Estonian Human Development Report
Estonian Human Development Report - Eesti Koostöö Kogu
Estonian Human Development Report - Eesti Koostöö Kogu
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expenditures of the private sector on health care services<br />
have increased considerably in recent years (24%), mainly<br />
in terms of patients’ co-payments, it is also important to<br />
recognize that the relative importance of health care services<br />
in total expenditures has grown in recent years especially<br />
among groups with lower incomes. By 2005, the<br />
relative importance of health care services in total expenditures<br />
had become equal in the case of the poorest and<br />
the richest income decile (see Figure 2.3.2.). It is important<br />
to note, however, that while poorer (and usually older)<br />
residents spend their money primarily on buying medicine,<br />
the health care expenses of wealthier (and usually<br />
younger) residents are mainly related to dental care and<br />
spa services.<br />
Figure 2.3.2. The percentage of people’s health care<br />
expenses related to their total expenses in the case of the<br />
first and tenth expenditure deciles and by years, including<br />
the actual difference in the health care expenses of people<br />
belonging to those deciles (in the form of a coefficient)<br />
5.0<br />
4.5<br />
4.0<br />
3.5<br />
3.0<br />
2.5<br />
2.0<br />
15<br />
1.5<br />
10<br />
1.0<br />
0.5<br />
5<br />
0<br />
0<br />
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006<br />
1 st expenditure decile 10 th expenditure decile Difference in health care costs (x times)<br />
Source: Statistics Estonia. http://www.stat.ee<br />
40<br />
35<br />
30<br />
25<br />
20<br />
2.4. Health as an indicator<br />
of the quality of life<br />
During the first half of the 20 th century, the average life<br />
expectancy in developed industrial countries grew by<br />
more than 50% – more than during the entire human history<br />
before that. This great change is associated with the<br />
decrease in infant and child mortality related to contagious<br />
diseases. People’s longevity began to be determined<br />
mainly by mortality related to non-contagious diseases,<br />
i.e. illnesses resulting from their behaviour (Omran 1971).<br />
After World War II, the causes of death and average life<br />
expectancy were similar in most European countries –<br />
there was an average difference of only 1–2 years (Health-<br />
GAP 2008). Starting from the 1960s, there was a slow but<br />
constant reduction in mortality rates in almost all of the<br />
Western countries. In the context of the decrease in general<br />
mortality, there was an increase in the prevalence of<br />
illnesses related to people’s individual health behaviour,<br />
and resulting from the longer average life expectancy, as<br />
causes of death (primarily cardiovascular diseases and<br />
malignant tumours) (Omran 1971). Meanwhile, in developed<br />
countries, parallel with the increase in the value of<br />
human life, a constant decrease in the proportion of illnesses<br />
and deaths caused by external factors (mainly injuries)<br />
also occurred. As a result of the decrease in general<br />
mortality, or the “postponement” of illnesses, an aging<br />
society came into being in the developed Western countries.<br />
Notably, the significant improvement in men’s life<br />
expectancy began only in the 1970s when the considerable<br />
effect of people’s behavioural changes (regarding eating,<br />
smoking, physical activity, alcohol consumption) on<br />
their health started to be recognized (Caselli 1995, Vallin,<br />
Mesle 2005).<br />
Due to these changes, the state of health of the public<br />
could no longer be measured only by mortality rates. In<br />
addition to the lengthening of people’s lives, the number<br />
of years they lived healthy, high-quality lives became an<br />
important criterion of the health-related quality of life.<br />
Healthy life years<br />
“Healthy life years” is one of the simplest concepts that<br />
combines data regarding mortality and illness, thus allowing<br />
us to measure the health-related quality of life (Eurostat<br />
2008). One of the first examples of this type of indicator was<br />
a set of calculations of disability-free life expectancy published<br />
in 1969 by the United States Department of Health,<br />
Education, and Welfare (HEW, 2008). Healthy life years<br />
are conventionally calculated in the European Union using<br />
the so-called Sullivan method, which was developed in<br />
the 1970s for the purpose of calculating disability-free life<br />
expectancy. The method is based on adding the dimension<br />
of good health to the life table. In other words, the method<br />
indicates an individual’s life expectancy in years adjusted<br />
by the degree of “good health” based on self-assessment<br />
with regard to different age groups (Eurostat 2008).<br />
The concept of healthy life years is relatively easy to<br />
understand as it comprises the population’s subjective<br />
assessments of their limitations to performing daily activities<br />
arising from their state of health by different age groups.<br />
As of 2004, the definition of “good health” has been agreed<br />
upon across the EU as the absence of limitations on daily<br />
activities and data is being gathered on this subject through<br />
the pan-European EU-SILC survey. Since this indicator is<br />
sensitive to interventions aimed at improving a population’s<br />
state of health, it is also suitable for measuring the success of<br />
health-related policies (Perenboom RJ, 2004). If the measurement<br />
of people’s state of health is based on limitations<br />
on daily activities or the lack thereof, the number of healthy<br />
life years also serves as a good gauge of the state of health of<br />
a population. In addition, it can be used in the comparison<br />
of a population’s state of health with others in terms of economic<br />
potential and competitiveness.<br />
In order to assess “good health” in different age groups<br />
in Estonia, we have used the Study on Health Behaviour<br />
of the <strong>Estonian</strong> Adult Population 1990–2004 and Esto-<br />
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