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Geographical Locations - Estonia
 The WWW Virtual Library: Public Health
Categories
Country Information
- (Statistical) Number of Inhabitants per Doctor: 210
- CIA World Factbook : Estonia
Organisations and Networks
UN and Multinational
Government
Non-Government
- Estonian AIDS Prevention Centre
"The mission of the AIDS Prevention Centre is to prevent the transmission of HIV/AIDS and to minimize the spread of sexually transmitted diseases (STDs) in Estonia. The homepages in Estonian and Russian provide full information about HIV, its transmission and prevention, STDs, safer sex, anonymous testing, treatment, sexual violence, drug abuse, statistics, etc. "
- Estonian Genome Project Foundation - The Estonian Genome Project Foundation (EGPF) is a non-profit organization founded by the Government of the Republic of Estonia in 2001. The EGPF carries out the Estonian Genome Project (EGP) with the goal to create a database of health, genealogy and genome data that would comprise a large part of the Estonian population. The database will make it possible to carry out research both in Estonia and outside to find links between genes, environmental factors and common diseases (cancer, diabetes, depression, cardiovascular diseases, etc) and to apply the information gained from research in making new discoveries in genomics and epidemiology, which eventually lead to increasing the efficiency of health care.
- Estonian Health Insurance Fund
- Estonian OH&S Information Network
This website contains information on occupational health and safety in Estonia and links to important relevant government departments, organisations, associations and societies
- Estonian Women's Studies and Resource Centre (ENUT)
"ENUT is a grassroots, non-profit, non governmental organisation for empowering women. It serves as a specialised library on women’s and gender issues, collects and disseminates information on gender issues, raises gender awareness through seminars, conferences and publications and promotes, co-ordinates and initiates activities to advance gender equality."
- Mapping the status of disease prevention and health promotion at primary health care level in Estonia
In Estonia, the burden of premature mortality from preventable diseases continues to be high though the rates have been decreasing in recent years. Primary health care plays a central role in the health system, providing a platform for the interface of health services with communities and families and for intersectoral and interprofessional cooperation and health promotion. The study, “Disease prevention and health promotion in primary care – needs and possibilities“, carried out in Estonia from November 2008 to June 2009, was initiated to identify the needs of primary health care (PHC) professionals – such as family doctors, family nurses, school nurses and occupational health doctors – in their routine work in disease prevention and health promotion, and the possibilities to strengthen their role in preventing noncommunicable diseases. The results show the level of readiness of the PHC professionals to practise health promotion and disease prevention in the current settings. The study also determined aspects that could be improved to enhance disease prevention at the PHC level in Estonia. A number of recommendations have been made as an outcome of the study. [publication abstract] [World Health Organization (Europe), with Tervise Arengu Instituut (National Institute for Health Development) and Eesti Haigekassa (Estonian Health Insurance Fund), 2010]
- Network of Estonian Nonprofit Organisations (NENO)
Network of Estonian Nonprofit Organizations (NENO) is a national association of NGOs. NENO's work is dedicated to the development of the civic initiative and the Estonian civil society, in which NENO is a conjoining party between the public benefit non-profit and the society.
- Open Estonia Foundation
The Open Estonia Foundation (OEF) is a non-governmental not-for-profit foundation that was established in April 1990 with the support of the Hungarian-born American philanthropist George Soros. The mission of the foundation was to create conditions for the development of an open society in Estonia. Programs are driven by a vision of democracy, civil society, social responsibility, and equal opportunities in the democratic decision-making process.
- Praxis Centre for Policy Studies
PRAXIS Centre for Policy Studies is an independent not-for-profit think tank based in Tallinn, Estonia. Founded in 2000, the mission of PRAXIS is to improve and contribute to the policy-making process in Estonia by conducting independent research, providing strategic counsel to policy makers and fostering public debate.
- Ruta Kruuda Foundation
The Dr. Ruta Kruuda Foundation has been established with the aim of perpetuating Dr. Kruuda’s contribution to the study and development of Estonian public health policy. The Foundation is the first of its kind in the field of public health in Estonia. The capital assets of the fund consist of donations and contributions from individuals and organizations. Each year the Foundation will award the Dr. Ruta Kruuda Scholarship in support of Estonian scientists, university students, politicians, public servants, healthcare workers, journalists and non-profit sector representatives to carry out policy studies on the public health in Estonia.
Academic Institutions
- Estonian Centre of Behavioural and Health Sciences
"The Estonian Centre of Behavioural and Health Sciences (ECBHS) was founded in 2001 in order to develop interdisciplinary research and organise doctoral studies in the fields of behavioural and health sciences. There are 11 research groups in the Centre, which are affiliated with the University of Tartu Faculties of Social Sciences, Medicine, and Exercise and Sports Science and Institute of Law, and with National Institute of Health Development and Estonian-Swedish Institute of Suicidology."
