Health Status of the Population
Population Characteristics and Trends
- Distribution, size, and rate of population growth
- The drivers of demographic change
- Population distribution by age and sex
- New perspectives on the demographic dividend
- Annex 1: Groupings of countries
- Full Article
The world is experiencing unprecedented demographic change (). Since the early 20th century, the human population has increased from 2 billion to over 7 billion, and that figure is expected to reach 10 billion by the end of the 21st century (). Other significant population changes have to do with new and varied fertility patterns (including adolescent maternity), mortality, migration, urbanization, and aging.
In this context, it is essential to describe the main features of population trends in the countries of the Americas in order to identify and analyze their implications for health. The importance of demographic dynamics is two-fold. First, demographic dynamics may be indicative of certain health issues (such as trouble preventing, treating, and controlling communicable and noncommunicable diseases in places experiencing rapid, excessive population growth). Second, they can afford an opportunity to overcome such obstacles (such as the development potential associated with the so-called demographic dividend).
The concept of the demographic transition is a very useful tool for explaining population changes and their regional differences. This concept describes the process of first moving from high to low levels of mortality, then from high to lower levels of fertility, which has consequences for population growth and the population’s sex and age structure. The clearest example of such a demographic evolution occurred in the mid-18th century, linked to the economic transformations of industrialization and the modernization of countries that have developed since then (). These changes took place in Europe, North America, and other places in the 19th and 20th centuries, then began in many developing countries in the mid-20th century ().
While exceptions can be found, the demographic transition concept is a practical way to analyze recent population trends and projections of future population size (). Although all the world’s countries undergo this process, they do it at different rates. There are four main stages in the classical demographic transition model: (1) incipient transition (high and relatively stable birth and mortality rates, with low population growth); (2) moderate transition (falling mortality, with a stable or rising birth rate due to improved living conditions, with high population growth); (3) transition in progress (low birth rate and stable mortality, with low population growth); and (4) advanced or very advanced transition (low birth rate and mortality, with population growth that is negligible or even declining) ().
In the Americas, the demographic transition has evolved differently according to geographical location. Historically, there has been a marked difference between the progress made by the countries of North America compared to most countries in Latin America and the Caribbean (LAC). In 1950, the vast majority of countries in Central and South America were about to begin their demographic transition, while the transition was already in progress in Canada and the United States. However, in just four decades, half of LAC was at this stage, while the other half had reached the advanced transition stage. By then, few countries were still at the pre-transition (Bolivia and Haiti) or incipient transition stage (Belize, Guatemala, Honduras, and Nicaragua). In 2010, these same countries were in the in progress stage, while the rest were in advanced or very advanced stages of transition.
In the LAC countries, birth rate and mortality indicators have changed differently (more due to the spread of general technological advances in health than due to sustainable and equitable development) and at different rates (more quickly than in more developed countries and somewhat independently of the economic, social, and political crises the Hemisphere has experienced for decades) (). Due to the depth and speed of their population transformations, the LAC countries currently tend to be at the same stage of demographic transition.
With demographic transition as a backdrop, this summary discusses how the main changes in population size and structure in the countries of the Americas are related to the drivers behind these changes: fertility, mortality, and migration. Additionally, future population trends in the Hemisphere are discussed. The information used comes from population estimates and projections by the United Nations Department of Economic and Social Affairs, Population Division (). For some countries, data come from the United States Census Bureau (). Data were also used from the PAHO bulletin Health situation in the Americas: basic indicators, for selected years ().
For ease of analysis, the countries of the Region of the Americas have been grouped into subregions and areas. The subregions are North America and LAC, with the latter consisting of Central America, Brazil, the Caribbean, the Southern Cone, Mexico, and the Andean Area (see Annex 1).
Distribution, size, and rate of population growth
In 2015, 7.3 billion people lived on our planet. The population of the Americas totaled 992.2 million, 13.5% of the total. In terms of subregions, 357.8 million people were living in North America and 634.4 million in LAC (36.1% and 63.9% of the total, respectively). At 207.8 million, Brazil’s population accounted for 20.9% of the LAC total; the Andean Area’s 137.6 million accounted for 13.9%; Mexico’s population of 127 million represented 12.8% of LAC; the 71.4 million in the Southern Cone accounted for 7.2% of the LAC population; the 45.7 million in Central America made up 4.6% of the LAC population; and the 44.7 million living in the Caribbean represented 4.5% of the LAC population. Brazil, Mexico, and the United States (321.7 million people) are among the 10 most populous countries in the world. On the other hand, the Region of the Americas is also home to Montserrat, a country with one of the world’s smallest populations (only 5,125 people) ().
