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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 Aruba is part of the Antilles and the smallest and
westernmost island of three Dutch Leeward Islands - Aruba , Bonaire and Curaçao
. It covers approximately 180 km2, and is divided into eight districts.
The island has a tropical climate and temperature ranges between 21o
C and 26o C. Rainfall averages 18 inches per year and because the
island lies outside the hurricane belt, it experiences, at most, only minor
effects of tropical storms. Dutch is the official language, used both in educational
and in the civil service. The native language, Papiamento, is used in the Parliament
and in the media and it is only spoken on these three Dutch islands. English
and Spanish are compulsory in the last grades of elementary school and are spoken
by much of the population. Aruba used to be part of the Netherlands Antilles
, along with Bonaire , Curaçao , St. Maarten , Saba , and St. Eustatius . In
1986, it separated from this federation, to become an autonomous entity within
the Kingdom of the Netherlands . Aruba is autonomous in its administration and
policy making, but the matters of defense, foreign affairs, and Supreme Court
decisions are under the Kingdom of the Netherlands . Aruba continues to have
strong economic, cultural and political ties with Holland.
Demography:The
total population increased 43%, from 66,687 inhabitants in 1991 to 95,201 in
1999, most of each attributable to immigration. From 1985 to 1999, population
density increased steadily from 341 to 529 inhabitants per km2. The
fertility rate during the 1995-1999 period decreased steadily from 68.2 per
1,000 women aged 15 to 44 years in 1995 to 52.7 in 1999. The crude birth rate
also decreased, from 17.4 per 1,000 inhabitants in 1995 to 13.0 in 1999. In
2000, life expectancy at birth was 73.2 years for males and 81.2 years for females.
A total of 21.3% of the population was under 15 years of age and 15.4% was older
than 60 years of age.
Economy:
Between 1986 and 1990, the average growth of the royal GDP in Aruba was 16.3
% each year, while in the 1991-1998 period, it slowed to 3.8% annually. The
purchasing power parity reached 11,352 US dollars in 2000. Throughout the 1990s,
the country underwent imbalances in the labor market, housing, utilities, health,
and education, and in other sectors. The most active section in the economy
is the service sector, and the tourism by far plays the most important role,
and its importance is growing. Of all jobs held in 1997, around 17% were directly
related to the hotel industry. Aruba 's share in the Caribbean tourism market
increased from 2.1% in 1986 to 4.3% in 1997. From 1986 to 1997, hotel rooms
nearly trebled, from 2,524 to 6,687, and the number of stay-over visitors increased
from 181,012 to 649,893. Tourists from United States made up almost 62% of arrivals,
followed by those from Venezuela (15.2%) and Netherlands (4.7%). Although the
employed population increased from 1991 to 1997, the total population grew more
quickly. As a result, the unemployment rate also increased, rising from 6.1
% in 1991 to 7.4% in 1997. The Government of Aruba established a free zone in
1995 for the purpose of supporting trade, light industry, and services, thereby
fostering economic diversification. To further stimulate the financial sector,
in 1996 the Government established a financial center to oversee offshore activities
and trust companies, develop new financial products, and market Aruba as a high-quality
financial center.
Mortality:Between
1995 and 1999, the crude death rate varied between 6.2 and 5.8 per 1,000 inhabitants.
Heart and cerebrovascular diseases constituted the leading cause of death for
both males and females. The three leading causes of death in 1994-1999 were
diseases of the circulatory system, malignant neoplasms and endocrine, nutritional,
metabolic, and immunological disorders. In 1999, 37.0% of 548 total deaths were
attributed to diseases of the circulatory system and 19.2% to malignant neoplasms.
Detailed mortality data by cause for 1999 show some differences between sexes.
Heart disease and cerebrovascular diseases were the leading causes of death
for both males and females. For males, these were followed by malignant neoplasms
of the prostate, hypertensive disease, and malignant neoplasms of trachea, bronchus
and lungs. For females, they were followed by diabetes mellitus, diseases of
the urinary system, and malignant neoplasms of digestive organs and of reproductive
organs. Communicable diseases accounted for only 8.0% of the total mortality.
