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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 Chile is a unitary State with a democratic government..
The country is divided into 13 political-administrative regions. The estimated
population in June 2001 was 15.4 million. The most densely populated area is
the Santiago metropolitan region. The country has eight indigenous groups that
make up 10% of the total population: Aymará, Atacameño, Quichua, Mapuche, Rapa
Nui , Colla, Kaueskar, and Yámana. The reform of the health sector is one of
the seven major changes proposed for the 2000-2006 period. The purpose of the
reform is to guarantee the right to health for all Chileans, without discrimination;
improve their levels of health; and reduce inequities owing to the socioeconomic
status and geographical location.
Demography:
The demographic profile is in transition. Birth and mortality rates have declined
in recent decades. In 1998, children under age 15 accounted for 28.8% of the
population, the 15-64 years age group for 64.2%, and persons aged 65 and older
for 7%. The dependency ratio was 35.8% in 1998. Life expectancy at birth in
the 1995-2000 period was estimated at 75.2 years.
Economy: The country experienced
sustained economic growth until 1998, with GDP
growing by 7.7% per year. Inflation was 4.7% in
1998 and unemployment rates were moderate. Due to
the crisis of the international markets, growth
turned negative in 1999 around -1.1% and
unemployment rose significantly. Aggregate social
and economic indicators for the country show clear
improvements, expressed in a reduction in poverty
levels from 39.3% in 1990 to 20.6% in 2000 and
growth in per capita GDP of 46.9% between 1991 and
1999, when it reached US$ 4,492. However, inequity
between social groups and regions persists. At the
end of 2000, 10% of the wealthiest households
captured 40.3% of the income, while the poorest 10
% obtained just 1.7%. In 1999, the literacy rate
among people aged 15 or over was 95.5%. On average
Chileans attended school for 9.9 years.
Economically active population grew from 5,500,000
in 1996 to 5,738,470 in 1998. Mortality:
In 1999, the mortality rate was 510.7 per 100 thousand population. In 1999,
age adjusted mortality rates per 100,000 population for broad groups of causes
were: diseases of the circulatory system (150.3), malignant neoplasms (124.2),
communicable diseases (67.5), and external causes (57.6).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): In
1999, the infant mortality rate was 10.1 per 1,000 live births. There was a
drop in early neonatal, neonatal, and postneonatal mortality. The leading causes
of death were perinatal disorders, congenital anomalies, respiratory diseases,
and injuries and poisonings. There were 461 deaths among children aged 1-4 in
1999, or 0.5% of the total, for a rate of 0.4 per 1,000 population. The leading
cause of death was external causes, accounting for 33.4% of all deaths.
Schoolchildren (5-9 years):The
5-9 years age group accounted for 0.3% of total deaths, making it the group
with the lowest age-specific mortality rate (0.20 per 1,000 population). Deaths
reported in 1999 were mainly due to external causes (39%).
Adolescents (10-14 and 15-19 years): The
mortality rate among adolescents between 10 and 19 years was 0.37 per 1,000
population. Injuries and neoplasms were the leading cause of death, 18% of the
total. Analysis for specific rather than broad causes showed the first nine
to be external causes, with suicide by hanging in fourth place for 56 deaths;
41 were young men.
Adults (20-59 years):People
between the ages of 20 and 60 years accounted for 53% of the country's total
population. Adults between the ages of 20 and 44 have a mortality rate of 1.3
per 1,000 population. The leading cause of death was external causes. The mortality
rate of the 45-59 years age group was 5.2 per 1,000 population. In 1998, the
main cause of death was neoplasms contributing 30% of total deaths in this group,
followed by diseases of the circulatory system (21%).
The elderly (60-years and older): The
mortality rate in the 65-79 years age group was 31.5 per 1,000 population. Neoplasms
was the leading cause of death, followed by diseases of the circulatory system
and diseases of the respiratory system.
Workers' health: In
1998, work-related accidents led to a loss of 3.3 million working days. Every
day about 822 workers experience work-related accidents. Close to 2 million
workers have no access to any kind of occupational health protection, and a
large percentage have only limited protection, particularly temporary, workers,
unskilled and laborers.
