Official Name: Republic of Colombia
Capital City: Bogota
Official Language: Spanish
Surface: 1'141,748 km 2
PAHO Subregion: Andean Region
UN 2 digits Code: CO
UN 3 digits Code: COL
UN Country Code: 170

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.

    Demography: Colombia has a land area of 1,141,748 km2, with a topography dominated by three branches of the Andean mountain range. The population is estimated at 42,299,000 people living in the country's 32 departments, which are divided into 1,076 municipalities. Colombia is experiencing demographic changes as well as changes to its epidemiological profile typical of transitional societies. Examples of demographic changes include population aging, decreasing fertility, rapid urbanization, while the change in the epidemiological profile emphasizes the persistence of communicable diseases with a concomitant increase of noncommunicable diseases. Life expectancy at birth had increased to 70.6 years, fertility dropped to 2.8 children per woman, and 71% of the total population lived in urban areas.

    Economy: In 1999, Colombia faced its most serious economic recession in 60 years, with GDP declining by 4.3% and unemployment rising. The low price of coffee on the world market and the extensive damage inflicted in coffee-producing areas by an earthquake added to Colombia 's economic problems. Although the economy grew by 2.8% in 2000, unemployment reached 19.7%. The number of persons living in poverty increased from 19.7 million in 1997 to 22.7 million in 1999. Between 1995 and 1999, Colombia 's total indebtedness rose from 19.1% to 34% of its GDP. In 2000, public expenditure was reduced, the tax base was broadened, a special tax on financial transactions was established, and measures were taken to control tax evasion. In addition, the salaries of government employees were frozen and an attempt was made to reduce bureaucracy and noninvestment spending. Although these actions halted the economy's downward trend, no progress was made in solving the problems of unemployment, poverty, or the steadily worsening situation of the most vulnerable sectors of the population. The country's development is seriously hindered by inefficient social expenditures. Spending on education is more than 4% of the GDP, but national coverage is only 88%. Health spending, in turn, was 3.9% of the GDP and the national Gini coefficient of 0.56 remained unchanged between 1997 and 1999, but the inequality of income distribution decreased in some departments. According to estimates, about 25% of the municipalities fell within the two strata with the highest proportion of unmet basic needs; another 25% were in the two strata with better living conditions. Social inequality can also be seen in the negative impact economic liberalization had on the agricultural sector in the 1990s. Some of Colombia 's grains and basic products were not competitive on the world market, and by the end of the decade, 700,000 hm2 of agricultural production had been lost, while planting of illegal crops doubled from 57,500 hm2 in 1994 to 112,000 in 1999. These changes exacerbated the armed conflict and societal deterioration, and contributed to the increase in all forms of violence. The situation is marked by the highest levels of violence in Colombia 's recent history. The Commission on Human Rights calculated that between 1985 and 1999, 1,700,000 persons were displaced due to violence. To address these serious problems, the government has initiated negotiations for a peace agreement among the conflicting participants. Another major problem is drug trafficking and the high levels of crime associated with it. Colombia has become the world leader in cocaine and heroin production.

    Analysis by population group
    Children (0-4 years):In 2000, Colombia had 4.8 million children under 5 years old. The infant mortality rate was 21 deaths per 1,000 live births and ranged from 17 in Bogotá to 29 in the coastal area. In this age group, the prevalence of chronic undernutrition was 13.5%; diarrhea, 13.9%; and acute respiratory infections, 12.6%.

    Schoolchildren (5-9 years): In the age group 5-9 years, there were 1,537 deaths in 1998 (36.9 per 100,000 males and 26.7 per 100,000 females); more than 65% were due to external causes.

