Home / Articles / Identifying the Needs of Estonia’s Russian-speaking Minority: COVID-19, Data Disaggregation, and Social Determinants of Health
Estonia’s reputation as one of Europe’s most digitally advanced countries is best exemplified in its residents’ abilities to do almost everything online—from filing taxes, to conducting business, to even casting their ballots. Such digital achievements are also observed within Estonia’s health system. Advancements in service provision have been improved with the use of electronic and digital alternatives for hosting health records, scheduling virtual consultations, and administering quick and efficient prescriptions.
Since 2004, e-health has been a priority for the government, and by 2008, the launch of the national health information system allowed for an enhanced digital storage system for patients and healthcare providers (Taal 2018). Given the successful planning and the implementation of digital services domestically, the Estonian government has been a leader in supporting the development of e-health projects in neighboring states, including Ukraine, Moldova, Belarus, and Georgia (Estonia 2020 SDG Report). On a broader level, Estonia’s ambitious digitalization agenda has promoted ongoing collaboration and leadership with the World Health Organization (WHO). Estonia and the WHO are now working together to develop and administer an enhanced international digital certificate of vaccination, as well as the European Roadmap for the Digitalization of National Health Systems (WHO 2020).
Estonia’s digital-focused health system and policy agenda has provided a basis for quick and proactive responses to the ongoing COVID-19 pandemic (Basile 2020; Meaker 2020). A pre-existing digital infrastructure alongside a commitment by the Estonian government to support digital innovations has contributed to a steady influx of health-focused digital applications intended to provide Estonians with accurate information and access to resources (Meaker 2020). The country has launched webinars and e-learning opportunities to support digital literacy for populations who require support in accessing health data, insurance information, and virtual employment opportunities. In mitigating barriers to learning due to the closure of schools across the country, the pre-existing digital schooling material and communication platforms for teachers, students, and parents has also spotlighted Estonia’s ongoing and responsive approach to distance learning (Weale 2020). For instance, E-Estonia’s Digital Transformation Advisor Anett Numa highlighted the country’s two decades of experience in streamlining school-managing systems of grades, assignments, and communication onto a single online platform (Quirk 2020). It is no surprise that supporters of the country’s digital infrastructure capabilities believe Estonia is well positioned for an inevitable transition to an online work and school lifestyle.
Estonia’s rate of COVID-19 infections proliferated in November of 2020 and by the end of February was the second highest in all of Europe (Wright 2021; ERR 2021). Important criticisms of the e-health sector immediately emerged—where there was no telemedicine capacity to address doctor-patient specific conflicts, data was both poor quality and not made easily available to the appropriate authorities. Further, the contract tracing system was not effectively digitized. Importantly, there was a failure to integrate state-level and volunteer-level data, including the “poor usability and lack of cross-border functionality” of the HOIA track-and-trace app.
Shifts in Estonia’s COVID-19 cases, as well as the overall impact of the pandemic, brings into question the realities of health outcomes in one of Europe’s leading e-societies. News articles since the onset of the pandemic have attempted to highlight COVID-19 disparities based on region and zeroed in on, among others, Ida-Viru County, which has been at the epicenter of increased cases throughout the pandemic (Terviseamet 2021). The majority of COVID-19 cases brought into Estonia from abroad have come from Russia and Ukraine, prompting public health officials to monitor the borders (Wright 2020). Ida-Viru County, boasting a majority ethnic Russian and Russian-speaking population, has seen a significant number of crossings at the Narva-Ivangorod border, leading the Health Board (Terviseamet) to suggest that Russian citizens may not be following the mandatory 14-day quarantine rule (Sein 2020). Ida-Viru County’s emergence as a COVID-19 hotspot provides public health officials and policymakers with a key opportunity to recognize and better understand the role of ethnicity or minority community status within the context of public health inequities.
In this article, we examine COVID-19’s inequitable impacts using Ida-Viru County and other geographic areas with large ethnic Russian and/or Russian-speaking populations. The authors’ note that the Estonian health system does not currently collect or publicly share health data on ethnic minorities, though there is growing interest and an international call for the disaggregation of health data. Yet, even with limited ethnolinguistic indicators, the use of geographic regions as proxies to demonstrate an ethnicized pattern of COVID-19 impacts can support the observation of health inequities, as has been observed and experienced elsewhere, including in the United States (Centers for Disease Control and Prevention 2021), United Kingdom (Razai 2021), and elsewhere in the European Union (Waldersee 2020).
