Estonian Human Development Report

dren. The majority of services are also available at least in
all county centres. Meanwhile, in the case of the school
health care service which was established to develop children’s
health and which reaches all schools, children who
do not comply with compulsory school attendance do not
receive the attention they need. Moreover, based on the
Health Insurance Act, the Estonian Health Insurance
Fund can only provide services to people who are insured,
which automatically leaves out a very vulnerable 5% segment
of the society. In the case of large-scale projects,
the volume and coverage of the services is often planned
beforehand based on the budgetary means of the Health
Insurance Fund instead of the needs of the population
(Aaviksoo, 2007) (Aaviksoo, 2008).
Many services are provided by non-profit association
that depend on national or external funding and sponsorship,
due to which the long-term development of such
services is insecure and their sustainability is weak. An
interesting recent development is the rise in social enterprise
(Terve Eesti SA, MTÜ Convictus, MTÜ Käi Jala,
etc.) where innovative business models allow for the better
targeting of services and thereby the inclusion of more
varied funding (including contributions from the private
sector) which, in turn, facilitate growth and the elimination
of risks.
Publicity and training related
to public health
The activities related to the national strategies are largely
aimed at changing the residents’ behaviour through the
public information provided by professionals dealing with
the general population or certain problems. This includes
the financing of media campaigns and mass events, as
well as the development and publication of informational
material and advice, and the organization of training.
The projects for preventing damage to health related
to injuries incurred at home and during free time, including
injuries related to alcohol consumption, which were
organized in all counties are characteristic and successful
examples of this. One of the most important results
of these projects was the creation of regional cooperation
networks that include not only agencies dealing with the
different aspects of injuries (the police, the Rescue Board,
educational institutions) but also the local decision makers
and the media. The readiness to engage in promoting
health has been increased at the national government
and local government levels with relatively modest financial
means. The political support of local governments
for the expansion of health promotion activities has been
achieved, with the result that local governments actively
participate in developing and implementing safety-related
activities.
As a result of an important structural change, socalled
health councils have been established as a result of
the public health strategies in all counties as well as larger
cities. The objective of these councils is to coordinate the
activities of the health care sector and outside fields in a
more health-friendly manner (Public Health Development
Plan, 2008). Successful inter-domain cooperation
has a potentially very significant effect on the health of all
residents of the region, for example, through the organization
of the planning process and the public transport
system, but also through the mutual provision of information.
Another activity that deserves separate attention is the
development of various health consciousness networks
which are also funded through public health programs.
This includes networks of healthy schools and kindergartens,
healthy workplaces and healthy hospitals. The aim of
all of these measures is to promote awareness regarding
options for benefiting one’s own health and that of one’s
loved ones through planning basic daily activities.
A very important activity at the national level involves
situation monitoring and analysis, which provides an adequate
overview of the situation, allowing the country itself
as well as other organizations and private individuals to
better coordinate their activities and avoid risks. This has
been stressed in every single one of the evaluation reports
prepared by the WHO on national strategies (Drew 2008/
Farrington 2006).
Cooperation between sectors and the
opportunities of local governments
International evaluation reports highlighted positively the
integral approach taken by Estonia’s newer public health
strategies and the engagement of various parties and
sponsors in accomplishing common goals. For example,
the evaluation report on the strategy for the prevention of
cardiovascular diseases advised us to develop further the
campaigns aimed at the community as a whole. Adding
transport policies (e.g. promoting walking and riding a
bicycle and creating the opportunities to do so) to schoolbased
intervention and individual programs aimed at
changing health behaviour allows us to achieve considerably
better results (Farrington, 2006). For example, areas
with pedestrian-friendly streets encourage people to make
walking an enjoyable part of their daily lives. However,
achieving this might require cooperation between various
sectors and the greater empowerment of local governments
with regard to decision making.
One of the positive factors influencing young people’s
physical activity is the improvement in the availability of
sports facilities and equipment to schools, which has coincided
with the overall successful development of the country.
In 2008, 62% of Estonian schools had stadiums (compared
to 49% in 2003), 85% had a gym or the option of
using one (compared to 75% in 2003), and 11% had the
option of using a swimming pool (compared to 4% in
2003) (Raudsepp et al. 2008).
The examples provided above are just some of the ways
in which health has been influenced positively by decisions
made on the national and local level. Although more than
half of Estonia’s school pupils still consider both alcohol
and tobacco to be readily available, the level of availability
has decreased in recent years according to them (ESPAD,
2008). This can be seen as the result of the more stringent
tobacco and alcohol policies adopted in Estonia. Positive
results have also been achieved with the ban on smoking
in establishments serving food, which was established in
June 2007, making Estonia the 11 th country in the world to
enforce such a ban. A study conducted a year later revealed
that the overwhelming majority of Estonian residents were
in favour of keeping public spaces smoke-free. According
to the study, a total of 86% of the respondents were satisfied
with the ban on smoking in establishments that serve
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