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girls, i.e. during this time period, the life expectancy in Estonia increased for both men and women based purely on the number of disability-free years left to live, which is a very gratifying result. Of course, actually, the number of disability-free years is not evenly divided among the entire population, because, unfortunately, some of us are sick our entire lives and others are healthy until they die. Most of the increases in life expectancy in Estonia, as well as in the rest of the world, are achieved thanks to the reduction of deaths among children and young people, and not thanks to the better management of illnesses later in life. Therefore, the difference between life expectancy and the years of disability-free life are constantly increasing, and global experience shows that an increase in average life expectancy beyond 70-75 years means that the longer life will be almost totally spent with health-related limitations. According to a Global Burden Disease Study (Salomon 2012), in the case of 50-year-olds, for every year that is added to life expectancy, only 0.6 years are free of disease. Since men’s life expectancy is shorter than women’s, the length of their disability-free life is also shorter. For instance, a boy that is born in Estonia in 2010 can expect to live 54.1 years, or 77% of his life (70.6 years), disability-free; and a girl born in the same year, 58.2 years, or 72% of her life (80.8 years) without health-related limitations. In 2010, the life expectancy of 65-year-old Estonian women (19.4 years) was significantly longer than that of similarly aged men (14.2 years), although the number of disability-free years was the same – 5.5 and 5.3 years, respectively. However, paradoxically, if at birth the life expectancy of Estonian women is 10 years longer, then the number of disability-free years left to live is only 4 years more than that of Estonian men, i.e. the majority of women’s additional life expectancy will be accompanied by health-related limitations. In comparison to our neighbouring countries (Figures 1.4.1 and 1.4.2), the increase in the number of years that Estonian women and men live disability-free has outpaced Latvia and Lithuania, and has arrived at the same level as Finland, although it lags significantly behind Sweden. In Sweden, the disability-free life expectancy of men is 71 years, which is longer than the life expectancy of men in the Baltic states. Although, in the ranking of disability-free life expectancy in the European Union, the Baltic states continue to be in last place, the improvements that have occurred in the last few years demonstrate that it is possible to increase disability-free life expectancy. This can be achieved if healthy lifestyles are purposefully promoted among the population, and heart disease and injuries can be prevented. This is what has ensured the progress to day, since these are also the areas where we lag behind the most, as compared to the rest of Europe. An explanation has yet to be found for why the number of their disability-free years has formed the basis for the increased life spans of both women and men in Sweden. Of course, it must be considered that the assessment of one’s health and health-related problems Figure 1.4.1 Remaining years of disability-free life, WOMEN Figure 1.4.2 Remaining years of disability-free life, MEN EU27 average Sweden Finland Latvia Lithuania Estonia EU27 average Sweden Finland Latvia Lithuania Estonia 70 70 65 65 60 60 55 55 50 50 Years 45 Years 45 2004 2006 2008 2010 2004 2006 2008 2010 42 Estonian Human Development Report 2012/2013
Table 1.4.1 Usage of prescription medications in Estonia in 2000 and 2010 compared to the average of four Nordic countries (Norway, Sweden, Finland and Denmark). ATC code Classes of medications Estonia 2000 Estonia 2010 Change in Estonia (2010/2000) Average in the Nordic countries 2000 Average in the Nordic countries 2010 Change in the Nordic countries (2010/2000) Digestive tract and metabolic diseases 539 850 158% 1074 1533 143% A incl. diabetes medications 69 114 165% 129 182 141% A10 Heart and cardiovascular disease medications 16 45 287% 32 58 181% C incl. ischemic heart disease medications 139 349 251% 274 440 161% C01D incl. various blood pressure medications 17 13 76% 19 17 90% C07-C09 incl. substances to reduce blood lipids 69 262 380% 131 273 209% C10 Antibiotics 1 26 1804% 36 159 438% J01 Anti-inflammation and anti-rheumatism medications 15 13 84% 17 22 128% M01 Medications for the nervous system 55 60 109% 80 118 146% N incl. anti-psychosis medications 46 85 185% 169 242 143% N05A Cold medications 4 6 147% 10 15 147% R01 Asthma medications 29 26 91% 29 42 145% R03 Cough and cold medications 16 18 112% 58 65 112% R05 Anti-allergy medications 14 6 42% 14 14 98% R06 Allergiavastased ravimid 6 9 154% 25 44 175% Usage is presented in daily doses per 1,000 residents per 24 hours (DPD/1000/ööpäevas). The data originates from the medication statistics of the Estonian State Agency of Medicines (http://www.ravimiamet.ee/) and the database of the Nordic Medico-Statistical Committee (http://www.nom-nos.dk). is affected by cultural and linguistic differences between both countries and ethnic groups. The concepts of health also change in time. However, Sweden’s experience demonstrates that the population can gain disability-free years of life in a relatively short period of time. Therefore, the eternal dream of a longer healthy life is achievable, so why not also in Estonia? 