"Latvijas formula": a society must want to be healthy

The latest episode of the discussion series Latvijas formula focuses on a perennially relevant topic – public health.

A healthy society is rooted in a desire to be healthy. The role of the state is to care for the sick, strengthen healthcare and provide opportunities for healthy lifestyles. However, as the panellists noted, people often rely on a magic pill that will cure all ills, rather than thinking ahead to avoid taking the pill themselves. How can we change this, what is the role of the state, including the education system, how responsible are we and has the state done its homework? These and other questions are discussed on TV24 by Stella Lapiņa, Deputy Dean of the Faculty of Medicine and Life Sciences at the University of Latvia (UL), Anda Kīvīte-Urtāne, Associate Professor and Director of the Institute of Public Health at Riga Stradins University (RSU), and Professor Ilze Beitāne, Vice-Rector of Studies at the Latvian University of Biosciences and Technology (LBTU). The discussion is moderated by Professor Mārcis Auziņš.

Public health literacy is at an alarming level

At the beginning of the discussion, Prof Auziņš draws attention to a tendency in society to only start taking care of one's health at the first sign of problems. 'We usually start talking about health issues when there are problems, but there has probably been a long period of time before that when we have not taken care of ourselves. Is the Latvian public sufficiently educated, motivated and interested in taking care of their health?'

According to UL expert Lapiņa, society should not be perceived as a monolithic organism. 'Society is very diverse. It is made up of different communities, different people and different values, which is why some people care about their health and see it as a priority, while others do not. It makes a big difference whether a person lives a well-off life in the suburbs or in the countryside. They have different options.'

RSU Assoc. Prof. Ķīvīte-Urtāne points out that there is a lack of data in Latvia on what proportion of the population has good health literacy, but at the same time there are objective indicators. 'A third of the population smokes, 60% of adults are overweight - this alone shows that we are not taking enough care of our health. A few years ago, I saw a study on health literacy in Europe, which showed different levels of health literacy in different shades of green, and in dark green the proportion of the population with the highest level of health literacy. In Latvia, there was no such shade at all. This is worrying.'

Families and schools need to do more

It is logical that if there is a lack of public knowledge in an area, we should think how to improve it. Auziņš draws parallels with media literacy, which is a subject of intense debate.

LBTU Prof. Beitāne also suggests that health issues should be addressed primarily in the family. 'In my opinion, health is based on three basic things: physical activity, nutrition and sleep. Theoretically, it is easy to implement, but as we can see from the statistics, we have problems with both a healthy diet and physical activity. Half of the Latvian population is overweight, and recent studies on 5-6-year-olds show that 19% are overweight. So we are not eating right in our families and we are not spending enough time on physical exercise. We have not taught this to our children. I think that if we are looking for the root of this problem, we should definitely start with the family. Do we go to the shopping centre or to the woods for a walk on weekends? After all, we know very well that Latvia is one of the greenest countries. We have a huge potential to be physically active in our free time and to teach it to our children.'

The environment shapes healthy lifestyles

During the discussion, the experts also address the issue of a healthy environment. Ķīvīte-Urtāne revealed that the influence of the environment on lifestyle has been proven in studies. 'It has been scientifically proven that the environment is what helps people make healthy decisions. If a person wants to cycle, they need an infrastructure. There are municipalities that have it, but if my only cycle path is along the side of the motorway, where lorries are constantly passing, I don't want to take the risk. Similarly, bans on smoking in cafés or on the sale of sugary drinks in schools are about adapting the environment to a healthy lifestyle. If we say that health is a priority, then it must be a priority not only for each one of us or only for the health sector, but also for everyone else. If we see that one of the leading causes of death is traffic accidents, this cannot be solved by the Ministry of Health without the involvement of the Ministry of Transport. I would very much like to see a situation where every decision taken at national or local level is evaluated not only in terms of its impact on gender equality or the Green Deal, but also on public health.'

What needs to be improved in the healthcare system?

The panellists focused on various aspects of healthcare, and at the end of the discussion, the host invited the experts to give their views on the most important improvements that are needed.

Professor Beitāne, Vice-Rector of Studies at LBTU, stressed that the most important thing is to ensure access to medical services. 'We know very well that if a person falls ill, they need help now and immediately, not in a month or two. Therefore, I think the biggest emphasis where we should invest is in education about the importance of a healthy lifestyle, but if a person has done everything on their part - thinking about exercise, nutrition, sleep and everything else - and still ends up in a health facility, they would be guaranteed fast and quality services.'

The Director of the RSU Institute of Public Health, Assoc. Prof. Ķīvīte-Urtāne, stressed the importance of prevention. ‘I am a public health specialist, and my field emerged when developed countries – such as Canada – realised, already in the mid-20th century, that investing in treatment and providing the best possible medical services at a certain level no longer significantly reduced, for example, mortality from cardiovascular diseases. They concluded that more investment was needed in disease prevention and in promoting healthy lifestyles, and with this approach, the figures improved many times over. In Latvia, however, health promotion and prevention account for barely 3% of total health spending.’

Lapiņa, Deputy Dean of the Faculty of Medicine and Life Sciences at UL, concurs: 'I agree that prevention and preventive actions are important. We need to strengthen the role of GPs and create practices that include a GP, a physiotherapist, a mental health specialist and others, so that we can get all the basic services in one place.'