabled people and older people.
The new Constitution also stresses the need to protect the natural
environment and to ensure sustainable development (Article 5),
requires public policies ensuring ecological security and provides the
right for all citizens to be informed about the quality of the
environment and its protection (Article 74) (55).
52
Health policies related to environment and health

Poland has no public health act that could be considered a legally
binding document controlling the effect of the environment on health.
The legal capacity to tackle environment and health is legally ensured
through specific legislation at the government level and controlled and
enforced at the municipal level. Laws drafted at the parliamentary
level can be commented on at the municipal level. The municipal
commentary is nevertheless mainly channelled through the political
representatives at the government level.
Municipalities control construction projects by issuing permits to
builders and developers. Municipalities are in charge of implementing
sanctions if limit values (noise, etc.) are exceeded. The municipal
level is also in charge of implementing concrete pollution abatement
measures and other projects (such as noise barriers).
National Health Programme

The key national policy for settings the priorities and the agenda for
public health in Poland is the National Health Programme. The
government adopted the current Programme for 20072015 on 15
May 2007. The Programme is based on the previous National Health
Programme, which was in force between 1996 and 2005 and is shaped
in accordance with the Health for All policy framework for the WHO
European Region. The National Health Programme functions through
an interministerial coordination group. The previous Programme
emphasized health promotion and the development of healthy
lifestyles.
The general principles set for the National Health Programme 2007
2015 are:
reducing territorial and social inequality in health; and
activating local governments and NGOs for health promotion.
Children are the main target group of the Programme. The targets set
are that premature births will drop from 6.4% to 5.5% and that infant
mortality will decrease to 4 per 1000 live births by 2015. Among the
53
19 priorities set, the Programme

environment and health are:
commitments
relevant
to
promoting physical activity for preventing cardiovascular diseases

and shaping desirable health behaviour (regional priority goal 2);
improving the eating habits of the population and food health
quality and reducing the number of obesity cases (regional priority
goal 2);
reducing tobacco smoking and exposure of children and pregnant
women to environmental tobacco smoke (regional priority goal 3);
reducing exposure to harmful factors in the living and working
environments (regional priority goal 4);
improving the national sanitary conditions, especially at the local
level and using the EU Structural Funds, and establishing EUcompliant systems for monitoring environmental sanitary
conditions;
reducing the number of accidents and injuries, especially among
children and adolescents (regional priority goal 2); and
creating healthy and safe living conditions for older people.
The National Environment and Health Action Plan

In 19971999, the NEHAP for Poland was developed according to the
Helsinki Declaration (5) as a joint action of the Ministry of Health and
the Ministry of Environment based on analysis and evaluation of the
environment and health situation in the country. The Institute of
Occupational Medicine and Environmental Health, the Institute of
Occupational Health and the Institute for Ecology of Industrial Areas
under the Ministry of Health revised and updated the NEHAP in 2000.
was appointed as the leading institution in implementing, supervising
and managing the NEHAP.
The major areas of the NEHAP for 20002005 were:
improving the development and implementation of the state policy
on environment and health;
improving the planning and management of environmental health;
54
preventing and improving actions aiming at reducing specific

environmental risks;
involving the economic sector in prevention activities;
improving international cooperation;
implementing environmental health action plans; and
monitoring the efficiency of environment and health activities.
During the review, several of the national public health professionals
consulted emphasized that the NEHAP has been an important tool for
mobilizing national resources for implementing environment and
health action.
After the NEHAP for 20002005 was finalized and in following up
the commitments taken through the adoption of the Budapest
Declaration, Poland is now in the process of developing a CEHAP.
The Institute of Occupational Medicine and Environmental Health is
coordinating the preparation of the CEHAP. No concrete plan has
been presented yet. The responsibility for the national CEHAP process
was transferred to the Nofer Institute of Occupational Medicine after
this review ended in July 2007.
Long-Term Governmental Programme Environment and

Health
The main instrument relevant to environment and health is the LongTerm Governmental Programme Environment and Health (56). The
Programme sets the most urgent priority tasks for environment and
health and is the implementation programme of the NEHAP. The
Programme was the first programme jointly developed and
implemented by the Minister of Health and the Minister of
Environment in Poland, with the participation of the Ministry of
Education and Science (succeeded by the current Ministry of National
Education and the Ministry of Science and Higher Education). The
Programme was launched in 2000 following the decision of the
Economic Committee of the Cabinet and was formally commenced by
the Council of Ministers on 5 June 2001.
55
The Programme was implemented between 2000 and 2004, and the
main participants of the project from Poland included the Institute of
Occupational Medicine and Environmental Health and the Institute for
Ecology of Industrial Areas. Since 2004, the Programme has not been
renewed.
The Programme had its own budget and implementation plan, and the
Ministry of Health and the Ministry of Environment funded action and
the Ministry of Education and Science funded research projects.
The main tasks to achieve within the Programme were:
developing and implementing an environmental health indicator
system in Poland;
evaluating environmental monitoring data for assessing
environmental health risks;
preparing and piloting guidelines for integrating health components
within the framework of environmental impact assessment;
preparing and piloting activities to prevent asthma and allergic
diseases among children exposed to adverse environmental factors;
implementing postgraduate education on environmental health and
occupational medicine;
developing and implementing an educational programme for
environmental health for children;
creating and implementing a system for transferring information
about the state of environment and health to the European
Commission;
including environmental health issues in the national sustainable
development strategy;
implementing health risk analysis to establish and control
compliance with the environmental quality principles;
promoting environmental protection activities among central and
local administrations, business, academic circles and
environmental and consumer organizations;
implementing tasks laid down by the Protocol on Water and Health
to the Convention on the Protection and Use of Transboundary
Watercourses and International Lakes;
56
developing appropriate measures to ensure the rational use of

degraded areas; and
implementing commitments under the Charter on Transport,
Environment and Health.
Environmental policies
Environment and health are covered by environmental legislation and
regulations, and there are three major acts.
Environmental Protection Act

In 2001, the Environmental Protection Act (Act No. 62/2001/627)
entered into force. This Act is the cornerstone of Polands
environmental legislation, establishing a comprehensive regulatory
framework in this field and introducing general policy guidelines. The
basic policies underlying the enforcement of environmental law by
competent authorities, include:
the principle of sustainable development;

an integrated approach towards solving environmental problems;
priority of preventive and precautionary principles; and
the polluter-pays principle.
The Act sets the requirements for planning documents (particularly at

the local level) to manage land-use development. It settles the
proportion between the built environment and green spaces necessary
for preserving a balance with nature.
Special emphasis is put on health aspects in procedures of
environmental impact assessment. Article 3 of this Act states: In the
Act, environmental impact is understood also as the impact on human
health. Article 47 informs that environmental impact assessment
procedures relate to analysis and assessment of direct and indirect
influence of the particular undertaking on the environment as well as
on the human health and conditions of life.
57
The Environmental Protection Act is harmonized with the existing EU

legislation.
Act on Access to Information on the Environment and its

Protection and on Environmental Impact Assessments
Polands parliament adopted the Act on Access to Information on the
Assessments (57) on 9 November 2000, and it entered into force on 1
January 2001. The Act comprises the following main parts:
access to (environmental) information;
public participation in procedures related to environmental
protection;
the environmental impact assessment procedure relating to the
implementation of plans and programmes;
the environmental impact assessment procedure for proposed
projects;
the environmental impact assessment procedure relating to the
transboundary impact on the environment; and
the environmental impact assessment commissions.
The environmental impact assessment legislation is strictly connected
to a number of other environmental acts, especially with: Land-use
Planning Act, Building Act, Environmental Protection Act, Nature
Conservation Act, Geological and Mining Act and Motorways
Construction Act. The Act defines effects on the environment as
effects both concerning the environment and human health (Article 2).
Following the Act, environmental impact assessment is required for
two types of projects. Group 1 projects require environmental impact
assessment in all cases, and group 2 projects may require
environmental impact assessment. The former are linked to the permit
requirements of other acts, and include mineral extraction,
groundwater abstraction and flood control, restructuring of rural land
holdings and constructing motorways. The latter are assessed on, for
example, whether the project requires the establishment of a
58
restricted-use area, whether it is likely to cause transboundary effects

and whether relevant environmental bodies feel that it should require
environmental impact assessment. Environmental impact assessment
is mandatory for major development projects (such as road
infrastructure) and hazardous undertakings.
The Act was drafted in close collaboration with civil society and
especially NGOs. Although many NGOs still consider the legislation
not fully satisfactory, the participation of NGOs in drafting the Act
can overall be considered a national success.
National Environmental Policy Programme

