The Health Transition in Estonia: Breaking Away from the Soviet Legacy

  • Luule Sakkeus
  • Kati Karelson
Part of the Applied Demography Series book series (ADS, volume 2)


Estonia, with a total population of slightly more than 1.3 million in 2010, offers an interesting opportunity to investigate the health transition and its determinants. On one hand, Estonia has been among the forerunners of the demographic transition (Coale et al. 1979; Katus 1994). This implies that the so-called epidemiological transition follows the trends of that of Northern and Western Europe (Omran 1971; Caselli 1995). However, the occupation of Estonia by the Soviet Union, which began in the 1940s and lasted for almost 50 years, introduced other systems, one of which pertained to health care. Estonia was brought into this new system that aimed to tackle the challenges of the second and third stages of the epidemiological transition. These challenges had already been overcome by Estonia by the beginning of the occupation. The Soviet Union on the whole was still in the previously mentioned stages. Most of the measures introduced took into account the overall situation in which the diversity of the population was substantial. Therefore, the approach of this past regime and health policy ignored regional variations and was ill suited to the small population of Estonia. Estonia had by that time reached the threshold of the later phase of health transition, as defined by Vallin (2005). The impact of the Soviet health care system, vaunted as a means of conquering all diseases, suppressed any initiative on the part of the population itself and neglected preventive programs. Such programs as existed were mostly oriented toward combating infectious diseases rather than advocating for a healthy lifestyle and early detection (Hertrich and Meslé 1999; Meslé 2004; Cockerham et al. 2002). The results of this approach are clearly manifested in mortality stagnation, starting at the beginning of the 1960s and lasting for almost 40 years in Estonia (Katus and Puur 1997). The deterioration of health in Estonia during the economic transition in the early 1990s, after the restoration of independence, is the continuation of this long-term stagnation. Since the end of the 1990s life expectancy gradually increased and recent years’ findings support our conviction that Estonia is the first country to break away from the Soviet legacy of population health development.


Activity Limitation Binge Drinking Risky Sexual Behavior Immigrant Population Health Transition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Angel, J. L., Buckley, C. J., & Finch, B. K. (2001). Nativity and self-assessed health among pre-retirement Hispanics and non-Hispanic Whites. International Migration Review, 35(3), 784–803.CrossRefGoogle Scholar
  2. Bernstein, J. H., & Shuval, J. T. (1994). Emigrant physicians evaluate the health care system of the former Soviet Union. Medical Care, 32(2), 141–149.CrossRefGoogle Scholar
  3. Cambois, E., & Robine, J.-M. (1999). Life expectancies applied to specific statuses. A history of the indicators and the methods of calculation. Population, 11, 7–34 (English edition).Google Scholar
  4. Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42(2), 189–214.CrossRefGoogle Scholar
  5. Caselli, C. (1995). The key phases of the European health transition. Polish Population Review, 7, 107–125.Google Scholar
  6. Coale, A., Anderson, B., & Härm, E. (1979). Human fertility in Russia since the nineteenth century. Princeton: Princeton University Press.Google Scholar
  7. Cockerham, W. C. (2005). Health lifestyle theory. Journal of Health and Social Behaviour, 46(1), 51–67.CrossRefGoogle Scholar
  8. Cockerham, W. C., Snead, M. C., & DeWaal, D. F. (2002). Health lifestyles in Russia and the socialist heritage. Journal of Health and Social Behaviour, 43(1), 42–55.CrossRefGoogle Scholar
  9. Cornia, G. A., & Menchini, L. (2006). Health improvements and health inequality during the last 40 years. UNU-WIDER Research Paper, 10, 1–28.Google Scholar
  10. Costa, D. L. (2005). Causes of improving health and longevity at older ages: A review of explanations. Genus, LXI(1), 21–28.Google Scholar
