Estonian Human Development Report

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Figure 2.4.1. Healthy life years of Estonia’s male and female population in the case of Estonians and non-Estonians 60 50 40 30 20 10 0 Source: Sakkeus 2009 Estonian Men Estonian Women Non-Estonian Men Non-Estonian Women 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 Figure 2.4.2. Healthy life years in 2006 in Estonia and some EU countries 70 60 50 40 30 20 10 0 Malta Sweden EU Lithuania ESTONIA Finland average Source: Eurostat Men Women Latvia Figure 2.4.3. Probability of death in Estonia as percentages related to probability of death in Finland in 2006 (by gender and age) 1000% 900% 800% 700% 600% 500% 400% 300% 200% 100% 0% Estonian men Estonian women Finland 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Note: 100% means that the probability of death in Estonia and Finland is equal in that age group. Source: Eurostat, Internet database, table Probability of dying by sex and age, http://europa.eu.int/comm/eurostat/ browsed on January 12, 2009. nian Health Surveys conducted in 1996 and 2006. With a healthy life expectancy of 52 years at birth according to 2006 data, Estonia ranks among the worst-performing countries in Europe with regard to both men and women. However, both in the case of genders and age groups, the differences in healthy life expectancy are smaller than in the case of life expectancy in general (see Figure 2.4.1.). Although the difference in women’s and men’s life expectancy is more than 11 years, there is a comparatively small gap of barely three years between men and women in terms of healthy life years (Figure 2.4.1.). On the one hand, this points to the different pattern of illness among men and the large effect of premature mortality. On the other hand, women’s increased life expectancy means that they live longer with illness-related factors limiting their ability to cope. The fact that as people grow older, the difference between the healthy life expectancy of both men and women as well as Estonians and non-Estonians decreases is determined by the state of health of those who have lived to the given age. (Sakkeus 2009). In 2006, the average number of healthy life years for men was 49.4 and according to this indicator, the health of men in Estonia has been at the lowest level among the EU member states throughout the past three years (Eurostat 2008). In terms of healthy life years, Estonian men are preceded, over short intervals, by Latvian, Lithuanian, and Finnish men (see Figure 2.4.2.). The average healthy life expectancy of Estonian women was 53.7 years in 2006. This indicator has fluctuated between 52 and 54 years over the period 2004– 2007. Latvia, the European country with the lowest healthy life expectancy in the case of women, has been preceded in second to last place alternately by Estonia and Finland. An additional assessment of the distribution of people’s state of health over various ages can be made based on a comparison with the probability of the death of people living in countries with a better state of public health over their entire life span. Figure 2.4.3. allows us to compare the relative difference in the probability of death in the case of every male and female age group in Estonia and Finland The figure displays two peaks that indicate a relatively high level of mortality in Estonia, including one in the 5–10 age group (5–15 age group in the case of men), which is associated, however, with the very low absolute mortality figures in that age group. On average, the mortality rate of boys during childhood and youth is four times higher in Estonia than in Finland, while that of girls is three times higher. Another significant difference in the two countries’ mortality rates occurs during the prime working age, among Estonia’s male population aged 25–65, whose death is two to three times more probable than that of their Finnish counterparts. The main source of the above described difference with regard to men aged 25–64 is the relatively large difference in mortality related to circulatory system diseases (2.6 times higher in Estonia), external causes, i.e. injuries and poisonings (2.2 times higher in Estonia) and tumours (2.0 times higher in Estonia) (see Table 2.4.1.). Life years lost due to the burden of disease In addition to the concept of healthy life years, there exists a similar approach to assessing the overall state of health of the population called the burden of disease or DALY (disability adjusted life years) method, which was used widely in 1990 by the WHO upon preparing a global comparison (Vals K, 2005). Measurements of the population’s health loss based on the burden of disease method also try to take into account the decrease in the “(full) value” of life years due to disease, in addition to life years lost as a result of deaths. The difference between the burden of disease method and the | 36