We focus on some key social determinants of health that are widely recognized to contribute or exacerbate increased risk among ethnic minority populations that have contracted COVID-19 writ large. Such determinants include: health system access and usage; income and socioeconomic status; housing; physical environment; education; and media, among others (Office of Disease Prevention and Health Promotion 2020; Centers for Disease Control and Prevention 2021). When the data is disaggregated based on ethnic and regional markers, Estonia’s pandemic response less resembles an early success and more the structural and systemic pattern of public health inequities prevalent worldwide vis-à-vis ethnic minorities (Brubaker 2011). Such public health inequities have yet to be effectively addressed by the country’s “harmonizing” digital infrastructure, providing a case for further examination and future solutions.
In the following sections, we first outline general challenges within Estonia’s health system and then narrow our focus on noted health inequities among the country’s ethnic Russian and Russian-speaking population through the lens of social determinants of health.
General Health System Challenges
Many health services have indeed improved with the implementation of digital reforms; however, the country’s general population continues to face negative health outcomes that are adversely affected by both structural and systemic factors. For example, approximately 6 percent of Estonians do not have access to healthcare insurance as a result of unemployment and/or irregular employment contracts (Sustainable Governance Indicators). This percentage can increase, up to 14 percent according to a study from 2018, when accounting for those who are not annually covered due to shorter-term contracts (EU Estonia State of Health Report 2019). In considering that non-Estonian-speaking populations and those with low income levels are more susceptible to precarious employment contracts, we can assume that Russian speakers continue to face health coverage barriers despite improvements in the country’s overall health services sector.
Another major long-term challenge for Estonia’s healthcare system is the current workforce shortage. Estonian policymakers have issued concerns with the number of retiring healthcare workers, a decrease in the proportion of healthcare graduates and the emigration of professionals (both to domestic urban centers and abroad). This, of course, has major impacts on the ratio of healthcare workers to patients (Health Systems Review 2018; EU Estonia State of Health Report 2019) and is highly pronounced in Ida-Viru, Southern Estonia, and the country’s islands. According to Katrin Rehemaa, the Secretary General of the Estonian Medical Association, prior to the pandemic, the Ida-Viru Central Hospital employed many physicians from third countries to address the hospital’s unmet labor needs (Eesti Haigekassa 2019). Even across aggregate rankings in the European Union, Estonia currently ranks as the country with the highest level of unmet health needs, largely due to long waiting times likely exacerbated by healthcare shortages (EU Estonia State of Health Report 2019). These system-wide healthcare challenges exist unevenly across Estonia’s population with those in rural or periphery settings having less access to healthcare.
General Health Outcome Challenges
Health outcomes for Estonians have improved significantly over the last two decades, particularly in overall quality of life and in life expectancy for those residing in the country. Since 2000, the life expectancy rose from approximately 71 years in 2000 to 78 years in 2017—the highest increase amongst EU countries in that period (EU Estonia State of Health Report 2019). However, the life expectancy of Estonians continues to be dependent on several compounding demographic factors, similar to how system-wide health challenges are more pronounced for certain residents. On average, women live 9 years more than men, those with lower education levels live less than those with a university degree (8.5 years for men and 5.4 years for women), and residents of certain counties live, on average, longer than others (Tartu county residents, a predominately Estonian ethnic region pronounced by higher levels of employment, high quality educational facilities, and increased financial investments in the service sector live 4.5 years longer than those in the largely Russian-speaking Ida-Viru county) (EU Estonia State of Health Report 2019; European Commission 2019). In 2017, 53 percent of Estonians reported being in good health compared to two-thirds across EU member states. Those aged 65 years and older and lower income respondents, in particular, reported self-perceived significantly lower health (EU Estonia State of Health Report 2019).