- Estonian Social Science Data Archive
The Estonian Social Science Data Archives (ESSDA) is an interdisciplinary centre that functions as the national data bank. ESSDA forms a constituent part of the Faculty of Social Sciences of Tartu University. The chief goal of ESSDA is to contribute to the maintenance and re-utilisation of social information that has been gathered in Estonia as well as the integration of Estonia into the international exchange of social science data.
- Kohtla - Järve Meditsiinikool - The Kohtla-Järve Medical School provides vocational training for the nursing professions.
- Tallinn University's Faculty of Educational Sciences
- University of Tartu
- Faculty of Medicine
- Department of Public Health
- Tartu University Hospital
National Policy and Related Documents
Reports, Guidelines, and Projects
- Childhood deaths from external causes in Estonia, 2001–2005
Background: In 2000, the overall rate of injury deaths in children aged 0–14 was 28.7 per 100000 in Estonia, which is more than 5 times higher than the corresponding rate in neighbouring Finland. This paper describes childhood injury mortality in Estonia by cause and age groups, and validates registration of these deaths in the Statistical Office of Estonia against the autopsy data. Methods: The data on causes of all child deaths in Estonia in 2001–2005 were abstracted from the autopsy protocols at the Estonian Bureau of Forensic Medicine. Average annual mortality rates per 100,000 were calculated. Coverage (proportion of the reported injury deaths from the total number of injury deaths) and accuracy (proportion of correctly classified injury deaths) of the registration of causes of death in Statistical Office of Estonia were assessed by comparing the Statistical Office of Estonia data with the data from Estonian Bureau of Forensic Medicine. Results: Average annual mortality from external causes in 0–14 years-old children in Estonia was 19.1 per 100,000. Asphyxia and transport accidents were the major killers followed by poisoning and suicides. Relative contribution of these causes varied greatly between age groups. Intent of death was unknown for more than 10% of injury deaths. Coverage and accuracy of registration of injury deaths by Statistical Office of Estonia were 91.5% and 95.3%, respectively. Conclusion: Childhood mortality from injuries in Estonia is among the highest in the EU. The number of injury deaths in Statistical Office of Estonia is slightly underestimated mostly due to misclassification for deaths from diseases. Accuracy of the Statistical Office of Estonia data was high with some underestimation of intentional deaths. Moreover, high proportion of death with unknown intent suggests underestimation of intentional deaths. Reduction of injury deaths should be given a high priority in Estonia. More information on circumstances around death is needed to enable establishing the intent of death. [author abstract] [BMC Public Health 2007, 7: 158 [doi:10.1186/1471-2458-7-158]]
- Costs, health effects and cost-effectiveness of alcohol and tobacco control strategies in Estonia
Objective: To assess the population-level costs, effects and cost-effectiveness of different alcohol and tobacco control strategies in Estonia. Design: A WHO cost-effectiveness modelling framework was used to estimate the total costs and effects of interventions. Costs were assessed in Estonian Kroon (EEK) for the year 2000, while effects were expressed in disability-adjusted life years (DALYs) averted. Regional cost-effectiveness estimates for Eastern Europe, were used as baseline and were contextualised by including country-specific input data. Results: Increased excise taxes are the most cost-effective intervention to reduce both hazardous alcohol consumption and smoking: 759 EEK (€ 49) and 218 EEK (€ 14) per DALY averted, respectively. Imposing additional advertising bans would cost 1331 EEK (€ 85) per DALY averted to reduce hazardous alcohol consumption and 304 EEK (€ 19) to reduce smoking. Compared to WHO-CHOICE regional estimates, interventions were less costly and thereby more cost-effective in Estonia. Conclusions: Interventions in alcohol and tobacco control are cost-effective, and broad implementation of these interventions to upgrade current situation is warranted from the economic point of view. First priority is an increase in taxation, followed by advertising bans and other interventions. The differences between WHO-CHOICE regional cost-effectiveness estimates and contextualised results underline the importance of the country level analysis. [author abstract] [Health Policy, 84 (2007): 75–88]
- Deaths of infants subject to forensic autopsy in Estonia from 2001 to 2005: what can we learn from additional information?
