Estonian Human Development Report

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-
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