PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Bermuda is a small group of islands located 586 miles
east of North Carolina, U.S.A., in the Atlantic Ocean. The islands cover an
area of 20.5 mi˛ with a maximum elevation of about 260 feet. The climate is
subtropical, mild, frost-free and humid. Hurricanes during the season May to
November are the only potential cause of natural disasters. Bermuda is the oldest
self-governing British Dependent Territory with the Westminster parliamentary
system of government. The Premier appoints a Cabinet of 12 members. The Legislature
consists of a Senate whose 11 members are appointed by the Governor and a House
of Assembly with 40 elected members.
Demography:
The population was estimated at 61,688 in 2000, female (52%) and male (48%).
19 % of the population was under 15 years of age, and 10% of the population
was 65 years or older. In 1999, the crude birth rate was 13.2 per 1,000 population
and the annual population growth rate was 0.7%. Life expectancy at birth around
2000 was estimated at 75 years for males and 79 years for females. The racial
composition of population has not changed substantially over the past decade.
In 1998, 61% of the island's residents were Black and 39% White and other races.
Census data indicated that 75% of the Bermuda-born population was Black, while
the foreign-born population was primarily White and other races (79%). In the
period 1997-2000, half of the population belonged to three religious groups:
Anglican (28%), Catholic (15%) and African Methodist Episcopalian (12%).
Economy:There
are virtually no natural resources on the island and it must import almost all
of its consumable goods. The economy is based almost entirely on tourism and
international company business. About one third of the work force is engaged
in wholesale retail trade, one third in restaurants and hotels; another third
is engaged in community, social and personal services. The country generally
showed a small balance of payments surplus; the Bermuda dollar (BD$) is pegged
to the U.S. dollar on an equal basis. Inflation was estimated at around 2.7%
per annum in 2000. GDP increased from US$ 1.9 billion in 1996-1997 to US$ 2.1
billion in 1998-1999. In 2000, Bermuda had one of the highest per capita incomes
in the world, with an estimated purchasing power parity of US$ 33,000 per capita.
A survey in 2000 estimated the employed male population at 19,310 and the employed
female population at 18,707. Women constituted 50% of the workforce, and 30%
of the workforce were foreign born. There were 27,200 households in 1998 and
household size continues to decrease. In 2000, it was estimated that 36% of
households were headed by females.
Education:Education
is free in public schools and compulsory up to the age of 17 years. In 1998
a total of 10,163 students were enrolled in both public and private primary
and secondary schools, and in Bermuda College. The literacy rate has been estimated
as being as high as 97%.
Mortality: In
1999, the crude mortality rate was 7.1 per 1,000
population. Diseases of the circulatory system
accounted for 39% (176) of total deaths in 1999,
while malignant neoplasms accounted for 31% (138).
There were 30 deaths due to communicable diseases,
including 9 from HIV/AIDS, 24 due to external
causes, and 2 originating in the perinatal period.
Diseases of the circulatory system and malignant
neoplasms were the first and second leading causes
of death every year from 1990-1998. Respiratory
diseases, AIDS, accidents, violence, and diabetes
have also been among the leading causes of death
since 1997.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):4.1%
of newborns had a birth weight of 2,500 grams or less compared with 1992 when
there were 7% low birth weight infants. There were 8 infant deaths and 6 stillbirths
during 1997-2000; no infant deaths in 2000. There were no recorded deaths in
infants due to communicable diseases during 1995-1999. For infants up to 1 year
old, respiratory diseases were the leading cause of hospitalization. For children
1-14 years old the leading causes were respiratory diseases and accidents.
Adolescents (10-14 and 15-19 years):
In youths 15-19 years old, accidents were the leading causes of death and one
of the major causes of hospital admissions along with pregnancy and respiratory
diseases. Decreases in the incidence of dental decay have been maintained over
the past decade and oral health in children is generally excellent. This is
largely attributed to a preventive dental care program for infants and children
that provides free fluoride treatment.