Health of the indigenous population: There
is a high concentration of indigenous groups in 39 of the country's "communes"
and a significant presence in 26. Standard-of-living indicators are lower in
these "communes" than in other parts of the country, and an association between
poor areas and indigenous areas is high. Infant mortality rates for the Atacameño
are up to 40 deaths per 1000 live births higher than the national average, and
life expectancy for the Aymará is up to 10 years less.
Analysis by type of health problem
Vector-borne diseases :The
last malaria epidemic occurred in March 1945, and no autochthonous cases have
been reported since then. The country is free from the presence of the mosquito
Aedes aegypti. Chagas' disease is endemic in rural and peri-urban areas in the
region of Tarapacá and Libertador General Bernardo O'Higgins, with 850,000 people
exposed. Mortality from the disease increased until 1985 and stabilized over
the last five years at about 55 cases a year. There is no report of Dengue,
plague, or schistosomiasis in Chile .
Diseases preventable by immunization:The last
case of poliomyelitis occurred in 1975. In 1999, reporting of acute flaccid
paralysis was 25% higher than it had been in 1998. In 1996, the last case of
diphtheria was reported. In 1993, one measles case was reported, and in the
following three years, no cases were confirmed. Subsequently, there were localized
outbreaks and sporadic cases of measles, totalizing 58 in 1997, 6 in 1998 and
31 in 1999. In 2000, a country-wide mass vaccination campaign against measles
was carried out in the country. The highest incidence rate of pertussis in 19
years (20 per 100,000 population) was reported in 1999, and in 2000, the incidence
rate was 73% higher than it had been in 1999 (6.4 and 3.7 per 1,000 population,
respectively). Sporadic cases of tetanus and neonatal tetanus occurred at a
constant incidence of 0.1 per 100,000 population over the last decade. In the
years 1997, 1998.1999, 2000, no case of neonatal tetanus was reported. The expanded
program on immunization has had very good results against mumps with the MMR
vaccine. In 1999, the morbidity rate was 15 per 100,000 population. Although
the incidence of rubella had declined due to the introduction of the MMR vaccine,
there was an unexpected increase in the number of cases in 1997 (28 per 100,000)
and 1998 (31), which dropped to 11 in 1999, and to 4.9 in 2000. Since June 1996,
vaccinations against Haemophilus influenzae type B has been gradually increasing,
which has continued to a drop in morbidity in children under five years of age.
National vaccination coverage of infants under 1 year with BCG, anti-measles,
Hib, OPV1, OPV2, OPV3, DPT1, DPT2 and DPT3 was 91% in 1998 and 96% in 1999.
Intestinal infectious diseases:
In 1998, there was an outbreak of cholera in San Pedro (Atacama), with 23 cases.
The incidence rates of typhoid and paratyphoid fever were in clear decline.
The lowest rate (5 per 100,000 population) was reported in 1999.
Chronic communicable diseases: Morbidity
from tuberculosis dropped from 52 per 100,000 population in 1989, to 22 per
100,000 in 1999.
Acute respiratory infections: Influenza
outbreaks generally occur in the cold months, with surges every three or four
years. In 1999, 131 deaths from influenza were reported (0.9 per 100,000 population),
for an increase of 62% over the previous year (81 deaths). The population aged
65 years and older accounted for 89% (117) of total deaths.
Zoonoses:Between
1996 and 1999, rabies did not alter its epidemiological pattern, which is marked
by permanent presentation in the insectivorous bats and sporadic cases in domestic
animals. In this period, there was one case of human rabies. Trichinosis took
the form of sporadic family outbreaks. The rate in 1999 was higher than in 1998
(0.3 per 100,000 population). With regards to human echinococcosis, the number
of notified cases fell slightly from 343 in 1996 to 313 in 1999
Emerging and re-emerging diseases :
Ninety-five percent of hantavirus pulmonary syndrome cases occurred in southern
Chile , mainly affecting rural areas. During 2000, 23 cases were confirmed,
17 in 1999, and 31 in 1998. Meningococcal disease has been endemic since the
1950s, with approximately 500 cases a year. It affects slightly more men (54%)
and children under the age of 5.
