Breaking down silos: Estonia’s journey towards a unified prevention system

In the complex and dynamic world of public health, cross-sectoral collaboration has emerged as an essential tool for fostering a more comprehensive approach to health promotion and disease prevention. By bridging the gaps between traditionally siloed sectors, such as healthcare, education, and social services, this collaborative approach enables a more holistic understanding of the social, economic, and environmental determinants of health, leading to more effective and targeted preventive interventions. Estonia is boldly embracing proactive prevention strategies as Karin Streimann and Triin Vilms from the National Institute for Health Development discuss.

In the sector of public health, 'prevention' is not just a buzzword; it is in fact the very foundation for a healthy society. Yet, achieving a unified prevention system that transcends the boundaries of various sectors and disciplines poses unique challenges.

Estonia's approach to prevention has been described as siloed and inefficient. Instead of investing in long-term, strategic prevention efforts, the country often relied on short-term project funding that failed to align with proven practices. However, in recent years, Estonia has embarked on a transformative journey towards a more comprehensive and effective prevention system.

Acknowledging the intricate relationship between societal factors and criminality such as income, education, food security, and housing, the country developed a cross-sectoral approach to prevention driven by the Estonian Ministry of the Interior and the Ministry of Justice. This landmark initiative marked a turning point in Estonia's prevention efforts, recognising the need for a coordinated approach that breaks down silos and unites experts from diverse fields.

The leadership by these two ministries and subsequently the involvement of other ministries including the Ministry of Social Affairs proved to be instrumental in shaping Estonia's new approach. They contributed their legal expertise, fostered collaboration among government agencies, non-governmental organisations, and communities, and utilised knowledge to assess prevention effectiveness. Alongside these efforts, the National Institute for Health Development (NIHD, Tervise Arengu Instituut) played a leading role in integrating prevention science and co-creation principles, exploring a systems-based approach to factors that affect prevention quality.

But in a world of diverse perspectives and fragmented prevention efforts, is it possible to forge a unified approach that transcends boundaries and delivers effective solutions for our communities? The answer lies in recognising the interconnected nature of societal problems. By bringing together stakeholders from diverse fields, such as healthcare professionals, educators, policymakers, social scientists, psychologists, and community leaders, we can effectively address the root causes of these problems before they arise. After all, the interconnectedness of societal problems and their common underlying factors emphasise the necessity of a multifaceted prevention approach that addresses these root causes.

Can we overcome the barriers to unified prevention?

In 2020, Estonia took on the challenge of understanding the strengths and weaknesses of its prevention system. The researchers' from NIHD examined the prevention system to see what was working well and what needed to be improved.

This study was not just about research; it showed Estonia's commitment to creating a healthier society for everyone. By bringing together experts from different fields, the team was able to find solutions to complex problems and create a more effective prevention system.

The study found several shortcomings in the prevention system. These included a lack of evaluation for preventive measures, limited knowledge of the effectiveness of existing programmes, and insufficient prevention skills among the workforce. These findings highlighted the need for a concerted effort to address these gaps and strengthen Estonia's prevention strategy. Interviews were conducted as part of this study with local, regional, and national level opinion leaders as well as decision-makers and revealed several key challenges including:

  • A lack of clear alignment and coordination across prevention initiatives.
  • Challenges in transparency and accountability regarding prevention funding.
  • Insufficient evaluation and assessment of preventive interventions.
  • A shortage of a qualified workforce with the expertise required for prevention initiatives.

A path forward: addressing the gaps

The absence of clearly defined prevention goals has long been a stumbling block for many countries, leading to unfocused and ineffective prevention efforts. Estonia, however, has taken a decisive step forward by establishing clear and measurable prevention goals that align with national priorities and address the most pressing societal challenges. These goals serve as a guiding compass, directing prevention efforts towards achieving real results and ensuring that resources are used wisely.

