THE HEALTH PROFILE OF TALLINN THE HEALTH PROFILE OF TALLINN Positive developments, problem areas and intervention needs in the health of the population of Tallinn at the end of the first decade of the 21st century Tallinn Social Welfare and Health Care Department Tallinn 2010 This document is a short summary of the Health Profile of Tallinn (http://www.tallinn.ee/ g4181s51124), analysing the changes in the health of the city’s population and temporal trends in factors affecting health, presenting positive changes and tight spots in the health situation of the city people. The Health Profile of Tallinn will be the basis for defining targets for the future health promotion and for setting up necessary interventions in health promotion in the city. DEMOGRAPHIC AND GENERAL MORBIDITY RATE DATA The area of Tallinn is 158.27 km² and the population density is slowly but consistently growing (Figure 1). In 2008, the population density was 2512.27 people per km2 and in 2009, 2518.40 people per km2. In the last few years, the net migration balance has remained stable. Tallinna rahvastik Paljasaare laht PIRITA Tallinna laht Kakumäe laht PÕHJA- Kopli laht TALLINN LASNAMÄE HAABERSTI KESKLINN Harku KRISTIINE järv MUSTAMÄE Ülemiste järv Asustustihedus 1 - 500 NÕMME 501 - 1 500 1 501 - 3 000 3 001 - 6 000 Allikas - Rahvastikuregister Figure 1 Population density in Tallinn, ppl./ km² 4 Source: Population Register 3,00 2,00 1,00 0,00 2000 2002 2004 2006 2008 -1,00 Tallinn Ees ti -2,00 -3,00 -4,00 -5,00 Statistikaamet Birth rate in Tallinn has increased (Figure 2) more than in Estonia as a whole and natural popula- tion increase has been positive since 2006 (Figure 3). 15,0 3,0 2,0 10,0 1,0 0,0 2000 2002 2004 2006 2008 Tallinn 5,0 -1,0 E stonia -2,0 0,0 2000 2002 2004 2006 2008 -3,0 Tallinn 9,2 8,9 11,6 13,2 13,6 -4,0 E stonia 9,5 9,6 10,4 11,1 12,0 -5,0 Statis tic s E s tonia Statis tic s E s tonia Figure 2. Crude birth rate per 1000 residents in Figure 3. Crude rate of population increase per 1000 resi- Tallinn 2000–2008. dents in Tallinn and Estonia Average life expectancy at birth has increased both in Estonia as a whole as well as in Tallinn (69.9 years in males and 80.2 years in females), how- ever, it is still alarmingly low compared to other member states of the European Union. The differ- ence between the average life expectancy of males and females in Estonia is one of the largest in the world and has not decreased in the last two dec- ades: males die at a significantly younger age than females. When it comes to healthy life years (the average number of remaining healthy life years at a certain age according to self-assessment and life table), the difference between men and women is relatively small – a mere three years. On the one hand, this refers to a different pattern of male morbidity and the substantial effect of premature mortality. On the other hand, increased female life expectancy means a longer period of life with limited substistence. A positive indicator is a decrease in abortion rates and in the percentage of teenage 5 mothers. 1600 The crude mortality rate of Tallinn residents 1400 1200 (number of deaths per 1000 annual average in- 1000 habitants in a year) has decreased in the last 800 years in a consistent manner (Figure 4). 600 400 200 0 M ale Fem ale M ale Fem ale M ale Fem ale 2002-2003 2004-2005 2006-2007 Statis tic s E s tonia Figure 4. Standardised crude mortality rate of Talliners by sex per 100,000 residents. Males in Tallinn die at a significantly younger age than women (Figures 5 and 6). Male longevity numbers are notably lower and male mortality rate is highest in the men’s age group of 70-74. In females, mortality is corresponding to age linearly. 1 60 0 3 00 0 1 40 0 2 50 0 1 20 0 2000 2000 2 00 0 1 00 0 2002 2002 800 2004 1 50 0 2004 600 2006 2006 1 00 0 400 2008 2008 200 500 0 0 0 2 4 4 4 4 4 4 4 4 4 0 2 4 4 4 4 4 4 4 4 4 -1 -2 -3 -4 -5 -6 -7 -8 -1 -2 -3 -4 -5 -6 -7 -8 10 20 30 40 50 60 70 80 10 20 30 40 50 60 70 80 Statis tic s E s tonia Statis tic s E s tonia Figure 5. Number of male deaths in Figure 6. Number of female deaths in Tallinn by age groups Tallinn by age groups 6 Up to the year 2006, the percentage of cardiovascular diseases, cancer and injury deaths de- creased significantly among the population of Tallinn (Figure 7). Since then the mortality due to cardiovascular diseases and cancer has increased. 