“Public Health Person of the Year” Prof. Ģirts Briģis is proud of his country

On 11 October, the Latvian Medical Association presented its Annual Award in Medicine, and in the Public Health Person of the Year category the award went to Professor at the Faculty of Public Health and Welfare at Rīga Stradiņš University (RSU) Ģirts Briģis, who is also Head of the Public Health and Epidemiology Department. He has raised an entire generation of Latvian physicians – they learned the basics of epidemiology and acquired skills in substantiating their arguments with real study results.

RSU Prof. Ģirts Briģis after receiving the Annual Award of the Latvian Medical Association in Medicine. Photo: Ieva Leiniša

Ģirts Briģis obtained his medical degree at Rīga Medical Institute (currently RSU) in 1977.

"I studied at Rīga Secondary School No. 49, and I believe more than half of my classmates chose to study medicine. We had a good foundation in chemistry and biology, without which medicine or medical studies would not be imaginable – but I believe my choice in favour of medicine was largely influenced by literature. Archibald Cronin, Aksels Munte and other authors wrote about medicine and the doctor’s profession. I learned from books that this profession is exciting – with elements of detective fiction and hard science, human interaction, prioritising health, the fight against diseases and death…"

Professor Ģirts Briģis has fond memories of his studies, including many "lecturers who to a great extent shaped my subsequent career – their lectures and classes gave me an early understanding that I was interested in medicine as a science, which had so many things that were unknown or contradictory, yet at the same time so much logic and internal coherence. I want to mention Professor Jūlijs Anšelēvičs, who lectured about internal diseases. Professor Juris Leja also influenced my subsequent interest and desire to pursue research."

Among his mentors, he also notes professor and gastroenterologist Nikolajs Skuja, who delivered lectures on internal diseases to 6th year students and "influenced my way of thinking to a large extent. One of the most important teachers to me in clinical medicine was Agnis Štifts. In research, I learned much from Alvils Helds – my colleague and supervisor of my doctoral thesis, who later became a professor. He was then employed in the laboratory of the Experimental and Clinical Medicine Institute and also consulting patients in clinical epidemiology. Additionally I would like to mention the deputy director of the Institute, endocrinologist Georgijs Šiliņš, who invited me to this institute and ultimately hired me ". Professor Briģis worked at the Institute for 14 years, in conjuction with also performing the duties of an endocrinologist. 

How did your path in scientific work at the Experimental and Clinical Medicine Institute of Latvia and your clinical work in endocrinology take you on to public health?

This happened quite logically in the 1990s, when Latvia was experiencing major changes in the social system – or, as I like to call it – the situation was revolutionary. I had defended my dissertation in endocrinology, and one of the most widespread diseases in endocrinology care was diabetes mellitus. After completing my dissertation, I had the opportunity to go to Cambridge (England) for a course lasting several weeks and devoted to the epidemiology of diabetes. Over there I got to meet many Western specialists in this field, I found out about a new understanding of epidemiology and began cooperating (as far as the Soviet regime allowed me) with US, Finnish, British and Swiss specialists in joint projects, acquiring knowledge and experience in modern epidemiology.

Is it true that doctors call you the father of public health?

That may well be, since I was present at and actively involved in the establishment of the new academic discipline which is now referred to as public health and epidemiology. Until the early 1990s, there was nothing offered in this discipline here, at least in the way we understand and practice it today. We began developing the understanding of epidemiology which was the norm worldwide and the Soviet Union had perceived quite differently up till then. Public health was formerly known as social medicine and social hygiene – so we developed a great many areas in the discipline from scratch. Of course, I was not the only one involved, I have been working with my team since 1992.

Previously epidemiology was associated with the monitoring of infectious diseases, epidemics, outbreaks. However, since the 1950s the world has looked at it from the perspective of its broader application, i.e., non-infectious diseases, accidents and any health-related event or condition became an object of interest for epidemiology – to a large extent, epidemiology had become the methodology for the study of health and medical sciences. Thus, anywhere people and the human population are involved, wherever there are patients or groups of patients – is a subject area for epidemiology. Furthermore, just as surgery is based on anatomy, public health is based on epidemiology – it provides information and an understanding of causality and prevention.

In public health practice, there are three core directions. The first is health promotion and prevention. The second is environmental health and occupational safety. The third is the health system, research and understanding, with many subdivisions such as health management, health economics, health policy, health law, jurisprudence. Consequently, public health is a very broad field indeed. By the early 1990s, there were certain elements of public health in the Soviet Union, such as sanitary training, social hygiene, but they were restructured to conform with global trends, layig a new foundation for academia and research, and it was primarily separated from the Soviet ideology – making it a scientific discipline.

You initiated the establishment of a Public Health Department at RSU in the 1990s…

In the early 1990s, the Latvian Council of Science and the Rīga Medical Institute realised the need for changes in the field of public health and epidemiology. At the time, the Institute already had a Social Medicine Department, headed by the Minister of Health Protection (1962 – 1986) Vilhelms Kaņeps, but this role was largely ideological; so the department was closed and a completely new Public Health Department was established instead.

The position of department head was advertised, but I had doubts about taking it up because I was engaged in clinical work as an endocrinologist, and the new job would require rather radical changes – there was also a certain amount of external pressure, of course, for instance, State Minister of Health Protection (1994–1995) Normunds Zemvaldis appealed to my sense of patriotism, my sense of duty, which partially influenced my decision. Of course, one of the main selling points was that I had gained knowledge and an understanding of epidemiology abroad – and epidemiology was the foundation of public health. I applied for the position and was hired to head the department.

At the time, the Latvian language did not have a term for "public health". In my application for the position of department head, I translated the English term “public health” literally, although the Latvian "publiskā veselība" did not sound too good, so I changed it to "sabiedrības veselība" [literally: health of society]. Together with other members of the department, we debated and ultimately decided to formulate and implement all the new terminology related to the development of this new area. 