Adults (20-59 years): According
to the 2000 Census, 36,317 persons, over 59% of the total population, were between
the ages of 25 and 64 years. In 2000, the National Drug Commission conducted
a survey of middle and secondary school students, which showed that 28% of those
surveyed, drink alcohol, 10% use tobacco, and 14% use marijuana. Another survey
in a same age group, revealed that 276 (8%) students had seriously considered
suicide in the last year, 64 % were females. The survey found suicide to be
the third leading cause of death among adolescents. Obesity is a public health
concern, 10% of children and adolescents are overweight or obese. During 1996-2000,
there were 25 deliveries to females 15 years and younger, of which 18 were live
births, 386 deliveries to 16-19-years-old, and 411 live births to 16-20-years-old.
There were 58 deaths from diabetes during 1997-1999, and 860 admissions to the
hospital due to diabetes during 1997-2000. Diseases of the circulatory and digestive
systems, and cancers were the leading causes of admission in the age group 50-64
years. The Adult Wellness Report in 1999 identified that 35% of adults were
obese and 57% were overweight and/or obese. In 1999, 95% of women 40 years of
age and older had a Pap smear, and 60% of men over 40 years had a prostate exam.
In 2000, 95% of women received prenatal care, all births took place in hospital.
Of the 4,168 births during 1996-2000, 23% were to women 35 years and older.
Elderly (60 years and older):
The elderly represent the fastest growing segment. Among this age group the
leading causes of death include heart disease and cancer. Among the 65-74-years-old,
the most common causes of hospitalization included diseases of the circulatory
system, cancer and diseases of the digestive system. For those 75 and older
the major causes of hospitalization were diseases of circulatory and respiratory
systems. Data from the general hospital indicates that 85 persons age 65 years
and older were hospitalized due to pneumonia, 84 for intermediate coronary syndrome,
81 for congestive heart failure, and 75 for cataracts between the period mid-1998
to mid-2000.
Workers' Health: The
office of Health and Safety oversees the enforcement of health regulations in
the workplace. "No smoking" policies are in place in Government offices and
other institutions. There were no industrial site fatalities during 1995-2000.
Disabled: Two
special education facilities are available for handicapped and impaired children.
A specially equipped housing complex, Summerhaven, is available for physically
impaired adolescents and adults. In 2000, an agency was established to oversee
the implementation of universally recognized human rights for disabled persons.
Analysis by type of health problem Diseases preventable by immunization: Immunization
against all five of the common preventable childhood diseases (measles, rubella,
DPT, polio and mumps) has been maintained at consistently high levels. Hepatitis
B and Haemophilus influenzae type b are also included in the national immunization
plan.
Intestinal infectious diseases: There
were 187 cases of Salmonella and 4 cases of shigellosis during 1997-2000.
Acute respiratory infections:
62 deaths due to this acute respiratory infections occurred during 1997-1999;
only 4 affected were younger than 60 years.
HIV/AIDS: HIV and AIDS, fist reported in 1982,
present a major public health problem. By the end of 2000, a total of 453 cases
had been recorded and 79% had died. Females accounted for 24% of all reported
cases. 90 % of the total cases occurred among the Black population. Most cases
(46%) occurred in the age group 30-39 years, followed by the age group 40-49
years (30%) and only 10% presented the age group 20-29 years. The percentage
of cases occurring in intravenous drug users has gradually declined while there
has been an increase in cases in homosexual and bisexual men and among the heterosexual
partners of persons infected with HIV.
Sexually transmitted infections: Reported
cases of gonococcal infections decreased, while the rates of reported cases
of syphilis, Chlamydia, and nonspecific urethritis have increased slightly.
During 1997-1999, there were 252 (22%) cases of sexually transmitted cases,
excluding HIV/AIDS.
Diseases of the circulatory system: Death
rates for heart disease remain unacceptably high during 1997-2000. In 1999,
there were 176 deaths from cardiovascular disease, of which 38 were due to acute
myocardial infarction, 25 to cerebrovascular disease, 20 to chronic ischemic
heart disease, 15 to atherosclerotic heart disease, and 6 to atherosclerosis.
