State of Health in the EU Estonia Country Health Profile 2017 European on Health Systems and Policies a partnership hosted by WHO The Country Health Profile series Contents The State of Health in the EU profiles provide a concise and 1 • HIGHLIGHTS 1 policy-relevant overview of health and health systems in the EU 2 • HEALTH IN ESTONIA 2 Member States, emphasising the particular characteristics and 3 • RISK FACTORS 4 challenges in each country. They are designed to support the efforts of Member States in their evidence-based policy making. 4 • THE HEALTH SYSTEM 6 5 • PERFORMANCE OF THE HEALTH SYSTEM 9 The Country Health Profiles are the joint work of the OECD and 5.1 Effectiveness 9 the European Observatory on Health Systems and Policies, in 5.2 Accessibility 12 cooperation with the European Commission. The team is grateful for the valuable comments and suggestions provided by Member 5.3 Resilience 13 States and the Health Systems and Policy Monitor network. 6 • KEY FINDINGS 16 Data and information sources The data and information in these Country Health Profiles are The calculated EU averages are weighted averages of the based mainly on national official statistics provided to Eurostat 28 Member States unless otherwise noted. and the OECD, which were validated in June 2017 to ensure the highest standards of data comparability. The sources and To download the Excel spreadsheet matching all the methods underlying these data are available in the Eurostat tables and graphs in this profile, just type the following Database and the OECD health database. Some additional data StatLinks into your Internet browser: also come from the Institute for Health Metrics and Evaluation http://dx.doi.org/10.1787/888933593494 (IHME), the European Centre for Disease Prevention and Control (ECDC), the Health Behaviour in School-Aged Children (HBSC) surveys and the World Health Organization (WHO), as well as other national sources. Demographic and socioeconomic context in Estonia, 2015 Estonia EU Demographic factors Population size (thousands) 1 315 509 394 Share of population over age 65 (%) 18.8 18.9 Fertility rate¹ 1.6 1.6 Socioeconomic factors GDP per capita (EUR PPP2) 21 666 28 900 Relative poverty rate3 (%) 12.5 10.8 Unemployment rate (%) 6.2 9.4 1. Number of children born per woman aged 15–49. 2. Purchasing power parity (PPP) is defined as the rate of currency conversion that equalises the purchasing power of different currencies by eliminating the differences in price levels between countries. 3. Percentage of persons living with less than 50 % of median equivalised disposable income. Source: Eurostat Database. Disclaimer: The opinions expressed and arguments employed herein are solely those of the authors any territory, to the delimitation of international frontiers and boundaries and to the name of any and do not necessarily reflect the official views of the OECD or of its member countries, or of the territory, city or area. European Observatory on Health Systems and Policies or any of its Partners. The views expressed Additional disclaimers for WHO are visible at http://www.who.int/bulletin/disclaimer/en/ herein can in no way be taken to reflect the official opinion of the European Union. This document, as well as any data and map included herein, are without prejudice to the status of or sovereignty over © OECD and World Health Organization (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies) Highlights . 1 1 Highlights Estonia The health status of Estonian people has improved and is rapidly closing the gap with EU averages. Yet large socioeconomic disparities persist and gains in life expectancy are spent in less good health than in other countries. Deregulation in the 1990s did not achieve the hoped for efficient and accessible health services, so there has been a gradual return to centralised planning and regulation. Health status Life expectancy at birth, years EE EU Life expectancy at birth was 78.0 years in 2015, compared with 71.1 years in 2000 and 82 is rapidly catching up with the EU average. These gains are mainly the result of a strong 80 80.6 reduction in premature deaths from cardiovascular diseases, although these remain 78 77.3 78.0 relatively high. Despite improvements, HIV infections and tuberculosis are still challenges 76 for Estonia. 