In the last 5 years, the Region added 27.5 million people in LAC and 10.8 million in North America. Although these figures denote a sizable absolute increase, they reflect a moderate annual average growth rate (1.12% in LAC and 0.78% in North America). This rate of population increase was slower than the annual rate the two subregions recorded in the early 1950s (3% and 2%, respectively). Furthermore, and due to national differences in progress towards demographic transition, there was great diversity in the current growth rate among the countries of the Americas (). Between 2010 and 2015, for example, Cuba had an average annual population growth rate of 0.14%, while Guatemala’s rate was 2.1% (). Figure 1 shows the total population and average annual growth rates of the countries of the Region.
Figure 1. The Americas: Population in 2015 (in thousands) and annual average rate of growth, 2010‐2015 (in percentages), by subregion
Despite the progressive decline in growth rates, the population of the Region is expected to continue growing for a long time due to demographic inertia, caused by high fertility rates in the past that result in a significant proportion of young people in the population. As this segment of the population reaches reproductive age, the resulting large number of births tend to surpass deaths for a prolonged period (). For this reason, although fertility is currently low in LAC, it is foreseeable that the population will not stop growing until the middle of this century. Demographic variables will continue to have a considerable influence on society since population growth involves a large number of young people and older adults–population groups with different potentials and needs, especially in the sphere of health.
Currently, only three countries in the Americas are experiencing net population loss: Bermuda (North America), United States Virgin Islands, and Puerto Rico (Caribbean). This trend is explained not only by progress toward the demographic transition in these countries, but also emigration.
A distinctive aspect of population distribution in the Americas is the impact of urbanization on overall population growth. The Region currently has the world’s highest proportion of the population living in urban areas—above 80%. This figure is almost the same in North America (82%) as in LAC (80%). However, disaggregation by subregion reveals a very high percentage in the Southern Cone (88%) and Brazil (86%), offset by lower rates in the Caribbean (70%) and in Central America (59%). Mexico and the Andean Area fall somewhere in between (79% and 78%, respectively).
Another distinctive feature of urbanization in the countries of the Americas is the existence of megalopolises, including three of the six most populated cities in the world: Mexico City and New York (both with over 20 million inhabitants) and São Paulo (19.9 million). Despite the high levels of urbanization in our countries and in the rest of the world, cities are expected to continue growing in the coming decades (). Rapid, unplanned urban growth threatens sustainable development if the necessary infrastructure is not created or if policies are not implemented to ensure an equitable distribution of the benefits of city life. Governments must set their sights on tapping into the opportunities offered by urbanization, at the same time as they respond to its challenges by implementing long-term policies that allow for sustainable urban growth. This approach includes creating better opportunities for income and employment in urban and rural areas; expanding the infrastructure required for water and sanitation, energy, transport, information, and communications; ensuring equal access to services such as education and health care; developing quality housing and reducing the number of people living in slums; and preserving natural assets in the city and surrounding areas ().
The drivers of demographic change
Fertility, mortality, and migration are the basic drivers of change in a population’s size, structure, and distribution. However, the significance of these factors varies according to the size of the units of analysis. For the world as a whole, the annual increase in population is due to fertility rates that exceed mortality rates. At the global level, and even for large regional aggregates, migration is less relevant. However, when the analysis is done at the country level, the opposite may be true, since migration can have a big impact on changes in the population ().
The most commonly used indicator to analyze this component of population dynamics is the total fertility rate (TFR). This rate is equal to the average number of children that a woman would have by the end of her reproductive period, if she had exhibited the age-adjusted fertility rates recorded by the population of interest, in a given year.
One of the best known criteria for classifying countries by TFR is the population replacement level. This value is equivalent to the average number of boys and girls who would suffice to replace both parents in a given population (2.1 children per woman). According to this criterion, in the 2010‐2015 period, the world’s population was distributed among 46% of countries with low fertility levels (TFR below 2.1 children per woman), 40% with intermediate levels (TFR between 2.1 and 4 children per woman), and 14% with high levels (TFR of 4 or more children per woman).
In the Americas, approximately half of the countries belong to the low fertility group (including all of North America plus 20 LAC countries) and the other half are in the intermediate group (Figure 2). Currently, no country has a level of fertility that can be considered high (4 or more children per woman). Very few countries have an extremely low level (1.5 children per woman or less). This situation is similar to that of Asia, and differs markedly from what is occurring in most countries of Africa and Europe, which have the highest and lowest levels of fertility in the world, respectively.