Background: Deaths from childhood injury are a public health problem worldwide. A relatively high proportion of child deaths of undetermined manner in Estonia raises concerns about potential underestimation of intentional deaths, especially in infants. This suggests that more information on the circumstances surrounding death is needed to establish the manner of death correctly and, more importantly, to prevent these deaths. The objective of this study was to detect, describe, and analyze the circumstances around deaths of infants subject to forensic autopsy in Estonia to reveal hidden cases of child abuse and more accurately determine causes of death. Methods: Study cases included all infant deaths in Estonia from 2001 to 2005 subject to forensic autopsy at the Estonian Bureau of Forensic Medicine. Additional information was obtained from a series of visits to general practitioners, including characteristics of infant health, family composition, parents’ education and employment, living conditions, and circumstances around death as perceived by medical staff in charge of outpatient services for these families. Results: The total number of infant deaths in Estonia between 2001 and 2005 subject to forensic autopsy was 98, with 40 (40.8%) deaths attributed to a disease and 58 deaths (59.2%) resulting from injury. Elements of child abuse were involved in as many as 57.7% (95% CI 46.9-68.1) of the deaths for which medical records were available (n = 90). At death, the majority of these cases were registered as diseases or deaths from unintentional injury. Average annual mortality from external causes in Estonian infants, 2001-2005, previously reported by us as 88.1 per 100,000 (95% CI 68.1-113.6) would decrease to 41.0 (95% CI 26.9-57.8). Many infants in the studied group had faced multiple threats and were living in poor hygienic conditions. In a number of cases, they were left alone or looked after by older siblings. Parents' alcohol abuse played an important role in a considerable number of cases. Conclusions: Using additional sources of information revealed new information about child abuse not reflected in the cause of death diagnosis. Effective interventions aimed at parent education and improved follow-up of children by medical staff may reduce mortality from external causes among Estonian infants by more than half. [author abstract] [Population Health Metrics 2010, 8: 27]
- Environment and health performance review: Estonia
"This report describes and evaluates the current environment and health situation in Estonia. It evaluates the strong and weak points of the national environment and health status and presents recommendations from independent experts. The conclusions and recommendations are based on a detailed environment and health performance review carried out in the country. The review identified the most important environment and health problems, evaluated the public health impact of environmental exposure and reviewed the policy and institutional framework taking into account the institutional set-up, the policy setting and legal framework, the degree and structural functioning of intersectoral collaboration and the tools available for action." [excerpt from publication abstract] [WHO Europe, 2009]
- Estonia’s health system in 2010: improving performance while recovering from a financial crisis
Estonia was struck by the worst financial crisis since regaining independence in 1991. High unemployment rates combined with shrinking revenues in both the public and private sector have had an impact on the available funding for Estonia’s health system. Several austerity measures were taken. These include changes in valued added tax and excise taxes, as well as health sector specific measures such as changes in the benefit basket and a reduction of prices. However, the crisis has also provided opportunities. It enabled implementing necessary but unpopular reforms and significant stimulus money was directed to health infrastructure. [publication summary] [Eurohealth, vol 16, no 2, pp.29-32, 2010]
- Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia
Background: Estonia has experienced an HIV epidemic among intravenous drug users (IDUs) with the highest per capita HIV prevalence in Eastern Europe. We assessed the effects of expanded syringe exchange programs (SEP) in the capital city, Tallinn, which has an estimated 10,000 IDUs. Methods: SEP implementation was monitored with data from the Estonian National Institute for Health Development. Respondent driven sampling (RDS) interview surveys with HIV testing were conducted in Tallinn in 2005, 2007 and 2009 (involving 350, 350 and 327 IDUs respectively). HIV incidence among new injectors (those injecting for < = 3 years) was estimated by assuming (1) new injectors were HIV seronegative when they began injecting, and (2) HIV infection occurred at the midpoint between first injection and time of interview. Results: SEP increased from 230,000 syringes exchanged in 2005 to 440,000 in 2007 and 770,000 in 2009. In all three surveys, IDUs were predominantly male (80%), ethnic Russians (>80%), and young adults (mean ages 24 to 27 years). The proportion of new injectors decreased significantly over the years (from 21% in 2005 to 12% in 2009, p = 0.005). HIV prevalence among all respondents stabilized at slightly over 50% (54% in 2005, 55% in 2007, 51% in 2009), and decreased among new injectors (34% in 2005, 16% in 2009, p = 0.046). Estimated HIV incidence among new injectors decreased significantly from 18/100 person-years in 2005 and 21/100 person-years in 2007 to 9/100 person-years in 2009 (p = 0.026). Conclusions: In Estonia, a transitional country, a decrease in the HIV prevalence among new injectors and in the numbers of people initiating injection drug use coincided with implementation of large-scale SEPs. Further reductions in HIV transmission among IDUs are still required. Provision of 70 or more syringes per IDU per year may be needed before significant reductions in HIV incidence occur. [author abstract] [BMC Public Health 2011, 11: 517]
- Governance of the health system, health insurance fund and hospitals in Estonia: opportunities to improve performance
"The report aims to give an overview of Estonia’s health system governance and its current challenges in three sections. The first section gives an overview of Estonia’s health system, focusing on institutions involved in regulating, providing or funding health services. This case study does not describe pharmaceuticals and public health, although they are part of the health system. The second section describes in more detail governance arrangements in Estonia’s health insurance system and highlights mechanisms for setting objectives and monitoring their attainment. The third section describes governance arrangements in Estonia’s hospital sector, focusing on the role and performance of supervisory boards of public autonomous hospitals." [World Health Organization, 2008]
- Health Care Systems in Transition: Estonia 2008
The Health Care Systems in Transition (HiT) profiles are country-based reports that provide an analytical description of a health care system and of reform initiatives in progress or under development. The HiTs are a key element of the work of the European Observatory on Health Systems and Policies.