The National Environmental Policy Programme 20072015 is an
implementation component of the Environmental Protection Act. The
current Programme was preceded by the Programme for 20032006.
The implementation of the Programme requires close collaboration
among different sectors and has been reviewed and commented on by
the Chief Sanitary Inspectorate.
This extensive document includes objectives, principles and directions
for environmental protection in Poland. The basic task for the state is
to ensure the environmental safety of the country (inhabitants, natural
resources and social infrastructure) and to create the basis for balanced
social development.
These objectives will be ensured by strengthening the environmental
protection management system, by protecting the natural heritage and
rationalizing the use of natural resources, by improving environmental
quality and safety for the health protection of Polands population and
by protecting the climate.
Chapter 6 of the Programme targets environmental health and human
health protection. It mainly focuses on water, air, noise,
electromagnetic fields and ionizing radiation. The following have
been envisioned for ensuring the protection of human health:
modernizing the existing water treatment plants and constructing
new ones;
59
constructing sewerage systems and water treatment plants in urban

areas exceeding 15 000 population;
constructing water treatment plants at food-processing plants;
optimizing transport systems and limiting transport-related
emission;
limiting exhaust emissions from industrial and municipal sources;
limiting emissions from large combustion sources;
supporting actions for environmentally safe recycling;
increasing municipal waste recycling to 10% by 2010;
limiting threats to human health and environmental conditions
caused by the use of chemicals;
forbidding substances destructive to the ozone layer;
strengthening the control of industrial installations to reduce the
risk of industrial breakdowns;
supporting measures limiting adverse noise effects;
protecting the population and environment from electromagnetic
fields; and
supervising sources of ionizing radiation.
Transport policies
The National Road Safety Programme
The Council of Ministers adopted the National Road Safety
Programme in 2001. It sets the priorities for 20012010 for road
safety in Poland. The programmes strategic goal is reducing the
annual number of deaths due to road traffic injuries to 4000 in 2010.
When Poland joined the EU in May 2004, the Council of Ministers
adopted the new National Road Safety Programme for 20052013.
The Programme comprises five objectives to be achieved by 2013
divided into 15 priorities with respective actions.
The objectives are:
building a basis for an effective and long-term road safety policy;
developing safe road user behaviour;
60
protecting pedestrians, children and cyclists;

building and maintaining safe road infrastructure; and
reducing the severity of crashes.
Activities should be implemented at different levels: national, regional
and local. The funds for road safety in Poland come from different
sources: central, regional and local budgets (bank loans and EU
funds), the budgets of ministries involved in road safety,6 specific EU
funds (the Transport Sectoral Operational Programme 20042006 and
the Road Infrastructure Sectoral Operational Programme 20072013),
NGOs, insurance companies, business and the National Road Fund.
Economics and funding

Policies and strategies designed to address environment and health
conditions should always be supported by the necessary resources or
through a formal mechanism to ensure that they can be raised. Similar
to many other countries in the WHO European Region, the lack of
funds is a challenge in the environment and health sector in Poland.
For the National Health Programme 20072015, the required budget
was determined only after the objectives and activities had been set.
This approach makes implementation rather difficult. The available
sources of funding are unclear. Only the NEHAP and the National
Road Safety Programmes show clear sources of funding, with budgets
allocated for the activities at the level of ministries and institutions.
NEHAPs and LEHAPs were to be funded by state and local budgets
from the Ministries of Health, the Environment and Science and
Higher Education. For the National Road Safety Programme, a
multisectoral funding scheme (comprising a variety of involved
institutions) was set up. The NEHAP has also been seen as a helpful
mechanism for mobilizing funds for priorities set by the Long-Term
Governmental Programme Environment and Health.
6
Ministry of Infrastructure, Ministry of Interior and Administration,

Ministry of Science and Higher Education, Ministry of Health, Ministry
of Finance, Ministry of Justice, Ministry of Labour and Social Policy,
Ministry of Economy, Ministry of Regional Development, Ministry of
Defence and Ministry of Environment (as of 2005).
61
Nevertheless, funds for environment and health activities are rather

small. Several examples can be provided. Unavailability of funds has
been mentioned as the major impediment for carrying out important
surveillance activities. The lack of systematic collection of injury data
has been attributed to funding problems. There are no stable
mechanisms for funding laboratories and for integrating NGOs into
preventive environment and health activities. Funding problems do
not uniquely affect environment and health development programmes
but are also compromising environmental management activities.
Expenses for environmental protection and water management
activities as a proportion of the national income have increased
slightly in recent years (1.2% in 20002003 to 1.8% in 20072008)
but are still small. Finally, budget shortages seem to be the cause for
some sectors dropping out from intersectoral collaboration structures,
as the National Road Safety Programme example has shown.
The lack of funds is especially reflected at the local level. Public
health programmes and activities and their funding mechanisms fall
under the responsibility of various levels national, regional and
local. Local authorities have been given more and more responsibility
in implementing national and international agreements and
regulations.7 Nevertheless, the available budget has not been
systematically raised, increasing the fiscal burden carried by the local
governments. In recent years, the fiscal autonomy of county sanitary
inspectorates changed. Funds for county inspectorates are not pre-set
anymore but are allocated at the local level through the voivodship.
Support for preventive environment and health activities is required
also at a broader public level. Television stations require payment to
broadcast disease prevention campaigns, such as road safety
campaigns, which the institutions involved have to pay. Public and
private television channels should support the broadcasting of disease
prevention campaigns free of charge.
62
Examples are the Mazovian Public Health Centre and the environmental
monitoring funded by the voivodship.
Nevertheless, positive developments were observed in the privatesector support for disease prevention activities in environment and
health. Many activities, especially in preventing road traffic injury,
have been carried out through the support of the private sector.
Nevertheless, this improvement has to be acknowledged with caution,
as the interest of automobile companies in injury prevention is highly
driven by economics.
Further, a positive development is the use of EU funds for improving
environmental health conditions. Funds from the European Investment
Bank have been used for improving the infrastructure at the local level
(with local communities having applied for it). EU funds have also
been used for revitalization programmes, mainly panel block
renovation programmes, and EU structural funds are supporting
institutions in achieving environmental standards. Some additional
efforts have to be made to guarantee transparent allocation of the
funds. During the review, a multisectoral self-governed committee or
jury was mentioned as being responsible for allocating the available
budget. Clarification on the allocation mechanisms and
responsibilities is needed. Marshals (voivodship authorities) also seem
to be responsible for regional development.
At the local level, municipalities increasingly support households that
are planning to improve their thermal insulation8 or to install a more
energy-efficient heating system.
Economic instruments are an important tool for improving
environmental management. Taxation money and income from fines
are increasingly being used for disease prevention activities in Poland.
For instance, fines collected from drunken driving are processed for
road safety measures, and fees from industry for high emissions are
collected into a fund for environmental protection. In some other
cases, however, similar approaches have been stopped. A 1999
tobacco control act stipulated that 0.5% of the tobacco excise tax
8
A special loan system with municipal support has been established for
improving insulation. In reality, the availability of these loans is rather
small and households have to wait for a long time before benefiting
from them.
63
would be allocated for tobacco control measures. This was repealed in

2007.
In summary, the lack of funds for environment and health activities
results in an increasing number of programmes for which institutions
have to apply for money, which is increasing the unequal access to
activities and services by institutions, stakeholders and target groups.
Given the increasing prevalence of obesity and the need to enhance
physical activity, the Ministry of National Education has set up a
programme for supporting children to participate in after-school sports
activities (memberships, access to sports grounds etc.). Families have
to apply for benefits. Although this a good approach, efforts should be
made to have access to safe playgrounds and sports facilities for
children as an implicit right.
Economic instruments for environmental policies are not sufficiently
developed in Poland. Despite the existing taxation policy on fuel,
there is no comprehensive policy related to transport emissions (for
example, no higher taxes for polluting cars and no sustainable taxation
policies for sustainable or alternative energy sources),9 and there are
no tax benefits for energy-related investments affecting air pollution
emissions.
The integration of environmentally related economic instruments into
economic development policies in Poland has to be strengthened. The
health costs of environmental pollution should be at the heart of
policy-making and be used to strengthen the preventive approach
towards the environmental burden of disease. The example of
chemical safety shows that chemical risk assessment is mainly
undertaken from a hazard analysis viewpoint and no costbenefit
analysis is undertaken.
Estimates of health costs due to environmental hazards are not used in
setting priorities and for taking preventive measures at the government
level.
9
64
On a research level, however, the Road Traffic Safety Centre is making

efforts to analyse the fuel consumption of different vehicles.
5 Intersectoral collaboration
Conclusions
There is strong cooperation with the private sector.
Intersectoral collaboration in Poland is very different at various
administration levels.
Actions and priorities are highly fragmented.
At the local level, establishing a master plan entails collaboration
between all sectors.
Intersectional collaboration in the area of transport (the National
Road Safety Programme and NGOs) is well developed.
Recommendations
International cooperation on environmental health needs to be
strengthened.
Clear responsibilities have to be defined for each sector involved as
well as funding schemes attached to the activities.
Dialogue between different sectors at regional level should be
strengthened.
Cooperation between different sectors is an essential prerequisite for
protecting health. The review has shown that intersectoral
collaboration in Poland differs greatly at different operational levels.
The collaboration seems to function better at the local or voivodship
level, where common activities and decisions are often initiated and
taken on a more personal basis than at the national level.
At the national level, intersectoral collaboration is formally
institutionalized through several legislative and consultation
processes. The Long-Term Governmental Programme Environment
and Health, as the implementation programme of the NEHAP, was
the first intersectoral programme on environment and health jointly
65
developed and implemented by different ministries. The Programme

had its own budget and implementation plan co-funded by the
Ministry of Health, the Ministry of Environment and the Ministry of
Education and Science.
Many efforts to ensure multisectoral collaboration have been made in
promoting road safety. The National Road Safety Programme and the
National Road Safety Council are examples of an institutionalized
cooperation mechanism. They rely on the involvement of ministries
and institutions meeting regularly and setting common objectives
under the leadership of the Ministry of Infrastructure. Despite the
institutionalized setting, not all sectors have been equally involved in
the process. The Ministry of National Education, originally part of the
council, has dropped out from the process mainly due to financial
constraints. This example shows that intersectoral collaboration
fundamentally relies not only on a well-defined definition of
responsibilities for each involved sector or institution but also on the
funding schemes attached to each of the activities for which the
involved institutions are responsible. In addition to the activities of the
Council, the Ministry of Health has also taken road safety promotion
initiatives not involving the transport sector.
Intersectoral working groups have also been set up for nutrition and
physical activity at the national and local levels. For example, the
National Food and Nutrition Institute has been closely collaborating
with the Ministry of National Education.
Although intersectoral committees have been set up, a gap still seems
to exist between theory and practice. Actions and priorities are often
fragmented. Information gathered by one sector is not shared with
other stakeholders. In air quality monitoring, for example, the
Ministry of Health does not seem to have access to all data collected
by the Chief Environmental Inspectorate. Data from the Chief
Sanitary Inspectorate, in contrast, are transferred to the environment
sector. Cooperation in managing sewerage systems is also difficult.
For many years, the cooperation was only on paper and based on an
agreement between the Ministry of Environment and the Chief
Sanitary Inspectorate that was not implemented. Conflicting
responsibilities in the maintenance of the road infrastructure seem to
66
affect its quality. The quality of the road infrastructure is perceived as

