Estonian Human Development Report
Estonian Human Development Report - Eesti Koostöö Kogu
Estonian Human Development Report - Eesti Koostöö Kogu
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2.7. National public health care services<br />
The majority of preventive activities aimed at the entire<br />
population of Estonia are undertaken through the public<br />
health strategies supervised by the Ministry of Social<br />
Affairs and the National Institute for Health <strong>Development</strong>.<br />
Furthermore, monitoring and supervision regarding<br />
infectious diseases and environmental health is performed<br />
by the Health Protection Inspectorate which grew<br />
out of the Soviet-era Sanitary and Epidemiology Service.<br />
As of 2009, all strategies related to this area are formally<br />
combined in the Public Health <strong>Development</strong> Plan<br />
2009–2020. The development plan includes five thematic<br />
categories, which are related to increasing social cohesion<br />
and equal opportunities, guaranteeing children a healthy<br />
and safe development, creating an environment supportive<br />
of health, facilitating healthy lifestyles, and ensuring<br />
the sustainability of the health care system. The priorities,<br />
strategic objectives, and sets of measures defined for the<br />
purpose of achieving the overall goals of the development<br />
plan are also broken down according to these categories<br />
(Public Health <strong>Development</strong> Plan, 2008).<br />
Vaccination or immunization is one of the economically<br />
most profitable public health measures for protecting<br />
residents against infectious diseases. For example, with<br />
the help of vaccination, poliomyelitis has been eliminated<br />
in Europe and smallpox has been wiped out in the entire<br />
world. The rate of immunization of children in Estonia<br />
is very high (Figure 2.7.1.) and therefore the incidence<br />
of infectious diseases avoidable through vaccination, for<br />
example viral hepatitis B, has decreased considerably, or,<br />
as in the case of measles, rubella, diphtheria, and tetanus,<br />
has remained at a constantly low level.<br />
The majority of the specific applied activities are carried<br />
out through categorized public health strategies which<br />
include:<br />
• The National Strategy for the Prevention of Drug<br />
Addiction Until 2010<br />
• <strong>Estonian</strong> National Strategy for the Prevention of Cardiovascular<br />
Diseases 2005–2020<br />
• 2006–2010 Strategic <strong>Development</strong> Plan for Physical<br />
Movement Activities<br />
• HIV and AIDS Strategy for 2006–2015<br />
• National Cancer Strategy for 2007–2015<br />
• 2008–2012 National Strategy for Combating Tuberculosis<br />
Services related to public health<br />
Several strategies directly fund various services. For example,<br />
the HIV and AIDS strategy provides funding for different<br />
damage reduction services aimed at drug addicts,<br />
such as syringe exchange programs and methadone substitution<br />
treatment. The strategy related to cardiovascular<br />
diseases funds counselling for quitting smoking; the physical<br />
activities’ development strategy provides financial<br />
backing for medical services for young athletes; the cancer<br />
strategy supports counselling for giving up tobacco products;<br />
the tuberculosis combating strategy funds directly<br />
supervised tuberculosis treatment, etc.<br />
Many services aimed at preventing diseases are also<br />
funded by the <strong>Estonian</strong> Health Insurance Fund. The<br />
implementation of these programs is part of the public<br />
health strategies. In 2007, the Supervisory Board of the<br />
<strong>Estonian</strong> Health Insurance Fund confirmed the long-term<br />
priorities for promoting health and preventing diseases.<br />
The pertinent projects are implemented based on these<br />
priorities.<br />
Such projects include the following activities:<br />
• pre- and post-pregnancy counselling;<br />
• counselling during pregnancy crises;<br />
• pre-birth screening for the prevention of chromosome<br />
diseases;<br />
• screening related to the hearing of newborn children<br />
in larger maternity hospitals;<br />
• phenylketonuria and hypothyroidism screening<br />
among newborn children;<br />
• rehabilitation of children who have lost a close family<br />
member;<br />
• provision of school health care services in all general<br />
education schools and vocational schools which operate<br />
on the basis of basic education;<br />
• counselling of young people regarding reproductive<br />
health and the prevention of sexually transmitted diseases;<br />
• screening for the early detection of cervical cancer<br />
among women aged 30–59;<br />
• additional study and testing of high-risk people who<br />
are aged 30–60 and have insurance for the prevention<br />
and early detection of cardiovascular diseases;<br />
• screening for the early detection of breast cancer<br />
among women aged 50–62;<br />
In the case of services aimed at the entire population of<br />
specific target groups it is important for them to reach all<br />
of those concerned, regardless of their socio-economic<br />
status, place of residence or level of education.<br />
An important flaw in many public health services is<br />
their insufficient reach and uneven coverage. The availability<br />
of services aimed at small and clearly defined target<br />
groups is usually very good, for instance in the case of<br />
services directed at pregnant women and newborn chil-<br />
Figure 2.7.1. Rate of immunization of children by age<br />
(%)<br />
1 y.o. – 14 y.o.<br />
7 m.o. – 14 y.o.<br />
7 m.o. – 3 y.o.<br />
1-year-olds<br />
2-year-olds<br />
98<br />
98<br />
95<br />
95<br />
97<br />
Diphtheria, tetanus<br />
Poliomyelitis<br />
Measles<br />
Rubella<br />
98<br />
45 29<br />
95<br />
97<br />
98<br />
95<br />
97<br />
Source: Health Protection Inspectorate<br />
98<br />
Hib<br />
Whooping cough<br />
Measles, mumps, rubella<br />
Mumps<br />
96 96 96 96<br />
Viral hepatitis B<br />
Haemophilus<br />
influenza type B<br />
47 |