There are several other key factors or variables that demonstrate unequal health outcomes among Estonian residents. Accounting for regional differences, often thought of as a limited proxy for Estonia’s Russian-speaking enclave in Ida-Viru county in the absence of ethnolinguistic demographic variables that speak to social determinants of health, respondents here reported that they have on average more negative perception of their health compared to the national average (38 percent of those in Ida-Viru county reported “good or very good” health compared to the 58 percent national average) (Health Statistics and Health Research Database). Based on Statistics Estonia’s census data, between 2014 and 2019, those in Ida-Viru have continued to also experience a lower number of lifelong years without disabilities compared to the national average: 5 years shorter than the national average and 7.7 years shorter than those from Harju county—the country’s most populous and economically prosperous county (National Institute for Health Development; European Commission 2019). With pressures for more accurate and disaggregated information, the collection of Estonian health data will need to better reflect the realities of uneven health outcomes across its populations. The data that is currently available is often based on geographic region or county, and while these variables are often understood as a proxy for ethnicity due to the regions’ large composition of Russian-speakers (i.e. Ida-Viru), they do not necessarily point to a correlation specific between ethnic differences and health outcomes. At the same time, we are likely to believe that other extraneous or confounding variables, including, in fact, geographic region and consequently accessibility to services, may contribute to differences in outcomes. While there is a general lack of ethnic available data, the country’s public health statistics, as mentioned, can provide a glimpse to major gaps in health outcomes despite significant improvements in the overall health of the general population.
Zeroing in on Russian Minority Health Outcomes During the Pandemic
Estonia’s Russian-speaking minority continues to face health inequities that have long been recognized as a national problem (Leisalu, Vagero, and Kunst 2004; Groenewold and Ginneken 2011; Lai and Leinsalu 2015). Russian speakers have been observed to have higher mortality rates compared to their ethnic Estonian counterparts (Poleshchuk 2009). In a notable study that looked at ethnic differences between Estonians and Russians from the late-1980s to 2000, the researchers found that mortality for Russian men and women increased, notably for men (Leisalu, Vagero, and Kunst 2004). The largest ethnic differences in mortality were for homicide, influenza, pneumonia, and alcohol-related diseases (Leisalu, Vagero, and Kunst 2004). This has been supported by newer scholarship that has demonstrated that Russian speakers, again notably men, are more susceptible to colon, lung, and stomach cancers (Lang 2009; Groenewold and Ginneken 2011; Lai and Leinsalu 2015). Mental health issues are also recognized as ethnically divergent, with Russian speakers facing higher suicide rates than ethnic Estonians (Lai and Leinsalu 2015). Such inequities are often connected to other issues or circumstances. For example, higher mortality and poor health have been linked to Estonia’s Russian-speaking population being less physically active, less well-off, more dissatisfied with healthcare access, and more often smokers (Groenewold and Ginneken 2011; Lai and Leinsalu 2015).
The researchers noted that broader societal changes may have likely sparked these inequities, as Russians or Russian speakers and Estonians shifted in their social, political, and economic statuses or roles in post-Soviet Estonia (Leisalu, Vagero, and Kunst 2004; Brubaker 2011). For example, Estonian citizenship policy altered Soviet-era migrants’ status in the country, which left many without citizenship (e.g., non-citizenship) (Brubaker 1992; Vetik 2011; Trimbach 2017) or opting for Russian citizenship. This distinct issue and population dynamic is partly the result of major policy change, individual assessments of conveniences (e.g., ease of travel to Russia) and/or structural barriers (e.g., language or naturalization challenges) (Human Right Watch 2016; UNHCR 2016; Vetik 2011). Unlike particular circumstances where statelessness or being a non-citizen affords a demonstrative lack of rights, Estonian non-citizens do have numerous rights and opportunities, including the right to vote in local elections, among others (UNHCR 2016; MIPEX 2019). Researchers have highlighted health inequities could be reduced by targeting prevalence and divergences in obesity, alcohol consumption, substance abuse, smoking, and HIV (Priimägi and Rüütel 2006; Laisaar, Avi, DeHovitz, and Uusküla 2011; Lai and Leinsalu 2015). Such research has also demonstrated that many of these issues are exacerbated in denser Russian-speaking areas, like Ida-Viru County, city of Narva, and specific parishes in the greater Tallinn area (Kaer 2015; Lai and Leinsalu 2015). Health data used and analyzed, also appears to originate with external or third-party sources, illustrating a greater need to collect and publicly share ethnic health data. Given these previously observed ethnic and geographic patterns of health inequities, it is no surprise that COVID-19 and its impacts are unfolding with similar socio-spatial intricacies.
