Overhauling healthcare: lessons from a small Baltic nation

Health care is lagging ten years behind when compared to other industries.

– Estonian President Toomas Hendrik Ilves

Estonia. Not the first place you think about when you’re imagining a leading health care system. You’d be surprised. The Estonian Genome Project (EGP) is a population-based biological database and biobank that was established in 2000. The EGP is based at the University of Tartu, with the objective of investigating the genetic, environmental and behavioral background of common diseases and traits of a large proportion of the Estonian population. Today, the Estonian Biobank has a cohort size of 52,000 (5% total population of Estonia). In comparison, President Obama’s proposed genetic biobank (announced last year) seeks to enlist 1 million American volunteers.

When we started our research, we were not aware of Estonia’s vision for personalized care. Indeed, the success of the Estonian Genome Biobank is based on Estonia’s innovative health programs, which have been active since its independence from the former Soviet Union in 1991. We learned that the program is supported under the Human Genes Research Act (HGRA) – a superior law that regulates all the activities of the EGP. This forward-looking law, combined with Estonia’s strategic growth in R&D spending; GDP (from 0.6% of GDP in 2000 to 1.7% in 2013); clinical trial sites (from almost nothing in 1991 to 671 in 2015); digital technology investments; specialized labour (Estonia boasts a national program to attract top scientists, including those Estonians returning home from abroad); and a nationwide electronic health record system (eHealth, which is the first in the world in providing EHR access to all Estonians), make Estonia a perfect case study to learn from.
We must seize these market opportunities to fulfill a vision for healthcare in the 21st century

– Estonian Health commissioner Vytenis Andriukaitis

Source: Estonian Genome Center 2001-2011

What does it mean to be patient-centered? We have learned that the EGP’s research on human genetics aims to shed light on other aspects of human life, like behavior and cognition, circadian rhythms and physical fitness. The type of strategic coordination that seems to be occurring between the EGP and other systems, such as IT, research, and governance, seem to suggest that Estonia is building the architecture for a different type of “health”. We know that this is just the beginning. Our goal is to try to understand Estonia’s healthcare paradigm shift: from “personalized medicine” and the curing of disease outcomes to a type of “personalized prevention” that involves changing lifestyles and preventive drug treatments.
We need a developmental leap in the field of e-services, including e-Health…we need to develop new digital services for the people of Estonia…”

-Estonian Prime Minister Taavi Rõivas

While we haven’t yet captured specific lessons from the case study of Estonia’s biobank, we do keep in mind one important thing: it is important to situate our work within its local/global perspective. Our findings should not be considered in isolation, but rather as part of a complex system of interaction. The Estonian Genome Project confirms the viewpoint that good ideas can come from anywhere.

Francisco Del Canto Viterale and Vivasvat Dadwal