    Adolescents (10-14 and 15-19 years): In 1998, there were 7,864 deaths in the adolescent population (133.4 per 100,000 males and 47.9 per 100,000 females). In young men aged 15-19, violence accounted for 69% of the deaths; there were 13 male deaths for each female death in this age group. Data from a national survey on juvenile drug use showed that among the population surveyed, alcohol and marijuana continued to be the most consumed drugs; 15.2% of all persons who drank alcohol and 6.8 % of cigarette smokers were under 18 years of age. The prevalence of cocaine consumption in the general population is 3.8%. During the 1990s, the proportion of pregnant women aged 15-19 years almost doubled, from 10% in 1990 to 19% in 2000.

    Adults (20-59 years): In 2000, the adult population in Colombia numbered 26 million. There were 78,820 deaths for this age group in 1998 (406.3 deaths per 100,000 males and 168.9 per 100,000 females). At the end of the 20th century, the adult population aged 15-44 saw an increased burden, especially among males, attributable to the rise in homicides and in AIDS as causes of death.

    The elderly (60 years and older): In 2000, 7% of Colombians (3 million people) were aged 60 years and over. In 1998, there were 73,121 deaths in this age group. The leading diseases for both sexes were ischemic heart disease; chronic obstructive pulmonary disease; diabetes mellitus; and malignant neoplasms of the trachea, bronchus, lung, prostate, and uterine cervix.

    Family health: Domestic violence is a high-priority problem. Forty-one percent of women who ever lived with a partner declared they had been physically abused by their partner (and an additional 20% by another relative). An additional, thirty-four percent had been threatened by their partner.

    Worker's health: Every year, there are thousands of cases of severe trauma and hundreds of deaths due to exposure to physical and chemical hazards in the workplace. The artisanal industries do not provide adequate health conditions for their employees.

    The disabled: Of the persons with disabilities, 12.1% are under 14 years old and 27.6% are over 60, and most of them are males.

    Indigenous groups: The indigenous population of Colombia was estimated at 2% in the year 2000. In addition, there is an ethnic population of African origin that numbers more than 10 million and represents 25% of the nation's total. The most prevalent health problems afflicting both sexes were acute respiratory infections, intestinal parasitosis , and acute diarrheal disease.

    Analysis by type of health problem
    Vector-borne diseases : Malaria poses a serious public health problem for Colombia . It is estimated that 18 million people live in areas where malaria is transmitted. In 1998, there was an epidemic with 240,000 confirmed cases. In 2000, there were 141,047 confirmed cases - a figure consistent with the endemic level observed over the preceding decade - and 41 deaths. Another serious public health problem in Colombia is dengue. Around 65% of the urban population faces a high probability of becoming infected with dengue and dengue hemorrhagic fever (DHF). In 1998, a total of 57,985 cases were documented, including 5,171 cases of DHF. The dengue-2 and dengue-4 serotypes were circulating simultaneously. In 2000, there were 22,772 reported cases of classic dengue and 1,819 cases of DHF, with 19 deaths. The high index of Aedes aegypti infestation in many municipalities poses a serious risk factor for the urban transmission of yellow fever, and jungle yellow fever continues to be active in Colombia . In the 1990s, there were an average of 4 cases per year.

    Diseases preventable by immunization: In 1993, Colombia joined a regional partnership for the elimination of measles by the year 2000; successive national campaigns in 1993, 1995, and 1999 achieved coverages of 97%, 95%, and 90%, respectively, in children under 5 years old. Reports of suspected cases increased from 632 in 1997 to 1,267 in 2000, while the number of laboratory-confirmed cases fell from 308 in 1995 to 0 in 2000, and the number of clinically confirmed cases dropped from 473 in 1995 to 34 in 1999 and to 1 in 2000. Coverage with measles vaccine was 80% in 2000. Rubella was added to the measles surveillance system in 2000, and that year, 679 suspected cases were reported, 155 of them laboratory confirmed and 4 of them clinically confirmed. The reports included outbreaks among military personnel and sanitation workers. Vaccination against Haemophilus influenzae type b was introduced in 1998. There has been a decline in meningitis caused by H. influenzae type b among children under 5 years, from 306 cases (6.4 per 100,000) in 1998 to 163 cases (3.4 per 100,000) in 1999 and 119 cases (2.8 per 100,000) in 2000. Most of the reported cases of pertussis occurred in the department of Antioquia (181 in 1998, 255 in 1999, and 264 in 2000). Also, in 2000, there was an outbreak of 46 cases with 7 deaths in indigenous population. Reported cases of hepatitis B numbered 1,354 in 1998, 1,490 in 1999, and 1,283 in 2000; most of the cases were in endemic areas ( Orinoquia , Amazonia , and Santa María ).

