Estonian Human Development Report

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Table 2.2.4. Differences in life expectancy as of 2002 by age groups: comparison between Estonia and EU10 and EU15 Age group Source: HealthGAP 2008 MEN Estonia vs EU15 Difference in Effect life expectancy (years) on the difference EU10 vs EU15 Difference in life expectancy (years) Effect on the difference 0–1 0.16 1% 0.4 6% 1–19 0.51 5% 0.2 3% 20–44 3.24 30% 1.1 16% 45–64 4.69 44% 3.0 45% 65+ 2.10 20% 2.0 30% Total 10.69 100% 6.8 100% WOMEN Estonia vs EU15 EU10 vs EU15 Age group Difference in life expectancy (years) Effect on the difference Difference in life expectancy (years) Effect on the difference 0–1 0.04 1% 0.4 8% 1–19 0.10 2% 0.1 3% 20–44 0.69 14% 0.3 6% 45–64 1.59 33% 1.2 26% 65+ 2.38 49% 2.6 56% Total 4.81 100% 4.7 100% At the same time, the mortality rates of children and young people (ages 0–19) in Estonia are significantly lower than those of other Central and Eastern European countries. Compared to EU15, this age group constituted, respectively, 9–11% and 3–6% of the entire difference. The same is true for the elderly – in comparison with EU15, the relative importance of men is 30% and that of women is 56% in EU10 countries, and 20% for men and 49% for women in Estonia. As of the 21 st century, men’s average life expectancy in the Baltic states was approximately 12 years shorter than, for example, in Sweden. Within the 20–64 age group, the number of fatal injuries suffered by men in the Baltic states was approximately 7–9 times higher than in the Netherlands and the United Kingdom. Premature adult mortality (deaths between ages 20 and 64) reached its highest level in Estonia in 1994. There was a significant decrease in premature mortality during the following years and the rate stabilized both among men and women in 1997–2002. In order to understand the causes of the shortness of life expectancy in Estonia and the other Baltic countries, we must look at our situation in the context of fundamental changes that occurred in the causes of mortality in developed Western countries. 2.3. The socio-economic background of health Different data indicate that inequality is characteristic of Estonia in terms of health, health behaviour, as well as the availability of health care services. During the period following the restoration of Estonia’s independence (1990– 2000), there was a significant increase in inequality with regard to different social groups. For example, mortality rates increased among people with a lower than secondary education but decreased in the case of people with a higher education. The gap between the mortality of Estonian and non-Estonian residents also grew, while the proportion between the mortality rates among inhabitants of Figure 2.3.1. Self-assessment of health by income quintiles (% of respondents) 80 70 60 50 40 30 20 10 0 41 34 26 37 37 26 53 31 16 I II III IV V Total 62 Very good + good Neither good nor bad Bad + very bad Source: Estonian Social Survey (ESU) 2005. 30 8 77 18 5 54 30 16 rural and urban areas remained constant in favour of citydwellers (Kunst et al. 2002). In practice, the differentiation of inequality as an objective inevitability and injustice as an ethically reprehensible phenomenon can be based on Whitehead’s 1990 treatment of various forms of inequality (Whitehead 1990). According to this approach, directed activities allow us to avoid: (1) freely chosen health behaviour that is harmful to one’s health, (2) the faster use of factors facilitating the improvement of health by those with better access to information, (3) social environment-related activities hazardous to health, (4) mental and physical environments harmful to health, (5) the unavailability of elementary health care, and (6) downward movement on the social scale as a result of a bad state of health (Mackenbach et al. 2002). One of the best indicators of quality of life is people’s self-assessment of their state of health. According to the Estonian Social Survey (ESU) conducted in 2005, 77% of the wealthiest quintile of the Estonian population rated their state of health as either good or very good, while only 41% among the poorest quintile considered their state of health to be good. Also, 5% of the wealthiest quintile and 26% of the poorest quintile rated their health as bad or very bad (Figure 2.3.1.), clearly reflecting the convergence of bad health in poorer social strata. In addition to the inequality in terms of state of health, the reasons for people’s inability to receive health care services are usually (in over 50% of the cases) economic (Habicht et al. 2008). Taking into account the fact that the | 34