Figure 2. Countries of the Americas: TFR, 2015 (children by woman) and fertility rate 15‐19 year age group 2010–2015 (per 1,000 women aged 15‐19 years)
The decline in fertility is a widespread, long-term demographic reality. In LAC, fertility fell below the world average starting in 1985‐1990. The decline began during that period in the Southern Cone and in Brazil, but started earlier in the Caribbean (1970‐1975), and later in Central America and Mexico (2005‐2010). The situation was very different in North America, whose fertility rates were already below the global average at the start of the 1985‐1990 period.
Although there has been a significant drop in fertility in the Americas, and particularly in LAC, adolescent pregnancy rates remain relatively high&ndashbetween 50 and 100 births per 1,000 women between 15 and 19 years of age. At the subregional level, the highest levels were recorded in LAC, with a rate of 66.5 live births per 1,000 adolescents from 2010 to 2015, the second highest rate in the world after Africa (). The countries of the Region with the highest adolescent fertility rates were the Dominican Republic (100.6 per 1,000), Nicaragua (92.8 per 1,000), Guyana (90.1 per 1,000), Guatemala (84 per 1,000), French Guiana (82.6 per 1,000), and Venezuela (80.9 per 1,000).
Life expectancy at birth is the most commonly used indicator to report changes in mortality. This is defined as the average number of years that a group of newborns would live if the specific age-adjusted mortality rates observed in a population remained constant during a given year.
One of the clearest manifestations of the progress made thanks to the Millennium Development Goals (MDGs) is the increase in life expectancy at birth. Globally, average life expectancy increased by more than 3 years between 2000–2005 and 2010–2015, rising from 67.1 to 70.5 years. This trend is primarily explained by the effective reduction of infant (–26.5%) and child (–29.6%) mortality. Furthermore, in the same periods, great progress was made in the fight against HIV/AIDS, both in preventing new infections and in extending the lives of people infected by the virus who received antiretroviral therapy ().
Life expectancy in the Region was higher than the global average: in LAC, it was 74.5 years, and in North America, 79.2 years. In LAC, mortality declined over the course of the last century and continues to decline today: from an approximate average of 59 years in the 1965‐1970 period, life expectancy increased to almost 75 years in the 2010‐2015 period. The population has gained 16 years of life on average in the last 45 years&ndash practically 2 years per 5-year period ().
In the LAC countries, there have also been differences in the pace and level of reductions in mortality. At present, average life expectancy at birth is at levels seen in North America between 1980 and 1985. Mexico recorded the highest rate (77.9 years), followed by the Southern Cone (77.2 years), Brazil and the Andean Area (74.5 years), and finally the Caribbean (73 years). However, the same indicator reveals contrasts between more and less advanced countries in each area (). For example, during the 2010‐2015 period, the gaps in life expectancy at birth were 19 years in the Caribbean and 8 years in the Southern Cone. Figure 3 shows life expectancy in the Region, by country.
Figure 3. Countries of the Americas: Life expectancy at birth, 2010–2015 (years)
The number of international migrants around the world has grown rapidly in the last 15 years. This number reached 244 million people in 2015, 22 million more than in 2010 and 71 million more than in 2000 ().
In general, between 1950 and 2015, the main areas of Europe, North America, and Oceania have been net recipients of international migrants, while Africa, Asia, and LAC have been net senders, with a volume of net migration that has generally increased over time (). While the United States had the largest number of immigrants in the world (47 million in 2015), LAC emigrants represented 5% of the total population (30 million approximately, in the same year). This figure includes those born in LAC countries that reside outside that subregion, as well as the native population living in countries other than their country of birth but within the subregion (). Mexico accounts for the second largest diaspora population in the world, that is, the largest number of emigrants in absolute terms: 12 million people. In LAC, Mexico is followed by Colombia, with 2 million, and El Salvador, with 1.3 million ().
In the Caribbean, the countries that had the highest “sending” rates in the 5-year period between 2010 and 2015 were Saint Vincent and the Grenadines, Grenada, Guyana, Jamaica, U.S. Virgin Islands, Puerto Rico, and Dominica. A similar level was recorded in one Central American country (El Salvador), and to a lesser extent, one South American country (Paraguay) (Figure 4).
Figure 4. Countries of the Americas: Annual average net rate of migration, 2010–2015 (per 1,000 population)
Although most of the LAC countries have had net negative migration rates for three or more decades, recently there has been a reduction in relative magnitude (), with net migration rates from this subregion falling from ‐1.4 per 1,000 in the 1995‐2000 period to ‐0.7 per 1,000 in the 2010‐2015 period. This phenomenon was quite consistent over the various areas. In those same years, net migration rates declined from ‐3.5 to ‐2.8 per 1,000 in the Caribbean; from ‐4.7 to ‐2.3 per 1,000 in Central America; from ‐3.7 to ‐0.9 per 1,000 in Mexico; from ‐1.6 to ‐1 in the Andean Area; and from ‐0.3 to 0.3 per 1,000 in the Southern Cone. In Brazil, there has been virtually no change (0 per 1,000).
