Anti-alcohol posters in Poland, 1945-1989: diverse meanings, uncertain effects.

We provide a historical study of the anti-alcohol public health poster in Poland between 1948 and 1990. Our case study illuminates public health policies under communism, with the state as the dominant force in health communication. Poland has a distinctive history of poster art, moving from a Stalinist phase of socialist realism to the diverse styles of the later Polish School. Quantitative and qualitative analysis of 213 posters establishes the major themes and differentiates community approaches, which depict the drinker as a social or political deviant, from those emphasizing individual risk. Medical issues were a minor theme, reflecting public policies geared more toward confinement than treatment. However, Polish School artists used metaphor and ambiguity, and references to the contested cultural symbolism of drink, to complicate and subvert the narrow propaganda intent. Thus, although apparently unsuccessful in restraining overall consumption, these posters offer valuable lessons for policymakers on the use of visual media in health campaigns.

Privatisation of hospitals in Poland--barriers and opportunities.

The paper discusses the question of privatisation of the in-patient care sector in Poland. The references to the general reforming processes are made, as well as the legal context of ownership changes is presented. First part of the article describes the forms of privatisation applied in Poland, such as privatisation of the management, partial privatisation, functional privatisation and total privatisation. The basic data concerning legal regulations currently being in force is also included. Legal status is an important obstacle for the process of privatisation, since the regulations are incoherent and ambiguous. The project of Commercialisation and Privatisation of Independent Public Health Care Facilities Law was presented in 2001, but the political situation was unfavourable for such a regulation. The paper discusses also the potential profits that may be gathered during the privatisation, which may be proved by the experiences in the field of out-patient care, as well as the examples of other countries. It is stated that success of privatisation depends on changes in the structure of sources of financing health care system. The last part of the article describes the previous course of privatisation processes of in-patient sector. Presently about 18% of hospitals in Poland are private facilities, but their role in the system is marginal. The case of hospital in Wiecbork, which was the first bankrupt private hospital in Poland, is presented as the example of dangers caused by the invalid law. The final conclusion is that there is an urgent need in Poland to create clear and coherent legal frames for the privatisation of hospitals, as well as harmonisation of the changes with general reforms of the health care system.

The case of the Silesian regional sickness fund--did "social capital" determine the success of health reform in the Silesian Voivodeship, Poland?

The paper is an effort to find what determined the success of Polish health reform implemented in 1999 in the Silesian Voivodeship. The problem has been referred to "social capital" proposed by R. Putnam; the first part of the article contains a short description of this approach. Then data concerning health insurance performance in Poland are presented, which confirm that the Silesian Regional Sickness Fund functioned most effectively. As a possible factor influencing present decentralised institutions performance, the situation of the Silesian Region during the mid-war period was described. Autonomy of the region, as well as tradition of social voluntary activity may be a source of "social capital" in Putnam's meaning. Besides, continuity of the Prussian bismarckian health insurance system is presented as a potential source of "institutional memory" also increasing the present reform's chances for success. In the last part of the paper, limitations of applying the "social capital" approach to the Silesian case are presented, such as shortness of the mid-war autonomy period and changes in the cultural structure of Upper Silesia caused by migrations after World War II. Other factors, which could increase the efficacy of the health insurance system, such as relatively high incomes of the region's inhabitants, are also described. Nevertheless, the final conclusion is that social and cultural conditions deriving from historical traditions could have had a significant influence on the process of implementing health reform in 1999.