Today, the Riigikogu deliberated the matter of significant national importance “Estonian Population Health Development Plan”, initiated by the Social Affairs Committee.
The Minister of Social Affairs Tanel Kiik, member of the Social Affairs Committee Hele Everaus and Director of the National Institute for Health Development Annika Veimer made reports.
In his report, Tanel Kiik gave an overview of the drafting of the development plan and described the health of the Estonian people. The life expectancy of women falls short of the EU’s average by one year (84 and 83, respectively), while there is a discrepancy of four years in the life expectancy of men (78 and 74, respectively), the minister said. This gap has indeed narrowed gradually over the last decade, yet the gap still persists. In Kiik’s words, healthy life years are even more worrying than that, as most people think that the issue of how long they are able to be healthy, and how long they are able to cope on their own and enjoy their working and family life and being active in society is more important than the number of life years. The minister noted that Estonian people spent the greatest part of their old age struggling with various health concerns, and with various health-related constraints.
In his report, Kiik also pointed out the differences in life expectancy by counties. “The average life expectancy is on the rise in most of the counties. The counties where we are seeing a lower average life expectancy figure are a cause for concern. In particular in Ida-Viru County where more attention needs to be paid to the living environment, the opportunities to lead a healthy life, as well as treatment opportunities when seeking solutions to any health concerns resulting from occupation or life-choices,” Kiik said.
Minister Kiik explained that the aim of the Population Health Development Plan for 2020–2030 was that people’s life expectancy would rise and that healthy life years would increase faster than life expectancy. “Our ambition is that the part of our lives and of the life expectancy of our people that can be spent without significant health-related constraints would grow gradually,” he specified.
In the minister’s words, Estonia has very many deaths arising mainly from cardiovascular diseases and malignant tumours. “However, injuries and the deaths that are preventable and avoidable and that often befall people regardless of their age, and sometimes maybe at a younger age, also play a very important role. Be they poisonings, be they suicides, vehicle accidents, falls, drownings, fire deaths or freezings – for all of them we have set the goal to reduce the relevant indicators by at least 20 % and in some cases by up to 80%,” Kiik said.
In her report, Hele Everaus said that 53 per cent of the Estonian population considered their health to be good, while an average of two thirds of the European Union population considered their health to be good. In her words, the inequality between income groups also deserves a mention. She pointed out as an example that more than three fourths of the people in the largest income group considered their health to be good, but only as few as one third of the people with a lower income could say that about their health.
Everaus said that Estonia still had room for development in the reduction of the rate of preventable and avoidable mortality. Although the number of avoidable deaths that can be prevented with a more effective health care and public health policy has decreased in the case of many diseases, including the ischaemic heart disease and stroke, the coefficient of both preventable and avoidable mortality in Estonia is still higher than the EU average.
In her report, Everaus also touched upon the shortage of medical workers and referred to the National Audit Office who has pointed out major problems in ensuring primary medical care outside Tallinn and Tartu.
Everaus also mentioned a recent analysis by the consulting firm McKinsey, according to which Estonia’s GDP would rise by as much as one tenth if premature mortality decreased and people stayed longer on the labour market. In her words, good health increases ability to work and raises productivity – every euro invested in health brings back 2.4 euro. “This is an economic perspective, but an individual could gain 28 healthy life days in a year on average,” Everaus said. “The Estonian social protection system is the most similar to the liberal social protection system and so far, the health insurance funding has been based on a narrow revenue base, i.e. exclusively on salary-based payments. Therefore, already by its design, the system is sensitive to economic downturns and the ageing of the population,” she added.
Everaus also said that progress towards a high-quality health care system that improved health and created trust and economic benefit was primarily a political and not a technical decision. “The systems that work are not just a happy chance, they need to be planned, designed and built. The approach to health care should be systemic,” Everaus noted.
Annika Veimer underlined that the average life expectancy in Estonia was higher than ever before. She said that today’s average life expectancy was 78.8 years, and it was longer by 8.5 years than it had been 20 years ago. “When we compare ourselves with countries in the European region, everything seems to be well, but for example when we compare ourselves with the Nordic countries, we have room for development,” she added.
Veimer said that, on the average, 3000 deaths could be prevented every year. In her words, they would include all deaths caused by diseases due to alcohol use, and some of the deaths due to ischaemic heart diseases and some of the deaths due to cancer.
In Veimer’s words, health is most affected by behavioural risk factors, and the best results can indeed be achieved with different complex prevention activities that are combined between different spheres of life. “Indeed, efficient work with children and young people already at an early age is what helps prevent problems in adulthood. Supporting the mental health of children and young people is very important,” she said.
Veimer mentioned people’s body weight as one of risk factors. In her words, over the last 20 years, the proportion of people with excess body weight has gradually increased among adults, and overweight and obesity can be seen more among men of all age groups. “In the case of small children, the proportion of children with excess body weight is below ten per cent, but among primary school age children as many as one in three children are overweight or obese,” she stated.
At the end of her report, Veimer noted that very much depended on the conditions a person was born into. “And reducing this inequality, the inequality in health is indeed one of the priorities of the Population Health Development Plan.”
During the debate, Signe Riisalo (Reform Party), Riina Sikkut (Social Democratic Party), Maria Jufereva-Skuratovski (Centre Party), Urmas Espenberg (Estonian Conservative People’s Party) and Heiki Hepner (Isamaa) took the floor on behalf of their factions.
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