- Health expectancy in Estonia
"Key points: (i) Estonian life expectancy (LE) at age 65 has increased by 1.7 years for women and 0.7 years for men over the 1997-2007 period: LE for both sexes between 1995-2001 was below the EU15 average and remained below the EU25 average in 2007; (ii) Because Estonia joined the European Union in 2004, health expectancy based on activity limitation (HLY) over the 1995-2001 period is not available; [and] (iii) The new HLY series, initiated in 2005 with the SILC data, shows that in 2007 women and men at age 65 can expect to spend 22% and 27% of their life without self-reported long-term activity limitations respectively. In 2007 the HLY values for Estonia are 4.6 and 5.1 years below the EU25 average for women and men respectively. Between 2006 and 2007 HLY slightly increased for women and decreased for men in Estonia." [European Health Expectancy Monitoring Unit, EHEMU Country Reports, Issue 3 – March 2010]
- Highlights on Health in Estonia
Published by WHO's Regional Office for Europe, Country Highlights give an overview of the health and health-related situation in a given country and compare, where possible, its position in relation with other countries in the region. The Highlights have been developed in collaboration with Member States for operational purposes and do not constitute a formal statistical publication. They are based on information provided by Member States and other sources as listed.
- History of public health research in Estonia: a review
The University of Tartu (which was founded in 1632) and its Department of Public Health (Hygiene) have been the centre of public health research in Estonia. Environmental factors such as living conditions, water, soil, air and food have been the traditional topics. The study on blind people and people suffering from eye diseases among the rural population of Livonia conducted by Professor Himmelstiem in 1856-1859 proved to be the first epidemiological study in Russia. Professor Korber, a supporter of a statistical approach in research, founded the local school of demographers in 1890s. Professor Khlopin's stay in Tartu (1895-1903) was a very fruitful period. He and his students paid much attention to communal hygiene. Professor Rammul, the head of the department in 1920-1940, initiated and supervised an extensive medicogeographical study of overall Estonia. The Second World War and post-war years caused a standstill In research. A revival occurred in the end of 1950s when Professor Kask returned to the department. After his death (1968), Associate Professor Ulbo and Professor Jannus continued his work. Their main study areas were concerned with public health aspects of the water supply, nutrition of pre-school children and their provision with vitamins, work conditions and health risks of some occupations. During resent years the area of research has enlarged to comprise health risks due to lifestyle factors, hearth economics and health care management topics. After the war special medical research institutes were established. They have made a considerable contribution to public health research in Estonia. [author abstract] [European Journal of Public Health, vol. 10, no. 3, pp.164-167, 2000]
- HIV/AIDS interventions for injecting drug users in Estonia: evaluation and recommendations
"The overall HIV and drugs situation has changed little in the last 5 years, with an HIV epidemic that remains primarily concentrated among IDUs (and to a lesser extent in their sexual partners) in specific geographic areas. As in 2002 targeted (harm reduction) interventions for injecting drug users, including opioid substitution therapy, still offer the best solution to the ongoing HIV crisis in Estonia." [United Nations Office on Drugs and Crime (UNODC) and World Health Organization Regional Office for Europe (WHO), January 2008]
- Hospital reform in Bulgaria and Estonia: What is rational and what not? – Final report
"The research undertaken in the framework of this project sought to contribute to the understanding of hospital reform in Bulgaria and Estonia by means of a detailed analysis of some policies implemented in both countries aimed at rationalising the provision of hospital services. An analysis of the theoretical and practical aspects of the hospital reforms in the two countries was performed. A study collecting primary data on the views and attitudes of hospital managers and stakeholders concerning the achievements and challenges in the reform of hospital care was conducted. A range of specific topics were selected to address the issues subject to research: a) review of health and hospital reform strategies in Bulgaria and Estonia; b) hospital service delivery, decentralization and level of hospital autonomy; c) measures for improving hospital efficiency." [Local Government Initiative Fund of Open Society Institute, Budapest, January 2007]
- Impact of implementing a nationwide cervical cancer screening program on female population coverage by Pap-tests in Estonia