%).
Malignant neoplasms:In
1999, there were 138 deaths from malignant neoplasms; of these, 27 were malignant
neoplasms of the trachea, bronchus, or lung, 17 of the prostate, 13 of the female
breast, 10 of the pancreas, 4 of the stomach, and 2 of the uterus. About one
of every four deaths was attributed to cancer, which has increased in frequency
as a cause of death.
Accidents and violence:From
1997-1999, 67 deaths occurred from violence and accidents. Accidents are major
public health problems that contribute substantially to morbidity and mortality.
Although alcohol analyzers have been introduced, and road safety campaigns are
on-going, fatalities from motor vehicle accidents remain high. Accidents were
the major cause of death among 15-34 -year-olds; males are affected disproportionately.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:Health policy emphasizes several areas, including
maternal and child health, health of schoolchildren, community nursing for the
elderly, dental health, control of communicable diseases, mental health, and
alcohol and drug abuse. Population groups designated for special attention include
mothers and infants, school-age children, and the elderly.
Health sector reform: Reform
activities focused on many areas, particularly quality assurance in hospitals,
physician accountability, and program management. During 1997-2000, reviews
were carried out to find strategies to contain escalating drug and health care
costs, and at the same time meet the needs of the elderly and of the poor. To
increase availability of pharmaceuticals for these groups, reconstruction of
insurance schemes is considered.
Health system: Responsibility
for public health care systems lies with the Ministry of Health and Family Services.
The Ministry is mandated to promote and protect the health and well being of
the islands' residents and is charged with assuring the provision of health
care services, setting standards and providing coordination of the health care
system. The Minister of Health sets public policy and reports to the Cabinet.
The Ministry has responsibility for health planning, and evaluation; there is
no central planning agency. The Ministry comprises several departments and agencies,
including the Department of Child and Family Services, the Department of Financial
Assistance, the Housing Corporation, and the National Drug Commission. Each
department is responsible for its own operation, under the authority of the
Permanent Secretary, and the direction of the department head or director. The
ministry is also responsible for the islands' hospitals. There is one acute
care hospital on the island, the King Edward VII Memorial Hospital, the general
hospital with 226 beds; and St. Brendan's Hospital, a psychiatric hospital with
120 beds. Bermuda has no universal, publicly funded health insurance. Insurance
schemes are provided through private companies, public agencies, and employers.
Government employees are insured through the Government Employees Health Insurance
Scheme. Hospitalization insurance is mandatory for all employed and self-employed
persons. Both employers and employees contribute to hospitalization insurance,
with employers contributing 50% of the premium cost. Hospitalization is free-of-charge
to children and the elderly, covered through the Government subsidy to the Bermuda
Hospitals Board.
Human resources: In
general, Bermuda has sufficient human resources to meet its health needs. There
were 16.7 physicians per 10,000 population in 1999. Out of 105 island physicians,
33 are in general/family practice, 9 are specialized in internal medicine, and
the rest are divided up into 17 other specializations. Nurses represent the
largest group of health care providers in the country; there were over 800 licensed
nurses, including registered nurses, and psychiatric nurses in 1999. Registered
nurses constitute 75% of the nurses. Most nurses were hospital based; a significant
proportion of these were non-Bermudian. There is an ongoing nursing shortage
in some nursing specialties. There were 4.6 dentists per 10,000 population.
There were 27 dentists in active practice; 5 were in the public health service.
Most private dentists have independence practices. Specialized dentistry, i.e.
periodontics, orthodontics, is available. Health care providers such as nurse
midwives are registered but do not provide independent care. There were a variety
of allied health personnel, including 15 physiotherapists, 7 speech-language
pathologists, 10 nutritionists/dietitians, 40 medical lab technologists, 23
radiographers, and 15 occupational therapists. There were 38 pharmacists who
provide services ranging from retail pharmacy to clinical pharmacology. Most
pharmacists were employed on a salaried basis. Bermuda has no medical schools
or graduate medical education programs. Continuing medical education is required
for hospital based physicians. Refresher courses and a degree program for trained
nurses have been developed at the Bermuda College in conjunction with overseas
institutions. Training programs for emergency medical technicians have been
established by both the Bermuda Fire Service and the Bermuda Hospitals Board.
