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Welcome speech by the President of the Republic at the Men’s Health conference at the Radisson Blu Hotel Tallinn, 3 November 2011

03.11.2011

Ladies and gentlemen,
Dear friends.

It is a pleasure for me to welcome everyone who considers Estonian men’s health important.

I will admit that I feel just a bit uncomfortable up here. For one thing, I am not exactly glowing with health myself – a late flight last night and the fickle autumn weather have made sure of that, as you can hear from my voice. The other reason is that I must remind myself that many of you in the audience have a health care background. So although everyone fancies themselves the world’s greatest expert on treating illness and doctors, I will try to stick to what I know, the perspective of an Estonian male and ordinary citizen. On matters medical, you are far greater authorities than I.

Dear friends,

I find that health – and self-perceptions of one’s health – is a matter of a deeply personal inner feeling. Some people are able to remain cheerful in the face of terminal illness, while others worry or complain about minor aches and pains.

But besides that abstract measure of health, we can set objective indicators, such as average life expectancy and healthy life expectancy.

To this point, Estonia and, in particular, Estonian men have not had great cause for pride or joy in these areas. The latest data indicates improvement and the average Estonian male child born today can expect to live more than 70 years. And that is indeed significant progress compared to a few years ago.

Although life expectancy has increased recently by years, we are still far from what is considered normal in the developed world, in our case in the European Union. We are at least five years off the mark, and I would venture to say the gap is still more than that.

Behind the increase in life expectancy is lower mortality. In particular, the number of deaths by misadventure is down. Fewer young men get themselves killed. And that is only to be cheered. It shows that, just as the state has matured, our people are also growing up, including Estonian men.

I recently attended a Mihkel Raud concert and he recalled the days of 15-20 years ago, how he wrote some of his songs at a time when it was not unheard of for filling stations to explode and bullets whiz through the air. I‘d like to add that, 15 years ago, it was almost a badge of honour to get behind the wheel of a car while impaired. That sort of behaviour should be roundly condemned. And our filling stations are also in much better condition than they were.

On the other hand, health life expectancy has not to my knowledge increased. From this, we can conclude that those who do not fall to their deaths, drink themselves to death or suffer a fatal accident, are still in about the same condition and their health could be better. Estonian men are still dogged by poor lifestyle choices, of which many have the inevitable tendency of worsening quality of life and – tragically – leading to a premature demise.

Medical practitioners and social scientists have frequently discussed these topics and have identified the greatest risk factors to men’s health: stress, lack of exercise and overweight. Throw in our characteristic Nordic tendency to be introverted and keep our feelings bottled up, and we arrive at the frequently uttered conventional wisdom that Estonian men work, worry and often drink themselves to an early death. But poor lifestyle choices are actually a major problem throughout the developed world.

As Estonia makes good headway in the economy and other fields, we are also seeing a rise in other indicators. For instance, incidence of type 2 diabetes has increased. An illness that once affected primarily elderly people is now becoming common in children, and this is correlated with the development level of the respective country. I went to Ireland a few years ago and learned that they had identified a link between type 2 diabetes and economic indicators. This stems from the lifestyle, including what we eat.

If you're up to date with biochemistry, I strongly urge you to read Good Calories, Bad Calories by US science journalist Gary Taubes. The science is heavy, but he also looks at a simple issue: what people looked like 100 years ago. Both the old and the young looked much slimmer.

We should recall the photographs taken of Estonians – especially of Estonian men – say, before the War of Independence. From these photographs, we can come up with a estimate of the body mass index of the men in that era and compare it to current figures. We know more or less how tall they were, how tall we are today, and how much they weighed.

The result favours the men from the last century. Presumably we will find fairly few men aged 50-60 today with a body mass index of less than 25, which is the upper limit of what is considered healthy.

Body mass index is calculated as follows, and anyone can do it: take your weight in kilograms, then take the square of your height in metres. Divide kilograms by the squared metres. If your index is over 25, you should take action. If it is over 30, you should take immediate action. If it is over 35, please go see a physician as soon as possible. I say this as someone who once had a BMI of over 35. This is no joke.

Yes, sometimes we laugh about it and treat men’s health as fodder for the tabloid press or try to elicit an emotional reaction by twisting someone’s words. But we risk looking right through problems that are very serious and affect our brothers, fathers, even our sons in some cases. These issues do not unfortunately make the front page of the tabloid press, because a fake quote about fat doctors sells more copies.

Earning clicks and cash does not serve the Estonian people or the interests of men’s health.

I want our attitudes to these things to change. I want us to take these matters more seriously as it is our people, our nation. I do not want our fathers, brothers and other men to take these things too lightly. It’s not a topic for the tabloid press. It is about our fathers, our brothers, our menfolk.

