DEVELOPMENT
The pdf-version - Eesti Koostöö Kogu
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Table 1.4.1<br />
Usage of prescription medications in Estonia in 2000 and 2010 compared to the average of four Nordic countries (Norway,<br />
Sweden, Finland and Denmark).<br />
ATC<br />
code<br />
Classes of medications<br />
Estonia<br />
2000<br />
Estonia<br />
2010<br />
Change<br />
in Estonia<br />
(2010/2000)<br />
Average<br />
in the<br />
Nordic<br />
countries<br />
2000<br />
Average<br />
in the<br />
Nordic<br />
countries<br />
2010<br />
Change in<br />
the Nordic<br />
countries<br />
(2010/2000)<br />
Digestive tract and metabolic diseases 539 850 158% 1074 1533 143%<br />
A incl. diabetes medications 69 114 165% 129 182 141%<br />
A10 Heart and cardiovascular disease medications 16 45 287% 32 58 181%<br />
C incl. ischemic heart disease medications 139 349 251% 274 440 161%<br />
C01D incl. various blood pressure medications 17 13 76% 19 17 90%<br />
C07-C09 incl. substances to reduce blood lipids 69 262 380% 131 273 209%<br />
C10 Antibiotics 1 26 1804% 36 159 438%<br />
J01<br />
Anti-inflammation and anti-rheumatism<br />
medications<br />
15 13 84% 17 22 128%<br />
M01 Medications for the nervous system 55 60 109% 80 118 146%<br />
N incl. anti-psychosis medications 46 85 185% 169 242 143%<br />
N05A Cold medications 4 6 147% 10 15 147%<br />
R01 Asthma medications 29 26 91% 29 42 145%<br />
R03 Cough and cold medications 16 18 112% 58 65 112%<br />
R05 Anti-allergy medications 14 6 42% 14 14 98%<br />
R06 Allergiavastased ravimid 6 9 154% 25 44 175%<br />
Usage is presented in daily doses per 1,000 residents per 24 hours (DPD/1000/ööpäevas). The data originates from the medication<br />
statistics of the Estonian State Agency of Medicines (http://www.ravimiamet.ee/) and the database of the Nordic Medico-Statistical<br />
Committee (http://www.nom-nos.dk).<br />
is affected by cultural and linguistic differences between<br />
both countries and ethnic groups. The concepts of health<br />
also change in time. However, Sweden’s experience<br />
demonstrates that the population can gain disability-free<br />
years of life in a relatively short period of time. Therefore,<br />
the eternal dream of a longer healthy life is achievable, so<br />
why not also in Estonia?<br />
1.4.3<br />
The treatment and<br />
medicalisation of disease<br />
In everyday parlance, the opposite of health is illness –<br />
the less sick people there are, the healthier the population<br />
is. From this, we could conclude that an increase in the<br />
utilisation of medical treatments and medications demonstrates<br />
a decline in the population’s health. However, real<br />
life is more complicated. During the last few decades, it<br />
has been proven that, in the case of many illnesses, it<br />
makes sense to start treatment in the earlier and more<br />
moderate stages of the illness, and that the utilisation of<br />
more effective medications, with fewer side-effects, has<br />
also made this more acceptable to the patients.<br />
Treatment in the early stages of an illness means<br />
that the number of people receiving treatment increases,<br />
not that the incidence of illnesses has become more frequent.<br />
For instance, let’s take hypertension or high blood<br />
pressure. The population’s average blood pressure indicators<br />
have not increased, but compared to ten years ago,<br />
there is now a wish to start treatment earlier, when the<br />
blood pressure readings are significantly lower.<br />
There are also other less objective reasons for the<br />
increase in the utilisation of medical treatment and the<br />
population’s demand for medical treatment. In medical<br />
sociology, this general trend is defined as medicalisation.<br />
Disputes about the contents, reasons for and even<br />
the existence of this phenomenon are prevalent in the<br />
medical community. However, generally it is described<br />
as the situation in which the intervention of doctors is<br />
being requested or demanded in cases which earlier were<br />
considered to be a normal part of life or, at least, to be<br />
problems that could be solved without medical treatment.<br />
An extreme example could be pregnancy, which today is<br />
prevented with the use of hormone tablets, or vice versa,<br />
induced by in vitro fertilisation.<br />
In this section, we use the term “medicalisation”,<br />
in its direct meaning, and monitor developments in the<br />
use of prescription drugs. In table 1.4.1, we see how<br />
the quantities of prescription drugs sold per person<br />
in Estonia have increased during the last 10 years,<br />
compared to the averages in the four Nordic countries<br />
(Norway, Sweden, Finland and Denmark). The data is<br />
directly comparable since both Estonia and the Nordic<br />
countries use the same medication classifications, in<br />
which the unit of measurement is the number of daily<br />
doses per person during 24 hours (DPD/1000/per 24<br />
hours). This unit shows the intensity of the population’s<br />
use of medications – how many people in a thou-<br />
Estonian Human Development Report 2012/2013<br />
43