Public health reforms in Estonia: impact on the health of the population

General information about Estonia

[posted as supplied by author]

Estonia is the smallest of the Baltic countries, covering an area of 45 227 km². The population increased constantly until 1990, both as a result of in-migration and positive natural increase. Since 1990, the in-migration has decreased at the same time as the out-migration from the country increased, the number of births began to diminish and the number of deaths began to grow. In January 2004, the population of Estonia was 1 351 069, 46% men and 54% women. About two thirds of the population are Estonians and one third Russians and other ethnic groups. The average population density is 30 inhabitants per one km². The urban population is 69% of the total inhabitants. Administratively Estonia is divided into 15 counties. In recent years, an ageing of the population can be observed. The proportion of children (0-14 years old) has decreased (from 22.3% in 1990 to 16.3% in 2003) and the proportion of people above 65 years old has increased (from 11.6% in 1990 to 16% in 2003). Since 1991, the natural increase (comparing birth and mortality rates) has been negative, but since 1994 the difference between birth and mortality rates is slowly decreasing again. In 2003, the birth rate was 9.6 per 1,000 inhabitants and the death rate 13.4 per 1,000 inhabitants.

After the establishment of re-independence in 1991, a number of economic and political reforms have started. In 1992, the new constitution was adopted, a monetary reform was carried out, and the first parliament elections were held. As most Estonian political parties tend to be at the right of the political spectrum, all the governments have also been on the right. Starting to move towards a modern market economy since the beginning of 1990, Estonia has undergone rapid changes in the whole society. The priorities in planning the reforms have been mostly economic, also in the social and health sector. However, in the second half of 1990s, social values and ideology have become more visible. Due to positive changes in Estonian economy, like job creation and increased wages and pensions, the percentage of people living below poverty line has fallen. Compared to 1997, the percentage of households living under the poverty line decreased from 36.1% to 17.0% in 2003. The percentage of children living under the poverty line has decreased from 47.1% to 26.7% in 2003. Unemployment increased from the beginning of the 1990s until 2000. Since 2001, unemployment has slowly decreased and was 10% in 2003. However, the unemployment of young people has risen and reached 20.6% in 2003. In 2002, unemployment insurance was launched. The Occupational Safety and Health Act, which regulates the area of safety and health requirements in the working places and the organisational aspects of occupational health system, came into force in 1999.

Sources

w1. Jesse M, Habicht J, Aaviksoo A, Koppel A, Irs A, Thomson S. Health care systems in transition: Estonia. Copenhagen, WHO Regional office for Europe on behalf of the European Observatory on Health Systems and Policies, 2004. (Available at http://www.euro.who.int/observatory, accessed May 17^th, 2005).

w2. Statistical office of Estonia: http://www.stat.ee/ (accessed May 17^th, 2005).

w3. Social sector in figures 2004. Ministry of Social Affairs of Estonia, Tallinn, 2004 (Available at http://www.sm.ee/est/HtmlPages/social_sector_2004/$file/social_sector_2004.pdf, accessed May 17^th, 2005).