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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 The Netherlands Antilles consist of five islands:
Curaçao, Bonaire, Saba, Saint Eustatius , and Saint Martin. Their total area
is 800 km2, and their population, 203,278 persons, for a population
density of 254.1 inhabitants per km2, with great variations between
the islands. The Netherlands Antilles are an autonomous territory within the
Kingdom of the Netherlands ; they are responsible for their own administration
and political affairs. The system of government is a parliamentary democracy,
with elections every four years. There are two levels of government: the central
government, with a Parliament made up of representatives of all the islands;
and the local government of each island, which consists of an Island Council
and a Legislative Assembly.
Demography: During
the 1996-1999 period , the birth rate declined from 18.1 per 1,000 population
in 1996 to 13.7 per 1,000 in 1999. Life expectancy at birth in 1998 was 71.8
years for men and 77.7 years for women.
Economy: In
1997, the country's main economic activity was wholesale and retail trade,
followed by real estate activities. In nominal terms, the GDP increased 3.5%
yearly and the GNP 2.9% yearly between 1994 and 1997. Nevertheless, GNP (in
1990 prices) declined 2.1% in 1997. Estimated GDP per capita fell 5.9% from
US$ 8,052 in 1994 to US$ 7,575 in 1997. On Curaçao , the import-export sector
of the economy employs the most people. The unemployment rate increased steadily
from 12.8% in 1994 to 16.6% in 1998, dropping to 14% in 2000. On all the islands,
the unemployment rate is higher among women.
Mortality: The
available mortality data are for 1994. Of the six major groups of causes of
death, the leading one is diseases of the circulatory system, with 34.4%,
followed by malignant neoplasms (22.9%), other diseases (19.8%), infectious
and parasitic diseases (10.2%), and external causes (7.9%). With regard to
years of potential life lost (YPLL) due to specific causes, AIDS ranked first
with a rate of 7 per 1,000 population , followed by transport accidents and
homicides with 5.5.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): The
infant mortality rate in 1994 was 11.6 per 1,000 live births (lb) and was higher
among females (12.3 per 1,000 lb). The infant and neonatal mortality rates on
Curaçao were 11.6 and 7.1 per 1,000 lb, respectively, in 1994. The main causes
of infant mortality in 1994 were certain conditions originating in the perinatal
period, with a rate of 6.1 per 1,000 lb, as well as birth defects with 1.9 per
1,000 lb. There has been a steady decline in the number of annual births from
1997 to 2000.
Schoolchildren (5-14 years): In
1994, there were four deaths in this age group, due to AIDS, malignant neoplasms,
accidental drowning, and mental disorders.
Adolescents (15-24 years):
In 2000, there were 2,371 births, 9.6% of them to teenage girls 13-19 years
of age and 0.2% to girls under age 15. In 1994, adolescents accounted for nine
deaths due to transport accidents, six homicides, two deaths due to other accidents,
and two deaths due to diseases of the nervous system, excluding meningitis.
Adults (25-59 years):In
1994, the leading causes of death among adults were AIDS (16.5% of all deaths),
homicides (10.3%), diseases of the cardiopulmonary system (7.2%), transport
accidents (7.2%), and suicides (7.2%). The prevalence of hypertension was 7.7%,
while that of diabetes mellitus was 1.7%. In 1998 the most commonly used birth
control method was the condom, followed by oral contraceptives. The trend in
maternal mortality in Curaçao has fluctuated due to the small number of maternal
deaths-one per year, except during 1991-1992, when there were three per year.
The elderly (60 years and older): In
1994, the mortality rate in this group was higher among males (61.3 deaths per
1,000 population ) than among females (4.6 per 1,000 population). The main causes
of death among older persons were diseases of the cardiopulmonary system, followed
by cerebrovascular diseases, malignant neoplasms, ischemic heart disease, and
acute respiratory infections. The most common chronic disorders were arthritis
and arthrosis (32%), hypertension (28.2%), and diabetes mellitus (15.1%).
The disabled:The
most common disability in the adult population over age 40 is blindness, whereas
among adults under age 40 the most common physical disabilities have been caused
by accidents. The prevalence of mental retardation is estimated at 3%.
Analysis by type of health problem Natural disasters: The
Netherlands Antilles suffered through Hurricanes Luis (1995), Georges (1998),
and Lenny (1999).
Vector-borne diseases:
In 2000, 110 suspected cases of dengue were reported (89 on Curaçao ); 31 of
the cases were confirmed serologically, and 5 of them were classified as hemorrhagic
dengue fever. The dengue-3 serotype was isolated.
Intestinal infectious diseases: I
n 1995 the most common agent was Salmonella (48.5%), followed by Shigella (35.4%).
Salmonella typhi was diagnosed in one patient from India . In 1999 and 2000,
there was an increase in diagnoses of Campylobacter, which in 1999 was the second
leading cause of intestinal infectious disease (36.1%) after salmonellosis (40.7%),
and in 2000, the leading cause with 53.4%.
Acute respiratory infections: In
1995, the rate of acute respiratory infections in those over 18 years of age
in Curaçao was 3.5 per 100,000 population on Curaçao , 3.4 on Bonaire, 3.9 on
Saint Martin, 4.6 on Saba, and 2.8 on Saint Eustatius . In 1994, acute respiratory
infections were the fifth leading cause of death on Curaçao.
