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Health promotion in Polish legislation
( Promocja zdrowia w polskim ustawodawstwie )
M BażydłoA, B, C, D, I RadlińskaC, E, B KarakiewiczF
Abstract – Introduction. Law has a variety of functions concerning public health and health promotion; among others, it
forbids selected anti-health attitudes, supports selected healthoriented attitudes, determines the powers of health care units,
regulates the practice of medical professions and determines
the requirements concerning the quality of health care.
The aim of the research. The research aims at the analysis of
legal regulations on the statutory level concerning health promotion.
Materials and Methods. The material for the research comprises legal acts on the statutory level (as on 15 March 2014).
The adopted method was document analysis. The acts regulating the issues concerning health promotion were analysed.
Results. The Constitution of the Republic of Poland indicates
that everyone has the right for health protection. Legal definition of health promotion is included in the Act on Medical
Activity. The act indicates that medical activity can involve
realisation of tasks concerning health promotion. The Act on
the Professions of Doctor and Dentist as well as the Act on the
Profession of Nurse and Midwife mention health promotion in
respect of the practice of these professions. Furthermore, the
Act on Public Benefit and Volunteer Work defines health
promotion as one of the spheres of public benefit activity. The
so-called self-government acts (the Act on Commune Selfgovernment, the Act on District Self-government, the Act on
Province Self-government) indicate that a commune, a district
and a province are competent for realisation of tasks concerning health promotion. Among the state administration authorities concerned with public health, there is State Sanitary Inspectorate.
Conclusions. 1. There is no legal act which would comprehensively regulate the issue of health promotion. 2. The tasks in
this respect rest mainly with the units of local selfgovernment, with communes and State Sanitary Inspectorate
in particular. 3. Polish legislation puts emphasis on the role of
public benefit organisations in shaping health-oriented attitudes.
Key words - health promotion, legislation, medical law.
Streszczenie – Wstęp. Prawo pełni różnorodne funkcje w zakresie zdrowia publicznego oraz promocji zdrowia, między
innymi: zakazuje wybranych zachowań antyzdrowotnych,
wspiera wybrane zachowania prozdrowotne, określa uprawnienia jednostek w opiece zdrowotnej reguluje kwestię wyko-
nywania zawodów medycznych, określa wymagania w zakresie jakości opieki zdrowotnej.
Cel pracy. Celem pracy jest analiza regulacji prawnych na
poziomie ustawowym w zakresie promocji zdrowia.
Materiał i metoda. Materiał stanowiły akty prawne na poziomie ustawowym (stan na dzień 15.03.2014 r.). Wybraną metodą była metoda analizy dokumentów. Analizie poddano
ustawy regulujące kwestie związane z promocją zdrowia.
Wyniki. Konstytucja wskazuje, że każdy ma prawo do ochrony
zdrowia. Definicja legalna promocji zdrowia znajduje się w
ustawie o działalności leczniczej. Ustawa ta wskazuje, że działalność lecznicza może polegać na realizacji zadań z zakresu
promocji zdrowia. Ustawa o zawodach lekarza i lekarza dentysty, a także ustawa o zawodzie pielęgniarki i położnej wymieniają promocję zdrowia w kontekście wykonywania wyżej
wymienionych zawodów. Z kolei ustawa o działalności pożytku publicznego i o wolontariacie określa promocję zdrowia
jako jedną ze sfer działalności pożytku publicznego. Tzw.
ustawy samorządowe (ustawa o samorządzie gminnym, ustawa
o samorządzie powiatowym, ustawa o samorządzie województwa) wskazują, że kompetentne do wykonywania zadań z zakresu promocji zdrowia są gmina, powiat, województwo.
Wśród organów administracji państwowej zajmującej cię
zdrowotnością publiczną znajduje się Państwowa Inspekcja
Sanitarna.
Wnioski. 1. Nie ma aktu prawnego kompleksowo regulującego
kwestię promocji zdrowia. 2. Zadania z tego zakresu spoczywają głównie na jednostkach samorządu terytorialnego, w
szczególności na gminach oraz na Państwowej Inspekcji Sanitarnej. 3. Ustawodawstwo polskie podkreśla rolę organizacji
pożytku publicznego w kształtowaniu postaw prozdrowotnych.
