Donald Tusk, the former president of the European Council, is poised to lead a new coalition government that will replace the outgoing right-wing Law and Justice (PiS) party in power in Poland. The shift is likely to bring rapprochement with the institutions of the European Union. Many hope, it will also bring changes to draconian laws that PiS introduced in the field of reproductive rights and bring at least some improvement to LGBTQ rights.
It remains less clear what people should anticipate from the new government when it comes to the field of health. As Michał Zabdyr-Jamróz from the Institute of Public Health at Jagiellonian University explains, one has to keep in mind the health landscape that predated PiS.
Zabdyr-Jamróz warns that it should not be taken for granted that health plans will automatically become more progressive as the new government takes office.
Read more: Donald Tusk returns as Polish premier after eight years of PiS rule
When it comes to health, according to Zabdyr-Jamróz, PiS was a “weird beast.” While the changes they introduced in the fields of abortion care were devastating, in other areas, they implemented changes that would usually be claimed by left parties.
This peculiarity has a lot to do with the extent to which neoliberal policies, including those in health, took root before 2015. “We could say that the people in Poland were very keen pupils of neoliberalism. We really embraced the idea,” says Zabdyr-Jamróz.
During the 1990s and early 2000s, this brought an overwhelming focus on health policies on competition, commercialization, and decentralization. Poorly prepared and implemented decentralization and competition usually leads to reductions in access to healthcare for some and a general increase in health inequities.
This was a trend across all policies, as Zabdyr-Jamróz explains: “Inequities and neglect in peripheral areas led to frustration as major economic centers benefited. The purchase of Pendolino trains symbolized this trend, prioritizing high-speed connections between major cities over affordable train connections, particularly in ‘county Poland.’ This phenomenon became known as ‘pendolinisation,’ signifying modernization of economic centers at the expense of the peripheries.”
The frustration and the political mobilization of peripheries has largely contributed to PiS gaining power in 2015. What is especially heartbreaking in this situation, according to Zabdyr-Jamróz, is that PiS captured some of the electorate that would otherwise lean left.
Their 2019 manifesto stated: “We reject principles of neoliberalism.” In stating that, unlike some Western populist politicians, PiS did not solely rely on anti-elitist rhetoric or vague promises of solidarity and economic self-reliance, continues Zabdyr-Jamróz. Instead, they implemented measures that could be seen as economically progressive.
For example, PiS reformed sections of the payroll tax financing healthcare to be less regressive, reflecting income differences among private entrepreneurs and promoting some level of fiscal fairness.
It still remains uncertain what direction in health policy Tusk’s government will pursue. Zabdyr-Jamróz says that it is unlikely that there will be a complete return to the pre-2015 policies. Many of them, in any case, are now considered outdated in European health policy expert circles.
That does not mean there will not be a push to return to the old, considering the entrenched economic interests and pre-existing notions that influence health reforms.
What can be expected is a partial continuation of the process of centralization of certain functions due to technical needs inside the system. Following this process will be necessary to achieve better coordination and integration of services, as well as reduction of waste in investments, according to Zabdyr-Jamróz.
“As this is an ongoing trend in European health reform in many decentralized systems, there will be some kind of centralization – at least regional centralization – going on in everything but name, because the term centralization remains a dirty word for (many of the stakeholders),” he added
Addressing the brain-drain in the health sector
One of the topics that any new minister of health will be forced to face is the issue of the health workforce. Like most countries in East Europe, Poland is trying to cope with a deficit of nurses, doctors, and other health workers.
Those employed in the public health system are getting older, and the working conditions, including income, are not good enough to retain younger workers. Since Poland joined the EU, many moved towards the core countries, leaving understaffed hospitals and health centers behind.
While attempts to improve working conditions in the public system in Poland were generally insufficient, the outgoing government attempted to deal with workforce deficits in two ways. First of all, PiS liberalized medical education in Poland. This means that any university can have a medical department without worrying too much about prerequisites.
A first generation of health workers completing their studies through this system is about to graduate, and concerns are already being voiced about their competencies. “Many fear that they will be very poorly prepared. Some even expect that hospitals will be refusing them (for residencies). People will be disappointed that their diploma is worthless,” says Zabdyr-Jamróz.
Another solution to deal with the health workforce shortage was to rely on immigration, especially from Ukraine. The health and medical education systems of the two countries differ, but the influx of migrant doctors and nurses has increased in recent years, particularly due to the war.
Importing ready-made health workers might seem a handy option at first, but it is deeply unfair to the neighbors, warns Zabdyr-Jamróz: “Basically, what we’re doing is brain-draining Ukraine. And that’s what West Europe did to us. For now, it can be explained due to the large refugee population in Poland. But what will it mean for Ukraine in the future?”
Increasing access to safe abortion
The second hot potato in Poland’s healthcare system will definitely be sexual and reproductive health rights. Since 2021, the country has implemented one of the strictest abortion policies in the region, including the criminalization of health workers and activists who support women during termination of pregnancy. Analyses of the election results leave no doubt that it was largely the mobilization around this question that brought an end to PiS’ rule.
“Many women fear for their lives and for their health because of the lack of availability of this access to healthcare service in the situation of life-threatening pregnancy complications,” says Zabdyr-Jamróz.
Parties of the incoming government coalition are aware of that. One of the main points highlighted by new Prime Minister Donald Tusk was the promise that decriminalization of abortion would follow a change in government. Yet the fulfillment of that promise might turn out to be more complicated than most would hope.
The new government will still be sharing the political arena with President Andrzej Duda, who is a major ally of PiS, as well as the current setup of the Constitutional Court, also appointed by PiS. In this landscape, it will be very difficult to introduce radical changes: Duda, for one, has already announced he would use his right to veto in cases like this.
Read more: Polish women intensify protests demanding repeal of ban on abortions
There is also the fact that the incoming government coalition is not a homogenous collective. “You might be under the impression that there are just three parties forming the coalition, but actually, some of these are coalitions of parties themselves,” explains Zabdyr-Jamróz.
“It’s a very wide anti-PiS coalition, which is actually a centrist-right coalition with itsy-bitsy pieces of the center-left,” he clarifies. Unsurprisingly, opinions about sexual and reproductive health rights differ a lot between the members of such a broad coalition.
Zabdyr-Jamróz points out that for them, it will not be easy at all to come to a shared understanding about this topic. In fact, some of the parties discussing the coalition agreement already got a bit of cold feet when it came to reforms of sexual and reproductive health rights.
One way to deal with the intra-coalition differences might be not imposing party discipline during related votes in the parliament, prioritizing the stability of the coalition over passing the reform. Another option that Zabdyr-Jamróz can see happening is the government calling for a referendum to resolve the issue and keeping their hands clean from the point of view of their more conservative voters.
Looking at the example of Ireland, where wins for sexual and reproductive health rights were achieved through a process of public consultation and deliberation, in addition to widespread mobilization of women’s rights groups, a referendum might not be a bad option.
“But the issue here is how the referendum will be conducted, what will be the questions. We have no idea how this would happen,” says Zabdyr-Jamróz.
In order for public consultations of this sort to work, they would need to be carefully planned and include adequate space for meaningful deliberation, leading to concrete proposals that the government can shape into a policy. Because of the level of polarization and animosity over the issue in Poland, however, Zabdyr-Jamróz remains worried that this will not be the outcome we’ll see.
“They will probably lean towards a referendum when Duda is out of office, but I fear that this is going to be a mess again. Because you can do a referendum well, but you can also do a referendum like Brexit.”
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.
