Estonian Human Development Report

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Figure 2.4.4. Various accidents, traumas and poisonings resulting in death 800 700 600 500 400 300 200 100 0 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 Source: Statistics Estonia mainly subject to loss of life years due to external causes from birth until the age of 45. Loss of life years resulting from tumours is predominant among women aged 45–59, and cardiovascular diseases are the most common cause of loss of life years in the 60+ age group (Vals & Lai 2005). Cardiovascular diseases Vehicle accident Accidental fall Accidental drowning Effect of smoke, fire and flames Freezing Accidental poisoning Alcohol poisoning Suicide Figure 2.4.5. Cancer morbidity and mortality per 100,000 residents by men and women 500 450 400 350 300 250 200 150 100 50 0 Figure 2.4.6. New HIV cases and total HIV cases, 1997–2008 7000 6000 5000 1994 1998 2002 2005 Morbidity (men) Morbidity (women) Source: Statistics Estonia 2008 New cases of HIV Total number of HIV cases 4000 3667 3000 2827 1928 2000 1000 0 454 899 840 51 52 64 390 1474 10 10 12 743 621 668 633 544 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Source: Health Protection Inspectorate Mortality (men) Mortality (women) 5063 4442 6908 6364 5731 While cardiovascular diseases account for 50% of the total mortality rate in Estonia, their share of the mortality rate in developed European countries is closer to one third of the total. However, the prevalence of cardiovascular diseases as a cause for loss of life years among women has decreased significantly during the past decade, while mortality related to malignant tumours has increased (Sakkeus 2009). Injuries Deaths resulting from injuries are one of the leading factors in the loss of life years among men in their prime working age. In 2006, deaths resulting from injuries constituted 9.4% of all deaths in Estonia (the respective percentages in Finland and Sweden were 11.2% and 7.7%) (Kaasik et al. 2008). Injury-related deaths occur, on average, 3.3 times more often among men than women (in some age groups, there are even eight times as many injury-related deaths among men). The most frequent causes of deaths resulting from injuries among both men and women are suicide, poisoning (including alcohol poisoning), and deaths related to motor vehicle accidents. Of all men who died between the ages of 1 and 49, 50% perished as a result of an accident (the corresponding percentage among women was 30%) (Kaasik et al. 2008). Since 2001, the number of deaths resulting from accidents, poisonings and traumas has fallen by 30%. The biggest decrease occurred in the case of deaths resulting from alcohol poisoning (see Figure 2.4.4.). Cancer Cancer is the second most important cause of death in Estonia after diseases related to the circulatory system and causes 20% of all deaths. According to the Estonian Cancer Registry, the number of first-time cancer patients is increasing constantly. In 1994–2005 malignant cancerous tumour incidence increased by 25% among men and 22.4% among women, while mortality increased by 20% among men and by 11% among women during the same period (see Figure 2.4.5.). According to data from 2003, men were most frequently diagnosed with lung cancer (nearly 20% of all new cancer cases among men), followed by prostate cancer, and colon and rectal cancer. Women are most often in danger of developing breast cancer (20% of all cases), followed by skin cancer, and colon and rectal cancer. Morbidity related to these forms of cancer has exhibited a continuous trend of growth over the years. HIV and tuberculosis By the end of December 2008, 6908 HIV cases had been registered in Estonia over the years, but UNAIDS estimates the probable number of infected individuals to be more than 10,000 (UNAIDS, 2008). The explosive spread of HIV began in 2000 in Ida-Viru County. The highest HIV incidence yet was diagnosed in 2001 – 1474 new HIV carriers were diagnosed during the year (see Figure 2.4.6.). Estonia’s registered HIV incidence rate is still the highest in Europe, although the number of new infections has decreased and stabilized compared to the peak level of 2001. The percentage of women among people who are first diagnosed with HIV has shown a trend of stable growth, increasing from 20% in 2000 to 36% in 2006 (Rüütle, 2008). This, however, can be explained by the decrease in the number of men diagnosed with HIV instead of an increase in HIV incidence among women. Since there is no evidence to the contrary, it is likely that the abovementioned women are | 38
