1. The 4^th Congress "Health of Poles" leading issue was preventive healthcare. Experts during each debate, panel, or lecture referred to this topic. Many speakers tried to assess the activities undertaken so far in this area; these assessments were unsatisfactory. Although much has been said about preventing illnesses for a long time, Polish healthcare policy favors primarily "restorative medicine." Prophylaxis doesn't receive enough attention and resources. Experts criticized this fact and discussed which areas of preventive healthcare receive the least attention from health authorities and the medical community.

We recommend a comprehensive approach to health-promoting campaigns, implementing health education in schools at all levels, promoting preventive healthcare, and systematically increasing resources used for it while simultaneously rationally and thoughtfully managing the resources for "restorative medicine." Concerning the areas of preventative healthcare most neglected by the authorities and the medical community, we recommend widespread social campaigns regarding vaccinations, hypertension and hypercholesterolemia prevention, widespread screening for the most common tumors, and screening tests in children to detect learning disorders and other conditions that may have a negative impact on development, such as hearing and sight disorders. The campaigns should be tailored to the objective and the target group profile.

2. During the Congress, the concept of One Health was presented - the idea comprising comprehensively the entirety of well-being and health of our planet – human environment with plant and animal world and health of the human population, which remain in immediate feedback. Critical for preventive health care is the clean air, surface, and underground waters, often contaminated by the chemicals used in agriculture, antibiotics and medicines used for farm animals treatment, and disinfection means commonly used on farms. Talking about efficient prophylaxis disregarding the environment in which we live is irrational.

We recommend considering the concept of one health in national preventive health care programs and paying attention to the impact of the quality of the environment on physical and mental health. Taking care of the environment should become an element of health education and implemented preventive health care programs. The health-promoting actions should take into consideration the fact that one of the consequences of climate changes can be physiological changes – particularly hazardous for health could be disorders of immunological system functioning resulting from long-term overheating of organisms causing the decreased response to vaccinations, increased vulnerability to illnesses and more complicated, longer treatment (e.g., the need to apply larger medicine doses).

3. The Congress debates emphasized the vital role of local governments in the health care system. A review of local governments' preventive health care and health-promoting initiatives showed that the scope of these actions is extensive. Local governments implement health-promoting programs for various groups of recipients, including children, youth, families, and seniors. It was underlined that health policies should be preferably formulated at the regional level, with lesser involvement of the central authorities. Regional authorities are closer to inhabitants, making it easier to identify the needs and the required tools.

We recommend tighter cooperation of central authorities with local governments regarding actions promoting the health of Polish people and tighter collaboration with other institutions in this area. Communication between different groups involved in building a pro-health attitude is essential for developing optimally efficient action plans. The groups involved include representatives of employers, medical self-governments (doctors, physiotherapists, paramedics, nurses), and the media. Society will clearly understand only a common, uniform message. We recommend inclusive and local promotional activities, including those related to vaccinations. A significant disparity in the vaccination rate between municipalities shows that actions targeting local communities are necessary. There are a number of good practices in Western countries, such as involving local opinion leaders in promotional activities. Future pro-health programs, including those related to vaccinations, should consider more activities involving residents of specific municipalities.

4. During this year's Congress, experts dedicated a lot of space to occupational medicine. While discussing prophylaxis, they emphasized the significance of employee examination. They criticized the fact that the system of occupational medicine fails to perform the wide range of tasks expected of it due to the lack of appropriate financing. Employee preventive health care in Poland boils down most often to periodic examinations required by the Labor Code.

We recommend starting work on creating an optimal and modern occupational health protection system that will be based on the close cooperation of all system participants and focused not only on work-related health aspects and accident prevention but on all aspects of employee health, including early detection of diseases, prevention of lifestyle diseases, diseases indirectly related to work due to multifactorial causes, including those related to exposure factors or work environment difficulties, and actions supporting healthy and active aging as well as medical rehabilitation. This system should include activities within public health programs to detect commonly occurring lifestyle diseases and be an integral part of the health care system. Moreover, we recommend updating the list of occupational diseases, which has not been modified for years. The emergence of new professions and changes in working conditions and places (home office) require a critical review of the currently applicable list of occupational diseases.

5. Many experts have pointed out the problem of high cancer morbidity, which remains unresolved. They emphasized that Poland is one of the European countries with the highest cancer mortality rates. The presented data indicate the low effectiveness of cancer-preventing actions undertaken in Poland. Many preventive programs aim at early cancer detection, but a significant percentage of Poles do not use these opportunities. According to experts, the reporting rate for oncological preventive tests is highly unsatisfactory.

We recommend, as last year, working out new strategies for fighting cancer. Sociological studies indicate the need for a broad and thorough consideration of the socio-cultural perspective in anti-cancer actions, with particular attention to false beliefs related to cancer and their impact on health attitudes and behaviors (oncological prevention, reporting to a doctor in case of alarming symptoms, starting treatment and following medical recommendations in case of cancer diagnosis). Considering the results of the health-related beliefs study, opinions and attitudes towards health education and disease prevention or health competencies in the prepared programs may increase Poles' activity in the cancer prevention field. As noted, an important element in planning such programs is building trust in medicine and doctors. The greater the trust patients have in healthcare workers and the more they know about the progress in medicine, the more willing they are to participate in offered oncology programs or preventive screenings.