Słowa kluczowe - promocja zdrowia, legislacja, prawo medyczne .
Author Affiliations:
Chair and Department of Public Health, Pomeranian Medical
University in Szczecin
Authors’ contributions to the article:
A. The idea and the planning of the study
B. Gathering and listing data
C. The data analysis and interpretation
D. Writing the article
E. Critical review of the article
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F. Final approval of the article
Correspondence to:
Marta Bażydło, Department of Public Health, Pomeranian
Medical University in Szczecin, Zabużańska 35a Str., Pl-71051 Szczecin, Poland, e-mail: [email protected]
Accepted for publication: November 15, 2014.
I. INTRODUCTION
ccording to the Ottawa Charter of 1986, “Health
promotion is the process of enabling people to increase control over (...) their health” in terms of
improvement and maintenance thereof [1]. Therefore,
health promotion aims at the change of behaviour of
individuals and, consequently, of the whole society. Behaviour changes of individuals and social groups are
achieved through two types of mechanisms: the first
mechanism involves influences of psycho-sociological
nature. The second one involves legal instruments [2].
The functions of law concerning public health and
health promotion include, among others, forbidding
actions and attitudes which are harmful for health of an
individual and a community, determining the right of an
individual and social groups as far as health care services are concerned as well as regulating the rules of
producing health care resources [2]. For health promotion, the creation of mechanisms enabling an individual
to increase their influence on their own health seems to
be the most significant issue.
Interestingly, legal norms which protect health can be
found in all bodies of law. According to civil law, health
is a personal, non-proprietary right. The infringement
thereof results in civil liability, which may take two
forms: tort liability, which is the result of committing a
tort, and contractual liability, which is the result of nonfulfilment of a contractual obligation [3]. In respect of
criminal law, it should be noted that violating another
person's health as well as acts or negligence which are
threatening to public health result in criminal liability
[4]. Administrative law, in turn, comprises numerous
norms that protect health, e.g. in the provisions concerning health administration, in public welfare law or
environmental protection law [5].
The norms concerning health promotion are present
in legal acts of every level, from the Constitution to lo-
A
5
cal law. For the purpose of this research, the authors
have limited themselves to legal acts on the statutory
level.
The research aims at the analysis of legal regulations
on the statutory level concerning health promotion.
II. MATERIALS AND METHODS
The material for the research comprises legal acts on
the statutory level (as on 15 March 2014). The acts
were selected with the use of Lex Legal Information
System (System Informacji Prawnej Lex) and Internet
System of Legal Acts (Internetowy System Aktów
Prawnych). The adopted method was document analysis.
The acts regulating the issues concerning health promotion were analysed.
III. RESULTS
In order to commence the analysis of legal status concerning health promotion on statutory level, the Constitution of the Republic of Poland of 2 April 1997 should
be taken into consideration in the first place. In Poland,
the right to health protection is regulated by Article 68,
Section 1 of the Constitution, which provides that “Everyone shall have the right to have his health protected”.
The importance of the right to health protection is emphasised by including it in the Constitution as well as by
the place it occupies therein, i.e. in Chapter II, among
economic, cultural and social freedoms and rights. Neither the Constitution nor ordinary acts define the concept of health protection. There is no legal definition of
health, either. Health protection, as well as health itself,
should be understood in a multi-faceted way and there is
rather no doubt that the concept of health promotion is
included in the concept of health protection [6].
Despite of the lack of legal definitions of health and
health protection, Polish law comprises the definition of
health promotion, which is stated in the Act on Medical
Activity of April 15, 2011. According to this act, health
promotion is an activity enabling individual persons and
a community to increase control over factors determining one's health status and consequently to improve it; it
is also the promotion of healthy lifestyle as well as of
environmental and individual factors beneficial to
health. The act also indicates that medical activity involves providing health services; it may also involve
health promotion and the realisation of educational and
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research tasks in relation to the provision of health services and health promotion [7].