What is the Public Health and Welfare Department currently working on?

There are currently 17 academic staff members working in the department. We are certainly conducting research, however, we are mostly engaged in pedagogical work. Most of the day is spent with students, and this takes a lot of energy.

Public health is a very broad discipline, which includes an enormous amount of different aspects. Public health can be defined as both a hard science and at the same time, to a large extent – a social science. In our department, we try to specialise as much as possible. For instance, some of our staff are educated as sociologists, lawyers and economists. Some know more about the healthcare system and health policy. We collaborate with all faculties that are associated with healthcare. We are about to launch a new study course together with the Faculty of Communication – a Master’s programme “Health Communication”. It is worth noting that, starting from next year, as students and lecturers of the Faculty of Medicine have expressed an interest in having a course in health research methodology, we are currently busy developing this study course. I mentioned earlier that research methodology is directly linked to epidemiology. 

I teach epidemiology at all study levels, along with health policy and health systems.

Prof. Ģirts Briģis in 2007. Photo from RSU Museum archives

Do you have time for research?

I have always been engaged in research, participating in a variety of projects. Initially I was researching the epidemiology of diabetes, then a number of non-infectious, as well as infectious diseases; at the beginning of the 21st century there was a huge demand from abroad for research of the Latvian health system. I took part in a variety of international projects due to an interest in Latvia from around the world. Everyone wanted to find out and understand how things were set up here. 

In the past few years, I have to say, my scientific activity has diminished somewhat. There are fewer projects, and I have less energy to spend five to eight hours in the auditorium and then go on to do my research; however, the European Union’s international health survey is still being conducted in every EU state. Latvia is implementing it through its Central Statistical Bureau, and I am engaged as their partner.

I am currently supervising three doctorate theses, and a fourth in cooperation with my colleague, with a broad range of topics – from clinical medicine to public health and health management.

RSU will be holding Research Week in spring. Are you planning to participate in the RSU International Research Conference?

From Day One, we requested that the conference organisers devote a section or an event at the conference to public health, so now a thematic conference will be devoted to public health and health system management. During this conference, reports will be presented and among topics discussed will be matters relating to health promotion and disease prevention, environmental and occupational health, health economics, health management and organisation, health policy and others.

What is currently new in the public health and epidemiology sectors in Latvia?

Latvia’s healthcare system is experiencing major problems, and this is to a great extent related to healthcare policy. From an academic standpoint, we would like public health policy to have evidence-based decision-making, also based on universal values, yet interests instead of evidence and other aspects often dominate in politics. Consequently, Latvia faces many of these manifestations of the healthcare system, which may appear odd from an academic perspective. For instance, one of the greatest values that underpin public health is the universal access to healthcare services, which is defined as a core value everywhere, regardless of the country – the right to health and healthcare is considered a human right. At the same time, Latvian politics, particularly in the past few years, has taken a completely different route, restricting access to healthcare. By defining availability as dependent on economic participation, and dependent on tax payments, the residents of Latvia are subject to social stratification. As you may know, last year the law on voluntary health insurance contributions was adopted – set to take effect on 1 January 2019; however, we hope that the new parliament and government will prevent this gross error from being committed. As an academic representative of the public health sector, I have the duty to talk about values and mistakes; whether someone listens to this and hears what I’m saying is a different matter.

Is Latvian society healthy compared to other European countries?

First, we need to define the concept of “health” and what is meant by the term “healthy”. We should remember that health is more than just the absence of illness or disability. Health can always be improved, this is a continuous process.

Of course, we can try to compare, and the simplest comparison of countries would be based on the incidence of disease and mortality – Latvia has a number of problems, including the high number of cardiovascular patients, the prevalence of oncological diseases, a large number of HIV-positive people etc. 

If we are talking about other health aspects – do we live and eat, following the guidelines of a healthy lifestyle, do we move more or smoke less than the rest of Europe – I would say that we can observe an improvement, but so far we can’t be proud of these figures. The trends are positive, and people are starting to pay more attention to their health, but we have a lot of work ahead of us.

What should we pay attention to in order to maintain good health?

I can’t single out one specific item. This is a complex matter because health is affected by a number of aspects of our life – including work, the people around us, our environment. The World Health Organisation and those involved in public health talk about health in all facets of life, underscoring that no aspect of a society should neglect to include health, whether it is education, food, safety and protection etc. This means that involving all these sectors in health matters is important, and it can make a contribution to people’s health. If it is handled only by doctors at the Ministry of Health, the opportunities are rather limited; if we start thinking more broadly, there is a lot more we can do. The Ministry of Finance, for instance, is responsible for the financial affordability of healthcare; as soon as the Ministry of Finance prefers to pretend that health is an unnecessary burden in relation to the flourishing of the Latvian economy, the consequences will most certainly not be good. Health is a very broad topic, however, we should start by improving the healthcare system. 

What are your thoughts and feelings on the eve of Latvia’s centenary, what do you think about the future of Latvia?

I feel proud! A lot has been achieved and accomplished, and whatever the problems or faults – or perhaps some things that aren’t as successful as we might want them to be – we have our own nation, and this warms the heart and soul.

What would you like to wish Latvia?

It is worth remembering that one of the key aspects of national and societal development – as highlighted by ancient philosophers – is education: knowledge and understanding, the ability to think critically. So my wish for Latvia is for an improvement in the education and wisdom of the people, their critical thinking skills, ability to analyse, to be able to compete using their mind and their intellect! May all of this contribute to our development and build our confidence! Of course, this also leads to smart politicians and wise government officials who genuinely care about national education, health, and well-being!