Estonian Human Development Report

2.10. Policy recommendations aimed
at improving quality of life related to
the health of the Estonian population
An important key to developing people’s health and
improving it, if necessary, is their own behaviour. However,
health-related quality of life can also be improved by
creating favourable conditions for making healthy choices
and by adding capital through involving responsible private
enterprises.
A good example of this, in addition to constructing
sports facilities, is simply creating the conditions for physical
movement in the form of light traffic roads, well-lit
paths, parks, etc. It is very important to support the physical
environment with active publicity and the activation of
business and social organizations. Estonia has a number
of good examples that should be presented to a wider public.
This would allow us to achieve the desired results more
quickly through learning from each other and engaging
in cooperation.
The best level for merging various fields and interests is
the community which, in many cases, can mean the local
government, the village or the city district. An important
achievement that should be reinforced is the creation of
local health networks between various parties who wish to
coordinate their activities in a health-conscious manner.
The propensity of people to emulate life around them
makes leadership and the creation of examples very important.
At the national level, for example, much has been
achieved with the technically simple but ethically multifaceted
decision to limit smoking in public spaces, which
is supported by the overwhelming majority of residents
and most smokers themselves. In addition to the changes
in the physical environment, such decisions send important
signals that help people make voluntary changes in
their behaviour. Fighting against the use of tobacco is also
a good example of international cooperation supported by
the WHO Framework Convention on Tobacco Control.
Dealing with the HIV epidemic will continue to be
a topical issue in Estonia. On the one hand, increasingly
more attention must be devoted to patients who
have reached the AIDS phase, meaning an increase in
the treatment burden, but also the necessity of increasing
our ethical level to attain the capacity for unbiased
relations with fellow-Estonians diagnosed with this disease.
Since Estonia continues to be the European country
with the fastest growing HIV infection rate, preventive
activities must be continued as strongly or even more
forcefully than before in order to ensure that the positive
trend achieved in recent years persists. Among other preventive
measures, the efforts of the local governments in
Tallinn and Ida-Viru County in solving the health problem
specific to them deserve recognition and encouragement
as well as to be set up as an example for other local
governments.
Health services paid for by public funds in order to
improve people’s quality of life should be universally and
freely available to all members of the target group, not only
those who are most accessible. This should be especially
closely monitored in the case of people who are worse off
economically, since poorer members of the society may
have very many risks competing with their health-related
choices. In this case, the professional approach means
finding solutions aimed at specific target groups rather than
the middle ground. This type of judicious policy requires
a significant investment in analysis focusing on everything
from the causes to the effects.
Previous economic recessions have shown that Estonian
residents are very sensitive to changes in the economic
environment and that it is usually the most vulnerable
social groups that are in danger of deterioration in
their state of health. In order to guarantee the successful
and sustainable development of society it would be important
to guarantee basic first contact medical care to the
entire population, regardless of their social status (including
their insurance status).
Taking into account the particularities of the funding
of the Estonian health care system and its reliance on just
half of the population, compensatory measures should
be implemented. Additional funding could be gained
through a more equitable distribution of the burden of
financing as well as through increasing the range of options
in areas where the interests of less capable members of the
society would not be hurt, thus guaranteeing a wide basic
service coverage. In relation to the suggestions above, it is
very important to ensure that the financial risk involved
in using the services does not increase, as this has been a
growing danger in Estonia during recent years.
In addition to the monitoring of contribution sizes,
successful risk management also requires us to guarantee
the deliberate interaction of various policies. In an economically
difficult context, residential policies, transport,
education and tax policies as well as regional policies can
be used to increase the health and life expectancy of the
population. In any case, analyses indicate that investment
in health is profitable.
References
1. Aaviksoo et al. (2007). Rinnavähi varajase avastamise projekt
aastateks 2002–2006. Tallinn: PRAXIS Center for Policy Studies.
2. Aaviksoo A, Paat G. (2007). Tervishoiuteenuste kättesaadavus . Sotsiaaltrendid
4/2007, Statistics Estonia.
3. Aaviksoo et al. (2008). Noorte reproduktiivtervisealane nõustamine
ja sugulisel teel. Tallinn: PRAXIS Center for Policy Studies.
4. Abdel R. Omran The Epidemiologic Transition: A Theory of the Epidemiology
of Population Change The Milbank Memorial Fund
Quarterly, Vol. 49, No. 4, Part 1 (Oct., 1971), pp. 509–538
5. Arvisto M, Noormets J, Paju K, Piisang M, Roosalu M. (2004).
Noorte spordiharrastuse struktuur ja arenguvõimalused, Estonian
Sports Information Centre.
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