What Can Geographic Patterns Can Tell Us?
While more rigorous research and analysis are needed, at first glance, geographic patterns and variations that exacerbate social determinants of health that disproportionately affect ethnolinguistic minorities in Estonia can act as a proxy to demonstrate potential inequitable impacts of COVID-19 on Estonia’s large minority Russian-speaking community. For example, counties where the largest segments of the country’s Russian-speaking population resides have had more cases than other counties. At the county scale, Harju (38,059 cases) and Ida-Viru (11,341 cases) counties have some of the largest caseloads in the country (as of March 4, 2021) (Terviseamet 2021).
At the parish scale, those parishes with larger Russian-speaking populations also have had large caseloads, notably in the city of Narva (4930-4939) (Ida-Viru County) and the Tallinn districts of Lasnamäe (9990-9999) and Mustamäe (3820-3829) (Harju County) (Terviseamet 2021). Such patterns can partly be explained by Ida-Viru county’s and Narva’s geographic proximity to the Estonian-Russian border, which has been identified as a partial cause of cases or spread (Wright 2021); however, some border restrictions have been put into place, given the region’s high caseload and impact (Ministry of Foreign Affairs 2021). Ida-Viru County’s high caseload differs markedly from Estonia’s other border regions, which may partly be explained by the high concentration of ethnic Russians and Russian speakers in the region, who are known to travel abroad (e.g., Russian Federation) more than their ethnic Estonian counterparts (Mooses et al. 2020) and extreme differences in cross-border traffic among Estonian’s key border crossing sites (Pihlak 2008). Ida-Viru County and Narva have emerged as major sites of COVID-19’s impacts (Turovski 2020; Whyte 2020), which has led to a greater awareness of the virus’ potential danger (Wright 2020).
Although the border can partly explain impacts, notably the high percentage of Russian citizens living in Estonia who cross the border or who reside in Ida-Viru County (Wright 2021), on a national scale, other linked factors or social determinants should also be acknowledged. Additionally, such patterns may also partly be connected to documented variations in health literacy that have been observed among Russians and Russian speakers elsewhere, stemming from previous experiences (Kostareva et al. 2020). Due to an overall lack of available data, particularly primary data, it is difficult to determine which factors are most significant or have the most impacts; however, acknowledging linked social factors or determinants can help demonstrate that Estonia is not immune to minority health inequities, as globally observed and recognized elsewhere.
Weaving in Social Determinants of Health
The Link Between Language, Educational Attainment, and Socioeconomic Status
The healthcare system produces good outcomes with limited resources, but coverage is tied to education and employment status, leaving many without free or immediate access (Sustainable Governance Indicators). Minority integration in this case relies on the official language as the instrument of ensuring socioeconomic cohesion in society. Estonian is the main (and in many cases the only) language of official communication required for upward mobility, re-training opportunities, and state-supported higher education. Russian speakers’ command of Estonian, especially that of young Russian speakers, has certainly and steadily improved over the last couple decades. For instance, the year 2007 saw the transition to partial Estonian-medium instruction in Russian-medium state and municipal secondary schools, and along with it, a demonstrable increase in Estonian-language acquisition, regardless of whether there is an Estonian-language environment or not (Estonian Language Foundation, 2011).
Still, the Estonian language has yet to take a sufficient role in daily inter-ethnic communication in order to effectively bridge ethnolinguistic intersections within one inclusive state. The performance gap between Estonian- and Russian-medium schools persists in that the proficiency in Estonian of students with a different mother tongue remains well under the national target of 90 percent. Furthermore, data from Pisa 2018 indicates that students in Russian-medium schools scoring an average of 42 points less than students in Estonian-medium schools in reading and science, and 29 points less in mathematics. Active governmental support of the intensive “language immersion” classes that require 50-60 percent of the curriculum to be taught in Estonian has led to the replacement of Russian-medium schools, with some programs launched to support bilingual teaching (Ministry of Education and Research, 2019). But these performance gaps, alongside relatively poor Estonian-language acquisition prior to entering and during secondary school, worsened in ethnically segregated regions and continue to impact Russian-speaking students’ higher education and skilled labor options, as Russian speakers who are not already fluent in Estonian must choose between “language immersion” schools or disengaging from the (national) education system entirely (OECD 2020).