inadequate and enhancing the risks of road crashes.
Despite these difficulties, other examples of intersectoral collaboration
function well. Research institutions in health interact and closely
collaborate with national policy institutions (such as the Institute of
Mother and Child). The same positive experience arises in the
collaboration with the private sector and churches, especially in road
safety. Some caution is nevertheless appropriate, as the private sector
involved mostly comprised interested parties.10
NGOs are increasingly being recognized as essential partners in
disease prevention activities. Road safety activities and smoking
prevention activities have been implemented through the support of
NGOs such as Alter Ego for road safety and the Foundation for
Children of the Copper Basin in environmental tobacco smoke and
smoking prevention. The National Health Programme officially
acknowledges this collaboration. Unfortunately, no funds are attached
to it, so collaboration is difficult to implement.
Cooperation is increasingly been initiated at the international level.
Several projects are being implemented in partnership with other
countries or in the framework of large-scale European projects (such
as a breastfeeding project, the PHARE Programme, an EU persistent
organic pollutants project, ECNIS and ESBIO). Although individual
experts are actively involved and make outstanding contributions, the
engagement of institutions and networking within the country is
lagging behind.
In summary, the review has shown that intersectoral collaboration in
Poland functions better at the local level and between research
institutes and with private partners. Specific areas such as physical
10
Cooperation with Toyota in the framework of the European Transport

Safety Council and the cooperation with the association of Polish
breweries; the Polish breweries had initiated a programme providing
special night buses for young people going out. The focus was later put
on information. The designated driver of the night (not drinking) got
tested and got a gadget.
67
activity, nutrition and road safety also seem to benefit from better
collaboration between sectors than other areas.
The need for strengthening the collaboration between sectors is
increasingly been recognized in Poland. Efforts are currently being
made to create an environmental protection agency with the aim of
coordinating all activities within environment management. The terms
of reference of the agency have not been defined yet. In addition,
national plans are underway to better consolidate and integrate the
work of the veterinary, environmental and health inspectorates,
possibly by merging the three.
68
6 Tools for action

Conclusions
Many agencies and institutions perform public health monitoring at
different levels (national, municipal, etc.).
Monitoring concerns either health or environment; there is a lack
of integrated health and environment information.
Chemicals seem to be the risk factors mostly monitored. Many
different institutions are involved in this.
There is no reliable countrywide surveillance of injuries and other
environmentally related diseases.
There is considerable information but not a uniform approach to
preparing, analysing and reporting it to support health and
environment policy action.
There is little data sharing between the different institutions or
sectors.
Reports from one sector are not always made available to other
sectors.
The health sector seems to inadequately cover health impact
assessment.
The existing procedures for health impact assessment do not seem
to be well developed.
Environment and health and disease prevention in the current
medical curriculum are scattered and not taught uniformly.
There are not enough experts with strong environment and health
knowledge.
There is no specialized or supplementary training for paediatricians
in environmental health issues.
In both secondary and primary schools, environment is dealt with
as a cross-sectional subject, and the health effects of environmental
factors (both positive and negative) are not explicitly emphasized.
69
There is little awareness of environmental risk factors in society

(such as environmental tobacco smoke and noise).
Existing information is not systematically communicated to the
public.
The Aarhus Convention on Access to Information, Public
Participation in Decision-making and Access to Justice in
Environmental Matters stipulates that all data on environmental
conditions should be accessible, but access to data is not always
ensured.
The mass media seem to focus more on specific fields: nutrition
and physical activity.
Recommendations
Tools for integrating health and environment data should be
improved.
The surveillance for injuries, water and foodborne diseases needs
to be strengthened.
The further development and implementation of the ENHIS needs
to be given higher priority, building on the work already done, and
further expanding current work on environmental health impact
assessment.
A uniform approach to preparing, analysing and reporting
information needs to be developed to facilitate its sharing and use
in environment and health.
A statutory framework should be developed for including the
ENHIS and health impact assessment in planning, monitoring and
evaluating environment and health policy and action programmes.
The responsibilities need to be clarified in health impact
assessment, environmental impact assessment and environmental
health impact assessment.
The methods of health impact assessment and environmental
impact assessment need to be developed further.
70
A national accreditation system for experts in environmental health

impact assessment should be established.
Continued efforts are needed in capacity-building, follow-up of the
training and establishment of annual programmes for knowledge
dissemination and updating and development of needed skills in
environmental impact assessment and health impact assessment.
An institutional entity should be designated as a formal body to
coordinate the implementation of environmental health impact
Country capacity in using the ENHIS and environmental health
impact assessment as a standard public health tools should be
strengthened further.
Environment and health education should be strengthened in the
university curricula.
Intensify the training of environmental health specialists, including
international training for a limited number of specialists and
participation in international technical cooperation projects.
Country capacity in using the ENHIS and environmental health
impact assessment as a standard public health tools should be
strengthened further.
Provide more public information about the right to health
information, environmental information and the burden of health
attributable to environment.
Encourage public participation in decision-making.
Other sectors should also support and fund structures for
communication concerning the status of environmental risk factors.
Public information and awareness-raising should be promoted.
The Ministry of Health should increase the resources available for
assessing and investigating health effects and for developing a
communication structure for feedback to the reporting regions and
districts.
The role of the mass media in communicating health risks deriving
from the environment to the public should be strengthened.
71
Monitoring
Environmental quality can be monitored to indicate the level of
compliance with a standard but also to assess trends over time.
Although EU legislation requires advanced monitoring and reporting
on environmental hazards, there is no national requirement on
monitoring and reporting on environment and health indicators and no
regulation on its establishment.
Many institutions and sectors monitor environmental hazards to health
in Poland, resulting in a scattered monitoring approach and in some
areas in duplicate efforts. Monitoring is mainly performed by the
national and respective local, sanitary and environmental
inspectorates, but also by the NIPH-NIH and specialized institutes or
agencies.
In the health sector, the NIPH-NIH is mainly involved in toxicological
and microbiological analysis and is in charge of monitoring the
database on water quality and of supervising the water laboratories.
The NIPH-NIH routinely collects health indicators. The Mazovian
Public Health Centre collects health data at the regional level and
forwards them to the Ministry of Health. The Chief Sanitary
Inspectorate manages a registry on data on communicable diseases
provided by general practitioners and laboratories according to 78
disease entities.
The involvement of many different institutes requires close
collaboration. The review has shown, however, that the parties
concerned do not always systematically transfer and share data. Thus,
data on water collected by the Chief Sanitary Inspectorate are
transmitted to the Ministry of Environment before being sent to the
European Commission, whereas the Ministry of Health does not seem
to have access to data on air quality collected by the environment
sector. Nevertheless, the review has shown that, at the voivodship
level, bilateral cooperation agreement between the sanitary and the
environmental inspectorate ensures collaboration in air quality
management.
72
The Ministry of Environment is responsible for preparing an overall

report on the state of the environment.
The following overview of monitoring responsibilities, standards and
management is organized along the four regional priority goals.
Water and sanitation

The Chief Sanitary Inspectorate monitors drinking-water and bathing
water following the requirements established by EU directives. The
monitoring is performed in 1500 bathing places and the results are
forwarded to the Ministry of Environment. The county sanitary
inspectorate collects data on the quality of the water along the chain of
distribution by assessing the quality of the transport equipment.
Through 118 laboratories for monitoring and control at the national
and at voivodship level, the Chief Sanitary Inspectorate analyses
predominantly arsenic, manganese, chromium, nickel, cadmium, iron,
lead, Escherichia coli and Enterococci. The NIPH-NIH analyses
chemical hazards in drinking-water (heavy metals, polycyclic
aromatic hydrocarbons, trihalomethane, bromates and chlorine
screening). The Chief Environmental Inspectorate monitors inland
surface water and groundwater. A total of 300 surface water sources
and 10 000 groundwater sources are tested. No information about who
is responsible for irrigation water could be found. Waterborne diseases
in Poland are not registered separately, but for 10 years there has been
a registry on Legionellosis and water. A system for registering
waterborne diseases is being created.
Injuries
A central registry for childrens accidents seems to be lacking, and the
various services seem to have little or no coordination. Police
departments register information on road crashes. The development of
a central registry on injuries has been mentioned as a priority in the
framework of the activities of the Childrens Memorial Health
Institute. Due to lack of funding, however, this will be difficult to
implement. Injury surveillance needs to be developed and
73
strengthened and an injury database established within the health

