The Estonian health policy vision needs new goals
In 2008, the Government of the Republic adopted the National Health Plan 2009–2020 (NHP), which has become the key document on health policy, integrating independent strategies for different fields. In 2016, the performance of the NHP was reviewed.
The general goal of the National Health Plan is to increase life expectancy and the Healthy Life Years indicator. By 2016, life expectancy has increased (to 73.1 years for men and 81.9 years for women) but the growth rate has slowed down. If the trend continues, it is likely that the goal for the year 2020 (75 years for men and 84 years for women) will not be achieved. Contrary to expectations, the Healthy Life Years indicator has decreased and is below the 2020 goal by 6.4 years for men and 8.9 years for women.
The main causes of death are cardiovascular diseases and cancer, as well as injuries among the youngest age groups. Cardiovascular mortality has decreased in Estonia but the number of new cases has not. The number of new cases of cancer among younger people and cancer mortality have not decreased. General injury mortality has decreased but the majority of accidental deaths affect people under the age of 65. Affective and addictive disorders, diabetes and other chronic diseases are significantly limiting the ability to work. Moreover, a new and serious challenge has arisen in the form of muscle and bone diseases.
Diseases and deaths among younger people significantly slow down the increase of life expectancy and limit the ability to work. In order to increase life expectancy, it is important to decrease mortality among people under the age of 65. Special attention should be paid to cardiovascular diseases and their risk factors (diet and physical activity), as well as to mental health policies with a view to reduce the harm caused by affective and addictive disorders, and reduce the number of suicides and deaths by poisoning. The third priority should be reducing the number of cases of cancer among younger people, and cancer mortality, since cancer diagnosis involves high costs for the patient and the healthcare system. It is important to also focus the health policies on muscle and bone diseases, which significantly affect the population’s work ability and quality of life.
NHP continues to be the most important document on health policy. However, it has not fulfilled its primary role of a guiding instrument for the national health policy. In order to restore the rapid increase of health indicators, it is important to improve the strategic management of health policy, determine the priority areas and adopt the short-term results management system. Health issues must occupy a visible place in government action plans and a possible inclusion of the question of health in the list of strategically important government questions should be considered.