Estonian Human Development Report

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Figure 2.8.2. How much a health disorder limited (or “would have limited” in the case of unemployed persons) the type of work the respondents did in 2002 100 90 80 70 60 50 40 30 20 10 0 Engaged 3.0 Unemployed Men 9.4 Source: Suhrcke et al. 2006 Non-active 24.9 Engaged 3.1 more labour force. The income effect probably increases in importance when the system of social benefits does not alleviate the impact of decreased productivity on one’s earnings. The result of the contrary influences of the substitution effect and the income effect is ultimately an empirical issue (Currie & Madrian 1999). The negative effect of a bad state of health is also confirmed by the smaller number of working hours and lower income. In the case of a bad state of health, the weekly number of working hours decreases by an average of 12 hours in the case of men and 8 hours in the case of women compared to people whose health is good (Suhrcke et al. 2006). Bad health reduces the net monthly income of working men by nearly 1300 kroons (i.e. approximately 30% of the average income of men in the given sample) and that of working women by about 600 kroons (i.e. approximately 20% of the average income of women in the given sample) (Suhrcke et al. 2006). Bad health also affects the economy due to the drop in productivity, assuming that healthy people are more productive per working hour. Productivity is increased directly by improved physical and mental activity, while people who are more active physically and mentally are also able to make better and more effective use of tech- Unemployed Women 10.6 18.1 Non-active Limits Does not limit Do not have a health disorder Do not know Figure 2.8.3. Simulated change in GDP per person in the case of different mortality rate scenarios (USD) 16 000 15 000 14 000 13 000 12 000 11 000 10 000 9 000 3% yearly decrease in mortality 1.5% yearly decrease in mortality mortality remains constant 2000 2005 2010 2015 2020 2025 Source: Suhrcke et al. 2006 nology, machines and appliances. A healthier labour force is presumed to be more flexible and adaptable to changes (e.g. changes in work assignments and the organization of work), thus decreasing labour turnover and the related costs (Currie & Madrian 1999). According to the Estonian Labour Force Survey, 21% of men and 23% of women aged 15–64 had experienced a health disorder in 2002. The percentage was 17% among working respondents, 24% among unemployed respondents, and 31% among inactive respondents. In general, a health disorder “considerably or somewhat limits” the type and amount of work done in the case of 3% of employed respondents, 9% of unemployed respondents, and 21% of inactive respondents (Figure 2.8.2.). Health also has a presumable effect on a population’s level of education. According to the theory of human capital, better educated people are more productive (and earn more). If children with a better state of health and a better diet obtain a better education, are absent from school less frequently, and do not drop out of school early, the improved health of young people will affect their productivity in the future. Furthermore, if good health is connected to longer life, healthy people have a stronger incentive for investing in education and training as their skill depreciation is smaller (Strauss & Thomas 1998). Savings and investment. The health of an individual or a population affects not only the level of income, but the distribution of income between consumption, saving, and investments. People with a good state of health are more likely to lead longer lives, which is why they may save more than people whose state of health is bad. Thus, a greater collection of savings can be expected from a population whose life expectancy is rising fast. This should also facilitate investments into physical and human capital (Bloom, Canning & Graham 2003). What, however, could the aggregated effect of the population’s health be on the economic development of an entire society? Countries’ experiences indicate that the health of the population has a clear impact on economic growth. Bhargava, Jamison and Murray (2001) use panel data regression to show that the speed of a 5-year GDP increase per person depends, among other things, on the mortality rate of a country’s adult population and that the direction of causality is clearly from adult mortality to economic growth. The results of a similar economic simulation conducted by Suhrcke, Võrk and Mazzuco indicate that the reduction in the rate of adult mortality would have a potentially significant positive effect on Estonia’s economic growth. The authors of the study emphasize that the value of the results does not lie primarily in predicting the absolute GDP level, but instead in comparing relative changes in the case of different scenarios. In the case of the three scenarios analyzed (see Figure 2.8.3.), a yearly 1.5% decrease in mortality would increase Estonia’s GDP per person by 14% in 25 years when compared to a situation where there is no drop in adult mortality. Accordingly, in the case of a 3% yearly drop in mortality, Estonia’s GDP per person could be 30% higher. Since a reduction in mortality rates is also accompanied by a decrease in morbidity, the actual positive effect on the economy could be even greater. | 50
A comparison with Finland shows that while the Estonian mortality coefficient (in the 15–64 age group) in 2000 was 641 (per 100,000 residents), the corresponding Finnish coefficient was 307 (WHO DMDB 2009). In the case of a 1.5% yearly decrease in adult mortality, it would take Estonia 49 years to reach the level Finland had attained by 2000. If our mortality rates dropped 3% on a 2.9. Summary In 2006, Estonia ranked 93 rd in the world in terms of life expectancy, with people in only 86 countries living shorter lives than us. However, during the first years of the 21 st century, life expectancy in Estonia has increased very quickly and the life expectancy of men and women has grown by 2.6 and 4.1 years, respectively (Statistics Estonia). This means that the increase in life expectancy has been quicker than at any time during the last half century and that Estonians live longer today than ever before. A stagnation trend began in the life expectancy of the populations of the entire Soviet Union, and also in all of the other so-called