1.4.3 The treatment and medicalisation of disease In everyday parlance, the opposite of health is illness – the less sick people there are, the healthier the population is. From this, we could conclude that an increase in the utilisation of medical treatments and medications demonstrates a decline in the population’s health. However, real life is more complicated. During the last few decades, it has been proven that, in the case of many illnesses, it makes sense to start treatment in the earlier and more moderate stages of the illness, and that the utilisation of more effective medications, with fewer side-effects, has also made this more acceptable to the patients. Treatment in the early stages of an illness means that the number of people receiving treatment increases, not that the incidence of illnesses has become more frequent. For instance, let’s take hypertension or high blood pressure. The population’s average blood pressure indicators have not increased, but compared to ten years ago, there is now a wish to start treatment earlier, when the blood pressure readings are significantly lower. There are also other less objective reasons for the increase in the utilisation of medical treatment and the population’s demand for medical treatment. In medical sociology, this general trend is defined as medicalisation. Disputes about the contents, reasons for and even the existence of this phenomenon are prevalent in the medical community. However, generally it is described as the situation in which the intervention of doctors is being requested or demanded in cases which earlier were considered to be a normal part of life or, at least, to be problems that could be solved without medical treatment. An extreme example could be pregnancy, which today is prevented with the use of hormone tablets, or vice versa, induced by in vitro fertilisation. In this section, we use the term “medicalisation”, in its direct meaning, and monitor developments in the use of prescription drugs. In table 1.4.1, we see how the quantities of prescription drugs sold per person in Estonia have increased during the last 10 years, compared to the averages in the four Nordic countries (Norway, Sweden, Finland and Denmark). The data is directly comparable since both Estonia and the Nordic countries use the same medication classifications, in which the unit of measurement is the number of daily doses per person during 24 hours (DPD/1000/per 24 hours). This unit shows the intensity of the population’s use of medications – how many people in a thou- Estonian Human Development Report 2012/2013 43
Page 1: ESTONIAN HUMAN DEVELOPMENT REPORT 2
Page 4 and 5: Table of Contents 1 Human Capital /
Page 6 and 7: Dear Reader Since the moment when E
Page 9 and 10: 1Human Capital Estonian Human Devel
Page 11 and 12: the HDI’s content has also been h
Page 13 and 14: Figure 1.1.1 The human development
Page 15 and 16: Figure 1.1.7 The income sub-index:
Page 17 and 18: The results of the Princeton Projec
Page 19 and 20: the hypothetical generation. The to
Page 21 and 22: Figure 1.2.3 Life expectancy. Eston
Page 23 and 24: Table 1.2.2 also presents the most
Page 25 and 26: The new trends that are appearing i
Page 27 and 28: Figure 1.2.8 Components of populati
Page 29 and 30: New features were introduced into E
Page 31 and 32: Initiation of Voluntary Birth Contr
Page 33 and 34: Table 1.3.1 Best-known educational
Page 35 and 36: (OECD 2012b). Therefore a certain r
Page 37 and 38: The reciprocal dependence of the pr
Page 39 and 40: Figure 1.3.8 Percentage of students
Page 41 and 42: Table 1.3.4 The quality of educatio
Page 43: 1.4 Health Raul-Allan Kiivet Change
Page 47 and 48: allude to the fact that approximate
Page 49 and 50: promote healthy lifestyles among th
Page 51 and 52: Figure 1.5.1 The World Values Surve
Page 53 and 54: Table 1.5.2 Estonia’s participati
Page 55 and 56: Figure 1.5.3 The percentage of the
Page 57 and 58: Figure 1.5.5 Percentage of the Esto
Page 59 and 60: The fact that Estonia’s position
Page 61 and 62: Summary Mati Heidmets The global vi
Page 63 and 64: 2People and Society Estonian Human
Page 65 and 66: Table 2.1.1 Structure of the Bertel
Page 67 and 68: tioning market economies (15 states
Page 69 and 70: 2.2 Freedom and democracy Martin M
Page 71 and 72: Table 2.2.1 Democracy indicators Po
Page 73 and 74: Figure 2.2.2 The distribution of th
Page 75 and 76: would be something that none of the
Page 77 and 78: political participation are general
Page 79 and 80: strongest, while a very small perce
Page 81 and 82: is concerned, Estonia is one of the
Page 83 and 84: Figure 2.4.2 Average circulation of
Page 85 and 86: 2.5 Corruption Jüri Saar In accord
Page 87 and 88: Lithuania, 61%; and in Russia, 69%.
Page 89 and 90: 2.6.2 Intentional homicides in Esto
Page 91 and 92: crime. And thirdly, there was a wis
Page 93 and 94: References 1. Ahven, A. & Tabur, L.
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states included in the EU Kids Onli
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2.8 Public assessments of the state