Of these cases, almost a third were due to acute respiratory infections (30.0%)
and less than a fourth to HIV/AIDS (22.7%).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):Between
1996 and 1999, there were 47 deaths in children under 1 year old, including
30 (64%) perinatal deaths. In 1998 and 1999, the infant mortality rates were
of 3.8 and 6.8 per 1,000 live births, respectively. In 1996, there were four
deaths in age group 1- 4 years, two males and two females. Maternal HIV infection
accounted for one of the female deaths.
Schoolchildren (5-9 years): Between
1997 and 1999, there were 12 deaths in the 5-9 age group : 8 males and 4 females.
These deaths were mainly due to external causes (4) and malignant neoplasms
(3).
Adolescents (10-14 and 15-19 years): Between
1996 and 1999, 15 deaths of adolescents were reported: two in 1996-1997, six
in 1998 and seven in 1999. Nine of these deaths were due to external causes:
six were due to motor vehicle accidents, two due to suicide and self-inflicted
injury, and one due to accidental poisoning. According to a 1998 survey, 20%
of children 6-14 years old who attended school do not eat breakfast before going
to study; however, more than three-quarters (76%) consumed a warm meal every
day or almost every day. The survey also found that children attending primary
school had a higher frequency of eating fruits (46%) than vegetables (39%).
Consumption of soft drink seems to be the preferred habit for 45% of the children,
at a frequency of at least one bottle per day. Approximately 70% of the children
bring food and a beverage to school. In 1997, a study on drug use among males
aged 17 to 25 years old found that the average age for marijuana use was just
under 21 years old and the average age for cocaine and crack use was slightly
older than 23 years. Of great concern is the finding that roughly one-third
of the people (30%) in this age group use drugs.
Adults (20-64 years): In
1998, there were 117 male deaths and 70 female deaths in the 20-64 years age
group. More than 29% of male deaths in this period were due to diseases of the
circulatory system, of which ischemic heart disease, and pulmonary circulation
and other forms of heart disease predominated. Among females, 31% of the deaths
were due to neoplasms, with most attributed to breast cancer. In 1999, 120 male
and 72 female deaths were recorded; 28% of male deaths were due to diseases
of the circulatory system; almost of these deaths were caused by ischemic heart
disease. Among females, 28% of deaths were due to neoplasms, of which carcinoma
of the cervix uterine; the uterus, body, and unspecified parts; and breast cancer
were the most common.
Family health:There
were no reported maternal deaths between 1998 and 2000. The fertility rate declined
from 67 live births per 1,000 women in 1996, to 53 in 1999. Throughout 1996-1999,
women aged 25-29 years and 30-34 years had consistently higher fertility rates
than other age groups. Exceptionally, in 1999, the group 25-29 years old far
outdistanced any other age group, with a fertility rate of 450 live births per
1,000 women.
The disabled: The
most frequent disability is limb impairment (28.7%), followed by motor disabilities
(18.3%) and visual disabilities (13.2%). Men have a slightly higher prevalence
of disability (5.7%) than women (5.4%).
Analysis by type of health problem Vector-borne diseases: In
1998, the first case of dengue was reported in an outbreak that affected the
country for five months. In 1999, a total of 202 suspected cases were reported;
of these, 180 were laboratory confirmed. In 2000, there were 198 suspected dengue
cases, 128 of which were laboratory confirmed. There were two cases of dengue
hemorrhagic fever, one of which was fatal. All serotypes, except type 4, have
been seen. There were no cases of malaria, yellow fever, Chagas ' disease,
schistosomiasis , or plague reported.
Diseases preventable by immunization:There were no cases of poliomyelitis, diphtheria,
acute flaccid paralysis, pertussis , or tetanus in the period under review.
In 1998, there were two registered cases of measles; none in 1999 or 2000. No
cases of mumps were recorded between 1998 and 2000. In the same period, there
were reports of 50 cases of hepatitis A - 9 in 1998, 12 in 1999, and 29 in 2000
-, 31 cases of hepatitis B - 11 in 1998, 11 in 1999, and 9 in 2000 - and 5 cases
of hepatitis C. Consolidated data for vaccine coverage is unavailable, but DPT
coverage has been estimated at 80% for children aged 1 and one-half years and
at 100% for children aged 6 years
Intestinal infectious diseases: There
were no reported cases of cholera.
