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1.4<br />
Health<br />
Raul-Allan Kiivet<br />
Changes and developments in the population’s health can<br />
be illustrated using very different indicators, of which<br />
each is informative in its own way. The indicators that<br />
have been chosen for this chapter characterise the events<br />
in Estonia from three viewpoints, in an attempt to answer<br />
the following questions:<br />
• How much, and based on what, is life expectancy in<br />
Estonia increasing?<br />
• How can the illness-related behaviour of the Estonian<br />
population be changed, based on the example<br />
of the use of prescription drugs?<br />
• What is the future prognosis for the health indicators<br />
of Estonian schoolchildren?<br />
1.4.1<br />
Life expectancy<br />
In international comparisons, life expectancy, which is<br />
based on mortality data, and is one of the three components<br />
of the Human Development Index, is the indicator<br />
most often used to assess the state of the population’s<br />
health. Life expectancy shows, in years, how long a person<br />
of a certain age will live if the current mortality rate<br />
or the distribution of deaths based on gender and age<br />
persists. For instance, in 2010, the average life expectancy<br />
for men in Estonia was 70.6 years, i.e. a boy born in that<br />
year would live that long if the mortality rate for the given<br />
year did not change.<br />
In the UN Human Development Reports, Estonia’s<br />
persistent characteristic is the fact that its health indicators<br />
lag significantly behind its general standard of living<br />
and level of education; and Estonia was ranked between<br />
80 th and 90 th place in the life expectancy rankings until<br />
the beginning of the 21 st century. The people in all the<br />
states wealthier than us, and also those in the 40 poorer<br />
states lived longer than the people in Estonia.<br />
During the last decade, life expectancy in Estonia<br />
has increased dramatically, and, in 2010, achieved<br />
an all-time record for both men and women. Between<br />
2004 and 2010, the average life expectancy of women<br />
increased by 3 years (from 77.8 to 80.8 years) and 4.2<br />
years for men (from 66.4 years to 70.6 years). Life expectancy<br />
increased because, during this time, the accidental<br />
deaths, and deaths caused by other outside factors, of<br />
young people were reduced significantly, along with the<br />
deaths of middle-aged people from heart disease and<br />
cardiovascular diseases.<br />
Life expectancy can be calculated for every age<br />
group, and as age increases, life expectancy, understandably,<br />
decreases – in 2010, for 65-year-old men it was 14.2<br />
years and 19.4 years for women, thereby lagging behind<br />
the European average by 3.1 and 1.7 years, respectively.<br />
In other words, although, if based on the adjusted life<br />
expectancy at birth, Estonia continues to be among the<br />
last five in the European Union, the prognosis for those<br />
over 65 is as good as in the rest of Europe.<br />
Comparing the gap between the life expectancies<br />
in various age groups, we see that two-thirds of the<br />
difference falls in the 20- to 65-year age group, and<br />
reducing deaths among the young and middle-aged continues<br />
to provide the greatest reserves for lengthening life<br />
expectancy.<br />
1.4.2<br />
Living healthy during one’s<br />
remaining years<br />
Life expectancy, which is calculated on the basis of mortality<br />
data, does not tell us anything about the health,<br />
illnesses, or the health-related quality of life of the living.<br />
The incidence of illness and the health-related quality of<br />
life can be measured using many indicators, and this is<br />
done from various points of view. However, since we are<br />
interested in the question of whether a longer life (which<br />
is definitely a value onto itself) is a full and healthy life,<br />
the concept of living a healthy life (Aru 2012) can be of<br />
help. This concept assesses both the duration of life, as<br />
well as the health-related quality of life, and takes into<br />
account the incidence of good and bad health in people<br />
of various ages.<br />
In this case, mortality statistics are derived from<br />
data obtained by survey research, in which people of<br />
various ages assess the state of their health, and the life<br />
expectancy is multiplied by the percentage of healthy<br />
people in the corresponding gender-age group. Since<br />
health can be measured in several ways, the definitions<br />
of a healthy life can also vary. The European Union’s official<br />
statistics use a definition that is based on every-day<br />
limitations, or the concept that living healthy means a<br />
disability-free life expectancy.<br />
A definition like this does not reflect people’s subjective<br />
feelings about their health, but rather, their ability<br />
to cope on their own and manage their own affairs. The<br />
incidence of bad health in the population can be overestimated<br />
if health-related limitations are used as an<br />
excuse in situations where coping is actually hindered<br />
by other factors, for instance socio-economic reasons.<br />
Despite the possibilities for various interpretations, this<br />
method is appropriate for compiling time-series data and<br />
international comparisons.<br />
Compared to the data for 2004, the number of<br />
years of disability-free life for Estonian boys born in<br />
2010 had increased by 4.1 years and by 4.4 years for<br />
Estonian Human Development Report 2012/2013<br />
41