Background: The objective of the EUROCHIP project in Estonia was to describe the organized cervical cancer screening program started in 2006 (after pilot studies in 2003-2005), to compare its performance with opportunistic screening, and to define priorities for improvement of the program. Methods: Population data was retrieved from Statistics Estonia, data about performed Pap-smear tests within the screening program from the Estonian Cancer Society and from clinics and labs participating in the program, data about Pap-smear tests outside the screening program from the Estonian Health Insurance Fund, and data about cancer incidence and mortality from the Estonian Cancer Registry database. Results: During the first year after implementing the nationwide cervical cancer screening program in Estonia, the number of tests outside the organized program remained high. Within the organized program, the number of Pap-tests in different age groups increased with age except for the oldest age group while population coverage with Pap-tests outside the organized screening program decreased with age. The number of cervical cancer cases at early stages increased after implementation of organized screening. The time-frame does not permit to draw any definitive conclusions. Conclusions: Implementation of organized cervical cancer screening did not decrease the volume of opportunistic screening. The factors influencing attendance in the organized cervical cancer screening program in different age groups should be studied further. Moreover, a central cancer screening registry without restrictive data protection legislation would improve data collection and enable to evaluate performance of the program on a regular basis. [author abstract] [Tumori, 96: 524-528, 2010]
- Implementation of social health insurance in Estonia – a case study
"The health system in Estonia has transformed concurrently with the national economy and state governance. After the more radical reforms established the broad principles of the new system, changes were made to facilitate a better alignment between the system structure and its intended functions." [World Bank Flagship Course in Health Reform and Sustainable Financing, Washington D.C., 12-30 October 2009]
- Income-related inequality in health care financing and utilization in Estonia since 2000
This paper summarizes recent research on income-related inequalities in health care financing and utilization in Estonia for the period 2000 to 2007. Quantitative analysis is used to analyse evidence for a number of priority policy issues. Considering prefinancing and out-of-pocket payments (OOPs) together, overall health care financing is mildly progressive. During the period studied about 3% of households (about 15 000) dropped below the national absolute poverty line after making OOPs. The number dropped from 3.7% in 2000 to 2.1% in 2007 due to wages and especially old-age pensions rising faster than the cost of living. For those services more dependent on OOPs, such as outpatient drugs and dental care, there are either more inequalities in utilization or households face higher risk of impoverishment. Thus the patterns of equity in both the finance and use of services are closely linked to the structure of the EHIF benefit package. Two recommendations are made, first to revise the structure of prescription drug copayments in order to ensure affordable access, in particular for pensioners, and secondly to improve financial access to adult dental care whilst concurrently maintaining the good protection that exists for other services, such as primary care, inpatient care and emergency care. [publication abstract] [WHO Regional Office for Europe, Health Financing Policy Paper 2010/3]
- Measuring burden of disease in Estonia to support public health policy
Background: Many countries have an overview on mortality and morbidity but few have performed contextualized national burden of disease studies. The objective of the present study is to provide a first set of national and sub-national burden of disease estimates for Estonia. Further, we present the causes and age-gender distribution of the burden. We conclude with the description of result uptake and impact of the study in Estonian public health policy arena. Methods: A burden of disease estimation procedure modified for best fit to country situation was used. That included disease classification reflecting Estonian disease profile, national disease severity assessments, mortality and morbidity prevalence data. Calculations were performed on national and sub-national levels. Results: Estonian population lost 446 361 (327/1000 persons) disability adjusted life-years in 2002. Premature mortality caused majority of the burden and cardiovascular diseases, external causes (e.g. suicide and injuries) and cancers were main sources of burden. Working age population (16–64 years) shouldered 60% of the burden. Sub-national levels of burden range from 114 to 725 disability adjusted life-years per 1000 persons and are correlated to regional socioeconomic development. Conclusion: Cardiovascular disease and injuries, premature mortality, working age population, male and people from economically less developed regions should be the priority targets for public health interventions. Estonian main public health strategies now address burden of disease concerns highlighted by our study. [author abstract] [The European Journal of Public Health, 28 April 2009 [doi:10.1093/eurpub/ckp038]]
- Mortality in patients with childhood-onset type 1 diabetes in Finland, Estonia, and Lithuania: follow-up of nationwide cohorts
Objective: To assess mortality of population-based cohorts of childhood-onset type 1 diabetic patients from the Eastern European countries of Estonia and Lithuania and compare this information with recent data from Finland. Research design and methods: Estonian (n = 518) and Finnish (n = 5,156) type 1 diabetic cohorts were diagnosed between 1980 and 1994, and the Lithuanian (n = 698) cohort was diagnosed between 1983 and 1994. The mortality of these cohorts was determined in 1995. Life-table analysis, Cox survival analysis with covariates, and standardized mortality ratios (SMRs) were used. Causes of death were analyzed. Results: Survival after 10 years duration of type 1 diabetes was similar in Estonia (94.3%) and Lithuania (94.0%), but much higher in Finland (99.1%). In the Cox survival analysis with covariates, the country of origin and age at diagnosis