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Figure 2.8.4 Changes releated to tr
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of the state’s development are en
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Table 2.9.1 The positions of Estoni
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3. IEP (2011). Structures of Peace.
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3Welfare and the Quality of Life Es
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choices made, not what people say t
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Figure 3.1.5 Public social spending
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tion agreed upon the social contrac
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References 1. Aidukaite, J. (2006).
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hand, to the “inequality of acces
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and explanations of the extent of i
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5- much more than I deserve. Some d
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people in Estonia consider the inco
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Table 3.3.1 Experienced Well-Being
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at about 70%. In Latvia and Lithuan
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sign. It seems that the usual view
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3.4 Quality of life Anu Toots 3.4.1
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a uniform composite indicator has n
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3.4.6 The components of life qualit
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Figure 3.4.4c Perceived quality of
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Figure 3.4.5 Changes in the depriva
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3.5 Environment dimension of well-b
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Figure 3.5.1.b Estonia’s position
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3.5.4 Energy intensity The energy i
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productivity, which is defined as t
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perceive themselves as worse off th
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4The Economy Estonian Human Develop
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vide a valuable connection for maki
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Figure 4.1.3 Components of economic
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ule of law, the sub-indicators for
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References 1. Acemoglu, D.; Robinso
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Development Report employs generali
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and pasture land, and this was capi
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Basing the total and net savings re
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4.3 Labour market Reelika Leetmaa,
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The problems include the very limit
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• Expenditures for active labour
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who lose their jobs. These ensure i
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4.4 Productivity and the economic s
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labour costs at the company level r
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Table 4.4.4 Comparison of the produ
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Figure 4.4.1 Annual average increas
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4.5 Innovation Erik Terk, Katrin M
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Table 4.5.2 Comparison of innovatio
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Table 4.5.4 Comparison of the indic
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in order to make the R&D potential
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It is characteristic of the South K
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mechanisms for increasing their sta
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Globalisation and Policy Patterns 5
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When Estonia regained its independe
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5.2 The impacts of globalisation an
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Table 5.2.2 Support of the differen
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5.3 Development policies Erik Terk,
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• C -the “Estonia-centred” su
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Figure 5.4.1 Support for the possib
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Summary Erik Terk Estonia is part o
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ehavioural patterns. Therefore, it
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EDR 2012/2013 authors Clemens Buche
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EDR 2012/2013 authors Alari Purju i
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Editor-in-Chief: Mati Heidmets Prod
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