The National Health Development Plan 2020–2030 has as one of its sub-goals the promotion of a health-supporting environment and recognizes that the negative effects of environmental factors may often only manifest years later (for example, the development of allergies, nerve damage, or tumors). However, many doctors today still do not know the causes of these damages, and unfortunately, they cannot be treated with pills.

The Cancer Control Action Plan 2021–2030, in the chapter on Primary Cancer Prevention, lists risk factors that are not given sufficient attention in practice, if at all: ‘The main cancer-causing factors in the physical environment are ultraviolet radiation (UV radiation), RADON, environmental tobacco smoke, and fine particles in outdoor and indoor air, EXPOSURE TO VARIOUS CARCINOGENS FROM PRODUCTS, as well as contaminants and additives related to food cultivation, handling, and preparation.’

The same action plan further highlights: ‘The ability to measure chemical substances present in work and living environments is limited. Information collected from various fields on risk factors arising from the living environment must be integrated and used to assess the total exposure of individuals, to develop interventions for reducing exposure, and to shape a health-supporting living and working environment.’

This complex statement means that we need to organize air quality measurements, product evaluations, and bio-monitoring of people, and compare these results. After all, science and evidence-based approaches are of the utmost importance! But these crucial preventive actions have remained undone for reasons unknown.

Volatile organic compounds (VOCs) emitted from products are not only carcinogenic but also neurotoxic, which has wreaked havoc on the mental health of the population. For example, formaldehyde is both carcinogenic and neurotoxic; additionally, it is a cause of all cardiovascular diseases, and relevant scientific research is freely available on all research platforms. And it is emitted from everyday consumer items such as foam and polyester mattresses and pillows, particle board, etc., which means we have all been exposed to them far too much. Product safety supervision is absolutely necessary!

If a patient goes to the doctor today with a chronic cough, does the doctor know to check if the patient is not living in a radon-rich area?

Unfortunately, the name change at the Health Insurance Fund has not led to any substantive change in its work; it continues to fund only disease treatment but not health. If the Health Insurance Fund does not start funding the important preventive activities outlined in health development plans, no improvement in public health can be expected. Next year, will there be 150 million missing from the budget? Treatment is not only expensive but also painful; a sick person cannot work or is not effective enough, and the planned tax increase is not feasible and only adds unnecessary stress. Therefore, let’s please invest in prevention instead.

I support Pille’s ideas!

There is a lot of talk about how raising awareness is necessary to achieve change, and that this will lead us to make better decisions. Awareness has been a focus for several decades and must continue to be so. Awareness is important, but it alone is not enough to bring about change.

To create change, we need to influence social norms. Social norms are a set of unwritten and written rules and expectations that guide our behavior throughout society. These norms determine what behaviors or actions have gained widespread acceptance in our society and which have not, thus influencing people’s decisions, actions, mindsets, and attitudes.

In a society where valuing health goes beyond the individual level (i.e., it is a social norm) and where health promotion is recognized as an essential part of a successful country’s development in all sectors, a healthy lifestyle is significantly more widespread and supported. This means that every member of society has a role and responsibility. All members of society benefit from this as well—healthier people can contribute much more to the development and well-being of society. Moreover, the fewer people who end up in the healthcare system (due to prevented illnesses), the more resources the state has to direct towards supporting the country’s development, thus improving the well-being of everyone.

Example: For instance, the private sector values employee health (employees spend most of their day at work) and adopts proven measures, such as encouraging regular movement during the workday in sedentary jobs.

Example: The food industry plans or modifies existing recipes to be health-supportive (based on evidence-based information), etc.

Example: Local communities actively participate and contribute to health-promoting activities in their areas.

Example: Local governments support local communities that contribute to evidence-based health promotion activities.

Simple Choices: People make choices that are easy for them to make. If healthy choices are the easier and socially favored/supported options, then people will make them. Unhealthy choices should be inconvenient and difficult so that they are made much less frequently. For example, access to alcohol should be inconvenient and moderately expensive so that people are less likely to buy it.

Healthy choices should be the simplest choices for individuals, as people often base their daily actions on what offers quick solutions in terms of time and money, and on what the social norm is.

And here we can actually bring up a very effective and proven example of prevention, which is vaccination. If we look at prevention as something aimed at averting potential issues, vaccination has, over decades, prevented a great many deaths and health complications.

Tõnu Mertsina previously mentioned that “quality healthcare is one of the cornerstones of a successful economy. If it keeps Estonians as healthy as possible and extends their healthy life years and life expectancy, it helps to improve and maintain the most important part of society—human capital.” We can say exactly the same about prevention. I would even argue that it is largely a part of successful economic policy and a crucial aspect of a better and more successful future outlook.

Let’s also consider mental health. According to the WHO definition, mental health is a state of well-being that enables a person to 1) realize their potential, 2) cope with the stresses of everyday life, and 3) work productively and contribute to society. The current state and future projections of mental health are no secret. And I ask, can healthcare alone solve this complex problem? Estonia needs healthier people who don’t fall into the trap of illness too early, and we need to think broadly and strategically about how to maintain human capital as an actual capital and a productive part of society. If too many people shift too early from being contributors to becoming dependents, it raises significant concerns for everyone. We all want Estonia to have a future, perspective, and hope as a society. One of the fundamental pillars of this is a healthy population. And to keep people “as healthy as possible for as long as possible,” various measures must be implemented. One part of this is healthcare, another part is prevention. And certainly, there are third, fourth, and fifth parts, etc. But what can be prevented must be prevented. We are too poor to massively treat problems that are largely preventable. Yes, not everything can be prevented, and not everyone can be saved, but we can definitely make significant progress in this area.

Could you, Pille, provide examples where effective prevention can be applied?