Before the pandemic, most Estonian schools routinely used digital materials, including a platform of digital books called Opiq and electronic school management systems such as eKool. Given the high degree of digital literacy of Estonian teachers, the transition to distance learning is currently touted as both successful and essential. Where children did not have access to a laptop or tablet, local authorities and voluntary organizations stepped in (Weale 2020). Current research does not disaggregate distance learning challenges by ethnic or regional markers, but it is reasonable to assume pre-existing educational disparities as identified in the OECD report would have carried over to the online pandemic era and disadvantaged Russian speakers more than their Estonian counterparts. For instance, health officials in Ida-Viru have struggled to force all municipal schools to transition remotely (ERR, 2021; Stepanov (ERR), 2021). While several supportive guidelines and information, educational technologists, and learning platform tools are set up for parents, teachers, and school leaders for Estonian-lanaguage schools, Russian-speaking teachers appear to have much more limited access to tools in Russian (Council of Europe).
A spotlight on Estonia’s economy once again reveals that the socioeconomic status of Russian speakers and/or ethnic Russians is often bound up with Estonian language acquisition levels. More specifically, the country’s welfare system is pronounced by higher poverty and inequality measures compared to the OECD average, especially for ethnolinguistic minorities (Sustainable Governance Indicators). While there is yet available data for at-risk-of-poverty percentage in 2020, the previous year’s insights suggest that Russian speakers are especially vulnerable to poverty. For example, in 2019, 24.6 percent of self-identifying ethnic Russians were at risk of poverty compared to 18.9 percent of Estonians. When making comparisons by citizenship, Russian citizens were 11.1 percent, and those with undetermined citizenship were 8.3 percent, more likely to be at risk of poverty.
In terms of labor outcomes in 2020, various demographic variables that identify the country’s Russian-speaking minority—be it ethnic identification, place of birth, citizenship, or domestic language—all suggest a more pronounced level of unemployment for the overall Russian-speaking minority, with particularly worse-off outcomes for those holding Russian citizenship (Statistics Estonia, TT70 Unemployment Rate by Group of Persons). In fact, 9 percent of those whose domestic language is Russian experienced unemployment compared to 5.7 percent of those who are Estonian domestic speakers. One explanation for such outcomes may relate to the structural limitations that impede older Russian speakers in learning sufficient Estonian in order to improve their socioeconomic status. Similarly, the unemployment rate for Russian citizens residing in Estonia (Estonia does not allow for dual citizenship) was 12.9 percent compared to 6.3 percent for Estonian citizens. It is worth mentioning that unemployment rates have decreased over the last couple of years for Russian speakers, and particularly for those with undetermined citizenship; however, Russian-speaker unemployment increased more drastically than for Estonian speakers in 2020, likely as a result of the pandemic.
When comparing employed persons by major group of occupations, it is evident that Russian speakers, again forming a variety of demographic variables, are more likely to also be employed in lower-skilled or blue-collar occupations compared to their Estonian counterparts, as exacerbated by lack of Estonian-language acquisition, spatial segregation, and citizenship status (Statistics Estonia, TT245 Employed Persons by Indicator, Group of Persons and Major Group of Occupations). Across several occupation areas, only 5.8 percent of all Russian citizens in Estonia and 7.6 percent of those who speak Russian domestically held managerial positions compared to 11.2 percent of Estonian citizens, or 11.8 percent of those who speak Estonian domestically. On the other hand, 22.7 percent of all Russian citizens in Estonia, or 15.8 percent of those who speak Russian domestically, are employed as plant and machine operators and assemblers, compared to 10.9 percent of Estonian citizens, or 10.7 percent of those who speak Estonian domestically.
Russian speakers also face more socioeconomic challenges despite the demand for Russian-language skills in many trades, the job market, and commerce. Compared to ethnic Estonians, Russian speakers earn less, face higher rates of unemployment, and are more likely to be rejected by prospective employers. Indeed, the Russian-speaking minority is overrepresented in the lower-level workforce, especially in Tallinn, which is tied to lower Estonian language proficiencies. At the same time, by virtue of being overrepresented in essential work settings such as factories, grocery stores, and public transportation, and subjected to well-documented job precarity, Russian speakers inevitably have a larger chance of being exposed to COVID-19 and less flexibility to leave jobs or take sick days. For instance, Turu-uuringute AS 20th survey conducted in December 2020 on behalf of the Government Office and Ministry of Social Affairs found non-ethnic Estonians have twice as few opportunities to work remotely as ethnic Estonians.
