Official Name: Bermuda
Capital City: Hamilton
Official Language: English
Surface: 52 km 2
PAHO Subregion: North America
UN 2 digits Code: BM
UN 3 digits Code: BMU
UN Country Code: 60


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.

    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.

    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 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.

    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.