  11. Crimmins, E. M. (1990). Are Americans healthier as well as longer-lived? Journal of Insurance Medicine, 22(2), 89–92.Google Scholar
  12. Crimmins, E. M., & Ingegneri, D. G. (1993). Trends in health among American population. In A. Rappaport & J. S. Schieber (Eds.), Demography and retirement (pp. 225–242). Wesport/London: Praeger.Google Scholar
  13. de Jong Gierveld, J., & van Tilburg, T. (1999). Manual of the Loneliness Scale. Amsterdam: Vrije Universiteit. Cited February 27, 2010,
  14. Dykstra, P., van Tilburg, T., & de Jong Gierveld, J. (2005). Changes in older adult loneliness. Results from seven-year longitudinal study. Research on Ageing, 27(6), 725–747.CrossRefGoogle Scholar
  15. EMCDDA (2009). Annual report of the state of the drugs problem in Europe. Lisbon. Cited March 3, 2010,
  16. Erickson, P. (1998). Evaluation of a population-based measure of quality of life: The health and activity limitations index (HALex). Quarterly of Life Research, 7(2), 101–114.CrossRefGoogle Scholar
  17. Estonian Statistics Database (2011). Cited October 19, 2010,
  18. Eurostat (2007). EHIS background and rationale of the questions (version 20/07/2007). Cited February 10, 2010,
  19. Eurostat Database (2010). Cited February 10, 2010
  20. Fries, J. F. (1980). Ageing, natural death and the compression of morbidity. National English Journal of Medicine, 303, 130–135.CrossRefGoogle Scholar
  21. Gold, M., Franks, P., & Erickson, P. (1996). Assessing the health of the nation: The predictive validity of a preference-based measure and self-rated health. Medical Care, 34(2), 163–177.CrossRefGoogle Scholar
  22. Haber, L. D. (1990). Issues in the definition of disability and the use of disability survey data. In D. B. Levine, M. Zitter, & L. Ingram (Eds.), Disability statistics: An assessment (pp. 35–51). Committee on National Statistics. Commission on Behavioral and Social Sciences and Education, National Research Council. Washington, DC: National Academy PressGoogle Scholar
  23. Haug, W. (2000). National and immigrant minorities: Problems of measurement and definition. Genus, LVI(1–2), 133–148.Google Scholar
  24. Helasoja, V., Lahelma, E., Prättälä, R., Petkeviciene, J., Pudule, I., & Tekkel, M. (2007). The sociodemographic patterning of drinking and binge drinking in Estonia, Latvia, Lithuania and Finland, 1994–2002. BMC Public Health. doi: 10.1186/1471-2458-7-241.
  25. Hertrich, V., & Meslé, F. (1999). The health crisis in the Baltic countries: A common and varied experience. Paper presented at The Hague European Conference, The HagueGoogle Scholar
  26. Human Mortality Database (2011). University of California, Berkeley (USA), and Max Planck Institute for Demographic Research (Germany). Cited October 19, 2011. Available at or
  27. Idler, E. L. (2003). Discussion: Gender differences in self-rated health, in mortality, and in the relationship between the two. Gerontologist, 43, 372–375.CrossRefGoogle Scholar
  28. Jagger, C., Gillies, C., Moscone, F., Cambois, E., van Oyen, H., Nusselder, W., Robine, J.-M., et al. (2008). Inequalities in healthy life years in the 25 countries of the European Union in 2005: A cross-national meta-regression analysis. The Lancet. doi: 10.1016/S0140-6736(08)61594-9.
  29. Jylha, M., Kuralnik, J. M., Ferrucci, R., Jokela, J., & Heikkinen, E. (1998). Is self-rated health comparable across cultures and genders? The Journal of Gerontology, 53B(3), S144–S152.CrossRefGoogle Scholar
  30. Kasmel, A., Helasoja, V., Lipand, A., Prättäla, R., Klumbiene, J., & Pudule, I. (2004). Association between health behaviour and self-reported health in Estonia, Finland, Latvia and Lithuania. The European Journal of Public Health, 14(1), 32–36.CrossRefGoogle Scholar
  31. Katus, K. (1994). Fertility transition in Estonia, Latvia and Lithuania. In W. Lutz, S. Scherbov, & A. Volkov (Eds.), Demographic trends and patterns in the Soviet Union before 1991 (pp. 89–111). London/New York: Routlage.Google Scholar
  32. Katus, K. (2004). Life Tables. Estonia 1923–1938 and 1950–2000 (RU Series C, Vol. 22). Tallinn: EKDK.Google Scholar
  33. Katus, K., & Puur, A. (1992). Eesti rahvastiku suremustrend elutabelite analüüsi põhjal [Estonian population’s mortality trends, analysis of life tables] (RU Series B, Vol. 14). Tallinn: EKDK.Google Scholar
