The primary objective of this study is to demonstrate that arterial hypertension continues to constitute a significant public health challenge in the 21st century. Hypertension, often referred to as a “silent killer”, remains one of the most significant global health challenges, contributing to cardiovascular diseases such as stroke, heart attack, and kidney failure. Despite advancements in medical knowledge, hypertension is underdiagnosed and poorly controlled worldwide, including in Poland. Hypertension is still a significant problem in the country, affecting 35.2% of adults. Many Polish patients often express the sentiment: “If you can’t see it, it doesn’t exist.” Globally, less than half of adults are aware that they have hypertension. This article examines the epidemiological trends of hypertension, emphasizing its modifiable risk factors such as physical inactivity, high sodium intake, obesity, and excessive alcohol consumption. Both lifestyle modifications – such as increased physical activity, a heart-healthy diet and smoking cessation – and pharmacological interventions are crucial in managing and preventing hypertension. In Poland, as elsewhere in the world, single-pill combination therapies are becoming the standard for effective treatment adherence. Reaching global hypertension control targets, including reducing harmful alcohol use, tobacco consumption, physical inactivity, and sodium intake, is essential to mitigate the morbidity and mortality associated with hypertension. Through coordinated interventions and public health strategies, substantial progress can be made in reducing the global burden of this preventable condition.
The concept of a tobacco endgame – strategies designed to permanently eliminate or drastically reduce commercial tobacco use – has moved from theoretical debate to active policy implementation worldwide. This review synthesizes key global progress, identifies common policy approaches, and analyzes fundamental challenges and opportunities facing the tobacco control community as it pursues prevalence targets, typically set below 5%. Despite advances in moving towards a tobacco endgame, significant barriers threaten the equitable achievement of endgame goals. These include a persistent implementation gap for proven tobacco control measures, growing socioeconomic and ethnic health disparities in tobacco use, the increasing complexity of the market due to novel nicotine products, and continued tobacco industry interference. Opportunities for accelerating progress include broad public support for innovative measures and the potential for expanding the focus to low- and middle-income countries, many of which are already “Endgame Ready” based on low prevalence and strong Framework Convention on Tobacco Control (FCTC) implementation scores. Furthermore, the FCTC’s adoption of “forward-looking” measures offers an international platform to solidify these goals. Ultimately, the success of tobacco endgame measures will depend heavily on how they are implemented and supported. Thus, continued research and monitoring of tobacco endgame efforts, as well as continued support for comprehensive tobacco control programs, is essential to ensuring success.
Access to healthcare in Central and Eastern European countries remains a complex and crucial issue, and despite the ongoing improvement of healthcare systems in the European Union, inequalities in access and quality of care persist. This article analyses the sources of these inequalities, paying attention to financial constraints, availability of services, place of residence and social factors such as education, gender and stigmatization. It indicates that socio-economic status and living in rural areas significantly increase vulnerability to health threats, delays in treatment and financial difficulties, especially in the case of chronic and oncological diseases. It discusses the effects of underfunding of healthcare systems, shortages of medical staff and infrastructure deficits, which most affect the poorest groups. Conclusions are presented regarding the need for integrated policy reforms, taking into account both systemic and social determinants, including investments in infrastructure, improving communication with patients, economic protection of patients and increasing the level of health literacy. Such actions are necessary to reduce inequalities, ensure equal access to care and achieve the Sustainable Development Goals.