sector.
Air quality
Both the Chief Environmental Inspectorate and Chief Sanitary
Inspectorate carry out monitoring at 550 stations at the national level
(excluding passive measurement stations). The Chief Environmental
Inspectorate collects the data, and the Chief Sanitary Inspectorate
analyses them. The voivodship environmental inspectorates collect
data, and the Chief Environmental Inspectorate is responsible for the
overall air quality assessment system. Data are collected in a central
database and forwarded to the European Environment Agency Airbase
database. This database is currently under reconstruction.
The Chief Sanitary Inspectorate is also in charge of monitoring air
quality. In 2004, PM10 was being monitored at 155 stations covering
about 50% of the population. In 2007, 252 stations were operating.
PM2.5 is monitored in two cities covering 15% of the population.
The NIPH-NIH analyses chemical hazards in outdoor air (heavy
metals, polycyclic aromatic hydrocarbons, trihalomethane, bromates
and chlorine screening).
The Nofer Institute of Occupational Medicine monitors heavy metals
and persistent organic pollutants in the outdoor air in the framework
of the UNECE Convention on Long-Range Transboundary Air
Pollution. The Institute is also involved in the WHO activities on air
quality and health. There is a vast array of air quality data, but it is not
effectively used for assessing population exposure and related health
aspects.
The Chief Sanitary Inspectorate is responsible for indoor air quality,
especially regulating indoor air quality in public places. The Nofer
Institute of Occupational Medicine is also involved in monitoring
indoor air quality. A Ministry of Health order regulates 30 chemicals
and physical elements in building construction. A new construction
law being developed will supersede this order. Ten laboratories in 10
74
sanitary inspections are dealing with indoor air quality, and plans were
made to carry out permanent monitoring of indoor air quality. Finally,
the NIPH-NIH certifies microbiological analysis and chemical
analysis of mould presence in indoor environments.
Chemical and biological risks

In food contamination, the NIPH-NIH assesses microbiological risk
(such as Salmonella). The health sector is responsible for all processed
food products. The NIPH-NIH has its own laboratories for food safety
assessment. It also performs human biomonitoring of persistent
organic pollutants in blood, milk and semen and virological
assessments of food products. The Institute of Food and Nutrition is
the national reference laboratory for food quality (macro- and
micronutrients) and safety. The General Veterinary Inspectorate under
the Ministry of Agriculture and Rural Development is responsible for
all products of animal origin. It cooperates with the National
Veterinary Institute.
As outlined in the section on water quality monitoring, chemical
hazards are mainly analysed and monitored by the NIPH-NIH. The
NIPH-NIH evaluates toxicological dossiers for pesticides, food
contaminants and food additives. It monitors chemical hazards in
drinking-water and outdoor air. It is also in charge of assessing the
occupational health risks of pesticides and biocides. The Nofer
Institute of Occupational Medicine and the Institute of Agricultural
Medicine monitor exposure to pesticides and to heavy metals and
related health hazards of the working environment (methylmercury,
phthalates, arsenic, cotinine and persistent organic pollutants). The
Nofer Institute is in charge of monitoring and assessing the
occupational exposure to physical, chemical and biological agents.
Summary
In conclusion, Poland has considerable statistics on health trends and
on specific environmental parameters, but the information needs to be
processed for assessing the state of environment and health within the
country. In addition, the available data are not systematically
75
communicated to the public, resulting in a lack of the public

awareness on environmental threats to health.
The ENHIS is considered to be a driving force for analysis of the
environment and health situation in the country. However, this is
mainly done at the national level. As noted in Chapter 2, most of the
data used in the ENHIS exist within the country. The data sources
should be clearly identified and an extension of the regular indicatorbased analysis and reporting following ENHIS methods should be
progressively adopted. This, in turn, will further advance the
implementation of the indicator system in Poland.
Environmental impact assessment and health

impact assessment
Environmental impact assessment was introduced in Poland through
the Environmental Protection Act (Act No. 62/2001/627) adopted on
27 April 2001.
Articles 3 and 47 stipulate that environmental impact assessment
procedures relate to the analysis and assessment of direct and indirect
influence on the environment as well as on human health and
conditions of life.
Environmental impact assessment is mandatory for: 1) the draft
concept of the national land-use policy, draft land-use plans and draft
regional development strategies and 2) draft policies, strategies, plans
or programmes in industry, energy, transport, telecommunication,
water management, waste management, forestry, agriculture, fisheries,
tourism and land use, where their preparation by the national or
voivodship public administration authorities is provided for by law.
Public administration authorities preparing draft documents that
normally require environmental impact assessment can decide not to
carry this out if they determine that that the policies are not likely to
have significant effects on the environment. Environmental impact
assessment is always required for major investment (motorways and
roads etc. and hazardous undertakings).
76
The Ministry of Environment, the Chief Environmental Inspectorate

and the National Commission for Environmental Impact Assessment
are responsible for environmental impact assessment. The Chief
Environmental Inspectorate takes part in decisions related to the
location of investment projects (Section 2, subsection 1, point 3 of the
Act on Environmental Protection Inspection of 20 July 1991) and in
the processes of commissioning buildings or installations completed
as projects that may significantly affect the environment (Section 2,
subsection 1, point 4 of the Act on Environmental Protection
Inspection). An advisory and supervisory role concerning human
health issues is delegated to the Ministry of Health and specifically to
the Chief Sanitary Inspection (and its local agencies).
Although environmental impact assessment falls under the
responsibility of the environmental sector, external environmental
impact assessment experts carry it out. Before the market
liberalization it was conducted by certified experts (on a list), but now
many companies can perform environmental impact assessment. The
review did not clarify whether the Ministry of Environment certifies
or accredits these companies. Investors must pay for two assessments;
the responsible ministries have to double-check it.
The extended responsibility of including health in environmental
impact assessment is still not sufficiently covered in the enforcement
of the law. There is not enough expertise to implement the legislative
regulations reliably and efficiently based on recognized methods of
health risk assessment or health impact assessment. The health part of
the environmental impact assessment has been reviewed by the health
sector more according to good practice standards.
Under the government programme on environment and health for
20032006, a project was started on strengthening environmental
impact assessment and integration of health concerns. The scope was
mainly to address the regional or local health and environment
administration involved in environmental impact assessment
procedures, receiving unprecedented response and showing substantial
demand for knowledge and methods on incorporating health aspects
77
into environmental impact assessment and strategic environmental

assessment.11
As a main conclusion, it was felt that there is no need for change in
legislation but for strengthening this procedure according to the good
practice standards such as using quantitative risk assessment to
strengthen environmental impact assessment. The first phase of such
advancement requires scoping and is ongoing in some countries (not
in Poland) with public participation. The review has shown that the
health component within environmental impact assessment reports is
still insufficient and inappropriate. The methods for including health
impact assessment in environmental impact assessment reports need to
be strengthened. The number of specialists in health impact
assessment is still insufficient. Training and education in this field
need to be developed further.
The Chief Sanitary Inspectorate is responsible for health impact
assessment. The NIPH-NIH mainly performs health impact
assessment of air quality. The most advanced projects include the
multinational APHEA (Air Pollution and Health A European
Approach) and APHEIS (Air Pollution and Health: A European
Information System) projects. The Ministry of Environment does not
accept health impact assessment. The major criticism is that the data
used come from research and that the population exposure based on
monitoring data is not considered.
The Institute of Food and Nutrition conducts risk assessment of health
hazards and assesses food.
11
78
WHO launched this project in 2004, and the Institute of Occupational

Medicine and Environmental Health was in charge of strengthening the
health impact assessment component of environmental impact
assessment.
Capacity-building
Environment and health in the medical curriculum are covered
through a course on hygiene that students have to take during their
fourth or fifth year of training. The name of the course can vary from
one university to the other, from Hygiene and the Ecology of Humans
to Hygiene and Epidemiology. These courses have the aim of training
students on how environmental determinants affect health. The course
generally takes about 30 to 45 hours and is taught through lectures,
seminars and practical work. Students are also required to take a
number of electives courses in the last years of their education, with
the option to choose environmental medicine or epidemiological
concepts.
Environmental health is part of the curriculum of the first year of the
public health studies. The medical training is inconsistent across the
institutions in the number of hours required. The required training
hours range between 30 and 60 hours.
There are additional upper-level courses in some public health
institutions on protecting the environment and how this benefits
individuals health. However, these classes are rare.
Communication
Anyone in Poland has the right to ask for and obtain information on
the environment and on the health status of the population. Generally,
the Aarhus Convention on Access to Information, Public Participation
in Decision-making and Access to Justice in Environmental Matters
(58) provides the right to access to information on the environment. In
Poland, more specifically, basic provisions concerning environmental
information are contained in the Act on Access to Information on the
Assessments (57). The Act lays down the principle of public
participation in procedures relating to environmental protection.
Under Article 4, citizens have the right to obtain full information on
the state of the environment. The Act specifies the role of public
79
administration authorities, which are obliged to make information on

the environment available to all people available to all people.
The review has shown, however, that the data are not always easily
accessible and that there is no clear agency under the Ministry of
Environment in charge of providing data and information on the state
of the environment.
The Ministry of Environment provides reports and data online.
Moreover, the Chief Environmental Inspectorate and the voivodship
environmental inspectorates post on their respective web sites their
own reports, communiqus and numerous information materials that
describe the state and condition of the natural environment in Poland
and in its respective regions. The voivodship environment protection
inspectorates make air quality measurements generated by automatic
monitoring stations accessible online.
The Chief Environmental Inspector has to transfer the results of the air
quality monitoring to the Chief Sanitary Inspector annually. However,
in practical terms, reports on the state of the environment and health
and monitoring results do not seem to be transmitted regularly from
one sector to the other. For a long time, the information was restricted,
such as data on air quality etc. The introduction of the EU
environmental information directive (2003/4/EC) has nevertheless
improved the exchange of information between the Chief Sanitary
Inspectorate and the General Veterinary Inspectorate.
In Poland, professionals have a wealth of knowledge and experience
in environmental health. Strong scientific research programmes
complement this. However, on the public level, although the public
interest in environment and health status has increased in the recent
years, knowledge is still lacking on many major environmental
hazards. Public information and education on environment and health
risks is essential for ensuring the successful implementation of
environment and health policies. Proper communication strategies and
journalists and mass media as important partners are essential. In
general, no funding mechanism has been developed for
communication activities at the ministry or institute level. There are
seldom specialized units or staff for communicating with the press.
80
One exception is the Childrens Memorial Health Institute, which