6. Vaccinations are an essential element of preventive health care. Unfortunately, as the COVID-19 pandemic has shown, a significant percentage of Poles have not decided to get vaccinated, and the anti-vaccination movement has been growing for some time. It is necessary to reverse this unfortunate trend. Promoting vaccinations (not only for COVID-19) is a way to protect people from many diseases, including cancer.

We recommend that the promotion of vaccinations as an efficient and safe form of preventing infectious diseases should be recognized as a medical reason of the state. We recommend developing the Vaccination Program to provide easy and free-of-charge access to vaccines for as many citizens as possible. Unnecessary barriers discourage people, including parents of young children, from getting vaccinated. It is necessary to strengthen the message about the benefits of vaccination at every age - reliable communication based on medical knowledge and facts should be easily accessible to every citizen. Commendable are initiatives such as MedvsFake, in which specialists, based on research and established knowledge, debunk myths about vaccinations. More decisive actions are needed to increase the presence of experts in public debates on vaccination and block the voice of the most radical representatives of the anti-vaccination movement in public discourse. By combating the views propagated by anti-vaccine movements, we must simultaneously support the role of nurses and pharmacists in the vaccination system.

Concerning COVID-19, we recommend creating a transparent vaccination schedule and instructions. The changing recommendations regarding the time intervals between doses, reminder doses, different schedules for different age groups, or new vaccines dedicated to specific coronavirus variants make it necessary to create clear, understandable, and transparent vaccination guidelines and schedules. Similarly to childhood vaccination protocols, COVID-19 vaccination should be accompanied by appropriate protocols and schedules that are effectively communicated to patients. The promotion of vaccinations should take into account the fact, highlighted by anti-vaccination advocates, that vaccines can have adverse side effects in sporadic cases. We also recommend creating a transparent and comprehensive compensation system for patients who experience adverse reactions to vaccines. The Ministry of Health has announced that the Vaccination Compensation Fund will also cover patients receiving vaccines other than those against COVID-19, which is an excellent step, but an information campaign should accompany it.

7. Polish society is aging. The proportion of older adults in the population of our country is systematically increasing. At the end of 2020, there were 9.8 million people at the age of 60 or more. The Polish Central Statistical Office (GUS) forecasts that in 2030 the number of people at this age will increase to 10.8 million, and in 2050 it will amount to 13.7 million. Senior people will then constitute 40% of the population of Poland. These forecasts should be taken into account when planning the state's health policy, as well as actions related to public health care and prevention. The healthier the increasingly numerous senior generation is, the lower the expenses required for their treatment.

We recommend that older people should be included as a target group in national and local health promotion strategies and preventive programs. The programs targeting that group should be developed to strengthen informal networks among older people (to counteract loneliness) and to create non-institutional forms of support for seniors, especially those with limitations in their daily functioning (the idea of intergenerational solidarity). At the same time, we recommend changes in the healthcare system to ensure that seniors have easy access to medical care in case of health problems.

8. Obesity is a consequence of a lack of physical activity and an improper diet and is one of the greatest contemporary civilization threats. Every fourth Pole suffers from obesity, and only 13 percent are aware of the risks associated with this condition. More than 80 percent of people suffering from obesity treat it as a cosmetic defect, not realizing it is a chronic, severe disease with many multi-organ complications, complex etiology, and pathogenetic mechanisms. Obesity does not spontaneously go away but tends to progress, with multiple medical, social, and psychological consequences. Despite many information campaigns, obesity is still primarily associated with the visual aspect, while its health aspect is disregarded. And despite being listed as a chronic disease with code E66, statistically, it is a disease that is often overlooked in diagnoses. Yet, it is the core pathology of many diseases recognized as civilization diseases, such as cardiovascular diseases, coronary heart disease, heart failure, arrhythmias, strokes, diabetes, arterial hypertension, and cancer. Awareness of these risks is particularly important given that we have become a European "leader" in obesity-related diseases. It is best seen in Polish children who rank first in this unfavorable statistic among children from European countries.

We recommend population-based monitoring of the incidence of overweight and obesity among school-aged children and youth. Currently, overweight and obesity significantly affect the health of this group - it affects 30% of the population aged 8-15. We emphasize the need for educating young people about the risks associated with unhealthy eating habits, considering the lack of regular physical activity after completing their school education and the decrease in energy requirements after age 19. Healthy eating pattern promotion is essential in the group of boys from rural areas whose mothers have secondary education levels.

We recommend directing educational programs on preventing overweight and obesity to entire families, considering the child's problem and that of the parent(s). We recommend implementing such activities in various extracurricular activities as well as in the curriculum of primary schools.