HIV/AIDS and sexually transmitted infections:
Because of its prevalence in urban areas, mainly
affects people with access to health care and education. Men who have sex with
men are the main victims. Between 1984 and 2001, 2,479 deaths were reported.
The incidence rate reached 280 per million inhabitants, and it has been rising
systematically over the years. Since the start of the epidemic, 90% of victims
have been men and 10% women, but there has been a relative increase in cases
among women. The total rate of notified sexually transmitted infections is 71,
6 per 100,000. The rates per 100,000 population reported in 1999 were 14.7 for
syphilis, 14.2 for Condyloma acuminatum, and 10.9 for gonorrhea.
Diseases of the circulatory system: These
diseases are the leading cause of death, accounting for 27% of the total. They
are also an important source of morbidity and disability.
Malignant neoplasms: Neoplasms
are the second leading cause of death, accounting for 22% of the total. There
is a greater prevalence of cancers of the digestive organs.
Accidents and violence:
Since 1995, accidents have been the fourth leading cause of death. In 1997 the
rate was 57 per 100.000 population. The risk is higher for men than women. Suicides
accounted for 10.5% of deaths from injuries.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:The policies and plans defined for the period 2000-2006
established strategic goals: (a) stress the importance of citizen health rights,
(b) reform the finance system; (c) prepare a program for equitable access to
health services; (d) modernize the social safety net for health; (e) improve
health guarantees in the public sector; (f) develop a government health promotion
policy; (g) monitor respect for the rights of members of the private health
insurance plans (ISAPRES); and, (h) institutionalize the quality of care. The
Ministry of Health's short-term goals (2000-2002) were to provide timely access
to care, respect the health rights of citizens by adhering to the patients'
bill of rights, and create a national program of user participation.
Health sector reform strategies and programs:To advance reform, the Government established an interministerial
committee in 2000. The basic proposal establishes a guaranteed plan that is
binding on the public insurer (FONASA) and the private insurers (ISAPREs) and
assures effective and timely treatment of the most frequent, most serious, and
most costly diseases. Priority is placed on primary care, and the family and
community health teams will be strengthened. In structural terms, the reform
is intended to create a solidarity fund, financed by government contributions
and three-sevenths of the mandatory health care quotas, which will finance a
guaranteed plan for the members of FONASA and the ISAPREs.
Health system: The
Ministry of Health is the lead agency in the sector. It formulates and establishes
health policies and issues general standards and plans and supervises, monitors,
and evaluates compliance with them. The Health Services, FONASA, the ISAPRE
Authority, the Public Health Institute, and the Central Supply Clearinghouse
(CENABAST) report to the Ministry. There is also an Environmental Health Service
in the Santiago metropolitan region. The Public Health Institute is responsible
for regulating drugs and medical inputs. The health services system is mixed.
Public insurance is provided through FONASA, which receives contributions from
its members and transfers from the national government to cover the indigents
and to carry out public health programs. The private sector is represented by
ISAPREs, which are health insurers. Services are delivered by public and private
suppliers. The vast majority of primary care establishments depend on "communes",
and the hospitals are under the direction of the Health Services. There are
a series of clinics, centers, laboratories, and pharmacies managed by private
individuals or companies. FONASA covers 63% of the population and the ISAPREs
23%. The remaining 14% is covered by other private plans (such as the armed
forces plan) or has no insurance at all. Organization of health regulatory actions:
Health care is regulated by rules that form part of the Ministry of Health's
programs. The programs define coverage, frequency of contacts between users
and services providers, and the responsibilities of the different levels in
the system. The Health Services Directorates are responsible for regulating
public and private health care establishments located in the territory of the
respective Health Service. Health supplies: The drug market is governed by a
series of regulations on standards for products and distribution and sales chains
and is affected by factors such as the significant market share of generic drugs,
the large presence of national laboratories, and the existence of the Ministry
of Health's Central Supply Clearinghouse. There are no price controls on medications.