    Intestinal infectious diseases:
    In 1998, a total of 445 cases and 7 deaths from cholera were reported for the entire country, followed by 18 cases in 1999 (11 of them confirmed), and 1 case in 2000.

    Chronic communicable diseases: The incidence of chronic communicable diseases are thought to have fallen substantially between 1970, when the group rate was 58.6 per 100,000 population (12,522 cases), and 1999, when it was 26.5 (10,999 cases). Reported cases in 2000 totaled 11,590. National policy called for eliminating leprosy as a public health problem. In 2000, the reported incidence was 0.5 per 10,000 population (2,124 cases). Although the incidence has been reduced, the proportion of new cases with some degree of disability has risen, which indicates a delayed diagnosis of the disease.

    Acute respiratory infections: Acute respiratory infections continued to be one of the leading causes of morbidity and mortality in children under 5 years old, even though mortality from pneumonia fell from 51.0 per 100,000 population in 1988 to 34.1 in 1998.

    Zoonoses : Since 1994, 61.8 % of Colombia 's canine population, estimated at 3.4 million, has been vaccinated against rabies. Cases of canine rabies decreased from 350 in 1990 to 67 in 2000. At the same time, human rabies dropped from 10 cases in 1990 to 1 case in 2000.

    HIV/AIDS: There were 17,163 cases of HIV/AIDS registered between 1983 and March 1999, of which 11,381 corresponded to carriers of HIV infection and 5,782 to patients with AIDS; 85% were males. During the same period, 3,441 deaths were reported (90% in males). In 2000, it was estimated that 67,000 persons were carriers of HIV. Sexual transmission is predominant.

    Nutritional and metabolic diseases: The prevalence of chronic undernutrition was 13.5% in children under 5, with 2.8% at risk for severe undernutrition . The prevalence of exclusive breastfeeding through the fourth month of life was 23%, and through the sixth month, 12%. The prevalence of anemia in children under 5 years old increased from 18% in 1997 to 23% in 1995, and it was higher in the 12-23-month-old group (36.7%) and in rural areas (27.2%).

    Diseases of the circulatory system: During 1995-1998, mortality due to diseases of the circulatory system accounted for 26% to 30% of all deaths. The highest rates are for ischemic heart disease, cerebrovascular damage, and hypertension (44.0, 31.1, and 13.5 per 100,000 population , respectively).

    Malignant neoplasms: Stomach cancer is the neoplasm with the highest incidence in Colombia , followed by lung cancer, and leukemia and lymphoma. In men, the lung and prostate are the most frequent sites; in women, cervical and breast cancer head the list. In 1998, the mortality rate from neoplasms was 62.7 per 100,000 in the population as a whole.

    Accidents and violence: The last 25 years have seen an increase in accidents and violence. There were 36,947 violent deaths in 1999, of which 23,209 were homicides, 7,026 were due to traffic accidents, and 2,089 were suicides. The group most affected were men aged 25-34 years (9,097 deaths) and 18-24 years (7,925 deaths).

    National health policies and plans: In 1990, the health sector gave impetus to Law 10 on Municipalization of Health, which launched the process of strengthening national health system institutions at all levels. This initiative, which sets forth the fundamental principles of sectoral reform, was reflected in the new Constitution of 1991. These mandates, in turn, were taken into account in Law 60, which defined the scope of responsibility of the different territorial jurisdictions and stipulated the resources to be made available to them. The legal framework was further refined by the enactment of Law 100 (1993), which created the General Health and Social Security System (SGSSS) and, under it, a comprehensive pension plan, coverage for work-related risks, supplementary social services, and the health and social security system itself.