Public health officials in Tallinn’s predominantly Russian-speaking Lasnamäe district specifically pinpointed increased frequencies of COVID-19 among low-income workers who are afraid to lose their jobs in industrial companies and therefore refuse to reveal symptoms of illness (ERR News, 2021). Dr. Arkadi Popov, Chief Medical Officer of the Estonian Health Board’s crisis team, pinpointed the exact same reason for those residing in Ida Viru, where the economy is based on the service industry running 24-hours a day (ERR News, 2020). This phenomenon was exacerbated by a delayed implementation of sick pay, which was only introduced January 1, 2021.
The Legacy of Soviet Housing Structures
Young adults from Russian-speaking communities in Estonia are becoming more and more concentrated in homogenous housing areas as compared to their parents (Silm, Ahas & Mooses, 2018). As such, old as well as young Russian speakers are likely to be increasingly segregated from ethnic Estonians in both places of residence and out-of-home nonemployment activities. Disproportionate instances of COVID-19 in Soviet-era communal housing have already been well documented in St. Petersburg, alluding to the structural unpreparedness of such crowded housing complexes to deal with disease outbreaks (Kramer 2020). Elsewhere in the Baltic region, such as in Latvia, pre-COVID-19 housing analyses have highlighted the precariousness of deteriorating communal-style buildings and stressed that the pandemic would likely exacerbate existing issues (Plouin et al 2020). Thus, the remaining legacy of Soviet urban planning in Estonia may play a role in the frequency of interactions with potential COVID-19 cases.
Estonian urban geographers already warned of Tallinn’s rapid geographical segregation between social groups in 2019, pinpointing the mainly Russian-majority Lasnamäe district characterized by Soviet-built tower blocks that house more than a quarter of the city’s population (Morgan 2019). By December 2020, Lasnamäe had the highest infection rate in Tallinn with 740 infected per 100,000 inhabitants in two weeks, with officials citing problem areas such as “big apartment houses, elevators, and staircases” (Öpik 2020).
The remnants of Soviet housing planning policies are most visible in Ida-Viru and Harju counties, where the share of family dwellings is less than ⅕ and apartments constitute 95% of all dwellings. Estonia’s housing stock has been strongly affected by the standard apartment design, which often was not adequate for the size of household needs. Overcrowding remains the worst in these counties’ rural municipalities (Eesti Statistika 2000). As such, the mayor of Narva and consequent opinion polling suggested reasons of higher infection rates nearly identical to Lasnamäe: high population density and Narvans living close together in apartment blocks with little opportunity for privacy, and a communal, family-oriented lifestyle (Wright 2020).
Media Consumption Patterns
The development of Estonia’s digital infrastructure has been met by an increasingly fraught media environment. In general, Russian speakers use four distinct information spaces: media from Russia, Russian-language media from within Estonia, Estonian-language media, and Western media. News broadcasted through Russia has traditionally remained the most significant information space for Russian speakers in Estonia (Dougherty & Kaljurand, 2015; RAND, 2018). However, the increase in digital literacy and smartphone usage, especially amongst younger Russian speakers, has proliferated the usage of social media. Those who are firmly embedded within the Russian-speaking community tend to use other platforms such as VKontakte (Dougherty & Kaljurand, 2015; RAND, 2018).
In recent years, the Estonian government has sought to bridge the information divide by diversifying the information consumption of Estonia’s Russian speakers in order to mitigate Russian-directed disinformation tactics that had spurred social unrest in previous years. For instance, emphasis was placed through the Estonian Public Broadcasting Development Plan 2015-2018 on Radio 4 and ETV+, which are two alternative sources of Russian-language information geared towards Estonia’s Russian speakers. Still, the program has had difficulty in maintaining audience members or attracting new ones. Furthermore, studies have shown that Russian speakers will choose Russian-broadcasted channels available to them because of their more diverse selection of options and higher-quality entertainment shows (Vengerfeldt, 2013; Dougherty & Kaljurand, 2015; RAND, 2018). Regarding news and information gathering, studies have shown that Russian speakers are generally skeptical towards certain sources of media information, will cross-consult several sources to inform their opinions, and are also less likely to utilize social media as an effective form of political engagement (Vihalemm, Juzefovičs & Leppik, 2019; Tiidenberg & Allaste, 2016).