  34. Katus, K., & Puur, A. (1997). Mortality development and economic transition: Case of Estonia (RU Series B, Vol. 35). Tallinn: EKDK.Google Scholar
  35. Katus, K., Puur, A., & Sakkeus, L. (2000). The demographic characteristics of national minorities in Estonia. In W. Haug, P. Compton & Y. Courbage (Eds.), The demographic characteristics of national minorities in certain European states. Population studies, 31(2), 131–192.Google Scholar
  36. Katus, K., Puur, A., & Sakkeus, L. (2003). Immigrant population in Estonia. In W. Haug, P. Compton & Y. Courbage (Eds.), The demographic characteristics of immigrant population. Population studies, 38, 131–192.Google Scholar
  37. Leinsalu, M. (2002). Social variation in self-rated health in Estonia: A cross-sectional study. Social Science and Medicine, 55(5), 847–861.CrossRefGoogle Scholar
  38. Leinsalu, M. (2005). Kolme küsitlusuuringu terviseküsimuste võrdlev analüüs [A comparative analysis of questions on health in three population representative surveys]. Cited February 27 2010,
  39. Leinsalu, M, Grintšak M., Noorkõiv R. & Silver B. R. (1998). Estonian Health Interview Survey. Methodological Report. Institute of Experimental and Clinical Medicine, TallinnGoogle Scholar
  40. Mackenbach, J., Stirbu, I., Roskam, A.-J., Schaap, M., Menvielle, G., Leinsalu, M., et al. (2008). Socioeconomic equalities in health in 22 European countries. New England Journal of Medicine, 358, 2468–2481.CrossRefGoogle Scholar
  41. Manton, K. G. (1982). Changing concepts of morbidity and mortality in the elderly population. Millbank Memorial Fund Quarterly/Health and Society, 60, 183–244.CrossRefGoogle Scholar
  42. McDonough, P., & Berglund, P. (2003). Histories of poverty and self-rated health trajectories. Journal of Health and Social Behaviour, 44, 198–214.CrossRefGoogle Scholar
  43. McMichel, A., McKee, M., Shkolnikov, V., & Valkonen, T. (2004). Mortality trends and setbacks: Global convergence or divergence? The Lancet, 363(9415), 1155–1159.CrossRefGoogle Scholar
  44. Meren, M., Raukas-Kivioja, A., Jannus-Pruljan, L., Loit, H.-M., Rönmark, E., & Lundbäck, B. (2005). Low prevalence of asthma in westernizing countries – Myth or reality? Prevalence of asthma in Estonia – A report from the “FinEsS” study. Journal of Asthma, 42, 357–365.Google Scholar
  45. Meslé, F. (2004). Mortality in Central and Eastern Europe: Long-term trends and recent upturns. Demographic research, special collections 2, determinants on diverging trends in mortality, 46–70.Google Scholar
  46. Oja, L., Matsi, A., & Leinsalu, M. (2008). Estonian health interview survey 2006. Methodological report. Tallinn: National Institute for Health Development.Google Scholar
  47. Omran, A. (1971). The epidemiologic transition: A theory of the epidemiology of population change. The Milbank Quarterly, 49, 509–538.Google Scholar
  48. Pallasaho, P., Lundbäck, B., Meren, M., Kiviloog, J., Loit, H.-M., Larsson, K., & Laitinen, L. A. (2002). Prevalence and risk factors for asthma and chronic bronchitis in the capitals Helsinki, Stockholm, and Tallinn. Respiratory Medicine, 96, 759–769.CrossRefGoogle Scholar
  49. Phelan, J. C., Link, B. G., Diex-Roux, A., Kawachi, I., & Levin, B. (2004). “Fundamental causes” of social inequalities in mortality: A test of the theory. Journal of Health and Social Behaviour, 45(3), 265–285.CrossRefGoogle Scholar
  50. Puska, P., Helasoja, V., Prättälä, R., Kasmel, A., & Glumbiene, J. (2003). Health behaviour in Estonia, Finland and Lithuania 1994–1998. Standardized comparison. The European Journal of Public Health, 13(1), 11–17.CrossRefGoogle Scholar
  51. Ramstedt, M. (2002). Alcohol-related mortality in 15 European countries in the post-war period. European Journal of Population, 18(4), 307–323.CrossRefGoogle Scholar
  52. Remennick, L. I., & Shtarkshall, R. A. (1997). Technology versus responsibility: Immigrant physicians from the former Soviet Union reflect on Israeli health care. Journal of Health and Social Behaviour, 38, 191–202.CrossRefGoogle Scholar