    The health system: Inspection, monitoring and regulation of the system (basically in terms of its juridical, contractual, administrative, and financial aspects) were delegated to the National Health Superintendency in 1993 after Law 100 was created. The new scenario also encompasses public health programs, and the present system has been designed to ensure equitable coverage, improve the quality of services, and actively advance promotional and preventive plans for improving the health conditions of all Colombian citizens. According to the Ministry of Health, the hospitals under its authority managed to improve their productivity by 5% between 1996 and 1997, while at the same time lowering their costs by the same percentage (since there was no increase in resources), but they experienced a moderate decline in overall production between 1997 and 1998; total hospital discharges, outpatient consultations, surgeries and deliveries fell. Nonetheless, visits for emergency care rose.

    Developments in health legislation: Article 22 of this law sets basic priorities for municipal investment: 25% to health; 30% to education; 20% to potable water; 5 % to physical education, recreation, culture, and sports; and the remaining 20% left to the discretion of the mayor or the community. In 1999, the National Congress received the draft of Law 156 for consideration that will fill in some of the gaps in public health law that created the SGSSS.

    Organization of regulatory actions: In the course of implementing the institutional reform of health services, it has been observed that institutions tend to operate in isolation, which makes it difficult to coordinate strategies against community health problems. The decentralization of local and intermediate-level health systems has been taken to mean that these regional and local systems were autonomous and self-sufficient, and it has not been accompanied by an adequate transfer of authority and technological and financial resources.

    Certification and professional health practice: The certification required to practice the various health care professions is conferred, in principle, by the educational institutions that grant degrees attesting to the specific professional or technical competency of their graduates.

    Environmental quality: One of the most serious effects of economic development has been the deterioration of natural resources, especially water, soil, and air. Poor water quality and variations in the water cycle are having a negative effect on health. The pollution of groundwater by domestic and industrial effluents and solid waste of all kinds is threatening not only the supply of water available for human consumption and production but also the nation's flora and fauna. One of the worst pollutants is oil, which has leaked into the soil and water sources as a result of attacks on the country's petroleum infrastructure. In 1998, the Ministry of Health and other sources estimated that leakage of 2 million barrels of oil had affected 70 municipalities in 13 departments, including 2,600 km of rivers and streams, 6,000 ha of land with agricultural potential, 1,600 hm2 of marshes and wetlands, and transnational catchment areas such as the Catatumbo and Arauca river basins. On average, Colombian households are made up of 4.2 persons. Almost four of five people (79%) live in houses and 19% live in apartments. Inadequate housing conditions, especially poor ventilation, provide favorable environments for diseases like tuberculosis, which is found especially in settlements with precarious infrastructures. Overcrowding in the large city centers also contributes to transmission of this disease.

    Food quality: In Colombia , the program for epidemiological surveillance of foodborne diseases and the corresponding information system initially met with certain difficulties in connection with decentralization standards and the division of responsibilities between the Ministry of Health and its decentralized agencies. Colombia has begun to set policies on food protection and to coordinate activities with international cooperation agencies, particularly with regard to the Codex Alimentarius .

    Organization of public health care services: In each municipality, the mayor is responsible for overseeing the management of health, guaranteeing the effective operation of the PAB, regulating health insurance, and monitoring health and health services. The program of the PAB calls for the development of health promotion activities and mandatory interventions to be carried out for and by communities in the various territorial jurisdictions. The health promotion initiatives of the PAB are healthy municipalities; promotion of peaceful coexistence and prevention of domestic violence; healthy schools; information, education, and communication strategies; promotion of sexual and reproductive health; prevention of the use of psychoactive substances that are harmful to health; promotion of healthy eating habits; and prevention of problems stemming from malnutrition.

