On Friday, 30 October 2015, experts from science and policy met for Population Europe’s event, co-organised with three universities (Kaunas University, University of Latvia, and Tallin University) in Latvia’s capital city of Riga to discuss demographic challenges in the Baltic countries.
Indriķis Muižnieks, Rector of the University of Latvia, and Juris Krūmiņs, Vice Chairman of the University of Latvia Senate, welcomed the participants to the event. Krūmiņs showed examples of how demographers and statisticians from the Baltic countries and other European countries work together. Muižnieks specifically praised the event as important for the exchange of opinions not only between the three Baltic countries, but also with the rest of Europe. He said: 'Demography should be our most important branch of research. The Baltic nations are facing many demographic challenges.'
Tõnis Nirk, Ambassador of the Republic of Estonia in Riga, emphasised a 'further boost in the cooperation between the three Baltic states.' He said: 'Latvia, Lithuania, and Estonia have to intensify their collaboration in the area of health policies. There is already an exchange of information and best practice, but we can do much more. We face common challenges.'
Andreas Edel, Executive Secretary of Population Europe, said: 'Health and life expectancy are the most important ressources. You realise it when they’re lost.'
The following presentations were introduced by Vladislava Stankūnienė, Head of the Demographic Research Centre at Vytautas Magnus University, Kaunas.
Trends and Differences Between the Three Countries
Domantas Jasilionis,
Research Scientist at the Max Planck Institute for Demographic Research in Rostock, gave a presentation entitled: 'Divergences and Convergences in Mortality in Baltic Countries'. He presented long-term life expectancy trends in Latvia, Lithuania and Estonia.
All three countries started healthcare reforms already in the 1990s aiming to clearly distinguish between primary and specialised healthcare levels, and to create effective networks of family medical practices at the primary healthcare level. But Estonia performed faster and had the most successful reforms. This led Jasilionis to ask: 'Why are Estonians so much more advanced in terms of life expectancy?'
In response to his research question, he named combating and preventing major chronic diseases such as cardiovascular system diseases as one of the major drivers, but also emphasised the meaning of policies concerning alcohol use. Compared to Estonia, Latvia and Lithuania had much slower and more complicated reforms, and there were inconsistencies in fighting alcohol and related harm. Thus, deaths due to alcohol-related liver diseases are much more pronounced, particularly in Lithuania. Jasilionis concluded: 'Mortality is very much related to alcohol consumption. Lithuania is one of the most consuming countries in the world.'
Benefits for Everyone
Johan Mackenbach, Chair of the Department of Public Health at Erasmus MC, University Medical Center in Rotterdam, focused on dynamics in health inequalities in Europe. He said: 'In the Baltic countries, there are large inequalities in mortality, but no large differences in morbidity.'
He showed that generally, mortality has been going down, but there has been a difference in the degree of decline. 'And this difference is a benefit for the lower educated groups', Mackenbach said. 'It implies that somehow everyone has benefitted – lower socioeconimic groups even more so than higher educated groups. This is a very positive development.'
His most important conclusion is that recent trends are much more encouraging than commonly thought – on a relative scale. However, this does not apply to the Baltic countries. By contrast, recent trends in inequalities in self-assessed health generally suggest stability, which also applies to the Baltic countries.
The next set of presentations was chaired by Allan Puur, Leading Researcher at the Estonian Institute for Population Studies, Tallinn University.
An Increase of Life Expectancy
Vladimir M. Shkolnikov, Head of the Laboratory of Demographic Data at the Max Planck Institute for Demographic Research in Rostock, gave a presentation entitled: 'Disparities in Length of Life Across Developed Countries'. He also agreed with the fact that life expectancy is increasing in all three Baltic countries. 'The reasons are different in the countries, but there is something in common.' He focused on the question: Do the diversions take place among all countries? 'There is a huge contrast, which is widening across time', he said. He also showed a large difference between male and female life expectancy.
'The role of mortality effects is much higher than the role of population effects, but the latter are not negligible, especially for males', Shkolnikov said.
Has the Convergence Phase Started?
France Meslé from the French National Institute for Demographic Studies (INED) in Paris asked in her presentation: 'Has the Convergence Phase Started?' After a general health crisis in Central and Eastern Europe from 1965 to 1985, she showed diverging trends between Central and Eastern Europe in the 1990s. She said: 'When divergence started in the mid-1960s, all European countries were completing their epidemiologic transition. Western European countries were very rapidly able to control and reduce those diseases, especially circulatory diseases. Central and Eastern European countries, in contrast, did not succeed.' She did, however, also mention Estonia’s outstanding role.
Meslé further pointed out the difference between male and female life expectancy: 'If we look at current life expectancy between males and females, these differences are still very important, especially when it comes to cardiovascular and external deaths.'
Her conclusion: 'The convergence has started, but it has not finished.'
Conclusions and Final Remarks
Luule Sakkeus, Senior Researcher and Director of the Estonian Institute for Population Studies, Tallinn University, followed with some concluding remarks. She said: 'One of the main challenges of the Baltic countries is bad health, so how can we contribute to this new convergence? The healthier we are, the less burden the remaining life expectancy will bring us. So the main source of addressing challenges of ageing are in health', she concluded.
She also pointed out the difference between the Baltic states. 'Lithuania was not catching up so quickly in terms of life expectancy, but in healthy life years, Lithuanian females are doing remarkably good.'
Saekkus also talked about other demographic problems, such as problems of development and growth, how to engage the population in employment, poverty at older ages, and new family behaviours.
Panel Debate
The following panel debate was moderated by Harald Wilkoszewski, Head of Population Europe’s Information Centre.
Ģirts Briģis,
Expert from the Public Health Association of Latvia, Strategy Council for Health at Latvian Ministry of Health and Head of the Department of Public Health and Epidemiology at Riga Stradins University, pointed out health behaviour in the Baltic countries: 'Alcohol addiction and mental health, tobacco and physical activity are major problems.' Another issue, according to Briģis is the access to healthcare. '10% of Latvians have no access to healthcare at all', he said.
Ivi Normet,
Deputy Secretary General on Health at the Ministry of Social Affairs of Estonia, Tallinn, explained the health policy process in Estonia. 'Health loss is preventable. The main health risks still are: Alcohol, tobacco and obesity.' For her, the best means of prevention is to address long term health policies.
Inna Šteinbuka,
Head of the Representation of the European Commission in Latvia, Riga, said: 'The demographic challenges in Baltic countries have significant consequences.' She also focused on the accessibility of healthcare: 'Seeing a doctor is too expensive for many!” But, again, there are differences in the three states: Speaking for Latvia, she said, 'In Latvia, it’s just too expensive. The health systems are underfinanced in all the three countries, but extremely in Latvia.'
Aurelijus Veryga, President of Lithuanian National Tobacco and Alcohol Control Coalition, Professor and Head of the Health Research Institute at the Lithuanian University of Health Sciences, Kaunas, said: 'There are two public health problems: very high alcohol consumption and a very high suicide rate.' He also mentioned the smoking reduction and compared it: 'We do even have international agreements for tobacco control. While for alcohol there is no such thing, not even on an EU level.'
He also agreed that the health system is mainly responsible for health inequalities: 'We have to keep people healthy, but are lacking resources.' Still, the health system cannot solve all the problems. 'The changes have to be prepared by the system and supported by the individual', Veryga said.