A notice should also be taken of the Act on the Professions of Doctor and Dentist of December 5, 1996,
which states that the practice of the profession of doctor
(and dentist) can involve conducting research in the
field of health promotion [8]. In turn, the Act on Professions of Nurse and Midwife of July 15, 2011 states
overtly that the practice of the profession of nurse (and
midwife) can involve health promotion and health education [9].
Particular activities of health promotion are described
in the Act on Mental Health Protection of August 19,
1994, which provides that the tasks of mental health
protection include the promotion of mental health [10].
The legislator's attitude towards the realisation of
health promotion tasks by non-governmental organisations is also an important issue. Thus, it is worthwhile
to cite the Act on Foundations of April 6, 1984 and the
Act on Public Benefit and Volunteer Work of April 24,
2004. According to the Act on Foundations, a foundation can be established in order to realise goals in the
area of health protection, i.e. also goals related to health
promotion. The Act on Public Benefit and Volunteer
Work, in turn, lists health promotion as one of the
spheres of public benefit activity [11, 12].
It appears, however, that tasks concerning health
promotion rest mainly with the units of local selfgovernment.
According to the Act on Commune Self-government
of March 8, 1990, commune's own tasks include tasks in
the areas of health protection, physical culture, tourism
and commune's green areas. In line with the principle of
the presumption of competences in favour of a commune, the scope of activity of a commune includes all
public matters of local importance which are not restricted by legislative acts to other bodies. A commune
can also commission its duties to non-governmental
organisations. A contractor must be chosen through an
open tender. However, legal doctrine points out that,
first of all, the catalogue of commune's tasks itself does
not order a commune to undertake the tasks listed therein (a separate act is required) and, secondly, it constitutes no legal basis for undertaking actions. In the case
when there is no specific thematic act on actions undertaken by a commune, a commune can undertake actions,
but only those which are not of binding nature - i.e. they
do not result in rights and obligations of third parties
[13, 14].
6
By virtue of the Act on District Self-government of
June 8, 1998, a district performs public tasks as provided by acts. Contrary to the catalogue of commune's
tasks, the catalogue of district's (as well as of province's)
tasks is exhaustive and it includes tasks in the areas of
health promotion and protection as well as the areas of
physical culture and tourism [15].
Similarly, the Act on Province of June 5, 1998, states
that a province self-government performs tasks of a
province range as provided by acts. Among the listed
tasks, there are health protection and promotion as well
as physical culture and tourism, like in the case of a
district [16].
The regulations referring to the tasks of a commune
and district concerning health promotion are included in
the Act on Publicly Funded Healthcare Benefits of August 27, 2004. The act provides that commune's own
tasks include the development, implementation and
evaluation of effects of health programmes arising from
recognised health needs and health status of the residents of the commune; providing the district with information on health programmes in realisation; initiating and participating in setting directions for local initiatives which aim at acquainting the residents with factors that are harmful for one's health and with their effects; undertaking other actions arising from recognised
health needs and health status of the residents of the
commune. The act provides for district's own tasks in
the way analogous to the tasks of a commune, with the
addition of the task of inciting actions that encourage
individual and group responsibility for health and actions that encourage health protection [17].
Among the state administration authorities concerned
with public health, there is the State Sanitary Inspectorate. According to the Act on State Sanitary Inspectorate of March 14, 1985, the State Sanitary Inspectorate, along with its main supervisory activity, initiates,
organises, conducts, coordinates and supervises educational activity concerning health, which aims at developing proper health-oriented attitudes and behaviour in
society [18]. For this reason, in the province units of the
State Sanitary Inspectorate, departments of healthoriented education and health promotion are established. The State Sanitary Inspectorate is known of its
numerous actions promoting health-oriented attitudes,
like, for example, the organisation of the World Health
Day in Poland (7th April), World Tobacco-Free Day
(18th November) or, on more local scale: “Safe winter
holidays”, “Safe summer holidays”. In the case of the
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State Sanitary Inspectorate, there are also no reservations about its evaluation of health education activity of
entities like: schools and other educational facilities,
institutions of higher education, mass media, health care
entities and other entities, institutions and organisations. However, it seems that regulations do not enable
the State Sanitary Inspectorate to fully develop its activity concerning the coordination of actions of various authorities and institutions in the area of health promotion
so that these actions would complement and support one
another. It is a pity, since the Inspectorate could undertake such tasks, given its nationwide administrative system and the strong position of the Chief Sanitary Inspector as a central authority of state administration.