    Disease prevention and control programs:
    The PAB component of SGSSS enables the mayor in each municipality to carry out his or her primary duty, which is to ensure the community's health. They encompass all the disease prevention and control programs. Health Analysis,

    Epidemiological surveillance, and public health laboratory systems:
    The enactment of Law 100 (1993) created a unified social security system that incorporates the private sector. The law also provides for the development of a single national public health information and surveillance system, encompassing both the public and private sectors. However, the surveillance system has remained unchanged since it was set up for the 1996-2000 period .

    Potable water, excreta disposal, and sewerage services: According to the Ministry of Development, barely 5% of Colombia 's 1,076 municipalities treat their wastewater before they dispose of it. This situation has turned the Cauca and Magdalena river basins essentially into sewers, as they receive more than 80% of the nation's wastewater. According to the Ministry of Health, 60% of the inhabitants in the municipal seats run a medium to high risk of contracting diseases because of the poor quality of the water. In 2000, 76% of municipalities did not have potable water. Solid Waste Services Very few urban areas in Colombia have adequate facilities for the disposal of solid waste. In rural areas, this waste is usually dumped in open fields or burned or buried on household property. The use of organic solid waste for productive purposes has not been sufficiently studied, and recycling programs lack continuity.

    Health supplies: The General Social Security and Health System guarantees access to essential drugs (from a list of some 350 medicines) through the Mandatory Health Plan (POS) for those insured under the contributory regime, with certain restrictions for those under the subsidized regime, and with no clearly defined criteria for those not affiliated with the system, although this last group receives prescribed medications for basic care. As a consequence of decentralization and health system reform, there have been some noteworthy advances in the area of biomedical technology. (1) The provision of maintenance services in public sector health institutions has been regulated. (2) A detailed inventory of infrastructure resources in second- and third-level hospitals (170 institutions) was conducted. (3) The procurement of medical equipment increased in both the public and the private sectors.

    Human resources: In Colombia, the inequitable distribution of human resources is more pronounced for professionals and, among physicians, specialists. Colombia has 43,166 physicians, for a rate of 10.4 per 10,000 population .

    Health research and technology: In Colombia , no agency does a thorough compilation of national data on health research. Until two years ago, the former Science and Technology Office in the Ministry of Health gathered partial information on research topics and teams working in the health sector. The Colombian Institute for Science and Technology Development (COLCIENCIAS) has various programs that are responsible for strategic planning within the national science and technology system. One of these programs corresponds to the health sector and follows up on research conducted with official funds made available through the Institute.

    Health sector expenditure and financing: Under Law 100 (1993), in 1996, an estimated US$ 300,482,310 was spent on health in Colombia , or the equivalent of 10.1% of the GDP (estimated for that year at US$ 4,400 million); 4.1% corresponded to the public sector and 5.9% to private sources. Of the total amount, spending on health promotion and disease prevention came to about 5% of all health expenditure. In 1997, health promotion enterprises were assessed and it was learned that 5 of the 11 mandatory programs used 86.3% of the resources. The largest amount (30.2%) was spent on the oral health program, followed by the prevention of diseases related to pregnancy, childbirth, and the puerperium (18.5%); the Expanded Program on Immunization ranked seventh, with a 2% investment; and the smallest expenditure reported was for the prevention of sexually transmitted diseases and HIV/AIDS infection.

    External technical cooperation and financing:
    The international cooperation received by the Ministry of Health in 2000 was reflected in the execution of 13 agreements for multilateral cooperation, entered into with the following agencies and international programs: JICA; GTZ; the Hipólito Unanue Agreement; Partners in Population; the Andean Development Community; the Organization of Iberoamerican States for Education, Science, and Culture; the World Bank; the IDB; the IOM; and the Andrés Bello Agreement. Ten provided technical cooperation in the following areas: strengthening health systems, sexual and reproductive health, hospital consortia, a meeting of the health ministers of the Andean area, and health sector reforms and financing. Bilateral cooperation agreements were undertaken with various agencies and governments.