recently has established a specific division for communication
purposes. The presence of some institutions in the press (such as the
Institute of Food and Nutrition) shows the need to strengthen the
media capacity of relevant institutions.
Efforts are being made at the local level. The example of Warsaw
shows that citizens are informed on emerging environmental health
hazards through the Warsaw communal gazette. Alarming air quality
data were published and the community informed. Promotional
activities need to be intensified. This relates both to the health and
environment sectors but also to other sectors and institutions that are
not directly involved in environmental health problems, such as
economic sectors and agencies, businesses and NGOs. Some
prevention campaigns have been going through churches (such as road
safety), but disease prevention information activities still need to be
strengthened at the community level.
The experience shows that raising awareness through television
campaigns is costly. Disease prevention campaigns, be it national
campaigns or campaigns organized by NGOs, are not broadcast for
free on television. The approach of the mass media towards
environment and health topics needs to be changed. The interest of the
mass media in supporting health-promoting activities is very limited.
Problem-oriented training courses for mass media aimed at enhancing
knowledge on basic environmental health issues at the national and
local levels should be developed. The example of road traffic injuries
shows that the mass media are often interested in the topic only in
cases of dramatic events and are not supporting preventive action. An
advertisement showing high-speed driving could not be stopped
although the National Road Safety Council opposed it. This approach
needs to be changed.
However, many institutions have made efforts to increase health
promotion programmes and campaigns. Personal basic hygienic
behaviour of children has been promoted through the campaign
Bright Smile Bright Future under the patronage of the Health
Promotion Department of the Ministry of Health and the Institute of
Mother and Child together with Colgate. The campaign is organized
81
as a game, and 13 500 schools with 400 000 students take part
annually. Pupils practice dental cleaning at schools and at home with
the parents. According to the Institute of Mother and Child, 90% of
the children have dental caries. Sometimes the Colgate toothbrush is
the first one the child receives. The campaign gives financial
incentives but also provides data and information enabling the
evaluation of intervention programmes.
Prevention of asthmatic diseases has been promoted through
Freedom to Breathe. This initiative is a multi-partner campaign
under the responsibility of the Chief Sanitary Inspectorate in
cooperation with the Polish Society for Health Education. The
campaign involves 708 000 children and more than 1.5 million adults,
sensitizing them through such means as films for teachers and parents
on how to deal with asthma attacks.
82
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90
Annex 1. Additional information by regional

priority goal
Regional priority goal 1: Water and sanitation
Summary
Water and sanitation are main environment and health issues in
Poland. Significant progress has been made in providing the
population in rural areas with an improved water supply in homes and
in connecting households to the public water supply. However, only
58% of the population is connected to wastewater-treatment facilities
and only 14% of the population is connected to sanitation facilities in
the home in rural areas.
Only 11.9% of the bathing areas in freshwater zones and 35.3% of the
bathing areas in coastal zones complied with the mandatory
requirements for water quality. In 2005, Poland had one of the lowest
compliance rates in the framework of the European Commission
bathing water quality directive in terms of compliance with standards
and insufficient sampling.
Many institutions conduct surveillance as an essential tool in
controlling waterborne diseases, depending on the type of water and
the parameters analysed. The procedures need to be harmonized and
access to data centralized.
Water contamination occurs more often in small water supplies and
more rarely in medium-sized ones. About 10% of the samples taken
did not comply with the standards. The non-compliance mainly
referred to the levels of iron, manganese, turbidity, less often to the
level of ammonia and in 2% to other water parameters analysed.
One of the major problems is increasing water prices.
91
Institutional set-up
The Chief Sanitary Inspectorate is responsible for drinking-water
and bathing water and for collecting data on the quality of water
along the chain of distribution.
The NIPH-NIH analyses chemical hazards in drinking-water.
The Chief Environmental Inspectorate monitors inland surface
water and groundwater.
The Ministry of Environment is responsible for source water
protection.
Local governments have to ensure that insufficient water quality is
remedied.
Local governments have to respond to the Ministry of Health on
the improvement of drinking-water (in the framework of the new
National Health Programme).
The local governments are responsible for the water supply for the
population.
The NIPH-NIH is responsible for setting up all legal provisions for
drinking-water.
Poland has 17 000 public distribution networks.
Tools for management
Main laws and policies recently established in this field
International
European Council Directive 2006/7/CE.
No ratification of the UNECE/WHO Protocol on Water and Health
to the 1992 Convention on the Protection and Use of
Transboundary Watercourses and International Lakes.
Water framework directive.
Directive 98/83/EC of 3 November 1998 on water quality intended
for human consumption.
Poland implemented Council Directive 76/160/EEC in a decree of
the Ministry of Health on requirements about bathing water quality
(Dz. U. Nr 183 poz. 1530 / 2002) of 16 October 2002. The Decree
is to be replaced by the Decree implementing Council Directive
2006/7/CE.
92
National
Act on requirements for water for human consumption.
Water safety plans.
Order of the Council of Ministers of 6 May 1997 on defining the
safety conditions for people in mountains and those who are
swimming, bathing and doing water sports.
Act of 7 June 2001 on collective water supply and collective
sewage disposal.
Water-law Act (Dz.U. Nr 115 poz 1229 / 2001) of 18 July 2001.
Order of the Minister of Health of 16 October 2002 on the
requirements for water in bathing resorts.
Decree of the Ministry of Health on the requirements about
drinking-water quality (Dz. U. Nr 203 poz. 1718 / 2002) of 11
November 2002.
Amendment of the Act on collective water supply and collective
sewage disposal of 22 April 2005.
Regulation of the Minister of Health of 19 November 2002 on
requirements for water quality intended for human consumption.
Decree of Ministry of Environment on the requirements about
surface water used as a source of drinking-water (Dz.U. 204 Nr
1728 / 2002) of 27 November 2002.
Order of the Minister of Environment of 27 November 2002 on
requirements for surface water used for supplying public with
drinking-water.
Order of the Minister of Environment of 10 November 2005 on
substances particularly dangerous to the aquatic environment and
the licence for a specified use of inland waters that is required
before placing them in sewerage systems.
Order of the Minister of Environment of 10 November 2005 on the
index of priority substances in water policy.
Order of the Minister of Environment of 24 July 2006 on
requirements necessary to fulfil when placing sewage into water or
soil and on substances particularly dangerous for the aquatic
environment.
Order of the Minister of Health of 29 March 2007 on the quality of
drinking-water intended for consumption.
93
Tools for action

Monitoring and reporting

The chemical parameters monitored by the Chief Sanitary
Inspectorate are: arsenic, manganese, chromium, nickel, cadmium,
iron and lead. From a microbiological perspective, the Inspectorate
monitors Escherichia coli and enterococci.
There are 118 laboratories for monitoring and control at the
national and voivodship levels under the Chief Sanitary
Inspectorate.
Monitoring is performed in 1500 bathing places.
The data have been available in an electronic database since 2004.
The Chief Sanitary Inspectorate prepares a report on the state of
the country on water quality. The annual report and short-term
reporting are available on the web.
Participation in the PHARE Programme with the aim of
implementing the acquis communautaire and strengthening water
quality monitoring in Poland.
The county sanitary inspector assesses the quality of materials for
water transport.
NIPH-NIH
Chemical hazards in drinking-water analysed by the NIPH-NIH
are: heavy metals, polycyclic aromatic hydrocarbons,
trihalomethane, bromates and chlorine.
The Institute of Hygiene is responsible for supervising the
laboratories in charge of environmental health monitoring
(managed by the Chief Sanitary Inspectorate). It has two accredited
laboratories for physical-chemical and for microbiological
parameters.
There is no separate registration on waterborne diseases in Poland,
but for 10 years there has been a registry on Legionella in water.
No information about who is responsible for irrigation water could
be found.
94
Intersectoral collaboration
The sanitary inspectorates forwards the results of the monitoring
performed in the bathing places to the Ministry of Environment.
There seems to be no regular information flow from the
environment sector to the health sector. Cooperation on a daily
basis is lacking.
Cooperation between the sectors was on paper only for many years
and based on an agreement between the Ministry of Environment
and the Chief Sanitary Inspectorate; in practice, the willingness to
cooperate can be improved.
Regional priority goal 2a: Injury prevention