were found to be significant predictors of mortality. The SMR for the Estonian cohort was 4.35 (95% CI 2.25–7.61), the highest for the Lithuanian cohort was 7.55 (4.89–11.15), and the lowest for the Finnish cohort was 1.62 (1.10–2.28). The most common cause of death in Estonia and Lithuania was diabetic ketoacidosis (DKA), and in Finland, it was violent causes. No deaths from late complications of diabetes have been documented so far in any of the three countries. Conclusions: Our results demonstrate a high rate of short - term deaths due to DKA and inferior survival of childhood-onset type 1 diabetic patients in Estonia and Lithuania compared with Finland. In Finland, the survival of childhood-onset type 1 diabetic patients has improved and is only slightly inferior to that of the background population. [author abstract] [Diabetes Care 23: 290–294, 2000]
- Occupational health services in Estonia
This report was generated by the Estonian-Finnish Twinning Project on Occupational Health Services 2003–2004. Contents: Challenges from EU enlargement to Estonian-Finnish co-operation (by Jaakko Blomberg); Twinning Project and Estonian occupational health policy (by Tiit Kaadu); Mestimisprojekt (by Twinning) ja Eesti töötervishoiupoliitika (by Tiit Kaadu); Occupational health and safety as a resource for social development (by Jorma Rantanen); Strengthening of the service provision of occupational health in Estonia (by Kari-Pekka Martimo); Twinning Project 2 in occupational health and safety – successes and problems (by Kari-Pekka Martimo); Estonian-Finnish Twinning project on training about work-related and occupational diseases (by Helena Taskinen, Tiina Saarelma-Thiel, Ahe Vilkis and Eda Merisalu); Networking system to strengthen occupational health and safety in Estonia (by Kari Kurppa, Ester Rünkla, Eva Tammaru and Marina Kempinen); Sectoral profile on occupational health and safety in Estonian agriculture (by Marina Kempinen and Kari Kurppa); Information in occupational health and safety – bringing about impact in practice in Estonia (by Suvi Lehtinen, Eva Tammaru, Pille Korpen and Ester Rünkla); Basic Occupational Health Services – Ensuring Universal Services Provision (by Jorma Rantanen); Lessons learnt (by Jorma Rantanen); Mida me sellest õppisime (by Jorma Rantanen); Recommendations for future (by Jorma Rantanen); [and] Soovitused tulevikuks (by Jorma Rantanen). [Finnish Institute of Occupational Health, Helsinki, 2004]
- Payment for Performance (P4P): International experience and a cautionary proposal for Estonia
"Some health systems in Europe use financial incentives for hospitals and specialist physicians linked to process and outcome indicators of performance in an attempt to improve health gain. This is called paying for performance (P4P). Can Estonia’s health system reward value for money and improved quality in hospital and other specialized care and, if so, how? These questions are discussed in a WHO report launched today: Payment for performance (P4P): international experience and a cautionary proposal for Estonia. The report advises caution in undertaking P4P but says that it can offer good value for taxpayers and the users of health services."
- Policies on health care for undocumented migrants in EU27: country report – Estonia
"Estimates, of the number of undocumented migrants, range from between 5 000 to 10 000. This equals a medium level in relation to the total population, 0.6%. Because of the geographical location, the vicinity of the Scandinavian welfare states and the number of illegal immigrants living in the Russian Federation, Estonia is believed to be a potential transit country for refugees coming from the south and east. In 2006, the Estonian Border Guard discovered 63 cases of illegal immigration and 109 illegal immigrants. The countries of origin of the undocumented migrants were Moldova (32), Kazakhstan (16), The Russian Federation (14), Ukraine (10), Byelorussia (4), stateless persons (28) and in addition, some individuals from African countries, Romania, Israel and Turkey… The European Health Insurance Card is required in the case of EU member state nationals. As regards migrants, they are insured if they have permanent residency or are living in Estonia by virtue of a temporary residence permit or in terms of a right to permanent residency, pay their own social taxes or are required to pay social tax. Asylum seekers’ entitlement to care is regulated by the Act on Granting International Protection to Aliens. In paragraph 12 (1[3]), emergency care and medical examinations are listed as services which the initial reception centre and subsequent reception centres are required to arrange… According to the Health Services Organisation Act, by virtue of being inside Estonian territory, undocumented migrants may access emergency care free of charge. Access to primary care and anything beyond emergency care is available only for insured persons and if the full costs are paid." [Work package 4, Policy Compilation and EU Landscape , Deliverabel No.6, MIM/Health and Society Malmö University, April 2010]
- Population-related policies in Estonia in the 20th century: stages and turning points