Public and individual health care services:
During 1997-2000, "Health for Success" was
developed to establish a network, which expands health promotion activities
in schools and communities. Television and radio advertising of tobacco products
is prohibited, and the advertisement in newspapers is controlled. Potable water
and sanitary excreta disposal are handled on an individual household basis;
hotels and other establishments have their own systems. By law, well water is
to be used only for non-drinking purposes. The Ministry also monitors food handlers
and itinerant food vendors. Primary health care services are delivered at private
physicians' offices, Government health centers and hospital outpatient clinics.
Additional ambulatory care services are provided through specialty clinics and
the emergency room at the hospital. A substantial proportion of primary health
care is delivered through the private sector. The majority of physicians and
dentists are independent, private practitioners. Most other health care providers
are employed on a salaried basis by the hospitals, the Public Health Service
or by private physicians. There are no health maintenance organizations; independent
practice associations; or preferred provider organizations. There are no provisions
for pre-paid medical care. There are a small number of multispecialty group
practices and a limited number of partnerships involving specialists. Primary
care physicians, including internists and pediatrics, constitute 50 % of all
physicians in active practice. General practitioners and other primary care
physicians coordinate care and control access to other specialists. Almost all
physicians have admitting privileges at the hospitals. Mental health services
are provided through psychiatrists, psychologists, a psychiatric social worker
and mental welfare officers attached to St. Brendan's. St. Brendan's
provides outpatient care, a halfway house and other community facilities for
the mentally ill and mentally handicapped. The Hospitals Board and the Government
operate long-term care facilities, including the skilled nursing care facility
Lefroy House, with 57 beds and the Extended Care Unit at the general hospital,
with 90 beds. There is also a hospice facility for the terminally ill, Agape
House, and eleven residential care facilities for the elderly. In addition to
its specialty, ambulatory care clinics, the general hospital operates a primary
care clinic for indigent patients. There are traditional links for the provision
of tertiary care with the U.S.A., U.K., and Canada.
Health care delivery: The
Department of Health is mandated to provide disease prevention and control,
and health promotion services for the island. It serves as a regulatory agency,
and monitors food safety, water and air quality. It also provides for a variety
of public health services including personal health and dental health as well
as environmental health services. The public health service is substantially
involved in providing personal health services and administers a number of traditional
public health programs including: maternal and child health, school health,
immunization, communicable disease control, as well as home health care (including,
health visiting and district nursing and select specialized care, i.e., AIDS),
rehabilitation, health education and health promotion programs. Bermuda is divided
into three health regions to facilitate the delivery of public health services.
These centers offer prenatal care, family planning, immunizations, child health
and other primary care services, as well as dental clinics for children. Private
voluntary agencies assisted by Government provide some specialized services,
such as community based oncology nursing, personal services for HIV infected
persons, and others. The general hospital and the St. Brendan Hospital are administered
by the Bermuda Hospitals Board, a statutory body appointed by the Ministry of
Health and Family Services. Both hospitals undergo periodic accreditation reviews
by the Canadian Council on Hospital Accreditation. There are no private hospitals
in Bermuda.
Health sector financing: Health services are
either paid through an insurer, by a Government agency or by consumers. The
prevailing method of payment for doctors and dentists is fee-for-service. There
are no Government controls on physicians' fees; however, a fee schedule for
hospital-based physician services is established annually by the Bermuda Medical
Society and the Health Insurance Association of Bermuda. Funding for the general
hospital is provided through a variety of mechanisms, including insurance and
Government subsidies. Government expenditure on health and social services amounted
to US$ 105.3 million in 1996-1997 and US$ 112.3 million in 1998-1999.