Chronic communicable diseases: Between
1998 and 2000, the highest number of cases of tuberculosis was reported in 2000,
with 11 cases. There were no reported cases of leprosy in the period.
Acute respiratory infections: According
to hospital data, the hospital discharge rate for acute respiratory infections
was 4.1 per 1,000 population in 1998 and 7.4 in 1999.The figure is three times
higher in the age group 1-4 years and in the group aged 65 years and older.
HIV/AIDS and sexually transmitted infections:
There were 115 registered cases of AIDS between
1997 and 2000, and 230 registered cases of syphilis between 1998 and 2000.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans: The
Government's goal is to achieve high-quality and affordable health care that
is accessible to all. To that end, Aruba's Department of Public Health has identified
the health sector's most pressing problems - the rising cost of health care,
insufficient availability of medical care, and flawed quality control-and has
set specific targets to achieve the goal.
Health sector reform strategies and programs:
The most far-reaching health care reforms in
Aruba involve the reorganization of the Department of Public Health and the
health services under its jurisdiction and the introduction of a general health
insurance plan. The Department of Public Health has provided direct health care
services through the operation of a medical center, a psychiatric service, ambulance
services, the public health laboratory, and an occupational health center, and
by retaining medical doctors in its payroll. Reforms plan to gradually privatize
all of these services, and most medical doctors will be removed from the payroll.
Furthermore, there are plans to reorganize and expand the Medical Center , expand
the occupational health department to include services to private companies,
improve health care inspection services, enhance mental health care services,
automate the public health laboratory and construct a new building, and improve
overall hospital care. Some existing services will merge as a way to gain in
efficiency. The planned introduction of a general health insurance plan intends
to achieve equal and universal access to the health care; achieve and maintain
high quality, cost-effective care; reach more uniformity in the financial management
of the medical costs; and develop the means to control health care expenditures.
The new general health insurance plan would entitle the insured to a basic package
of services, including primary medical care provided by general physicians;
secondary care provided by medical specialists, obstetricians, and physical
therapists, and coverage for prescription drugs, hospitalization, home nursing,
dental care, and ambulance transportation.
Health system: The
Department of Public Health falls under the jurisdiction of the Ministry of
Public Health, Social Affairs, Culture and Sport. It is charged with promoting
overall public health; it also operates the Dr. Rudy Engelbrecht Medical Center,
the psychiatric ward, and the public laboratory. The Department embraces about
a dozen services with which it carries out prevention, inspection, and medical
activities.
Health insurance: Every
citizen of Aruba has compulsory medical insurance, and Aruba has an old-age
pension program designed to guarantee a minimum income to senior citizens.
Organization of regulatory actions: Aruba
's health care legislation falls into two categories: general laws, also known
as organizational regulations, and specific or individual laws. The general
regulations that set the institutional organization of the health system are
based on the Public Health Law. According to that law, the Department of Public
Health is entrusted with the organization that looks after health care and the
supervision and promotion of health. Specific regulations deal with the functioning
of such issues as health professions, mental health, supervision of drugs and
narcotics, hygiene and diseases. The Director of the Department of Public Health
is in charge for inspecting medical proceedings, thus ensuring the quality of
medical professional services in Aruba . The Office of Medical Inspection is
an autonomous institution headed by a pharmacist that is entrusted with supervising
the production and delivery of medicines; it also is charged with supervising
the practice of pharmacists and assistant pharmacists.
Health promotion services:
In 2000, the Department of Public Health launched a multidisciplinary effort
dealing with various nutrition and healthy lifestyle related areas, such as
education, physical activity, and agriculture. Representatives from a variety
of sectors will come together in order to develop a 10-year plan in this regard.
Prevention and control programs:
Within the Department of Public Health, the AIDS task force works on preventing
and controlling HIV infection, reducing mortality and morbidity, and diminishing
the effects and consequences of HIV and AIDS on the community. A committee to
combat dengue was established in 1999, in response to an epidemic of dengue.
