Estonia and Pain: Jaan Kross' The Czar's Madman

Summary

Questions around how best to improve health in Latvia will be central to the reorganization of the health care system. Health promotion aimed at changing personal behaviour that shortens the life span, such as excessive drinking, smoking and poor dietary habit, has not yet begun. Environmental problems have been made more visible by media publicity, but actual pollutants have diminished only marginally. The medical profession has gone through a prise de conscience but the tremendous shortages of equipment and medical drugs have led to a deterioration of medical care in a period of economic disorder.

The total expenses in Latvia for health care were for a long time the lowest of all Soviet republics claiming 3.6% of the national budget in 1989 compared to an average of 4.1% in the USSR as a whole. In the United States over 12% of the GNP is devoted to health.⁴⁷ Unfortunately, the comparative gaze of many Latvian doctors is to the United States. The level of their frustrations will no doubt rise considerably when they realize that, under circumstances of economic uncertainty and of competition with so many other needs, only marginal gains in financing will be possible.

Under these conditions great strides could be made in upgrading health and extending average life span by concerted, well-planned educational campaigns and public policy which focus on health promotion and hygiene. The number of male smokers, for example, has decreased dramatically in Canada in the last two decades in large measure as a result of active publicity. In Latvia, not enough attention as yet has been paid to the relatively inexpensive prophylactic strategies for health improvement. At the same time unrealistic expectations are placed on the health benefits derived from sophisticated equipment and modern pharmaceutical drugs. To be sure, attention needs to be paid to both prevention and treatment but the former is much less costly and in the context of present day Latvia should receive far more attention. Improvement in health could be the catalyst that nudges people into a much more positive outlook on life, work and the future in general.