HIV/AIDS: The
HIV-positive population has access to medication. The number of people infected
with HIV increased from 55 in 1986 to 1,069 in 1999, and between 79 and 88 cases
were diagnosed annually in the period 1995-1999. The rate of HIV infection is
higher among men, with a male-female ratio of 1.3:1. Heterosexual transmission
predominates, and the highest risk of HIV infection can be seen in the 15-24
years age group.
Sexually transmitted infections: Tracking
of these infections has begun in sentinel centers. For the time being, laboratory
data are not available.
Nutritional and metabolic diseases: Obesity
is a serious health problem on the islands. A 1997 study found the prevalence
of obesity on Curaçao to be 19% among males and 36 % among females. Diabetes
mellitus is also a serious public health problem on the islands. According to
the 1995 Curaçao Health Study, the prevalence on that island was 5.6%.
Diseases of the circulatory system:In 1994, diseases of the cardiopulmonary system were
the leading cause of death in the country, and ischemic cardiopathy was the
third leading cause among both males and females. In 1995, the rate of hypertension
was 14.5%.
Malignant neoplasms: Malignant neoplasms are
the second leading cause of death among the broad groups of causes, with a rate
of 120 per 100,000 population . Up to age 14, the most common malignant neoplasms
are leukemia (with 45.8% of the total incidence) and neuroblastomas (with 37.5%).
Accidents and violence:
Among external causes, accidents account for the most deaths, with transport
accidents in first place, followed by drowning and accidental falls.The second
leading external cause of death is homicide, followed by suicide.
Oral health:
T he DMFT index in the group of 12-year-olds was 1 per 100, and among adults
it was 8 per 100. In both groups, the prevalence of periodontal disease, in
accordance with the community periodontal index, exceeds 85%, which represents
a major problem in the population.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:The major political parties that make up the coalition
government of the five islands signed the "Governing Accord on the Program for
Economic and Financial Recovery," which was in effect from 1998 to 2000. It
called for the drafting of an urgent plan of action to revive the economy, create
jobs, reduce poverty, improve the country's social situation and public finances,
and develop a comprehensive program for young people to reduce unemployment,
drug use, and crime through both preventive and law-enforcement measures. Enhancing
public administration at the central level and on the islands is a priority
of the plan. The public sector, particularly health care, is being revamped,
including cuts in expenditures and in administrative personnel. The plan also
emphasizes the urgent need to restructure the Department of Public Health and
Environmental Hygiene. One of the suggestions in this regard is to separate
public health management from health inspection. Prevention programs are being
updated, and the importance of monitoring and assessment activities is being
emphasized. The law on food imports (fish, dairy products, etc.) to the islands,
which includes quality control and inspection, went into effect in 1996. As
for the environment and nature, sustainable development is being promoted, with
the participation of the health, education, and economic affairs sectors.
The health system: The
national plan for the recovery of the health system went into effect in 1998.
Among its priorities were to implement systems to investigate the effectiveness
of health services, to deepen the processes of decentralization and institutional
mergers, to enhance the decision-making ability of personnel in the health system
through training, and to privatize several health services, among them the mental
health clinic, the office for the prevention of drug use, and the public health
laboratory. A basic care package for general social insurance is under study.
Data published by the CSO indicate that the social security system guarantees
a minimum of resources for each family to meet its basic needs. Government agencies
provide social support for vulnerable groups, among them older persons, widows,
and orphans. The Department of Adolescent and Youth Care in the Department of
Public Health and Environmental Hygiene is working on a health care plan that
prioritizes health promotion.
Organization of public health care services:Health promotion activities focus on the prevention
of noncommunicable diseases associated with the high prevalence of risk factors,
among them obesity, poor diet, and a sedentary lifestyle.
Health analysis, epidemiological surveillance,
and public health laboratory systems: On Curaçao
and Saint Martin , there are sentinel clinics that monitor signs, symptoms,
and well-defined syndromes.
Potable water, excreta disposal, and sewerage
services:Curaçao , Bonaire , and Saint Martin
have appropriate potable water and sewerage services. Desalinization plants
produce high quality water, but at high cost.
Solid waste services:
The islands have solid waste collection services operated by private companies
under the supervision of the local authorities.
Organization of individual health care services:
Secondary health care is provided in hospitals.
There are 7 on Curaçao , with a total of 1,187 beds, 46% of them in Saint Elizabeth
Hospital and 16.9% in the specialized institutes for the disabled and drug addicts.
Bonaire has Saint Francis Hospital , with 60 beds; Saint Martin , the Saint
Martin Medical Center , with 74 beds; Saint Eustatius , the Queen Beatrice Medical
Center , with 20 beds, and an auxiliary home with 12 beds. There is a Medical
Center with 14 beds on Saba . The Government was in charge of mental health
care until May 2000, when it was privatized; it is currently the responsibility
of a foundation hired by the Government. The mentally disabled can be admitted
to institutions run by foundations. There are 12 elder-care homes, which together
have 739 beds. There is one blood bank on Curaçao , run by the Red Cross
Human resources:In
1998, the economically active population numbered 54,182 persons, of whom 4,207
(7.8%) worked in the health sector. The ratios of health care personnel per
10,000 population in the main categories are: 16.5 physicians, 32.7 nurses,
3.1 dentists, 1.4 nutritionists, 1.2 psychologists, and 0.5 midwife. The University
of the Netherlands Antilles has three departments: law, social and economic
sciences, and technology.
Health research and technology: Projects
are carried out with financing from the Netherlands and international agencies.