Summary
In Poland, the mortality rates due to road traffic injuries among people
aged 024 years and the mortality rates due to unintentional injuries
among those 119 years old are only slightly above the European
average but still unacceptably high. Poland is within the range of
countries with moderate to low commitment in implementing policies
to prevent injury. The risk of childrens injuries seems to be a concern
specifically in rural areas.
The Ministry of Infrastructure has the main responsibility for
preventing road traffic injuries, but efforts have been made to involve
other sectors. The National Road Safety Programme follows a
multisectoral approach. Despite the institutionalized setting, however,
not all sectors have been equally involved in the process. The Ministry
of National Education, originally part of the National Road Safety
Council, has dropped out from the process mainly due to financial
constraints.
Cooperation with the private sector and with NGOs seems to be
effective.
95
Although efforts have been made to prevent unintentional injuries,

there is no reliable registry for childrens accidents. Many institutions
are involved in collecting data but they all use different methods.
Beside information and prevention campaigns, safety needs to be
improved from an urban planning perspective (such as constructing
safe bike lanes).
The Institute of Mother and Child has coordinated the information
collected on injuries.
The Childrens Memorial Health Institute is currently developing a
registry for childrens injuries.
The National Road Safety Council established in 2002 under the
Ministry of Infrastructure guides and coordinates activities taken
by the central government in road safety: developing road safety
programmes and guidelines, and initiating and providing opinions
on legislative acts and regulations. It promotes safe behaviour in
road traffic: cycling licences, producing safety kits for cyclists and
preparing advertisements on traffic injuries.
The Ministry of National Education has initiated programmes on
safe cycling (cycling licence).
The main focus of Alter Ego (an NGO) is preventing road crashes.
They are cooperating within the framework of the National Road
Safety Programme and are particularly interested and engaged in
supporting the victims of road crashes.
The Medical University in Cracow will be implementing the Child
Safety Action Plan.
96

National
Objective number 10 of the National Health Programme 2006
2020 aims at reducing injuries among children.
Reducing the number of road crashes was an objective of the
National Health Plan 19962005.
The National Road Safety Programme the Council of Ministers
adopted in 2001 sets the priorities for 20012010 for road safety in
Poland. The programmes strategic goal is reducing the annual
number of deaths due to road traffic injuries to 4000 in 2010.
When Poland joined the EU in May 2004, the Council of Ministers
adopted the new National Road Safety Programme for 20052013.
The national policy on road safety is covered by the Traffic Act
(Dz. U. 1997 Nr 98 poz. 602). The Act includes regulations
considering childrens heath and safety in following areas:
o child safety seats;
o safety belts;
o as passengers in the back seat of the car;
o wearing safety helmets while riding in motorcycles;
o speed limitation system; and
o pedestrians younger than 7 years old and younger
than 15 years old.
The Decree of the Ministry of National Education of 2002 (Dz. U.
51. poz 458) lays down regulations on road safety education as part
of school education.
The Act on Chemical Substances of 2001 regulates child-resistant
packaging for non-pharmaceuticals.
The Decree of the Ministry of Health of 2004 on dangerous
substances requires child-resistant packaging and warnings.
Child Safety Action Plan.
Funding and economics
The budget of the National Road Safety Council estimated for

2007 was Zl 6 million (about 1.6 million) to be used for
97
cooperation in infrastructure development and developing

information material (brochures, leaflets etc.).
Prevention campaigns, whether national campaigns or campaigns
organized by NGOs, are not broadcast for free on television.
The lack of systematic collection of injury data has been attributed
to funding problems.
Funds from the European Investment Bank have been allocated to
local authorities for infrastructure work and preventing road
crashes.
The National Road Safety Council set up by the government and
managed by the Ministry of Infrastructure is coordinating activities
on road safety across sectors.12
The Council meets twice a year, but not all involved sectors
participate regularly; the Ministry of National Education, originally
part of the Council, has dropped out from the process mainly due
to financial constraints.
Many projects are run only by the Ministry of Infrastructure, and
the Council does not have any legislative power on the activities of
the other sectors involved.
The Ministry of Health seems to have independent activities on
preventing road traffic injuries, which are not known to the
Council.
There is good cooperation with the private sector and NGOs:
projects with Renault, Toyota and Alter Ego.
International projects: Italy, Spain and Poland within the European
Transport Safety Council.
12
98
The members are representatives of regional government authorities

(voivodes) designated by the Prime Minister, the Minister of National
Defence, Justice, Interior and Administration, State Treasury, Finance,
Economy, Regional Development, National Education, Environment,
Infrastructure and Labour and Social Policy as well as the Police
Commander-in-Chief, the Fire Brigade Commander-in-Chief and the
General Director for National Roads and Motorways.
There is cooperation with the National Agency for Alcohol

Prevention of the Ministry of Health, which is responsible for
setting blood alcohol limit values.
The cooperation in road safety generally works better with the
private sector than with the public sector.
Tools for action
Monitoring
In Poland, police departments register information on road crashes.

Research is being undertaken on the procedures to follow for
monitoring childrens injuries: the Ministry of Interior and
Administration, Ministry of Health, Ministry of National Education
and Ministry of Infrastructure all use different methods and
different specifications.
There is no system for collecting information on the causes of
accidents.
The development of a central registry on injuries is a priority in the
activities of the Childrens Memorial Health Institute.
Safety promotion
The National Road Safety Council distributes safety kits for

cyclists (reflective materials etc.) and issues cycling licences.
The development of a magazine on road safety for teachers has
been stopped due to lack of funds.
A CD for children on road safety was sent to local authorities (also
for adults).
Global Road Safety Week.
Many campaigns involve churches.
In large cities, the use of public transport has been promoted for
people who go out and drink alcohol.
Communication
The mass media are only interested in dramatic accidents and do

not systematically support preventive activities.
Public television does not broadcast public campaigns prepared by
the state.
99
The National Road Safety Council tried to oppose an

advertisement that indirectly showed high-speed driving but was
not successful in stopping the campaign.
Regional priority goal 2b: Physical activity

Summary
Poland ranges in the average of countries, with 11-year-old boys who
were physically active at the level recommended by the guidelines on
moderate-to-vigorous physical activity. Further, the prevalence of
excess body weight (including obesity) among 13-year-old boys in
Poland is lower than the average in the European Region. Policies to
reduce and prevent excess body weight and obesity among children
and adolescents have steadily improved.
Although efforts are being made to increase the level of physical
activity, particularly in schools, nutritional policies have not yet been
applied to schools. The sale of food and drinks in schools is still not
controlled, and all children do not have the explicit right of access to
safe playgrounds and sporting facilities for children after school.
The Department of Public Health of the Ministry of Health is in
charge of prevention campaigns for enhancing physical activity
(Keep Fit programme).
The Institute of Mother and Child is a partner institution in the
Health Behaviour in School-Aged Children project and is
cooperating with the National Food and Nutrition Institute and
with the school behaviour network.
The Ministry of National Education has set up a programme for
supporting children in participating in after-school sport activities.
International
100
WHO Global Strategy on Diet, Physical Activity and Health

through the National Programme on Prevention of Overweight,
Obesity and Noncommunicable Diseases through Diet and
Improved Physical Activity (20072016).
National
One of the objectives of the National Health Programme focuses
on promoting physical activity for preventing cardiovascular
diseases and promoting healthy behaviour.
Long-term national programme for preventing overweight
(including physical activity),
The number of compulsory hours of physical activity per week at
school has been raised to five hours.
Given the increasing prevalence of obesity and the need to enhance

physical activity, the Ministry of National Education has set up a
programme for supporting children in participating in after-school
sports activities (memberships, access to sports fields etc.).
Families have to apply to benefit from this support. Although this
is a good approach, efforts should be made for children to have
access to safe playgrounds and sports facilities as an explicit right.
Intersectoral working groups have been set up for nutrition and
physical activity at the national and local levels. The National Food
and Nutrition Institute has been closely collaborating with the
Ministry of National Education and universities of physical
education.
Tools for action
Physical activity promotion
Keep Fit is run by Department of Public Health of the Ministry

of Health in cooperation with the Institute of Mother and Child; in
September 2006, 5000 schools at the county level (throughout
Poland) were participating in the project. The project will be
evaluated within three years.
101
The Ministry of Health has developed information brochures on

how to prevent obesity through examples of diets.
Activities are mainly carried out in primary school.
Information desks at hypermarkets should support the right diet.
A total of 7000 schools have used new handbooks with physical
activity lessons.
Communication
The mass media often focus on nutrition and physical activity.
Regional priority goal 3: Air quality

Summary
Air pollution and exposure to environmental tobacco smoke are major
environment and health issues in Poland. Respiratory diseases are the
fourth leading cause of death and particularly affect children.
Environmental tobacco smoke is by far the most significant indoor air
quality issue in health terms, and Poland is strengthening its policies
to reduce childrens exposure.
The mean concentration of PM10 calculated for cities in Poland is
relatively high among the countries of the European Region for which
data are available. Overall, transport is one of the major problems at
the urban level resulting in high air pollution.
Many efforts have been made to reduce environmental tobacco smoke
by introducing smoking bans. Nevertheless, smoking at home is still a
major concern. Despite many prevention campaigns, the priority
recently seems to be treating tobacco-dependent people.
Air quality has improved steadily through the closure of many
industrial plants, improving the quality of the environment in the past
15 years.
102
There is considerable air quality data, but it is not used effectively for
assessing population exposure and the related health effects.
Environmental tobacco smoke
The Department of Public Health of the Ministry of Health is
responsible for campaigns to prevent smoking.
The Labour Inspectorate is responsible for checking the situation at
workplaces.
The Chief Sanitary Inspectorate is responsible for checking the
enforcement of the smoking ban.
The Ministry of National Education is implementing smoking
prevention activities, but they are not sufficiently disseminated;
stronger involvement of the educational sector is required.
The Institute of Mother and Child performs research on the effects
of environmental tobacco smoke on health.
The Health Promotion Foundation initiated the campaign Quit
Smoking with Us.
International
On 21 May 2003, Poland ratified the WHO Framework
Convention on Tobacco Control.
National
Act on health protection against the effects of using tobacco and
tobacco products of 9 November 1995 (last amended on 5
November 1999). The Act has been complemented and updated by
several decrees of the Ministry of Health and the Ministry of
Interior and Administration.
National tobacco control and action plan.
One priority of the National Health Programme is reducing tobacco
smoking and the exposure of children and pregnant women to
environmental tobacco smoke.
103
Legislation on tobacco control in 1999 stipulated that 0.5% of the