The Russian state’s misleading public health information on COVID-19 has propelled more Russian speakers than ever before to turn to Estonian state-sponsored news for up-to-date and objective information. Indeed, several studies suggest that interest of Russian speakers in Estonian media is continuing to grow. The reliance on local information has resulted in a three-fold increase in viewership for ETV+, had a unifying effect on other information spheres, and prompted the acknowledgment that Russian speakers are not a monolithic group consuming a singular media perspective— in fact, they rely on Estonian-based media for key information (Kõuts-Klemm, 2021; Sander, 2020). Officials are being careful to communicate important information in both Estonian and Russian and boosting the visibility of ethnically Russian Estonians, such as the head of the Health Board’s (Terviseamet) emergency medical department Dr. Arkadi Popov as a “reassuring nightly TV presence” that locals have responded well to. Surveys conducted by Turu-uuringute AS throughout 2020 confirm various successes accelerated through the unified mediascape: 1) Almost all Estonian residents are working to slow down the spread of COVID-19, and 2) Estonian- and Russian-speaking people are almost equally informed about issues related to COVID-19.
Estonia’s rapidly changing health infrastructure can largely be attributed to the direction from the Ministry of Social Affairs. The ministry has spearheaded the e-health service deliveries and oversees the sustainability of the national health information system. Health data collection and analysis continue to evolve with a variety of institutions supported by the ministry, including the National Institute for Health Development. The pandemic has prompted the ministry to better consider how to collect and store health data in an efficient and meaningful manner.
There are several core areas that the Estonian government and general policy advisors can address in order to ensure that the 2030 National Health Plan effectively tackles social determinants of health that disproportionately affect ethnolinguistic minorities in Estonia. First, most important in terms of understanding the public health challenges that Russian speakers face is to begin collecting demographic-specific information on ethnolinguistic minorities. Specifically, Estonia’s health indicators must be disaggregated by ethnolinguistic variables. While geographic variables have indicated that the Russian enclave of Ida-Viru experiences lower health outcomes in comparison to the national average, Russian speakers are widespread and live in a variety of counties throughout Estonia. National health data would benefit from employing a set of markers similar to Statistics Estonia data on labor outcomes, which provide context for inequality through the inclusion of several demographic selection options, such as: ethnicity, citizenship, and domestic language. The international call for data disaggregation is simple: Obtaining specific data to identify the impact on subgroups will provide valuable information to policymakers to determine the appropriate intervention.
Second, Estonia’s ministries must work together to address the multidimensional inequities that minorities continue to face. In Estonia, these issues have long fueled the “othering” of Russian-speaking enclaves in relation to the formation of the Estonian state and its political processes, media spaces, and interethnic relations. Cross-cutting policy decisions must synergize objectives and initiatives across ministries in order to appropriately respond to lower than average outcomes of Russian speakers in health, education and the labor market. Last, attention must continue to be paid to methods of harmonizing the information sphere in order to both maintain and increase the newfound surge in Russian speakers’ interest towards state-sponsored media.
Estonia has a unique opportunity to capitalize on the newly unified media environment in order to build long-term neutrality, trust, and interethnic integrative processes vis-à-vis the Russian-speaking minority. This year is particularly important as the country will first employ its largest vaccination program and its economic pandemic recovery plan, and it marks the conclusion to several key national plans, which will likely be renewed. More specifically, the Estonian government and general policymakers can use the opening to support integration mechanisms through the National Health Plan, the Strategy of Children and Families, the Regional Development Strategy, the Estonian eHealth Strategic Development Plan, and most importantly through the Ministry of Interior’s Integrating Estonia Plan. Indeed, Estonia in the digital age is better positioned than ever before to incorporate equity-framed considerations in the launch of its short- and long-term strategies and emerge from the pandemic as a public health success story.
The views expressed in this article are those of the author alone and do not necessarily reflect the position of the Foreign Policy Research Institute, a non-partisan organization that seeks to publish well-argued, policy-oriented articles on American foreign policy and national security priorities.