expenditures of the private sector on health care services have increased considerably in recent years (24%), mainly in terms of patients’ co-payments, it is also important to recognize that the relative importance of health care services in total expenditures has grown in recent years especially among groups with lower incomes. By 2005, the relative importance of health care services in total expenditures had become equal in the case of the poorest and the richest income decile (see Figure 2.3.2.). It is important to note, however, that while poorer (and usually older) residents spend their money primarily on buying medicine, the health care expenses of wealthier (and usually younger) residents are mainly related to dental care and spa services. Figure 2.3.2. The percentage of people’s health care expenses related to their total expenses in the case of the first and tenth expenditure deciles and by years, including the actual difference in the health care expenses of people belonging to those deciles (in the form of a coefficient) 5.0 4.5 4.0 3.5 3.0 2.5 2.0 15 1.5 10 1.0 0.5 5 0 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 1 st expenditure decile 10 th expenditure decile Difference in health care costs (x times) Source: Statistics Estonia. http://www.stat.ee 40 35 30 25 20 2.4. Health as an indicator of the quality of life During the first half of the 20 th century, the average life expectancy in developed industrial countries grew by more than 50% – more than during the entire human history before that. This great change is associated with the decrease in infant and child mortality related to contagious diseases. People’s longevity began to be determined mainly by mortality related to non-contagious diseases, i.e. illnesses resulting from their behaviour (Omran 1971). After World War II, the causes of death and average life expectancy were similar in most European countries – there was an average difference of only 1–2 years (Health- GAP 2008). Starting from the 1960s, there was a slow but constant reduction in mortality rates in almost all of the Western countries. In the context of the decrease in general mortality, there was an increase in the prevalence of illnesses related to people’s individual health behaviour, and resulting from the longer average life expectancy, as causes of death (primarily cardiovascular diseases and malignant tumours) (Omran 1971). Meanwhile, in developed countries, parallel with the increase in the value of human life, a constant decrease in the proportion of illnesses and deaths caused by external factors (mainly injuries) also occurred. As a result of the decrease in general mortality, or the “postponement” of illnesses, an aging society came into being in the developed Western countries. Notably, the significant improvement in men’s life expectancy began only in the 1970s when the considerable effect of people’s behavioural changes (regarding eating, smoking, physical activity, alcohol consumption) on their health started to be recognized (Caselli 1995, Vallin, Mesle 2005). Due to these changes, the state of health of the public could no longer be measured only by mortality rates. In addition to the lengthening of people’s lives, the number of years they lived healthy, high-quality lives became an important criterion of the health-related quality of life. Healthy life years “Healthy life years” is one of the simplest concepts that combines data regarding mortality and illness, thus allowing us to measure the health-related quality of life (Eurostat 2008). One of the first examples of this type of indicator was a set of calculations of disability-free life expectancy published in 1969 by the United States Department of Health, Education, and Welfare (HEW, 2008). Healthy life years are conventionally calculated in the European Union using the so-called Sullivan method, which was developed in the 1970s for the purpose of calculating disability-free life expectancy. The method is based on adding the dimension of good health to the life table. In other words, the method indicates an individual’s life expectancy in years adjusted by the degree of “good health” based on self-assessment with regard to different age groups (Eurostat 2008). The concept of healthy life years is relatively easy to understand as it comprises the population’s subjective assessments of their limitations to performing daily activities arising from their state of health by different age groups. As of 2004, the definition of “good health” has been agreed upon across the EU as the absence of limitations on daily activities and data is being gathered on this subject through the pan-European EU-SILC survey. Since this indicator is sensitive to interventions aimed at improving a population’s state of health, it is also suitable for measuring the success of health-related policies (Perenboom RJ, 2004). If the measurement of people’s state of health is based on limitations on daily activities or the lack thereof, the number of healthy life years also serves as a good gauge of the state of health of a population. In addition, it can be used in the comparison of a population’s state of health with others in terms of economic potential and competitiveness. In order to assess “good health” in different age groups in Estonia, we have used the Study on Health Behaviour of the Estonian Adult Population 1990–2004 and Esto- 35 |
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Page 5: 4.2. Ethnic differentiations in sat
Page 9: Preface This year, the Estonian Hum
Page 12 and 13: CHAPTER 1 Estonian Human Developmen
Page 14 and 15: Figure 1.1.3. Life expectancy in co
Page 16 and 17: Figure 1.2.2. Life expectancy at bi
Page 18 and 19: to reality. The greatest inaccuracy
Page 20 and 21: Figure 1.2.9. Internal migration ev
Page 22 and 23: 12. Marksoo, A. 1992. “Dynamics o
Page 24 and 25: Table 1.3.1. PISA 2006 study result
Page 26 and 27: Table 1.3.2. Number of students in
Page 28 and 29: 1.4. The gross domestic product and
Page 30 and 31: Figure 1.4.3. Estonian GDP (right a
Page 32 and 33: 1.5. Changes in the Estonian Human
Page 34 and 35: 2.2. Health of Estonian residents i
Page 38 and 39: Figure 2.4.1. Healthy life years of