This article is about the experience of population-related policies in Estonia. During the recent decade much has been published on this theme, usually with an analysis of currently enforced regulations. Repeated amendments of legal norms and procedures, which are inevitable in a period of fundamental reforms, however, tend to limit their value quite rapidly. Against such a background, this paper applies a longer perspective with an attempt to cover the main stages and turning points in the development of population-related policies in the country since the establishment of statehood in 1918. In the interwar period, the efforts to build up a modern nation included setting up relevant institutions and regulations in the field of population-related policies. These undertakings have been seldom discussed in the recent publications. Somewhat similarly, the postwar decades are frequently regarded as fairly distant and of little relevance to present challenges. To understand the developments, however, the longer view should not be neglected. Today’s concerns are rooted in the arrangements and disarrangements of the past, and no less importantly, such continuity is strengthened by the nature of population development and the flow of cohorts which absorb the influences of the societal environment and carry them along through their lifetime. The article is structured in four sections focusing on the development of marriage and the family, children and fertility, the pension system and social welfare, and the health care system. In each section, the aim is to outline successive policy regimes and their main characteristics in terms of objectives and methods of regulations. Understandably, limited space does not allow coverage of minor changes and technicalities, so for more specific information the article provides further reference to various source materials. [author abstract] [Yearbook of Population Research in Finland 40 (2004), pp. 73–103]
- Public health reforms in Estonia: impact on the health of the population
"We describe public health reforms in Estonia, focusing on the institutional structure, the reform rationale, the specific proposals and reform processes, the achievements and limitations, and the wider impact of the reforms.1 To describe trends in the health of the population, we use life expectancy, infant mortality, rate of abortions per 100 live births, morbidity rates (tuberculosis, HIV, sexually transmitted diseases), and the level of individual risk factors (smoking, diet, alcohol consumption). The study is based mainly on an analysis of previously published reports and official statistics." [BMJ 2005; 331: 210–213]
- The Social Patterning of Health, Smoking and Drinking in Estonia, Latvia, Lithuania and Finland in 1994–2004
The Baltic countries share public health problems typical of most Eastern European transition economies: morbidity and mortality from non-communicable diseases is higher than in Western European countries. This situation has many similarities compared to a neighbouring country, Finland during the late 1960s. There are reasons to expect that health disadvantage may be increasing among the less advantaged population groups in the Baltic countries. The evidence on social differences in health in the Baltic countries is, however, scattered to studies using different methodologies making comparisons difficult. This study aims to bridge the evidence gap by providing comparable standardized cross-sectional and time trend analyses to the social patterning of variation in health and two key health behaviours i.e. smoking and drinking in Estonia, Latvia, Lithuania and Finland in 1994-2004 representing Eastern European transition countries and a stable Western European country. [excerpt from thesis abstract] [National Public Health Institute (Finland), October 2008 (KTL A10) on behalf of the Department Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland and the Department of Public Health, University of Helsinki, Finland (Thesis within the Faculty of Medicine of the University of Helsinki)]
- United States, Department of State Country Reports on Human Rights Practices Estonia
- Use of evidence-based pharmacotherapy after myocardial infarction in Estonia
Background: Mortality from cardiovascular disease in Estonia is among the highest in Europe. The reasons for this have not been clearly explained. Also, there are no studies available examining outpatient drug utilization patterns in patients who suffered from acute myocardial infarction (AMI) in Estonia. The objective of the present study was to examine drug utilization in different age and gender groups following AMI in Estonia. Methods: Patients admitted to hospital with AMI (ICD code I21-I22) during the period of 01.01.2004-31.12.2005 and who survived more than 30 days were followed 365 days from the index episode. Data about reimbursed prescriptions of beta-blockers (BBs), angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARBs) and statins for these patients was obtained from the database of the Estonian Health Insurance Fund. Data were mainly analysed using frequency tables and, where appropriate, the Pearson's χ2 test, the Mann-Whitney U-test and the t-test were used. A logistic regression method was used to investigate the relationship between drug allocation and age and gender. We presented drug utilization data as defined daily dosages (DDD) per life day in four age groups and described proportions of different combinations used in men and women. Results: Four thousand nine hundred patients were hospitalized due to AMI and 3854 of them (78.7%) were treated by BBs, ACE/ARBs and/or statins. Of the 4025 inpatients who survived more than 30 days, 3799 (94.4%) were treated at least by the one of drug groups studied. Median daily dosages differed significantly between men and women in the age group 60-79 years for BBs and ACE/ARBs, respectively. Various combinations of the drugs studied were not allocated in equal proportions for men and women, although the same combinations were the most frequently used for both genders. The logistic regression analysis adjusted to gender and age revealed that some combinations of drugs were not allocated similarly in different age and gender groups. Conclusions: Most of the patients were prescribed at least one of commonly recommended drugs. Only 40% of them were treated by combinations of beta-blockers, ACE inhibitors/angiotensin II receptor blockers and statins, which is inconsistent with guideline recommendations in Estonia. Standards of training and quality programs in Estonia should be reviewed and updated aiming to improve an adherence to guidelines of management of acute myocardial infarction in all age and gender groups. [author abstract] [BMC Public Health 2010, 10: 358]