6,00 G enitourinary Chlam ydia 5,00 M ortality ratio in G onorrhoea cardiovascular 2008 S yphilis 4,00 diseases 2006 M ortality ratio in Lym e d isease 2004 3,00 m alignant tum ors Tick-B orne E ncephalitis 2002 2,00 M ortality ration in S eve re hepatitis C 2000 external reasons 1,00 S evere hepatitis B Carrier HIV 0,00 2002 2004 2006 2008 0 100 200 300 400 500 600 700 Statis tic s E s tonia Statis tic s E s tonia Figure 7. Mortality ratio in cardiovascular diseas- Figure 8. Morbidity ratio in infectious dis- es, malignant tumors and injuries per 1000 resi- eases per 100,000 residents of Tallinn dents of Tallinn. From 2002 onwards, the number of deaths caused by external reasons (accidents, poisonings and traumas) has slowly but consistently declined. The number of deaths caused by alcohol poisoning has decreased the most. Nevertheless, these indicators are alarmingly high when compared to other states of the European Union. Injury deaths are one of the main reasons for the deaths in males in their prime working age and in children, totalling 9.4% of all deaths in Estonia in 2006. 50% of males and 30% of women dying between the ages of 1 and 49 years, perished due to in- juries. Injuries are namely the main reason why men in Tallinn die at a significantly younger age than women. According to the Statistics Bureau of Estonia, the frequency of traffic accidents with human casu- alties has consistently declined in the last decade, particularly in the past few years - although the number of those injured is extraordinarily high, amounting to more than 630 cases in 2009. The number of occupational accidents in Tallinn is high. In 2008, more than 500 occupational ac- cidents were registered. High prevalence of HIV/AIDS and other infectious diseases in Tallinn population poses a problem, although, a downward trend can be perceived in the last few years (Figure 8). 7 THE SAFE AND HEALTHY DE- VELOPMENT OF CHILDREN AND YOUTH The basis for good health is formed in childhood. Healthy children are the basis of positive development of the population health. According to the World Health Organi- zation evaluation, helpful improve- ment in public health performance is achieved by focusing the attention and activities to expecting mothers, infants, children and adolescents. The support of the health and development of children and youth is based on the flexible and efficient partnership be- tween the health, social and educa- tional sector. Positive trends At present the juvenile health in Estonia is better than ever before – the mortality rate of children and adolescents under the age of 20, and especially that of children under the age of 5, has steadily decreased. The mortality rate in children under the age of 1 has significantly decreased inTallinn over the last ten years, amounting to 5.0 cases out of 1000 live births. The percentage of infants who were ever breastfed has increased. Sexual risk behaviour among adolescents has decreased and increase in students smoking has halted in the past few years. Nevertheless, more than 1/3 of the schoolchildren of Tallinn smoke, 14% of them on daily basis. Physical activity of children and youth has increased. The occurrence rate of misdemeanours committed by children has decreased. The health of the schoolchildren of Tallinn based on self-assessment has consistently improved. In 2007, 90% of male children and 83% of female children considered their health to be very good or good. Problems The rate of immunisation in children in Tallinn is the lowest in Estonia. The number of overweight children has consistently risen in the past few years. According to data from 2007, 14% of male and 15% of female children aged 14–15 years are overweight (Figure 9). 35 70 30 60 25 50 20 Fem ale c hildren 40 M ale c hildren 15 M ale c hildren 30 Fem ale c hildren 10 20 5 10 0 0 1996 2003 2007 1996 2003 2007 Survey o f t he health and b ehaviour of 9 th-grade s tudents i n T allinn, Survey o f t he health and b ehaviour of 9 th-grade s tudents i n T allinn, T allinn 2008 T allinn 2008 Figure 9. Trends in the occurrence of obesity among Figure 10. The occurrence of drunkenness by gender the students of Tallinn (%) among the students of Tallinn (%) Alcohol consumption among adolescents has steadily increased in the last decade and has become one of the most serious health problems.