9. In recent years, there has been a rapid increase in microbial resistance to antibiotics worldwide. It is estimated that in 2019, approximately 5 million people worldwide died due to infections caused by antibiotic-resistant bacteria. ECDC estimates that in Europe in 2020, the number of infections caused by antibiotic-resistant bacteria was 801,517, whereas the number of deaths amounted to 35,813. Unfavorable trends have intensified during the COVID-19 pandemic due to inadequate hospital infection control procedures, primarily focused on protecting healthcare workers from SARS-CoV-2 infection but also contributing to the spread of resistant microorganisms among patients, as well as uncontrolled and unjustified use of antibiotics in patients infected with SARS-CoV-2. In Poland, during the pandemic, there was a significant increase in antimicrobial resistance among invasive microorganisms - according to experts, the situation got out of control and requires urgent remedial action.

We recommend actions aimed at stopping the increasing resistance of microorganisms and thus ensuring the usefulness of available antibiotics, such as: implementing and strictly adhering to hospital infection control procedures, including rapid detection and isolation of patients infected/colonized with multi-resistant microorganisms, as well as implementing and rigorously adhering to the principles of rational antibiotic therapy.

The above actions require adequate resources, such as full-time employed infection control teams and antibiotic policy teams. The latter should include an infectious disease specialist (microbiologist or doctor of another specialty trained in this field), a clinical pharmacologist, and a microbiology diagnostician. The teams like this operate in all developed countries; however, their role is still underestimated in Poland, and their work is often combined with other activities, which significantly limits their effectiveness and leads to the consequences described above.

10. Recently, the number of patients (both adults and children) with mental health disorders has been increasing. At the same time, the literature emphasizes the effectiveness of preventing mental disorders. Emphasis is placed on specific differences in psycho-prophylaxis compared to prophylaxis of somatic diseases. At the same time, a detailed analysis of publications on psycho-prophylaxis suggests that inadequate effects of interventions most often result from the imprecise application of these interventions.

We recommend a new approach to the problem of increasingly common mental disorders, which assumes that preventive interventions can effectively reduce them through all three phases. In the first phase of prevention, we believe that in addition to physical activity, a healthy diet, and adhering to sleep hygiene principles, it is essential to maintain a balance between work and personal life, conscious value hierarchy, and good social relationships.

In the second phase of prevention, it is crucial to recognize that mental disorders are not "normal" psychological reactions but have their biological dynamics and require treatment at the earliest stages of development. Early treatment of neglected mental disorders such as insomnia, anxiety, and depression is paramount.

There is also an increasing focus on tertiary prevention, which should consider the latest scientific findings, including the effectiveness of aerobic exercise in reducing symptoms of schizophrenia. Third-phase prevention is one of the most effective forms of intervention in developed mental disorders, with an excellent cost-effectiveness ratio.

11. The technological revolution in the medical industry has become a fact. New technologies are an excellent opportunity to improve the quality of life of patients, streamline the work of doctors, and better functioning of the health care system. Unfortunately, at the current stage, they often reveal shortcomings in the quality of legal and managerial procedures. Advancements in technology also increase patients' expectations regarding the quality, accessibility, and promptness of medical services provided. At the same time, it forces healthcare workers to acquire new skills. Technologies will not replace the work of specialists but will shape the future of health care and - as the speakers emphasized - are a hope for a better tomorrow.

We recommend further implementation of the ITC systems. Online tools for patient registration and ordering vaccines have proven to be one of the strongest elements of the National Vaccination Program (NPS). Similar infrastructure should be used for other types of vaccinations. Similarly to the National Vaccination Program, digital solutions should be implemented through remote training methods.

Implementing ITC systems should be accompanied by actions aimed at increasing the level of digital competence of medical personnel, considering that the generation gap promotes the aging of some medical professions (e.g., nurses). Older adults are at risk of digital exclusion.

Monitoring the impact of introducing digital solutions on health inequalities is necessary. Additional actions and financial resources should be undertaken to ensure adequate medical care for digitally excluded individuals in the era of increasing digitization of medical services.

In addition, it is necessary to modify the legal framework for protecting personal/medical data and using such data for scientific research and clinical practice, including obtaining the patient's informed consent for sharing data within and outside the public system.

12. In the Polish healthcare system, doctors do not deal with a culture of safety but with a culture of fear. Similar opinions were expressed during the discussion on medical errors and the creation of responsible laws. Some part of the medical community in Poland demands the implementation of no-fault rules, which eliminate the need for determining guilt, as recommended by many healthcare safety experts. Supporters of such a system believe that punishing doctors will not reduce the likelihood of adverse medical events. Many experts argue that the more decisive factor in reducing the frequency of medical errors is the certainty of their detection. The equivalent of this can be mandatory reporting of adverse events. Opponents of such a solution see it as favoritism for a specific professional group.

We recommend analyzing available data regarding the no-fault system and taking action to determine which legal solutions best promote a safety culture in clinics and hospitals, ensuring maximum patient safety. It is worth noting that the problem of professional liability and drawing conclusions from mistakes is not unique to health care but applies to activities in the so-called high-risk sector, where a small error may have tragic consequences. Noteworthy is the psychological phenomenon occurring when analyzing medical errors, which consists in over-attributing responsibility for errors to specific individuals and underestimating many abstract factors, such as procedures, institutional environment, or other circumstances independent of the individual. This phenomenon has been referred to as a fundamental attribution error.

Prof. Henryk Skarżyński