Alcohol consumption is one of the most significant modifiable risk factors affecting global health. In Poland, alcohol-related diseases have become a major public health challenge, reflected in rising consumption levels and rates of alcohol-related morbidity and mortality, as well as increased availability and affordability. Although alcohol is widely accepted socially, it is a psychoactive, addictive, toxic, and carcinogenic substance associated with over 200 diseases. Even small amounts increase the risk of chronic non-communicable diseases, mental disorders, and cancer. In 2019, alcohol caused approximately 2.6 million deaths globally and more than 115 million disability-adjusted life years (DALYs). Poland is one of the few European countries where alcohol consumption has increased steadily since the early 2000s. This rise has been strongly influenced by the weakening of policy measures, including reduced excise taxes leading to higher affordability, liberalized advertising regulations, 24/7 availability, and the introduction of small-bottle spirits. As affordability and exposure grew, alcohol-related morbidity and mortality followed. Alcoholic liver cirrhosis (that is, fully attributable to alcohol) illustrates this trend clearly: between 1999 and 2022, mortality rose several-fold across all adult age groups, particularly among women and older adults. Alcohol-related cancers and injuries also increased. While many European countries have reduced consumption through strict regulation, Poland has weakened previously effective control measures. World Health Organization assessments highlight insufficient action on taxation, availability, and marketing restrictions, which has contributed to worsening epidemiological trends. Effective alcohol harm reduction requires comprehensive public health strategies: regular excise tax increases, strict advertising bans, limits on availability, and well-funded national educational programmes. Raising public awareness is essential, as many Poles remain unaware that even light drinking increases cancer risk. Restoring a robust national alcohol policy, aligned with international standards and focused on prevention, monitoring, and population-wide risk reduction, is crucial for reversing the ongoing health crisis in Poland.
Both Poland and the US have made tremendous progress over the past several decades in reducing both tobacco use and lung cancer mortality. However, this victory was not easily won. The outcome was the result of substantial effort over decades, requiring multi-sector collaboration and countering of competing interests. The US and Poland also share over 50 years of formal cooperation in health, with a continuous bilateral agreement in place since 1974. Beginning in the 1960s, the US government, particularly the National Cancer Institute, supported biomedical research projects in Poland under the Foreign Assistance Act. However, the bilateral relationship around tobacco control was more complex, with competing economic and foreign policy interests. During the 1970s and 1980s, Poland was among the highest smoking nations in the world. Smoking prevalence had risen to around 80% among men and 50% among women. The fall of Communism, Poland’s transition to democracy during 1989 to 1991, and the move towards a capitalist market also had implications for the tobacco market, as multinational tobacco firms raced into Central and Eastern Europe. During the 1990s, US tobacco companies were rapidly expanding their markets abroad and the US government was actively promoting greater exports of US tobacco products and subsidizing sales of US tobacco to Poland. However, the enactment of a comprehensive national tobacco control law in Poland 1995, after years of hard fought efforts, finally began to drive down cigarette smoking. This success was largely a result of efforts from journalists, voluntary organizations, and activists, part of a growing civil society movement in newly-democratic Poland. The international community, including the US, had an important role in bringing tobacco control experience to Poland, but this assistance came not from government but from voluntary and advocacy organizations. These collaborative efforts turned Poland into a tobacco control success story.
In January 2025, the municipality of Milan, Italy, implemented a total smoking ban for public areas in the city, excluding selected, isolated zones. This is one of the few smoking regulations adopted in Italy over the last 20 years. In January 2006 a smoking ban was implemented in all closed spaces open to the public, including private and public workplaces, commercial and catering establishments, places of entertainment, gyms and sports centres. No other relevant measure was subsequently adopted, and cigarette prices are lower in Italy than in most of western Europe. Between 2005 and 2021, the Italian Tobacco Control Scale (TCS) score, developed by the World Bank and the World Health Organization to measure tobacco control in European countries, decreased in Italy. It dropped from 8 th place in the 2006 TCS to 18 th place in 2021. The Milan regulation is relevant for the control of active and passive smoking in public places and constitutes a model for other Italian and European urban areas.
This paper summarizes current evidence on excess mortality in Europe from 2020 to 2023, emphasizing the different drivers of excess death rates during the COVID-19 pandemic. The first two years (2020-2021) accounted for a substantial proportion of additional deaths – estimated at approximately 1,000,000 across 29 European countries – largely due to direct SARS-CoV-2 infection and other factors such as hospital resource constraints and deferred medical care. Excess mortality persisted in 2022 and substantially decreased in 2023. Marked regional disparities emerged, with Eastern Europe, parts of Southern Europe, and specific high-density urban areas reporting some of the highest excess mortality, often linked to structural healthcare limitations and lower vaccination uptake. By contrast, Nordic countries experienced lower surges, partly attributable to robust healthcare infrastructure and proactive public health measures: the smallest excess mortality was in Sweden. Older adults bore most of the burden, underscoring the role of demographic vulnerability. Socioeconomic factors, including gross domestic product and healthcare accessibility, further shaped the uneven toll of the pandemic.