The committee offers information to the general public on how to prevent the
spread of breeding sites of the mosquito vector, Aedes aegypti ; conducts an
ongoing evaluation of the dengue situation based on epidemiological and clinical
information from Aruba and the Region; and takes necessary action. The Youth
Health Services of the Department of Public Health vaccinates infants and primary
schoolchildren. Children are vaccinated against diphtheria, pertussis , tetanus,
poliomyelitis, mumps, measles, rubella, and Haemophilus influenzae type b. Vaccination
coverage is approximately 80%, but awareness campaigns have been launched in
an effort to increase it.
Health analysis: In
1994, as part of a UNDP technical cooperation program, the Department of Public
Health implemented a project to develop and manage an epidemiology section.
As a result, the Department now has a well-equipped and staffed epidemiology
unit, databases and data sources have been identified, and the unit is able
to provide data to other governmental and non-governmental institutions. Epidemiological
data have been used in outlining strategic plans for several health issues.
The epidemiology unit also issues regular bulletins and provide courses for
physicians among other activities.
Potable water and excreta disposal services:
Aruba has no natural source of fresh drinking
water and very little rainfall. The island's water and energy company produces
drinking water by desalinating marine water. Tap water is distilled water, filtered
through coral stone beds. It is safe for consumption without further treatment.
Aruba has an adequate sewerage system: sewage is put through a water purification
system and then drained into one of the largest inland waterways. Every house
and building in the capital, Oranjestad , is connected to the sewerage system,
representing about 30% of all houses and buildings of the island. Of the remainder,
about 62% of houses rely on cesspools or septic tanks, and some 8% drain their
sewage directly into the ocean.
Food safety: Aruba
's reliance on tourism - some 750,000 tourists come to the island each year
- makes food safety particularly important. Almost all food is imported. Every
year, the Public Health Laboratory tests all workers in the food preparation
or sale for shigellosis, salmonellosis , and tuberculosis.
Organization of individual health services:
Aruba 's single hospital, the Dr. Horacio Oduber
Hospital, is a private, nonprofit hospital with 264 inpatient-care beds and
41 beds in its psychiatric ward. In 2000, there were 11,718 admissions, for
an occupation rate of 92.0%. The hospital has a 24-hour emergency room, and
also provides outpatient care among other services. Deliveries are normally
carried out in this hospital, but women also can opt to give birth at home.
There is no breast-feeding promotion policy in Aruba . When a patient needs
medical treatment or diagnostic services that are unavailable on the island,
arrangements can be made to refer the person abroad. In 1999, 41.8% of these
patients were referred to Venezuela . Four institutions offer programs for rehabilitation
for drug addicts, in which people from 22 to 59 years are attended.
Human resources: Although
the island has a wide range of medical specialists, it does not have sufficient
nurses. In the last few years, nurses have been recruited from abroad, especially
from Philippines , where nursing education is similar to Aruba 's. Most physicians
obtain their degrees at accredited institutions in the Netherlands , followed
by medical schools in the United States , Costa Rica , Colombia , and Venezuela
. Most who want to obtain a graduate nursing degree go to Curaçao or to the
Netherlands.
Health sector expenditure and financing: Since
1990, health care has taken an increasing share of the Government's budget.
In 1998, the proportion of Government's expenditures allocated to health was
close to 5.3 % of total expenditure. Between 1990 and 1998, government expenditures
in health grew from US$ 47 million to US$ 81 million, with an average annual
increase of 10%. Population growth and aging, as well as an enormous increase
in the use of medical facilities, are the main reasons for the increase in health
care expenses.
External technical cooperation and financing:
Cooperation funds from the Kingdom of the Netherlands
decreased from US$ 9 million in 1998 to approximately US$ 1 million in 1999.
In 1997, a committee of the Government of the Netherlands issued a report recommending
that the Dutch cooperation program be terminated in 2010 in order to make Aruba
more autonomous financially. Up to 1998, Dutch contributions represented approximately
44% of total public investment. In 1999-2000, the Department of Public Health's
Disease Control section received US$ 10,000 from the European Union and US$
10,000 from Dutch Development Cooperation. The funds were channeled through
UNAIDS for use in Aruba 's UNAIDS Theme Group campaigns. Aruba 's Kiwanis Key
Club also donated US$ 5,700 to the theme group.