almost exclusively sexual partners of male injecting drug addicts and that the HIV epidemic has not yet spread outside the risk groups (Drew et al. 2008). HIV has not yet had a significant effect on the comparative indicators of Estonia, but it is likely that the number of people who suffer from or have died of AIDS will increase significantly in the near future as the victims of the concentrated HIV epidemic 7 that started at the beginning of this century will reach the final phase of the illness. According to the worst scenario, the contribution of HIV to the burden of disease may equal that of cardiovascular diseases in a few years (Lai T, 2004), due to the fact that the Estonian epidemic has predominantly affected very young people. In Estonia, people under 25 made up 61% of all newly registered HIV cases in 2004, 57% in 2005, 45% in 2006, and 38.4% in 2007. The number of children to have contracted HIV from their mothers is 25 (Rüütle 2008). The incidence of tuberculosis became more frequent in Estonia during the 1990s. In 1997, 51 new cases of tuberculosis were diagnosed per 100,000 residents – an incidence rate ten times higher than that of the Nordic countries. The danger of the recurrence of a tuberculosis epidemic came into being in Estonia due to inadequate care and the use of incorrect treatment regimens, which were, in turn, caused by a decrease in vigilance regarding tuberculosis in the health care system and the society as a whole (TAI, 2004). In 2006, there were 24.5 cases of tuberculosis diagnosed in Estonia per 100,000 residents (see Figure 2.4.7.) and by 2007 the number had grown to 29.8. In 2007, the tuberculosis incidence rate per 100,000 residents was lowest in Iceland (3) and highest in Lithuania (66.12) (Health Protection Inspectorate, 2008). Although the incidence of tuberculosis has fallen in recent years, multiresistant forms of tuberculosis still pose a serious problem. Along with the halt in the decrease of 2007 infections, there has been a considerable increase in the frequency of HIV and tuberculosis coinfection. According to the Tuberculosis Registry, a tuberculosis patient was first diagnosed with HIV in Estonia in 1997. As of 2007, a total of 183 people with tuberculosis infections have been diagnosed with HIV. The tuberculosis patients who have contracted HIV have been 20–44 years old. The average age of a tuberculosis patient in Estonia is 45, so the risk groups do not overlap significantly based on age (Rüütle 2008). Mental health According to data gathered by WHO, mental disorders are the most important cause of loss of healthy life years all over the world, constituting 37% of the burden of disease among adults (people aged 15 and older) (WHO, 2008). According to the WHO, 9% of West and South European adult men and 17% of adult women suffer from severe lifelong depression. Although depression is the most common cause of mental disorders among both women and men, the latter are characterized by a much more frequent use of addictive substances (alcohol and narcotics). During the past five years, there has been a constant increase in the number of mental and behavioural disorder cases in Estonia, especially among men (see Figure 2.4.8.). Figure 2.4.7. Tuberculosis incidence rate per 100,000 Estonian residents in 1998–2006 (including home care cases) 60 50 40 30 20 1989 First-time cases and recurrences First-time incidence Incl. repeated treatment cases 1990 1991 1992 1993 1994 1995 1996 1997 Source: Health Protection Inspectorate Figure 2.4.8. Mental and behavioural disorders per 100,000 residents in the case of women and men 2200 2100 2000 1900 1800 1700 Men Women 1998 2000 2001 2002 2003 2005 2006 2007 Source: Ministry of Social Affairs, 2007 Among men, the most common mental problems are mental and behavioural disorders caused by the use of psychoactive substances (917 cases per 100,000 residents). The most frequent mental disorders in the case of women are stressrelated, neurotic, and somatoform disorders (871.4 cases per 100,000 residents) (Ministry of Social Affairs, 2007). Suicides are an important cause of premature death in Europe. In 2006, an average of 10.7 suicide-related deaths per 100,000 residents occurred in the European Union (Lithuania had the highest suicide-related mortality rate with 28.9 deaths per 100,000 residents, while Cyprus had the lowest rate with only 2.4 deaths per 100,000 residents) (WHO). In 2008, there were 18.4 suicide-related deaths per 100,000 residents in Estonia (30.9 deaths per 100,000 residents among men and 7.7 deaths per 100,000 residents among women) (Statistics Estonia, 2008). Compared to adults, the use of addictive substances by young people has increased recently (for more on this subject, see the next subchapter). The most common mental disorders among children and young people are disorders related to psychological development, behavioural and emotional disorders originating from childhood (including communication disorders and fears), and stressrelated somatoform disorders (anxiety, adjustment disorders, mental retardation, etc.) (Saame, 2008). 1999 2000 2001 2002 2003 2004 2005 2006 7 Estonia is characterized by a concentrated HIV epidemic, where the percentage of injecting drug users infected with HIV is higher than 5%, but remains lower than 1% in the case of pregnant women (National Institute for Health Development, HIV-nakkus ja AIDS arvudes 2006). 39 |
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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 36 and 37: Table 2.2.4. Differences in life ex
Page 38 and 39: Figure 2.4.1. Healthy life years of
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
Page 88 and 89: 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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