Biennial Collaborative Agreement (BCA) 2018-2019

Health situation analysis

Since regaining independence, the health status in Estonia has shown significant improvements. Life expectancy at birth has increased in 20 years by nearly 8 years reaching 77.8 years (2016). The increase in life expectancy is the result of reduction in mortality, especially due to the decline in cardiovascular deaths, and is closing the gap with European Union (EU) averages (3.5 years in 2014).  At the same time large health inequalities in health status persist and gains in life expectancy are spent in less good health than in other countries. There are big gender and socioeconomic disparities in life expectancy.  Boys born in 2016 can expect 8,7 years shorter life expectancy than girls. At the same time life expectancy at birth for university-educated Estonians is more than 14 years higher than for those with no more than lower secondary education.

Similar to other developed countries, the main causes of mortality are cardiovascular diseases (52% in 2016), cancers (25%) as well as injuries and external causes (6%). The lifestyle risk factors causing the high level of disease burden are harmful use of alcohol, use of tobacco, unhealthy diet and insufficient physical activity. However, there are positive trends in some lifestyle risk factors, such as alcohol consumption has since 2010 decreased by 13% – from 11,4 liters of absolute alcohol per adult population to 9,9 liters in 2016. In the same way daily smoking has declined by 15% and physical inactivity 9%. A growing public health concern is the steadily increasing prevalence of overweight and obesity. Over half of the adult population has excessive body weight (51.7%) and almost one in five persons is obese (19,2% in 2016).

The persistently high HIV incidence is still a public health challenge. The new infections exceed the EU average four times. Illegal drug use and use of unsafe injecting equipment have been the main driver for the HIV epidemic, however the potential pockets of infections among general population are of rising concern. Also immunization coverage is slowly but steadily on decline, below the WHO recommended thresholds, creating vulnerability for potential outbreaks of vaccine-preventable illnesses.

Estonia has been over decades implementing effective health system reforms. Health spending in Estonia is lower than in most other EU countries and the financing system is vulnerable due to ageing population and economic downturns. There is a need for further strengthening people-centered health system based on primary care. The need to ensure the continuity of care and chronic disease management and inter-sectoral links between health care, public health and social care is one of the priorities.

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Priorities for collaboration

In Estonia Health 2020 vision is carried out mainly through an intersectoral value-based policy document, National Health Plan 2009-2020 (NHP), which covers priority areas of Health 2020 in most parts and is linked to the national development agenda – Sustainable Estonia 21. In addition government-level NHP with its multisectoral steering body provides a good potential for whole-of-government approach through intersectoral planning and action.

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Linkage of BCA with national and international strategic frameworks

This Biennial Collaborative Agreement (BCA) for Estonia supports the realization of Estonia’s National Health Plan 2009-2020. This BCA has already identified the related key Sustainable Development Goals (SDGs) targets and indicators.

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Programmatic priorities for collaboration

The collaboration programme for 2018–2019 as detailed in Annex is based on the country specific needs and the WHO regional and global initiatives and perspectives and was mutually agreed and selected in response to public health concerns and ongoing efforts to improve the health status of the population of Estonia. It seeks to facilitate strategic collaboration enabling WHO to make a unique contribution. The programme budget outputs and deliverables are subject to further amendments as stipulated in the Terms of Collaboration of the BCA. A linkage to the related Sustainable Development Goals targets and indicator is provided for every programme budget output, as described in Annex.

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