- Young Men's Sexual Behaviour in Finland and Estonia: Opportunities for prevention of sexually transmitted infections
Background: The incidence of sexually transmitted infections (STIs) in most EU states has gradually increased and the rate of newly diagnosed HIV cases has doubled since 1999. STIs differ in their clinical features, prognosis and transmission dynamics, though they do share a common factor in their mode of transmission − that is, human behaviour. The evolvement of STI epidemiology involves a joint action of biological, epidemiological and societal factors. Of the more immediate factors, besides timely diagnosis and appropriate treatment, STI incidence is influenced by population patterns of sexual risk behaviour, particularly the number of sexual partners and the frequency of unprotected intercourse. Assessment of sexual behaviour, its sociodemographic determinants and time-trends are important in understanding the distribution and dynamic of STI epidemiology. Additionally, in the light of the basic structural determinants, such as increased level of migration, changes in gender dynamics and impacts from globalization, with its increasing alignment of values and beliefs, can reveal future challenges related to STI epidemiology. STI case surveillance together with surveillance on sexual behaviour can guide the identification of preventive strategies, assess their effectiveness and predict emerging trends. The objective of this study was to provide base line data on sexual risk behaviour, self-reported STIs and their patterns by sociodemographic factors as well as associations of sexual risk behaviour with substance use among young men in Finland and Estonia. In Finland national population based data on adult men’s sexual behaviour is limited. The findings are discussed in the context of STI epidemiology as well as their possible implications for public health policies and prevention strategies. Materials and Methods: Data from three different cross-sectional population-based surveys conducted in Finland and Estonia, during 1998–2005, were used. Sexual behaviour- and health-related questions were incorporated in two surveys in Finland; the Health 2000, a large scale general health survey, focussed on young adults, and the Military health behavioural survey on military conscripts participating in the mandatory military training. Through research collaboration with Estonia, similar questions to the Finnish surveys were introduced to the second Estonian HIV/AIDS survey, which was targeted at young adults. All surveys applied mail-returned, anonymous, self-administered questionnaires with multiple choice formatted answers. Results: In Finland, differences in sexual behaviour between young men and women were minor. An age-stratified analysis revealed that the sex-related difference observed in the youngest age group (18–19 years) levelled off in the age group 20–24 and almost disappeared among those aged 25–29. Marital status was the most important sociodemographic correlate for sexual behaviour for both sexes, singles reporting higher numbers of lifetime-partners and condom use. This effect was stronger for women than for men. However, of those who had sex with casual partners, 15% were married or co-habiting, with no difference between male and female respondents. According to the Military health behavioural survey, young men’s sexual risk behaviour in Finland did not markedly change over a period of time between 1998 and 2005. Approximately 30−40% of young men had had multiple sex partners (more than five) in their lifetime, over 20% reported having had multiple sex partners (at least three) over the past year and 50% did not use a condom in their last sexual intercourse. Some 10% of men reported accumulation of risk factors, i.e. having had both, multiple sex partners and not used a condom in their last intercourse, over the past year of the survey. When differences and similarities were viewed within Finland and Estonia, a clear sociodemographic patterning of sexual risk behaviour and self-reported STIs was found in Finland, but a somewhat less consistent trend in Estonia. Generally, both, alcohol and drug use were strong correlates for sexual risk behaviour and self-reported STIs in Finland and Estonia, having a greater effect on engagement with multiple sex partners rather than unprotected intercourse or self-reported STIs. In Finland alcohol use, relative to drug use, was a stronger predictor of sexual risk behaviour and self-reported STIs, while in Estonia drug use predicted sexual risk behaviour and self-reported STIs stronger than alcohol use. Conclusions: The study results point to the importance for prevention of sexual risk behaviour, particularly strategies that integrate sexual risk with alcohol and drug use risks. The results point to the need to focus further research on sexual behaviour and STIs among young people; on tracking trends among general population as well as applying in-depth research to identify and learn from vulnerable and high-risk population groups for STIs who are exposed to a combination of risk factors. [author abstract] [Thesis, Department of Public Health, University of Helsinki, Finland, 2009]
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