tobacco excise taxes were to be allocated for tobacco control
measures. This was repealed in 2007.
There are no funds available for advertising supporting
environmental tobacco smoke control; 80% less is spent than what
should be invested in antismoking campaigns.
The national tobacco control and action plan is enforced by an
intergovernmental body built up by the Ministries of National
Education and National Defence and the Chief Sanitary
Inspectorate; at the time of the review, the cooperation between the
different stakeholders did not seem to be working very well.
Tools for action
Health promotion activities
Preventive actions and guidelines are developed targeting different

age groups.
Poland has two annual nonsmoking days.
The prevention activities of the Ministry of National Education
target three priority areas: schools, health care facilities and
workplaces.
Following the campaign Quit Smoking with Us initiated by the
Health Promotion Foundation, an estimated 2.5 million people in
Poland gave up smoking.
Indoor and outdoor air quality
The sanitary inspectorates are in charge of surveillance and control
of compliance with regulations concerning environmental health
(including air quality).
The NIPH-NIH assesses threats to health arising from exposure to
indoor air and is responsible for supervising the laboratories in
104
charge of environmental health monitoring (air quality). It assesses

the health impact of air quality.
analyses environmental health hazards and focuses on indoor air
quality.
The toxicology laboratory of the Nofer Institute of Occupational
Medicine performs human biomonitoring biomarkers of exposure
to heavy metals and related health effects (methylmercury,
phthalates, arsenic, cotinine and persistent organic pollutants).
Persistent organic pollutants and heavy metals in outdoor air are
also monitored in the context of the UNECE Convention on LongRange Transboundary Air Pollution.
The Nofer Institute of Occupational Medicine is involved in the
WHO air quality activities and is a partner in several large EU
projects such as the ECNIS (36) project and also actively involved
in the ESBIO (a project under the EU Environment and Health
Action Plan) for the EU countries.
Voivodship governments at the regional level are responsible for
air quality plans.

International
UNECE Convention on Long-Range Transboundary Air Pollution.
Air quality framework directive (EC) 96/62 on ambient air quality
assessment and management.
From May 2004, Poland adopted the basic regulations and
directives of the European Commission in ambient air protection.
National
Decree of the Ministry of Environment on acceptable levels of
some substances (including PM10) in ambient air, hazardous levels
of some substances in ambient air and the margins of tolerance of
the acceptable levels of some substances (Dz. U. Nr 87 poz. 796 /
2002) of 6 June 2002 as the national transposition of the air quality
framework directive (EC) 96/62.
105
Decree of the Ministry of Environment on assessment of the

substances in ambient air levels (Dz. U. Nr 87 poz. 798 / 2002) of
6 June 2002 as the national transposition of the air quality
framework directive (EC) 96/62.
The Act of Environmental Protection of 27 April 2001 defines the
principles of air quality and air protection, followed by decrees on
specific subjects by the Minister of Environment and the Minister
of Health.
Order of the Minister of Environment of 5 July 2002 on the
detailed requirements for air quality protection programmes.
Order of the Minister of Environment of 20 June 2005 on the
evaluation of the levels of substances in the air.
Order of the Minister of Health and Social Care of 12 March 1996
on the acceptable concentration and intensity of harmful elements
emitted from building materials for health, as well as appliances
and pieces of equipment on premises intended for people.
Act of 20 April 2004 on substances that deplete the ozone layer.
Order of the Minister of Economy and Work of 16 January 2007
on detailed requirements for limiting emission of organic
compounds formed as a result of using organic solvents in some
paints, varnishes and products used for car renovation.
A new construction act being developed will contain basic
requirements for construction materials.
The environmental policy programme 20072015: Chapter 6 of the
programme targets environmental health and human health
protection. It mainly focuses on water, air, noise, electromagnetic
fields and ionizing radiation.
Despite the existing taxation policy on fuel, there is no

comprehensive policy related to transport emissions (for example,
no higher taxes for polluting cars and no sustainable taxation
policies for sustainable or alternative energy sources)13 and no tax
benefits for energy-related investments affecting the emission of
air pollutants.
13
106
On a research level, however, the Road Traffic Safety Centre is making

efforts to analyse the fuel consumption of different vehicles.
At the voivodship level, a bilateral cooperation agreement between
the sanitary and the environmental inspectorates ensures
collaboration in the air quality management.
Tools for action
Monitoring
The Chief Environmental Inspectorate and Chief Sanitary

Inspectorate carry out monitoring at 550 stations at the national
level. Data are collected in a central database and forwarded to the
European Environment Agency AirBase database. This database is
being reconstructed.
The Chief Sanitary Inspectorate is also in charge of monitoring air
quality. In 2004, PM10 was monitored in 155 stations covering
about 50% of the population. In 2007, 252 stations were operating.
PM2.5 is monitored in two cities covering 15% of the population.
Following the transposition of EU directives into national policies,
the number of pollutants monitored has been reduced.
The NIPH-NIH is analysing chemical hazards in outdoor air
(heavy metals, polycyclic aromatic hydrocarbons, trihalomethane,
bromates and chlorine screening).
The Nofer Institute of Occupational Medicine monitors heavy
metals and persistent organic pollutants in the outdoor air in the
framework of the UNECE Convention on Long-Range
Transboundary Air Pollution.
The Chief Sanitary Inspectorate is responsible for indoor air
quality, especially regulating indoor air quality in public places.
The NIPH-NIH certifies microbiological analysis and chemical
analysis of mould presence in indoor environments.
Thirty chemicals and physical elements in building construction
are regulated by the order of the Ministry of Health.
Ten laboratories in 10 sanitary inspections are dealing with indoor
air quality, and plans are being made to create permanent indoor air
quality monitoring.
The Chief Sanitary Inspectorate is responsible for health impact
assessment.
107
For air quality, the NIPH-NIH performs most health impact

assessment. The most advanced projects are APHEA (Air Pollution
and Health A European Approach) and APHEIS (Air Pollution
and Health: A European Information System).
International collaboration
The Nofer Institute of Occupational Medicine is also involved in

the WHO activities on air quality and health.
Communication
The Warsaw communal gazette reports on the air quality in the

different districts.
Regional priority goal 4: Chemical (including food safety),

biological and physical risk factors
Summary
Other environmental hazards to public health include chemicals,
especially in food and working environments, and noise exposure. The
review generally shows that environment and health is predominantly
covered through an occupational health approach.
Childrens exposure to lead in Poland has been of concern, especially
in some regions like Silesia. The blood lead concentration in children
has decreased with the introduction of unleaded fuels, but local
industrial plants continue to be a risk factor.
Analysis of the policy response to food safety and chemicals shows a
large variety of data collected under the responsibility of multiple
sectors.
108
The Chief Sanitary Inspectorate runs surveillance and control of
compliance with regulations concerning environmental health
conditions in workplaces and checks the conditions of food:
production, transport, storage and sale.
The NIPH-NIH deals with urban noise and is the national reference
laboratory for pesticide residues.
is in charge of health promotion at the workplace through
educational activities and for treating diseases caused by exposure
to biological, chemical and physical factors; it also researches and
monitors noise levels, electromagnetic fields and ionizing
radiation.
The Nofer Institute of Occupational Medicine carries out
measurements of noise levels at work, vibration, electromagnetic
fields and ionizing radiation and evaluates the harmfulness of
chemical substances and preparations, including the development
of safety cards.
The health promotion activities of the Mazovian Public Health
Centre tackle the educational, living and working environments.
The overview of the major projects carried out in recent years
shows that priority is put on health promotion in the school
environment targeting children (such as noise at school).
The main responsibilities of the Chief Environmental Inspectorate
are to monitor and report on the level of noise, hazardous waste,
electromagnetic fields and ionizing radiation.
The Institute of Environmental Protection appointed by the
Minister of Environment is in charge of abatement of noise and
vibrations.
The Polish Building Research Institute, through a specialized
department, prepares expert opinions and provides training on the
quality of the environment, buildings and building products with
the aim of ensuring adequate hygienic and health conditions for the
users. It is in charge of testing the emission of harmful substances
from building products and how they influence the indoor living
environment, the workplace, industrial protection zones and the
natural environment.
109
Municipalities are in charge of implementing sanctions if limit

values (noise, etc.) are exceeded.
Alert systems for pollution incidents (gas, chemicals and fire) are
organized at the level of the city of Warsaw and the districts.
International
Chemicals
The Rotterdam Convention on Prior Informed Consent Procedure
for Certain Hazardous Chemicals and Pesticides in International
Trade
The Basel Convention on the Control of Transboundary
Movements of Hazardous Waste
Food safety
EU directives 178/2002/EC,
854/2004/EC and 882/2004/EC.
852/2004/EC,
853/2004/EC,
Occupational safety
Convention concerning the Prohibition and Immediate Action for
the Elimination of the Worst Forms of Child Labour, 1999
(International Labour Organization)
United Nations Convention on the Rights of the Child
Optional Protocol to the Convention on the Rights of the Child on
the involvement of children in armed conflict
National
The National Environmental Policy Programme 20072015 covers
chemicals, noise, waste and radiation.
Noise
Act on Environment Protection (Dz. U. Nr 62, poz. 627) of 27
April 2001 (includes noise).
The Decree of the Ministry of Environment on threshold levels of
noise (Dz. U. 02.8.81 / 2002) of 9 January 2002 stipulates special
110
limits for noise for areas of buildings related to long-lasting stay of