socialist Eastern European countries around the 1960s. Estonia was no exception. As a result, in forty years the life expectancy of men has not changed at all and the life expectancy of women has grown by only two years (Katus 2009). In the 1960s, Estonian and Finnish women had the same life expectancy, while our men’s life expectancy was one year less than that of the men living in what was one of the most backward Nordic countries at the time. The difference has constantly increased ever since (see Caselli 1995, Katus 2009). In Estonia, the average life expectancy of 1980 was surpassed only in 1996. We have worked hard to reach the level that Europe’s wealthiest countries were at 20 years ago and despite our great spurt during the past five years, the other countries have kept increasing their lead over Estonia throughout the time following our restoration of independence. The development in women’s health has been more stable; the difference between the life expectancy of Estonian and Finnish women was nearly 5 years in 2006. In the case of men, however, the difference was already 9 years (WHO 2009). Why is that? Overall, the shortness of Estonia’s average life expectancy can be attributed to both the self-destructive health behaviour of the population along with the environment and values that promote such behaviour as well as the inefficient health system that has not been capable of implementing measures that improve health with the necessary speed (Nolte & McKee 2004). Empirical studies indicate that the good state of health of a population is not only a natural by-product of economic growth, but that the health of the population also affects economic development. With an aim of a yearly 3% decrease in mortality, we could reach Finland’s current level by 2025 and the GDP per person could potentially increase by 30% compared to a scenario where the mortality rate remains at its present level (Suhrcke et al. 2006). There is potential for the development of public health in both the improvement of health behaviour as well as the more extensive and effective operation of the health system. While relatively good results have been achieved yearly basis, we would reach Finland’s level by 2025. Figure 2.8.3. indicates, among other things, that the growth of GDP per person halts or may be replaced with a downward trend if Estonia’s adult mortality rate remains at its current high level (the constant mortality scenario). Thus, economic growth cannot last if the health of the population does not keep up with economic success. in improving the healthiness of the population’s diet, taking into account our latitudinal position and purchasing power, the rate of engagement in movement activities of Estonian residents is still as insufficient as it was at the beginning of the 1990s, despite the significant improvement in opportunities. Moreover, risk behaviour, especially among working age men, has not changed considerably, as alcohol use is constantly growing and the reduction in smoking is slow. Estonia’s relative backwardness in comparison with other European countries is smallest in the case of children’s and young people’s health. It is true that Estonian youth cannot be set up as an example for their health behaviour, but during the last couple of years their rationality has increased with regard to several aspects and there have been changes for the better. Examples of such improvements include the decrease in risky sexual behaviour and even a halt in the increase of alcohol and tobacco use. However, compared to other countries, Estonian children’s problems include early experimentation with addictive substances and more frequent cases of alcohol-induced intoxication. Health behaviour can be affected directly through the provision of relevant information and the creation of a favourable environment. This also applies in the case of Estonia. Practical examples include the improvement of people’s diet through the increase in the availability of vegetable cooking oil and fresh fruits and vegetables since the 1990s, but also the improvement in the sexual practices of young people as well as the changes in attitudes towards smoking among both Estonia’s youth and adults. In addition, regardless of the unjustifiably fast spread of HIV, the occurrence of an epidemic among the general public has been so far successfully avoided. According to the latest analyses, this can be associated with the prevention measures implemented (Drew et al. 2008). There still exist considerable inequalities in Estonia between men and women, between Estonia’s different regions and between different ethnic groups or groups based on income and education. Women’s mortality indicators are still improving faster than those of men in all age groups (Statistics Estonia 2009). The average life expectancy of ethnic Estonian men is comparable to the European average in the 1970s, while the life expectancy of non- Estonian men is three years lower and thus comparable to the average of the rest of the Europe in the 1950s (Sakkeus 2007). People with lower incomes and those who are ill more frequently contribute more of their own resources to health care (Habicht et al. 2006) and specialized medical care is not equally available. In addition, there are manifold differences between the use of, for example, hospital care in different regions (Kunst et al. 2002). 51 |
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Page 9: Preface This year, the Estonian Hum
Page 12 and 13: CHAPTER 1 Estonian Human Developmen
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Page 18 and 19: to reality. The greatest inaccuracy
Page 20 and 21: Figure 1.2.9. Internal migration ev
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Page 26 and 27: Table 1.3.2. Number of students in
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Page 30 and 31: Figure 1.4.3. Estonian GDP (right a
Page 32 and 33: 1.5. Changes in the Estonian Human
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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
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Page 50 and 51: dren. The majority of services are
Page 54 and 55: 2.10. Policy recommendations aimed
Page 56 and 57: CHAPTER 3 Quality of life and life
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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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