IV. DISCUSSION
A similar scope of statutory regulations concerning
health promotion was described already in the 1990s by
Górska-Marciniak. The author indicates that the legal
situation as of that time also featured a definition of
health promotion and of various obligations related to
health promotion realised by government and selfgovernment administration, medical personnel, employers, entities providing health services. It is nonetheless
difficult to agree with a definite statement that the above
listed entities, in the past as well as present legal situation, have been subject to the obligation of health promotion (except for the Management of Health and Safety at Work regulations). It should also be noted that the
attitude of Polish legislation to health promotion has not
changed since the 1990s.
Słońska points out that a cross-sectoral cooperation
should ensure the success of health promotion [20].
However, it is difficult to speak about a cross-sectoral
cooperation in a situation when the legislator regulates
the issues concerning health promotion in a chaotic
way. It is the legislative deficiencies that are identified
by Słońska as the reason for the lack of cooperation at
the cross-sectoral level in the first place, only then followed by financial limitations. At the same time Słońska
points to commune as a unit that is most suitable for the
realisation of tasks in the area of health promotion. It is
impossible not to agree with the author's opinion that at
present there are no mechanisms which would guarantee the realisation of tasks in the area of health promotion [20].
7
Krajewski and Kaczmarek notice that the division of
tasks among a commune, a district and a province is
unclear. The authors point out, however, that such a
situation could open a possibility for interested entities
to undertake actions. They also notice that local selfgovernment units are burdened with numerous tasks and
they would not want to undertake actions in the area of
health promotion due to the lack of financial resources.
Contrary to the opinion presented by Słońska, Krajewski
and Kaczmarek express a position that communes do
not possess resources appropriate for the realisation of
health promotion projects [21].
The research carried out by the Public Opinion Research Center (Centrum Badania Opinii Społęcznej –
CBOS) demonstrates that communes do not consider
health protection and promotion as belonging to their
tasks, they are not priority tasks and there are more important needs in communes. Another reason for the fact
that communes do not realise tasks in the area of health
promotion is the lack of sufficient financial resources
[22].
A question arises, whether tasks in the area of health
promotion should be realised by district. The research
conducted by Nosko and Marcinkiewicz in 2008 discloses that out of all Polish districts only 57% included
provisions concerning preventive health care and health
promotion in the organisational regulations of District
Starosties and Town Offices of towns with district right
[23].
It appears that, given the lack of coordination and the
lack of entities unequivocally responsible for the realisation of tasks in the area of health promotion, it would be
reasonable to implement the solutions put forward in the
bill on Public Health [24-26], which provide for systemic solutions.
V. CONCLUSIONS
1. There is no legal act which would comprehensively regulate the issue of health promotion.
2. The tasks in this respect rest mainly with the
units of local self-government, with communes
in particular.
3. Polish legislation puts emphasis on the role of
public benefit organisations in shaping healthoriented attitudes.
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VI. REFERENCES
[1] Ottawa Charter for Health Promotion First International Conference on Health Promotion Ottawa, 21
November 1986.
[2] Czupryna A, Poździoch S, Ryś A, Włodarczyk C.
Zdrowie publiczne - wybrane zagadnienia Kraków;
Wydawnictwo Vesalius, 2001.
[3] Ustawa z dnia 23 kwietnia 1964 r. - Kodeks cywilny
(Dz.U. 1964 nr 16 poz. 93, ze zm.).
[4] Ustawa z dnia 6 czerwca 1997 r. - Kodeks karny
(Dz.U. 1997 nr 88 poz. 553, ze zm.).
[5] Wierzbowski M, Jagielski J, Lang J, Szubiakowski M,
Wiktorowska A. Prawo administracyjne. Warszawa;
Wydawnictwo Lexis Nexis, 2011.
[6] Konstytucja Rzeczypospolitej Polskiej z dnia 2 kwietnia 1997 r. (Dz.U. 1997 nr 78 poz. 483).