children or teenagers.
Order of the Minister of Environment of 29 July 2004 on
acceptable noise levels in the environment.
Order of the Minister of Economy of 21 December 2005 on
essential requirements for outdoor equipment in terms of emitting
noise to the environment.
Order of the Minister of Transport of 30 January 2007 specifying
the scope of information required to issue a decision on introducing
limitations or bans on aviation operations in order to reduce noise
emitted at the airport.
Order of the Minister of the Economy and Work of 5 August 2005
on safety and hygiene measures related to noise or vibration
exposure at work.
Radiation
Council of Ministers Decree (Dziennik Ustaw Nr 220 poz. 1850)
of 3 December 2002 on requirements regarding the content of
natural radioactive isotopes in stocks and materials used in
buildings intended for humans and livestock and in industrial
wastes used in construction as well as control of the isotope
content.
Chemicals
Act of 11 January 2001 on chemical substances and preparations
(and its implementing legislation).
Order of the Minister of Economy of 5 July 2004 on limitations,
bans or conditions of production, turnover or use of dangerous
substances and preparations.
Order of the Council Of Ministers of 16 October 2006 on
contamination detection systems and competence of authorities
concerning these matters.
Order of the Minister of Economy of 20 December 2005 on
essential requirements for aerosol products.
Act of 28 July 2005 on waste electrical and electronic equipment.
Act of 13 September 2002 on biocidal products (and its
implementing legislation). The Act specifies conditions of
introducing biocidal products on the market and using biocidal
products and active substances they contain in Poland, taking into
111
account requirements concerning their efficiency and safety. The

objective of the Act is to prevent from threats to human and animal
health and threats to the environment resulting from the use of
biocidal products.
Waste
Act of 27 April 2001 on waste.
Resolution of the Council of Ministers No. 233 of 29 December
2006 on the National Plan for Waste Management 2010.
Asbestos
Resolution of the Sejm of 19 June 1997 on the withdrawal of
asbestos from the economy.
Act of 19 June 1997 on the prohibition of products containing
asbestos. According to the Act, it is forbidden to import to Poland
products containing asbestos and asbestos, produce products
containing asbestos and market asbestos and products containing
asbestos to eliminate the production, use and marketing of products
containing asbestos.
Order of the Minister of Economy, Work and Social Policy of
2 April 2004 on the conditions and ways of safe use and removal
of products containing asbestos.
Order of the Minister of Economy and Work of 14 April 2005
about health and safety during the protection and removal of
products containing asbestos and the training programme dedicated
to these issues.
Order of the Minister of Environment of 20 December 2005 on
emission standards from installations.
Food safety
Act on health conditions of food and nourishment of 12 May 2001
(Dz. U. Nr 63 poz. 639 / 2001), last amended on 7 February 2005
(Dz. U. Nr 31 poz. 265 / 2005).
Act on commercial quality of farm and food products (Dz. U. 5 Nr
poz. 44 / 2001) of 1 January 2002
Decree of the Ministry of Health on permissible additional
substances and substances instrumental in processing of 23 April
112
2004 (dz. U. Nr 94 poz. 933 / 2004), last amended on 20 January

2005 dz. U. Nr 79 poz 693 / 2005).
Decree of the Ministry of Health on enriching substances added to
food and conditions of their employment (Dz. U. Nr 27 poz. 237 /
2002) of 19 December 2002.
Decree of Ministry of Health on dietary supplements (dz. U. Nr 27
poz. 236 / 2002) of 19 December 2002.
Hazard analysis and critical control points (HACCP) system
obligatory in Poland since 1 May 2004, last amended on 1 January
2006.
Act of 25 August 2006 on food safety.
Order of 29 March 2007 requirements intended for human
consumption.
The example of chemical safety shows that chemical risk is mainly

assessed from a hazard analysis viewpoint, and no costbenefit
analysis is undertaken.
Tools for action
Monitoring
The Chief Sanitary Inspectorate runs surveillance and control of

compliance with regulations concerning environmental health
conditions in workplaces and checks the conditions of food
production, transport, storage and sale.
The NIPH-NIH analyses chemical hazards in drinking-water:
heavy metals, polycyclic aromatic hydrocarbons, trihalomethane,
bromates and chlorine screening.
The NIPH-NIH also analyses chemical hazards in outdoor air:
heavy metals, polycyclic aromatic hydrocarbons, trihalomethane,
bromates and chlorine screening.
It is also in charge of assessing the occupational health risks of
pesticides and biocides. Particular attention is paid in this respect
to pesticides, polychlorinated biphenyls and mercury.
The Institute of Agricultural Medicine monitors exposure to
pesticides and exposure to heavy metals and related health hazards
in the working environment (methylmercury, phthalates, arsenic,
113
cotinine and persistent organic pollutants). The Institute is in

charge of monitoring and assessing occupational exposure to
physical, chemical and biological agents.
The NIPH-NIH evaluates toxicological dossiers for pesticides,
food contaminants and food additives.
In food contamination, the NIPH-NIH assesses microbiological
risk (Salmonella etc.).
The health sector is responsible for all processed food products.
The NIPH-NIH has its own laboratories for food safety assessment.
It also performs human biomonitoring of persistent organic
pollutants in blood, milk and semen and virological assessment of
food products.
The Institute of Food and Nutrition is the national reference
laboratory for food quality (macro- and micronutrients) and safety.
The General Veterinary Inspectorate is in the Ministry of
Agriculture and Rural Development and is responsible for all
products of animal origin. It cooperates with the National
Veterinary Institute.
Capacity-building
The NIPH-NIH supports the Chief Sanitary Inspectorate through

specialized training for employees and postgraduate training for
specialists on epidemiology and public health. Training can be
expanded to representatives of industry.
114
Environment--04-f__POLAND embeddPage 1
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2:34:40 PM
The present report conveys a clear picture of the current environment and health
situation in Poland. It evaluates strong and weak points of environmental and
health status and policy making in Poland and brings recommendations from
independent experts.
C
Environment and health performance review
Following the decisions of the Fourth Ministerial Conference on Environment and

Health (Budapest, 2004), WHO Regional Office for Europe initiated a project to
ensure that environment and health policy making was more focused on the real
needs of the member states. This included providing country-specific advice in
order to better plan preventive interventions, and to tailor service delivery and
surveillance in the field of environment and health to those needs. Through detailed
Environment and Health Performance Reviews (EHPRs), WHO Regional Office for
Europe is continuing to provide a country-specific analytical description of the
environment and health situation in Member States. The major areas assessed
through this process include the countrys institutional set-up, the methods applied
when setting policy and the legal framework that is available to enforce environment
and health action. Also the capacity of the many sectors, partners and stakeholders
to establish national intersectoral collaboration and the related tools and resources
ensuring action are assessed.
Environment
and health
performance
review
CM
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CY
CMY
Scher
vej 8, DK-2100 Copenhagen , Denmark
Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18
E-mail: [email protected]
Web site: www.euro.who.int
Poland

Regional O ce for Europe
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ovakia Poland Poland Poland Poland
vakia PolandPoland Poland Poland
Poland Poland Poland Poland Poland
kia Poland Poland Poland Poland Po

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Environment and health performance review

Following the decisions of the Fourth Ministerial Conference on Environment and

World Health Organization

akia Poland Poland Poland Poland Sl

Environment and health

Environment and health

Text editing: David Breuer

Health characteristics of Polands population ..................... 8

Environment and health priorities ................................... 11

Institutional set-up ........................................................ 27

Tools for management: policy setting and legal

Intersectoral collaboration ............................................. 65

Tools for action ............................................................. 69

Pawe Goryski, Head, Department of Medical Statistics, National

Krzysztof Jamrozik, Project Coordinator, National Road Safety

Zbigniew Kuaga, Head, Public Head Division, Hospital Memorial

Janusz Popiel, Alter Ego NGO

Lucjan Szponar, National Institute of Food and Nutrition

Air Pollution and Health A European Approach

Source: United Nations Map, No. 3784 Rev. 4, January 2004.

We acknowledge Grant Agreement 2005156 from the European

Executive summary: main conclusions and

A more concrete programme on health and environment should be

Health National Institute of Hygiene is responsible for advising on

Programme is a good example. Nevertheless, the intersectoral

Priority-setting in environment and health should be supported by the

Environment and Health Performance Review Poland

to assist Member States in building up a national institutional

to provide a country-based analytical description of the

to determine whether health policies are well designed to

Environment and Health Performance Review Poland

conferences, with the aim of eliminating the most significant

The Budapest Declaration (4):

Environment and Health Performance Review Poland

implementation work. To provide assistance to member states, the

The EHPR process

Environment and Health Performance Review Poland

EPRs, providing a review of the health aspects related to the

regional priority goal 1: prevent and significantly reduce the

regional priority goal 2: prevent and substantially reduce health

Environment and Health Performance Review Poland

promoting safe, secure and supportive human settlements for all

regional priority goal 3: prevent and reduce respiratory disease

regional priority goal 4: reduce the risk of disease and disability

The implementation of EHPRs is made possible by the European

The standardized method for the review developed at the

Environment and Health Performance Review Poland

Prior consultations are held with the environment and health

Relevant policies, information, evidence and data are collected

A draft report is compiled, summarizing the information

A final report with recommendations for action is submitted

Final conclusions are presented to policy-makers at a national

Structure of the report

Environment and Health Performance Review Poland

Environment and Health Performance Review Poland

1 Health characteristics of Polands

Environment and Health Performance Review Poland

Fig. 1. Leading causes of death in Poland, 2004