Generic drugs account for 38% of the total pharmaceutical market. Food quality:
A new regulation governing food safety has been promulgated. There is also a
control and hygiene program with national coverage and coordination, which is
supported by the national network of bromatological laboratories.
Prevention and control programs: The
Ministry of Health's basic programs (children, women, adults, and oral health)
have been designed to take a comprehensive approach, including promotion, prevention,
treatment, and rehabilitation. The Ministry of Health has established specific
prevention programs, including immunization, food supplements, control of respiratory
diseases, prevention of traffic accidents, control of the Red Tide, and eradication
of Chagas' disease. There are also programs that detect uterine cervix and
breast cancer with coverage of 60% and 30%, respectively.
Health analysis:The
Public Health Institute carries out epidemiological surveillance in cooperation
with the Ministry of Health's Epidemiology Department. Through the National
Control Department, the Public Health Institute monitors the national system
for control of pharmaceutical products, food, cosmetics, pesticides for sanitary
and domestic use, and medical articles. Potable water and excreta disposal services:
In 1998, 99% of the urban population had access to potable water through public
systems, 90% had access to sewerage systems, and 4% to mainly septic tanks and
soakaways. One percent of the urban population (115,000 people) had no water
service, and 7% (853,000 people) had no adequate sewage disposal system. Pollution
prevention and control: Studies indicate that metering equipment should be installed
in the cities of Rancagua, Temuco, Valparaiso and Viña del Mar. Organization
of individual health services: The public health network is comprised of ambulatory
and hospital facilities offering services of different complexity. They include
196 general hospitals, 20 high-complexity hospitals, 526 primary care clinics,
1,840 rural health posts and medical stations, and 73 establishments of other
kinds. There is one clinic for about 28,500 people (1 per 17,100 if only FONASA
members are considered). There is one rural post for every 1,900 rural dwellers,
considering only FONASA members, who represent an estimated 14.6% of the total
population. The country has about 30,000 hospital beds or one bed per 5,000
people (or one per 3,000 FONASA beneficiaries). In 1998, there were approximately
1 million discharges from public hospitals. Acute treatment is provided by emergency
services in hospitals and emergency primary care services. The main private
hospital and clinics also offer emergency care. Auxiliary diagnostic and therapeutic
services offered by the public and private sectors. In the public sector, the
services are located in hospitals, and serve demand generated in ambulatory
services and hospital.
Human resources: The
country had 17,467 physicians in 1998 (18 physicians per 10,000 population).
It is estimated that just 8,000 of the country's 18,000 nurses worked in the
public sector. In 2000, the public health sector employed 90,000 people, which
indicates that administrative and service staff accounted for one-third of the
total.
Health research and technology: Health
research is carried out primarily in universities and research centers. The
Government, through the National Science and Technology Council, provides incentives
for health research, that has targeted basic sciences and clinical areas more
than public health. To promote essential research on the country's priority
health problems, the Ministry of Health has developed a national research policy
directed to health policies. Health sector expenditure and financing: In 1999,
average per capita spending for the total beneficiary population of FONASA and
ISAPREs was US$ 279 (US$ 245 for FONASA beneficiaries and US$ 362 for ISAPRE
beneficiaries). The public sector is financed from government contributions,
quotas, and copayments by members of the public system and operating system.
In 1999, this distribution was 54%, 39%, and 7%, respectively; in 1990, the
figures were 41%, 53 % and 6%, respectively. Direct contributions by municipalities,
which average US$ 8.50 per capita in 1998, should be added to these figures.
Spending on health accounted for 17.1% of public social spending in 1999. As
a percentage of GDP, health spending rose from 2.0% in 1990 to 2.8% in 1999.
Technical cooperation and external financing: In 2000, external technical cooperation
was received for projects on the quality of life, mental health, epilepsy, measures
of equity in health, and HIV/AIDS. Efforts were made to seek lines of work shared
with the United Nations system, and between it and its national counterparts.