[7] Ustawa z dnia 15 kwietnia 2011 r. o działalności
leczniczej (Dz.U. 2011 nr 112 poz. 654, ze zm.).
[8] Ustawa z dnia 5 grudnia 1996 r. o zawodach lekarza i
lekarza dentysty (Dz.U. 1997 nr 28 poz. 152, ze
zm.).
[9] Ustawa z dnia 15 lipca 2011 r. o zawodach pielęgniarki i położnej (Dz.U. 2011 nr 174 poz. 1039, ze
zm.).
[10] Ustawa z dnia 19 sierpnia 1994 r. o ochronie zdrowia psychicznego (Dz.U. 1994 nr 111 poz. 535, ze
zm.).
[11] Ustawa z dnia 24 kwietnia 2003 r. o działalności pożytku publicznego i o wolontariacie (Dz.U. 2003 nr
96 poz. 873, ze zm.).
[12] Ustawa z dnia 6 kwietnia 1984 r. o fundacjach
(Dz.U. 1984 nr 21 poz. 97, ze zm.).
[13] Ustawa z dnia 8 marca 1990 r. o samorządzie gminnym (Dz.U. 1990 nr 16 poz. 95, ze zm.).
[14] Dominowska J, Hauser R, Jaroszyński K, Zygmunt
Niewiadomski Z, Piątek W, Skoczylas A .Ustawa o
samorządzie gminnym. Komentarz z odniesieniami
do ustaw o samorządzie districtowym i samorządzie
województwa. Warszawa; Wydawnictwo C.H. Beck,
2011.
[15] Ustawa z dnia 5 czerwca 1998 r. o samorządzie districtowym (Dz.U. 1998 nr 91 poz. 578, ze zm.).
[16] Ustawa z dnia 5 czerwca 1998 r. o samorządzie województwa (Dz.U. 1998 nr 91 poz. 576, ze zm.).
[17] Ustawa z dnia 27 sierpnia 2004 r. o świadczeniach
opieki zdrowotnej finansowanych ze środków publicznych (Dz.U. 2004 nr 210 poz. 2135, ze zm.).
[18] Ustawa z dnia 14 marca 1985 r. o Państwowej Inspekcji Sanitarnej (Dz.U. 1985 nr 12 poz. 49, ze
zm.).
[19] Górska-Marciniak E. Promocja zdrowia w uregulowaniach prawnych. IV Seminarium CINDI nt. postępów w profilaktyce i leczeniu przewlekłych chorób
8
niezakaźnych 1999.10.28-29 Spała, Polska. Łódź:
YAGRAF/bis; 1999.
[20] Słońska Z. Warunki skutecznego wdrażania promocji zdrowia w Polsce. Ter Leki 2001; 2: 24-28.
[21] Krajewski-Siuda K, Kaczmarek K. Promocja zdrowia w zadaniach samorządów terytorialnych - analiza obowiązującego ustawodawstwa. Ann Acad Med
Siles 2006; 60(3): 231-240.
[22] CBOS. Realizacja zadań z zakresu ochrony i promocji zdrowia. Prezentacja wyników badań realizowanych w wybranych communech. Warszawa, grudzień
2010 [cited: 01.04.2014 r.
www2.mz.gov.pl/wwwfiles/ma_struktura/docs/real_
zaad_zp_16112011.pdf
[23] Nosko J, Marcinkiewicz A. Ochrona i promocja
zdrowia w strukturach formalnych starostw districtowych i urzędów miast na prawach districtu Med Pr
2009; 60(2): 131-136.
[24] Projekt ustawy o zdrowiu publicznym z dnia
20.07.2011
r.
[cited:
2014.03.10].
http://gis.gov.pl/dep/?lang=pl&dep=10&id=12.
[25] Stawarz B , Sulima M , Lewicka M, Brukwicka I,
Wiktor H. Health and determinants of health - a review of literature, p.I. JPHNMR2014; (2):4-10.
[26] Stawarz B , Sulima M , Lewicka M, Brukwicka I,
Wiktor H. Health and determinants of health - a review of literature, p.II. JPHNMR2014; (2): 11-16.