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Troubled transitions: Social variation and long-term trends in health and mortality in Estonia
Södertörns högskola, Avdelning 4, SCOHOST (Stockholm Centre on Health of Societies in Transition). Stockholms universitet.ORCID-id: 0000-0003-4453-4760
2004 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

This thesis is about social variation and long-term trends in health and mortality in Estonia. After five decades of Soviet occupation Estonia’s independence was re-established in 1991 on the basis of the historical continuity of its statehood. Estonian independence changed political, economic and social realities; it was accompanied by a sharp decline in living standards. By 1994/1995 the socioeconomic and political situation had started to stabilize. Both transitions, the Sovietization and the return to independence, were particularly hard on the population. Life expectancy had improved little or not at all from the 1960s. At the beginning of the 1990s there was an unprecedented fall. From 1995, life expectancy started to rise again.

Cause-specific mortality for 1965–2000 was examined in order to understand both the recent and the earlier long-term health crises in Estonia; educational and ethnic differences in cause-specific mortality were analysed for 1987–1990 and 1999–2000. Self-rated health was examined for 1996/1997. The cause-of-death data come from the national mortality database, and the self-rated health data come from the Estonian Health Interview Survey.

Circulatory diseases, neoplasms, and injuries and poisonings account for over 80% of all deaths in Estonia. Circulatory disease mortality started to decline considerably later than in Western countries, is very high by international standards and was sensitive to sudden social changes in the 1980s and 1990s. Cancer mortality rates among men increased, mostly because of lung cancer mortality. Mortality from injuries and poisonings is extremely high, has increasingly been contributing to Estonia’s long-term mortality stagnation and was the major contributor to the decline in life expectancy in the 1990s. Educational and ethnic differences in mortality increased sharply in 1989–2000. In 2000, male graduates aged 25 could expect to live 13.1 years longer than corresponding men with the lowest education; among women the difference was 8.6 years. Estonian men could expect to live 6.1 years longer than Russian men in 2000; among women this difference was 3.5 years. Injuries and poisonings were mainly responsible for the lagging behind of the lower educated and of Russians; in terms of total mortality the ethnic differences were small and not significant in 1989.

Generally low living standards (particularly a poor diet), and the increasing gap with Western countries, may have contributed to the long-term mortality stagnation from the mid-1960s. In the 1990s, the increasing differentiation of wealth and opportunity, as well as perceived social exclusion and poor adaptation to the social and economic changes, in particular among the low educated and among ethnic Russians, are important determinants of the growing mortality divide in Estonia. Alcohol consumption, in particular binge drinking, has to be seen as a main cause of increasing mortality among middle aged men from the mid-1960s, most evident in those causes of death that can be directly linked to alcohol. It accounts for a considerable part of circulatory disease mortality as well. Alcohol also contributes to educational and ethnic differences in mortality and their widening over the 1990s. Tobacco smoking, similarly, has contributed to long-term mortality stagnation and the widening of educational, but not ethnic, differences in mortality. Adverse living conditions in childhood may also have contributed to the educational and ethnic differences in mortality and to the long-term mortality development in Estonia. Estonia needs to think hard about policies to remedy this situation.

