Eurostat data indicate that only Latvia and Lithuania have wider gender gaps in life expectancy in Europe.

"In this respect, we are still clearly in the Eastern European niche. In terms of life expectancy in general we are very close to the European average, but we have some persistent issues," said Mall Leinsalu, a senior researcher at the National Institute for Health Development in Estonia and an associate professor at the Stockholm Center for Health and Social Change at Södertörn University, Sweden.

The coronavirus pandemic decreased the average life expectancy in the EU to 80,1 years in 2021, whereas it was 77.2 years in Estonia. On average, Lithuanians lived three years less than their Latvian neighbors. According to Leinsalu, the most significant factors involve drinking and smoking, among others.

"Even before the pandemic alcohol-related mortality increased and during the epidemic, alcohol use climbed even more. People remained at home during this time, and studies suggested also a decline in their mental health," the researcher said.

Although it is more difficult to accurately attribute accidents to drinking, there has been a rise in both alcohol poisoning and alcohol-induced liver cirrhosis.

However, Leinsalu said that these numbers do not demonstrate a causal relationship; rather, it is a scientifically backed opinion. Also, Estonia's gender gap in life expectancy can be expected to close in the long run. It decreased by a month or two per year before the corona years, depending on the year, due in part to men's higher life expectancy.

Men continue to visit the doctor for health concerns later than women, but their health behavior is improving. At the same time, if current trends continue, the future closing of the difference will be due to the rising alcohol use of young women.

"Life expectancy gaps are shrinking, although this is not necessarily due to positive factors," Leinsalu explained.

However, she said that we cannot rely solely on prevention interventions within the health system to achieve a significant breakthrough in this area, but we could strive for a concept that has already gained traction in Western Europe: health in all municipalities.

"Although Estonia is geographically small and our genes are closely related, life expectancy differs greatly from region to region. Northeast Estonia has long been a concern for us, and southeast Estonia is also problematic. People are struggling in life, and it shows in their health," she said.

What is possible in one county should be also achievable in another.

Despite the occasional crises that have hit Estonia, the overall living standards of Estonians have improved significantly over the last couple of decades, according to the researcher.

"This improvement is seen in life expectancy: people's health awareness has increased, and life has generally improved. Unfortunately, mortality does not necessarily reduce at the same rate as the economy improves. People do not immediately understand how to use their surplus wealth to improve their health," Leinsalu said.

For people with a lower level of education and a lower standard of living the gap is usually even wider.

"All at the same, we prefer to deal with those who are more successful, it is simply easier. So, prevention should be more targeted. These are the difficult decisions. We can always question why we should establish additional programs for those with a history of bad decision-making. But, from a national perspective, poor health and all of these diseases is a secondary burden on the state," the senior researcher went on to say.

Anomaly in infant mortality

Eurostat published comparative data on infant mortality in addition to life expectancy in European countries. Estonia has long been at the forefront of Europe in terms of one of the best indicators of a country's level of development.

However, by 2021, it will have risen from 1.4 to 2.2 cases per thousand births. In comparison, the European average continues to hover around 3.2. Latvia and Lithuania rank higher than the EU average.

Heili Varend, senior lecturer in medicine at the University of Tartu Hospital, said that small-country characteristics were important factors in 2021 growth, as random chance can significantly distort statistics.

"Early neonatal mortality, or mortality between 0 and 7 days of age, is a significant factor in infant mortality. In Tartu, the early newborn mortality rate climbed from the average of two to four cases per year to nine cases per year, which has a large national impact," Varendi explained.

Last year, however, only two infants aged 0 to 7 days died in Tartu. Thus, the indicator should be considered a multi-year sum.

"Between 2019 and 2021, 69 infants died in Estonia, giving a three-year cumulative infant mortality rate of 1.7 infants per 1,000 live births," Varend said.

In 1991 and 1995, after regaining independence, the number increased to 15.

"If we had used the previous year's figure, I would have been able to say that Estonia's infant mortality rate is the lowest in Europe and clearly the best," Leinsalu emphasized.

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