healthy life years method consists in using epidemiological studies or databases instead of self-assessments in researching the spread of disease. As a subjective component, a socalled disability weight is assigned to every diagnosis, i.e. an assessment of the time spent living with a certain disease or disability that reflects the comparative social significance of various states of health (Lai T, 2004). According to the DALY method, we first calculate the number of years of life lost (YLL) due to premature death and the healthy life years lost due to disability (YLD). Subsequently, both indicators are summarized (Lai T, 2004): DALY = YLL + YLD The total health loss of the Estonian population in 2000 was 341,164 years. This figure decreased somewhat during the next two years (340,968 in 2001 and 338,242 in 2002). No significant dynamics occurred during this period with regard to social groups based on age and gender (see Table 2.4.2.). In 2002, the summarized loss of life years in Estonia according to the DALY method amounted to 338,224 years – 170,736 in the case of men, and 167,506 years in the case of women (Lai T, 2004). Although men and women lose an approximately equal number of years in total, the loss of years is mainly the result of deaths in the case of men and illnesses in the case of women (see Table 2.4.3.). Of the entire burden of disease, 8% is borne by children and young people (aged 0–19), 39% by pensioners (aged 65+), and over half of the burden is borne by the working age population (20–64) (58% in the case of men and 43.6% in the case of women). The three main groups of illnesses that cause loss of health (cardiovascular diseases, tumours, and external causes) make up 65% of the total burden of disease. HIV/AIDS is not yet represented in this list, although according to the burden of disease study conducted in Estonia, the loss of life years resulting from the contraction of AIDS may be as substantial in 2012 as the mortality rate related to cardiovascular diseases in 2002 (Lai T, 2004). Women’s burden of disease is twice as high as that of men in the field of muscle and joint diseases, while men’s loss of health is triple that of women with regard to external causes. The majority of women’s burden of disease is constituted by cardiovascular diseases (35%), tumours (22%), and muscle and joint diseases (8.5%). Table 2.4.1. Principal reasons of death among Estonian and Finnish men aged 25–64 in 2005 Estonia Finland Note: standardized mortality coefficients per 100,000 people Estonia/Finland ratio Tumours 204 104 2.0 Circulatory system disease 358 136 2.63 External causes related to injuries and poisonings 280 129 2.17 Source: European detailed mortality database (DMDB). Copenhagen, WHO Regional Office for Europe, updated in January 2009 Table 2.4.2. Health loss in years due to mortality and morbidity in 2000–2002 Men Women 2000 2001 2002 2000 2001 2002 Years of life lost (YLL) 108 458 112 483 111 573 89 954 88 585 86 781 Years lost due to disability (YLD) Disability adjusted life years (DALY) 59 620 59 026 59 163 82 072 80 872 80 725 168 078 171 508 170 736 172 023 169 458 167 506 Source: Lai T, Maakondlik haiguskoormus Eestis 2000–2003. Tallinn: Ministry of Social Affairs; 2006 The largest differences between men and women in terms of loss of life years appear in age groups 5–19 and 20– 44. In these age groups, men lose three times as many life years as women. Boys and young men experience accidents several times more frequently than girls; in this age group external causes are the main reason for the loss of life years in the case of 60% of men and 40% of women. The loss of life years is 2.3 times higher among Estonian men than among women before the age of 65 (72,642 and 32,002 years, respectively) and 61% of the life years are lost by working age men. Of Estonian men, 13% die before they reach the age of 45, and 25% of lost life years can be attributed to this group. Meanwhile, although only 4% of women die before the age of 45, they make up 11% of the lost life years. In the case of men, external causes have a dominant role in causing loss of life years from birth until the age of 50, after which cardiovascular diseases assume a prominent role. Women are Table 2.4.3. Summarized loss of health (DALY) – men and women Men Women 0–4 5–19 20–44 45–64 65+ Total 0–4 5–19 20–44 45–64 65+ Total Respiratory organ diseases 512 902 2067 4562 3360 11402 240 656 1773 2882 2748 8299 Tumours 243 1057 2616 1164 14319 29889 393 1138 5637 13843 15872 36883 Genitourinary organ diseases 17 64 254 701 1072 2108 22 235 1041 953 1179 3430 Joint and muscle diseases 152 910 2260 2935 1512 7770 134 1064 3148 5903 4114 14363 Other diseases and conditions 554 1364 2492 3386 3009 10804 843 1569 2640 3377 6726 15156 Infectious diseases 54 272 1082 798 191 2398 54 206 583 227 184 1253 Neurological diseases 2335 888 1425 1196 539 6427 2158 733 960 889 871 5610 Psychiatric diseases 145 1176 2721 1823 616 6481 66 770 2567 2223 1638 7263 Digestive organ diseases 61 107 1816 3163 1450 6598 46 151 1070 2005 1822 5093 Cardiovascular diseases 59 317 5110 21701 26214 53402 51 344 2585 12044 43745 58769 External causes 433 2831 14831 10503 2078 30676 254 917 3185 3758 1590 9705 Deformities and birth-related conditions 2042 465 178 46 11 2742 1017 394 209 47 17 1684 Total 6627 10353 36852 62478 54425 170737 5278 8176 25397 48151 80504 167507 % 3.9 6.1 21.6 36.6 31.9 3.2 4.9 15.2 28.7 48.1 Source: Lai T, Kiivet R. (2004). Haiguskoormuse tõttu kaotatud eluaastad Eestis: seosed riskifaktoritega ja riskide vähendamise kulutõhusus. Ministry of Social Affairs, University of Tartu. 37 |
Page 1 and 2: Estonian Human Development Report
Page 3 and 4: Estonian Human Development Report T
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 36 and 37: Table 2.2.4. Differences in life ex
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
Page 68 and 69: Figure 3.3.4. Percentage of people
Page 70 and 71: Figure 3.4.1. Types of quality of l
Page 72 and 73: Figure 3.5.1. Percentage of teenage
Page 74 and 75: Figure 3.5.4. Percentage of respond
Page 76 and 77: Arieh A., Conti C., Kutsar D., Nicg
Page 78 and 79: Figure 3.6.2. Subjective quality of
Page 80 and 81: Pieper, A. Sixsmith, Care related q
Page 82 and 83: Figure 3.7.1. The placement of Euro
Page 84 and 85: Figure 4.2.1. Life satisfaction by
Page 86 and 87: 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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