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Figure 1.4.3 Usage of tranquilisers and anti-depressants 1999-2008 Tranquilisers and sleep aids Anti-depressants 90 Estonia Finland Sweden 80 70 60 50 40 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 In daily doses per 1,000 residents per year 30 20 10 0 sand use medications in normal dosages every day. The Table and the initial data in Figure 1.3.3 originate 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). For instance, in Estonia in 2000, the total medication usage for gastric and duodenal ulcers was 10 DPD/1000/per 24 hours, i.e. 10 people in a thousand (1% of the population) could be using these medications in normal doses every day throughout the year. This is a statistical average, because in real life, some people take larger doses, some do not use any medications at all, while others may be using several at the same time. Unfortunately, it is not possible to compare the data on the use of medications in Estonia with any other states in the world, besides the Nordic countries, because only in these states do representative sales statistics for medications exist that cover the entire population and provide a reliable indirect assessment of the amounts of medications used by the population. During the last 10 years, the total usage of prescription drugs in Estonia has increased by half and, by 2010, arrived at approximately the same level as in the Nordic countries ten years ago. However, the amount used in Estonia continues to be half of that in the Nordic countries, because the increase in absolute quantities (459 DPD/1000/per day) has been even greater than in Estonia (311 DPD/1000/per day). In 2000, a total of 1074 DPD/1000/per day were consumed, i.e. everyone (from newborns to the elderly) could be taking one ordinary dose of a prescription medication per day. In 2010, the average amount was already 1.5 ordinary doses of prescription medications per resident per day. What can we conclude from this – are there more illnesses, or are they being treated more vigorously? Maybe the longer life spans and additional years of disability-free life in the Nordic countries and Estonia are the result of the increase in medication usage? The medication manufacturers and sellers would like this explanation, but it is unlikely to be true. Anxiety and worry, sleeplessness and depression are an increasingly significant part of modern life, while we also know how to and want to influence these conditions with medication. Figure 1.4.3 shows the dynamics of the use of tranquilisers, sleep aids and anti-depressants for the treatment of anxiety and mood disturbances in Estonia, Finland and Sweden. For instance, in 2008, the amount of tranquilisers and sleep aids used in Finland totalled 84 DPD/1000/per day, i.e. 8.4% of the Finnish population could be taking one dose of tranquilisers every day throughout the year. But hopefully, they are not using them on a daily basis, because, as a rule, these medications lose their effect if used regularly. The impact of anti-depressants manifests itself after longer usage, and the quantities of these medications taken in Finland and Sweden 44 Estonian Human Development Report 2012/2013
allude to the fact that approximately 6% to 7% of the populations (regardless of age) could be taking anti-depressants every day. The great increase in the usage of anti-depressants leaves the impression that life in Finland and Sweden has become depressive for at least twice as many people. Although, in regard to the groups of medication shown in Figure 1.4.3, the medicalisation of the Estonian population lags far behind that of the Nordic countries, we are already at the same level, for instance, in regard to the frequency of the usage of medication for the treatment of heart disease and diabetes. In this case, what do we make of the fact that, in comparison to Finland and Sweden, three to four times fewer tranquilisers and anti-depressants are taken in Estonia? Is there any reason to believe that we have three times fewer cases of anxiety and mood disturbances, or are two-thirds of the sufferers in Estonia left untreated? Or, is life for the people in the Nordic countries not as free of worry and stress as we would like to think? The increase in those receiving treatment in Estonia and the greater intensity of medication usage (Volmer 2012) means that, from the perspective of each person taking medication, the period of treatment increases and the years of disability-free living decreases. In Estonia too, the readiness of the medical system to treat and intervene has increased, as has the readiness of the population to be treated, and to admit that it needs help. 1.4.4 Health of schoolchildren Figures 1.4.4 to 1.4.7 describe the interlinked parameters chosen from the health indicators for schoolchildren in Estonia and the neighbouring countries – obesity and physical activity. The initial reasons for obesity and corpulence are an imbalance in the assimilating and expending of calories, which accompanies increasingly frequent sedentary lifestyles. The data originates from a survey conducted every four years, titled Health Behaviour of Schoolaged Children (HBSC, see http://www.hbsc.org/), which Estonian joined in 1993. Today, 41 countries participate in the survey, including the U.S., Canada, Russia, Turkey and the separate areas of Great Britain, in addition to all the European Union Member States. Standard questionnaires are answered by 11-, 13- and 15-year-old schoolchildren. Obesity is calculated based on a body mass index (weight is divided by height squared), and adjusted for age and gender. The children that participate daily in at least 60 minutes of moderate or active physical activity are considered to be physically active. The graphs present data on 13-year-olds, but the same trends are characteristic of both the 11- and 15-yearolds. Whereas, in almost all of the states, the older children are less physically active than the younger ones, and there are more overweight children among them. In all of the age groups, obesity in boys appears twice as often as in girls, although, there are twice as many physically active boys as there are girls. Figure 1.4.4 Percentage of obese girls among 13-year-old girls 2002 2006 2010 Percentage Estonia Latvia Lithuania Finland Sweden HBSC average Percentage 2002 2006 2010 Percentage Estonia Latvia Lithuania Finland Sweden HBSC average Percentage 0 5 10 15 20 0 5 10 15 20 Figure 1.4.5 Percentage of obese boys among 13-year-old boys 0 5 10 15 20 0 5 10 15 20 Estonian Human Development Report 2012/2013 45
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 and 44: 1.4 Health Raul-Allan Kiivet Change
Page 45: Table 1.4.1 Usage of prescription m
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.
Page 95 and 96: 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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