  53. Riley, J. C. (2005). The timing and pace of health transition around the world. Population and Demographic Review, 31(4), 741–764.CrossRefGoogle Scholar
  54. Robine, J.-M., Cambois, E., Mormiche, P., & Vandelbaum, J. (2007). Did the prevalence of disability in France really fall sharply in the 1990s? Discussion of questions asked in the French Health Survey. Population, 62(2), 315–337 (English edition).Google Scholar
  55. Robine, J. M., Romieu, I., & Michel, J. P. (2008). Trends in health expectancies. In P. A. Dykstra (Ed.), Ageing, intergenerational solidarity and age-specific vulnerabilities (pp. 99–133). The Hague: KNAW Press. NIDI.Google Scholar
  56. Sakkeus, L. (2007). Population development from the social cohesion perspective. In A. Purju (Ed.), Social Trends (Vol. 4, pp. 10–38). Tallinn: Statistics Estonia.Google Scholar
  57. Sakkeus, L. (2008). Eesti rahvastiku tervise areng [The development of health of Estonian population]. Eesti Arst, 88(Lisa2), 10–21.Google Scholar
  58. Sanders, B. S. (1964). Measuring community health levels. American Journal of Public Health, 54, 1063–1070.CrossRefGoogle Scholar
  59. Sant, M., Allemani, C., Capocaccia, R., Hakulinen, T., Aareleid, T., Coebergh, J. W., et al. (2003). Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe. International Journal of Cancer, 106(3), 416–422.CrossRefGoogle Scholar
  60. Sewell, W. H. (1992). A theory of structure: duality, agency, and transformation. American Journal of Sociology, 98, 1–29.CrossRefGoogle Scholar
  61. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.Google Scholar
  62. Shields, M., & Shooshtari, Sh. (2001). Determinants of self-perceived health. Statistics Canada Health Reports, 13(1), 35–52.Google Scholar
  63. Shkolnikov, M., Andreev, E. M., Jasilionis, D., Leinsalu, M., Antonova, O. I., & McKee, M. (2006). The changing relation between education and life expectancy in central and eastern Europe in the 1990s. Journal of Epidemiology and Community Health, 60, 875–881.CrossRefGoogle Scholar
  64. Shkolnikov, V., Jasilionis, D., Andreev, E., Jdanov, D., Stankuniene, V., & Ambrozaitiene, D. (2007). Linked versus unlinked estimates of mortality and length of life by education and marital status: Evidence from the first record linkage study in Lithuania. Social Science and Medicine, 64(7), 1392–1406.CrossRefGoogle Scholar
  65. Spiers, N., Jagger, C., Clarke, M., & Arthur, A. (2003). Are gender differences in the relationship between self-rated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom. Gerontologist, 43, 406–411.CrossRefGoogle Scholar
  66. Statistics Estonia (2002). Population and housing census 2000. Place of birth and migration, 3, Tallinn: Statistics Estonia.Google Scholar
  67. Tekkel, M., Veideman, T., & Rahu, M. (2009). Health behaviour among Estonian adult population 2008. Survey report. Tallinn: National Institute for Health Development.Google Scholar
  68. Vallin, J. (2005). Diseases, deaths and life expectancy. Genus, LXI, 279–296.Google Scholar
  69. Vallin, J., & Meslé, F. (2005). Convergences and divergences: An analytical framework of national and sub-national trends in life expectancy. A new approach to health transition. Genus, LX(1), 83–124.Google Scholar
  70. van de Water, H. P. (1997). Health expectancy and the problem of substitute morbidity. Philosophical Transactions: Biological Sciences. Ageing: Science, Medicine and Society, 352(1363), 1819–1827.Google Scholar
  71. Verbrugge, L. M. (1985). Gender and health: An update on hypoteses and evidence. Journal of Health and Social Behaviour, 26, 156–182.CrossRefGoogle Scholar
  72. Verbrugge, L. M., & Jette, A. M. (1994). The disablement process. Social Science and Medicine, 38(1), 1–14.CrossRefGoogle Scholar
  73. Vishnevski, A. (Ed.). (2006). Demograficheskaya modernizatsija Rossii 1900–2000 [Demographic modernization of Russia in 1900–2000]. Moscow: Novoje Izdatelstvo.Google Scholar
  74. WHO Health-for-All Database (2010). Cited February 10 2010,

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.Estonian Interuniversity Population Research CentreTallinn UniversityTallinnEstonia
  2. 2.Department of Health Statistics, National Institute for Health DevelopmentTallinn UniversityTallinnEstonia

Personalised recommendations