74 72 71.1 78.0 70 YEARS 2000 2015 Risk factors % of adults in 2014 EE EU In 2014, 24% of Estonian adults smoked tobacco daily, only slightly above the EU average but with men smoking much more heavily than women. Alcohol consumption per adult Smoking 24% has also decreased but binge drinking among men is high. Adult obesity rates have grown by 40% overall since 2000 and are higher than the EU average whereas overweight and Binge drinking 23% obesity among children pose a real public health concern. Obesity 20% Health system Per capita spending (EUR PPP) EE EU Health spending in Estonia, at EUR 1 407, is lower than in most other EU countries, and €3 000 in 2015, was only about half the EU average per head. This was the equivalent of 6.5% €2 000 of GDP, again well below the EU average (9.9%). There is a strong reliance on payroll €1 000 contributions that makes the system vulnerable but still three quarters of health spending €0 is publicly funded, which gives the population more protection than in neighbouring 2005 2007 2009 2011 2013 2015 countries. Health system performance Effectiveness Access Resilience Amenable mortality in Estonia remains Access to health care shows little variation Financing is vulnerable one of the highest in EU countries, which between income groups but could be to the impacts of together with other indicators indicates improved considerably by addressing high ageing and economic substantial room to improve health services. unmet needs for medical care and by downturn, while addressing waiting times for specialised care. infrastructure and the Amenable mortality per 100 000 population EE EU health workforce remain a considerable 300 % reporting unmet medical needs, 2015 273 challenge. Improvements are planned to 260 High income All Low income 235 broaden the revenue base and create long- 220 term stability. EE 180 149 140 EU 126 100 2010 2014 0% 6% 12% 18% STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – ESTONIA 2 . Health in Estonia Estonia 2 Health in Estonia Life expectancy has risen remarkably rapidly, those who attain only lower secondary education.1 This is the but still lags behind for men widest gap among EU countries with data available. A large part of the gain in life expectancy has been after age 65, so Estonian Life expectancy at birth in Estonia increased by over 7 years women at 65 have another 20 years to live and men more than between 2000 and 2015, faster than in any other EU country. 15 years (2015). However, a higher proportion of these additional Nonetheless, it is some 2.5 years below the EU average (Figure 1). years are lived with disability (three quarters for women and two Men in particular lag behind, with life expectancy at birth (at 73.2) thirds for men) than in much of the EU.2 nearly 5 years below the EU average, whereas the gap is just over a year for women (82.2 years). More positively, the gender gap has been declining since 2011. 1. Lower education levels refer to people with less than primary, primary or lower secondary education (ISCED levels 0–2) while higher education levels refer to people with tertiary education (ISCED levels 5–8). Socioeconomic disparity in life expectancy is particularly wide. 2. These are based on the indicator of ‘healthy life years’ which measures the number of Estonians who go on to university will live 14 years longer than years that people can expect to live free of disability at different age Figure 1. Life expectancy in Estonia is increasing rapidly, but remains below other EU countries Estonia Years 2015 2000 90 78years of.0 age 85 EU Average years of age 83.0 80.6 82.7 82.4 82.4 82.2 81.9 81.8 81.6 81.6 81.5 81.3 81.3 81.1 81.1 81.0 80.9 80.8 80.7 80.6 80 78.7 78.0 77.5 77.5 76.7 75.7 75.0 74.8 74.7 75 74.6 70 65 60 EU Italy Spain Malta Latvia France Cyprus Poland Ireland Greece Austria Croatia Finland Sweden Estonia Belgium Bulgaria Portugal Hungary Slovenia Romania Denmark Germany Lithuania Netherlands Luxembourg Czech Republic Slovak Republic United Kingdom Source: Eurostat Database. Cardiovascular disease and cancer are Looking at trends over time in more detail, heart diseases and leading causes of death but external causes stroke remain the leading causes of mortality (Figure 3), though the standardised death rate from heart diseases and stroke fell also take a toll substantially (about 34%) between 2000 and 2014. During the Cardiovascular diseases kill more than three in five women and same period, however, mortality from cancer did not fall and nearly half of men (Figure 2) with a mortality rate nearly double remains well above the EU average. Despite policies to combat the EU average. Mortality from cancer is the second leading cause smoking (see Section 5.1), lung cancer remains the most common of death (accounting for 22% of women and 27% of men). External cause of cancer mortality. causes come third for both and account for the death of about 10% of men. STATE OF HEALTH IN THE EU: COUNTRY HEALTH PROFILE 2017 – ESTONIA Health in Estonia .