Page 40 and 41: Figure 2.4.4. Various accidents, tr
Page 42 and 43: 2.5. Lifestyle and behaviour as a s
Page 44 and 45: Figure 2.5.5. Smoking in Estonia in
Page 46 and 47: Figure 2.6.1. Overview of the compo
Page 48 and 49: Table 2.6.2. Use of specialized med
Page 50 and 51: dren. The majority of services are
Page 52 and 53: Figure 2.8.2. How much a health dis
Page 54 and 55: 2.10. Policy recommendations aimed
Page 56 and 57: CHAPTER 3 Quality of life and life
Page 58 and 59: Table 3.2.1. Characteristics of liv
Page 60 and 61: Table 3.2.4. An assessment of the e
Page 62 and 63: Figure 3.2.4. Difference in the job
Page 64 and 65: Table 3.2.6. Agreement with stateme
Page 66 and 67: Figure 3.3.1. Satisfaction with lif
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Page 70 and 71: Figure 3.4.1. Types of quality of l
Page 72 and 73: Figure 3.5.1. Percentage of teenage
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Page 76 and 77: Arieh A., Conti C., Kutsar D., Nicg
Page 78 and 79: Figure 3.6.2. Subjective quality of
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Page 82 and 83: Figure 3.7.1. The placement of Euro
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Table 4.2.1. Factors forming genera
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Annexes Annex 4.2.1. Socio-demograp
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Figure 4.3.1. Changes in the assess
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Figure 4.3.4. Attitudes of the Esto
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olds considered themselves to be pa
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Table 4.4.3. Agreement of the Russi
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Table 4.5.2. The prospects of non-E
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Figure 4.5.4. Certainty of Estonian
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mote equal opportunities. At the (e
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CHAPTER 5 Quality of life in a cons
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Figure 5.2.1. GDP and AIC per capit
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Figure 5.2.3. Distribution of consu
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Figure 5.2.4. Indexes of environmen
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Table 5.3.1. Comparison of countrie
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Figure 5.3.3. Comparison of types o
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Table 5.3.5. Connections between po
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Table 5.4.1. Who and what are the f
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Table 5.4.3. Young people’s asses
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Figure 5.4.6. Time spent on the con
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Table 5.4.6. The perception of prob
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5.6. Summary To briefly summarize t
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Table 6.2.1. Objective and subjecti
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Figure 6.2.4. Relationship between
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Figure 6.2.7. Difference between th
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Figure 6.3.1. GDP, government secto
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Figure 6.3.3. Employed 15-74-year-o
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Figure 6.3.8. Percentage of social
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References 1. Aaviksoo, A., G. Paat
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Figure 6.4.1. Labour market flexibi
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Figure 6.4.3. Creations of jobs ind
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Figure 6.4.5. Public expenditures o
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Figure 6.4.6. Ratio of the particip
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6.5. Cities as development engines
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Table 6.5.2. Existence of developme
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have been underfinanced or are not
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Table 7.1. Factors that favour and
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Table 7.2. Potential economic devel
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Authors Chapter 1 Ene-Margit Tiit,
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Margit Keller (PhD) is a Senior Res
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Special prizes Estonian Human Devel
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Estonian Human Development Report H
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Estonian Human Development Report H
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Estonian Human Development Report T
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Honorable mentions Estonian Human D
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Estonian Human Development Report P
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Estonian Human Development Report A
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Estonian Human Development Report T
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Estonian Human Development Report

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