Ort, förlag, år, upplaga, sidor
Stockholm: Centre for Health Equity Studies [Nationellt nätverkscentrum för forskning om ojämlikhet i hälsa] in collaboration with Södertörns högskola , 2004. , s. 146
Serie
Health Equity Studies, ISSN 1651-5390 ; 2
Nyckelord [en]
self-rated health, cause-specific mortality, social transition, social differences, long-term trends, Estonia
Nationell ämneskategori
Sociologi
Identifikatorer
URN: urn:nbn:se:sh:diva-9670ISBN: 91-22-02062-4 (tryckt)OAI: oai:DiVA.org:sh-9670DiVA, id: diva2:428449
Disputation
2004-03-15, Aula Svea, Socialhögskolan, Sveaplan, 13:00
Opponent
Handledare
Tillgänglig från: 2011-06-30 Skapad: 2011-06-30 Senast uppdaterad: 2016-10-10Bibliografiskt granskad
Delarbeten
1. Time trends in cause-specific mortality in Estonia from 1965 to 1989
Öppna denna publikation i ny flik eller fönster >>Time trends in cause-specific mortality in Estonia from 1965 to 1989
1995 (Engelska)Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 24, nr 1, s. 106-113Artikel i tidskrift (Refereegranskat) Published
Nationell ämneskategori
Sociologi
Identifikatorer
urn:nbn:se:sh:diva-9620 (URN)
Tillgänglig från: 2011-06-29 Skapad: 2011-06-28 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
2. Social variation in self-rated health in Estonia: a cross-sectional study
Öppna denna publikation i ny flik eller fönster >>Social variation in self-rated health in Estonia: a cross-sectional study
2002 (Engelska)Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 55, nr 5, s. 847-861Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Over the past 40 years Estonia has experienced similar developments in mortality to other former Soviet countries. The stagnation in overall mortality has been caused mainly by increasing adult mortality. However, less is known about the social variation in health. This study examines differences in self-rated health by eight main dimensions of the social structure on the basis of the Estonian Health Interview Survey, carried out in 1996/1997. A multistage random sample (n = 4711) of the Estonian population aged 15-79 was interviewed; the response rate was 78.3%. This study includes those respondents aged 25-79 (n = 4011) with analyses being performed separately for men and women. The study revealed that a low educational level, Russian nationality, low personal income and for men only, rural residence were the most influential factors underlying poor health. Education had the biggest independent effect on health ratings: for women with less than an upper secondary education the odds of having poor health were almost fourfold (OR = 3.88) when compared to those with a university education, and for men these odds were almost two and a half times (OR = 2.32). Material resources, in this study measured by personal income, were important factors in explaining some of the educational and ethnic differences (especially for Russian women) in poor self-rated health. Overall, we found no differences between men and women in their health ratings. On the contrary, when we controlled for physical health status, emotional distress and locus of control women reported better health than men. Health selection contributed to, but did not explain the differences by structural dimension. This study also showed a strong association of poor self-rated health with three correlates-physical health status, emotional distress and locus of control, although the influence of these correlates on poor health ratings was not seen equally in the different structural dimensions.

Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:sh:diva-9638 (URN)10.1016/S0277-9536(01)00221-0 (DOI)000177094000012 ()12190275 (PubMedID)
Tillgänglig från: 2011-06-29 Skapad: 2011-06-29 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
3. Estonia 1989-2000: enormous increase in mortality differences by education
Öppna denna publikation i ny flik eller fönster >>Estonia 1989-2000: enormous increase in mortality differences by education
2003 (Engelska)Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 32, nr 6, s. 1081-1087Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Social disruption and increasing inequalities in wealth can be considered main recent determinants; however, causal processes, shaped decades before recent reforms, also contribute to this widening gap.

Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:sh:diva-9664 (URN)10.1093/ije/dyg192 (DOI)000187463200041 ()14681279 (PubMedID)
Tillgänglig från: 2011-06-30 Skapad: 2011-06-30 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
4. Increasing ethnic differences in mortality in Estonia after the collapse of the Soviet Union
Öppna denna publikation i ny flik eller fönster >>Increasing ethnic differences in mortality in Estonia after the collapse of the Soviet Union
2004 (Engelska)Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 58, nr 7, s. 583-589Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Political and economic upheaval, increasing poverty, and alcohol consumption can be considered the main underlying causes of the widening ethnic mortality gap.

Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:sh:diva-9654 (URN)10.1136/jech.2003.013755 (DOI)000222021500011 ()15194720 (PubMedID)
Tillgänglig från: 2011-06-29 Skapad: 2011-06-29 Senast uppdaterad: 2017-07-19Bibliografiskt granskad

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