Estonia has taken a bold step towards cross-sectoral prevention by forging an agreement among its ministries of education, justice, culture, finance, interior, social protection, and health and labour. This landmark agreement, signed in 2021, laid the foundation for a strategic plan, effective interventions, promising evaluations, and a focus on prevention workforce competencies.

Recognising the critical importance of evidence-based decision-making in prevention, Estonia established the Prevention Science Council in 2022 under the guidance of the National Institute for Health Development, and in 2023 the cross-sectoral prevention action plan was agreed upon. This council brings together experts from diverse fields, including public health, healthcare, education, social science, psychology, and law, with the mission of ensuring that prevention policies and practices are firmly grounded in sound scientific evidence. This creates a significant link between policymaking and science, as well as between science and practice.

Of course, what cannot be underestimated is the link between communication and advocacy. Both are undoubtedly powerful tools in fostering a common thread between different sectors. So, creating a common language for prevention and setting high standards for prevention programmes are vital steps in building these bridges and has been a key part of our strategy.

Further action is needed

Despite the progress made in organising the prevention system, several themes still need further action. The Prevention Council's task force requested funding to carry out its assignments, but this request was not granted. This means that running the task force comes second to the involved parties' daily responsibilities, which threatens the sustainability of the work and makes the system dependent on the people currently involved with it.

Additionally, some components of the prevention system have not yet been fully addressed. Economic reforms are still needed to revise the prevention funding mechanisms and support evidence-based decision-making at the local and national level. Unfortunately, at this moment, there are no established quality standards for funding and implementing preventive interventions, and no links created between implementation and research.

Building a stronger foundation for prevention

Addressing societal challenges requires a coordinated approach that breaks down silos and unites experts from diverse fields. Estonia has emerged as a beacon of cross-sectoral prevention, demonstrating how collaboration, shared language, and evidence-based decision-making can empower nations to tackle complex issues effectively. By bringing together stakeholders from diverse fields, establishing a common language, and prioritising research and evaluation, Estonia has created a model for sustainable prevention that can be replicated by other countries.

What initially began as a strategy to prevent crime has evolved into a broader understanding of the need for cross-collaboration in strategic planning. This approach aims to link different topics, reflect a unified approach, set priorities, and achieve shared goals. By working together, we can address the root causes of social inequalities and foster a more equitable and prosperous society for everyone.

A collaborative approach to reforming food systems

- a brief insight from EuroHealthNet

In the fight against non-communicable diseases (NCDs), regulating our food systems stands as a pivotal frontline. The unhealthy nature of our current food systems has been clearly linked to the rise in NCDs. Addressing this issue demands a systemic approach, with regulation reaching across various sectors.

Marketing regulation, for instance, calls for a collaborative effort between healthcare professionals, legal experts, and digital infrastructure experts. This cross-sectoral, systemic approach ensures that marketing practices align with public health goals and ensures the onus is not on the individual.

Similarly, in the realm of agriculture, businesses and healthcare providers must work in tandem to promote sustainable and nutritious farming practices. By fostering a culture of collaboration, we can transform our food systems into allies of health, not rivals.

The time has come to dismantle the silos that have hindered progress in this crucial arena. By embracing a systemic approach to food system regulation, we can pave the way for a healthier future for all.

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Karin Streimann
Researcher at the National Institute for Health Development at Tervise Arengu Instituut | Website | + posts

Karin Streimann works as the researcher and unit lead of cross-sectoral prevention in the National Institute for Health Development. She is coordinating the Estonian Prevention Science Council and provides advice for the board of the European Society for Prevention Research. Her research profile is available online at: https://www.etis.ee/CV/Karin_Streimann/eng/

Triin Vilms
Senior Specialist at the National Institute for Health Development at Tervise Arengu Instituut | + posts

Triin Vilms works as a Senior Specialist in the National Institute for Health Development. She is leading the task force of cross-sectoral prevention together with the representative from the Ministry of Justice and co-coordinates the Estonian Prevention Science Council.

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