1. Estonian experience in NCD control
Maris Jesse
June 13, 2013

2. Population 1,3 mln (2012)
Independent 1918-1940,
re-gained independence 1991
Member of EU from 2004
Transparency International ranking
32
GDP per capita 13 136 € (2012)
Health Expenditure (2011)
• 5,9 % of GDP
• Per person € 704,9
• Public expenditure 79.3 %
•Social health insurance 68.6%

3. Source: Statistics Estonia, 2013; calculation by T.Lai
Cardiovascular
Injuries
Neoplasms
Respiratory
Perinatal
Congenital
Other
Psychiatric
-0.5 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0
Gain in life-excpectancy 1994 vs 2011

4. Laying the foundations: (near) UHC
• Move from state budget funded health care to social health
insurance in 1992
• Coverage 94-96%, incl all children, pregnant women, old-age and
disability pension recievers etc
• Incentivised provider performance
through new provider-payer relations
- contracts and new payment methods
• Challenge of overcoming undertreatment
and catching up with gap
in use of technology
Source: Kiivet, 1998

5. Laying foundations: Strengthening primary care
From hospital-centered health care provision to one based on PHC
1993 – family medicine established as a speciality
residency programme
re-training programme for family medicine
1998 – 2002 gradual implementation of new organisational and
funding model in support of strengthening PHC
Treatment guidelines to support cooperation of primary and specialist
level : - e.g. guidelines for hypertension in 1999, revision in 2012
- targets and indicators in PHC quality bonus system based on
guideline recommendation
- patient materials
Role of FD and nurse in health promotion and prevention:
Training in motivational interviewing (MI) and support materials
From 2013 second nurse focusing more on promotion-prevention

6. Health promotion
1995 – first programs, advocated by the World Bank and financed by
the health insurance
1995 – community level network of health promotion specialists
2005–2011 national strategy on cardio-vascular disease prevention
tobacco
nutrition
strengthening community networks
2007 – Strategy on cancer prevention
tobacco
alcohol
2009 – 2013 support from EU Structural Funds to strengthen NCD
prevention and community health promotion, incl work on
inequities

7. Source: Adult population health behaviour survey, HBSC- NIHD; alcohol-Institute of Economic Research

8. Enhancing balanced nutrition: examples
• Support for balanced nutrition
- kindergartens 3 meals per day, co-payment by parents
- free school lunches until 10th grade (16 year-olds)
- regulated nutritional content
- skills training, sample menus
- professional reputation –
- competition among school chefs
• Internet based aid for planning
menus – from use by schools and
kindergartens to use by
individuals
• National nutrition guidelines
• Renewal jointly with
Scandinavian renewal process

9. Information
Advice , incl online Q&A
Promotion of healthy diet
Social marketing campaigns
Salt calculator:
http://www.toitumine.ee/kampaania/sool/ru/

10. Male cardio-
vascular disease
mortality
by age-group,
comparision to
1989 (1-point line)
Female cardio-
vascular disease
mortality
by age-group,
comparision to 1989
(1-point line)
Source: Causes of death registry, NIHD

11. Lessons and challenges
• Importance of foundations – health system
• Alignment of understanding, objectives, priorities and activities
• Within health system – public health and health care
• Across sectors
• Across levels
• Bilateral and regional cooperation
• Global response to a global challenge