I have been talking about the prevalent mindsets in our society for a number of years now. An atmosphere where there is unfortunately too much nastiness, intolerance, acrimony and envy. This has a very different impact depending on the field. Nastiness chips away at everyone’s life expectancy. If your soul is sick and your mind is troubled, sooner or later it will be felt in the form of stress. And a person suffering from stress can start doing things that are not good for the health. We know that Estonians often take to the bottle, the health effects of which are known.

I heartily recommend a long article by Nicholas Eberstadt in this month's Foreign Affairs, in which he describes the state of Russian democracy. We can say with certainty that we have taken a different path for the last 20 years. The population of Russia is shrinking with incredible speed thanks to the fact that men die so young. We see that the primary reason for premature mortality is alcohol. This should be a negative, cautionary example for us. We must treat these problems much more seriously and understand that too much alcohol use has harsh consequences. In today’s Russia, men outside Moscow and other major cities die about as young as they do in poor African countries.

As President, it would be fitting for me to say what the state can do in this field, and I admit that the answer is not very much. The state is not in the role of moral teacher or instilling good conduct in people. We can try, but it is not easy to change people’s behaviour. But the state can promote a situation where everyone, including every person, every family member and father, feels necessary and well-cared for, where ultimately they feel good.

To this point it appears accepted that children’s mothers are the primary ones caring for their young, attending nursery school events and parent-teacher meetings. It is the mother who is expected to stay home from work to be with a sick child. But in my opinion a father can handle these things just as well. A man’s work is not more important than a woman’s work. An Estonian man man could well see it as part of the natural order of things that he, too, take time off and devote time to other family members. This is enriching, and it is a change of pace. Among other things, it makes us think about what is really important in life. Is it money, or being together with people close to you?

Ladies and gentlemen.

A man’s health is largely in his own hands. He must not neglect his health – this knowledge must be drummed into men by both government agencies and by society, including a man’s wife and children.

Middle-aged men – men my age – are generally still relatively healthy. But we know that many people with health problems do not experience symptoms until much later, sometimes only when it is too late. For that reason, I am convinced and in fact I will plead for men over 40 to get a check-up at least once a year at their family doctor, to get themselves screened and blood work done to determine whether everything is all right, to start paying more attention to their parts that inevitably start wearing out.

I understand that we have the attitude that a “real man doesn’t worry” – that he doesn’t have time to worry. I know it, I have said it myself and this reflects our Nordic version of machismo. Seeing a doctor and the procedures done at the doctor’s office are far from the most pleasant thing in the world. These, too, are the butt of jokes, for instance men’s health procedures. But the issues are no joke. Not when a body is no longer healthy.

A thorough health examination should be in order for everyone every two or three years. Every man knows when their car is due for a roadworthiness test, or what shape their tyres are in. If they paid the same amount of attention to their own health, that would be a big step in the right direction. After all, we are more important than our automobiles, aren’t we?

Body mass index, blood cholesterol and blood pressure are easy to measure. These indicators are signals which it would be unwise to ignore. Physical exertion and following a diet seem bothersome only at first. Everyone who has started following such a regimen either voluntarily, or under medical or spousal orders, gets used to it eventually and end up giving themselves and their loved ones a precious gift – a longer life.

And what about the excuse that there is no time? Perish the thought – it is simply not true. Three years ago my brother sent me a link to a Washington Post article that analyzed why then president-elect Barack Obama was in such good physical shape. I had just been telling my brother – who had expressed concern about my weight and recommended that I start working out – that I didn’t have time, I had all these appearances scheduled at men’s health conferences and elsewhere. Then he sent me the article which said that Obama worked out six times a week for 60-90 minutes at a time. Three of those workouts involved strength training and three built stamina.

The office of US President is probably one of the most high-stress jobs in the world. Certainly nothing comes easy. In spite of that, he elects to tax himself physically. I don’t know if that article did it, but certainly it had something to do with me starting to work out. I can tell all of the men here today that although I do not have much time and stress can sometimes be high, I find I have more time and less stress since I started working out regularly. If the US President finds time in his schedule to work out, I think all of us can. At the end of the day it is up to each one of us what is more important – the time spent working out or the time spent feeling stressed.

So I wish you productive discussions here today. I find that men’s health is one of the most serious topics we should be addressing together here in Estonia. We have made a transition toward a Western country with a good public health care system and standard of living, and now that our state and government are operating rather smoothly, it is time we think about what we can do to improve our health, how we feel, and take the responsibility that no one else can do for us.

To everyone out there, especially the men, I wish you health, endurance and stamina.