Official Name: Aruba
Capital City: Oranjestad
Official Language: Dutch
Surface: 180 km 2
PAHO Subregion: Non-Latin Caribbean
UN 2 digits Code: AW
UN 3 digits Code: ABW
UN Country Code: 533


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.

    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%).

    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.

    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.