Population distribution by age and sex
Of note among demographic transformations in the world is the distribution by age: there have never been so many young people as now and, at the same time, it has never been so apparent that we are moving toward an inevitable process of aging. Just as the number of young people offers an opportunity for economic and social development under certain conditions (mainly satisfaction of health and education needs, in a context of full employment), the growth of the older adult population portends new needs, especially in the realm of health and social security.
The age structure of the population is constantly changing due to changes in mortality, fertility, and migration. A population is said to be young when 40‐50% of the people are younger than 15 or 20 years old. This distribution can only be attained when fertility is high and mortality at early ages is moderate. An aging population begins to develop when fertility declines and mortality at older ages is progressively reduced ().
In the different regions of the world, current and expected transformations in the age structure are expressed in the following population pyramids for 2015 and 2050 (Figures 5 to 10). Over time, two patterns are observed: one is the narrowing of the base of the pyramid, concomitant with the decline in the child population, and the other is the widening of the apex to reflect the increase in the proportion of older adults (more markedly among women). The first phenomenon is quite noticeable in Africa and is primarily related to changes in fertility. The second characterizes Europe and North America, which have generally had low levels of fertility and mortality for decades, with population inflows from migration.
Figures 5 to 10. Population pyramids, by regions and selected subregions, 2015‐2050
The population age structure in LAC has been between these two extremes. Although the young population (0–19 years) has been the largest segment thus far, by the early 2020s, the young adult population (20–39 years) is expected to be the largest group. By 2045, this group should be replaced by the adult population (40–59 years), and less than 10 years later, by the older adult population (60 years and over) ().
The extraordinary number of young people in the world–3.1 billion (42% of the world population in 2015)–is not distributed evenly throughout the regions. Ninety percent of people under age 24 live in Africa, Asia, and LAC. Of these, 1.7 billion are children (0–14 years) and 1.1 billion are adolescents and young adults (15–24 years). Due to differences in fertility levels, Africa has a higher proportion of children than the other two regions (41% compared to 24% and 26%, respectively), while the proportions of adolescents and young adults are more similar (19% compared to 16% and 17%).
A young population has specific needs that must be met, including those related to sexual and reproductive health, in order to develop its full potential and avoid bad health outcomes in the long term (). The health of children and newborns is particularly vulnerable to malnutrition and infectious diseases, which are largely preventable or treatable. Adolescents, who constitute a generally healthy population group, are still exposed to many health risks. Many die from suicide, accidents, interpersonal violence, complications related to pregnancy and childbirth, and preventable or treatable diseases. Furthermore, many ailments of adulthood begin at this stage of life, such as those related to tobacco use, HIV and other sexually transmitted infections, poor diet, and a lack of physical exercise ().
Demographic aging is the most relevant trend in changes to the age and sex structure of the contemporary population. According to the United Nations Population Division (), there were 901 million people aged 60 and over in 2015, comprising 12.3% of the total population. This reflects a high rate of annual growth for this population group (3.3%), surpassing that of any other age group. Consequently, countries must take time to prepare and plan actions to ensure the well-being of older persons by protecting their human rights, economic security, access to appropriate health services, and formal and informal support networks ().
At the world level, aging is occurring at different rates. In 2015, Europe and Africa were the regions with the highest and lowest proportions of people aged 60 and over (23.9% and 5.4%, respectively). On average, the countries of the Americas had an intermediate level of population aged 60 and over (14.6%), although there were significant differences between subregions and areas. The over-60 population in North America was 20.7%, an average that accurately reflects the levels observed in Canada and the United States. In LAC, the older adult population was at 11.2%, with significant differences between the Southern Cone (14.9%), the Caribbean (13.1%), and Brazil (11.7%), compared to the Andean Area and Mexico (9.6%) and Central America (8.7%). The countries with the highest percentages of population aged 60 years and older are in the first two subregions: Uruguay (19.1%), Cuba (19.4%), Puerto Rico (19.6%), Barbados (19.8%), Guadeloupe (20.2%), Curaçao (21.1%), U.S. Virgin Islands (24.1%), and Martinique (26.2%) (Figure 11). By contrast, Central America is home to the country with the lowest proportion of older adults in LAC: Belize (with just 5.9% of the population aged 60 and over).
Figure 11. The Americas: Population age 60 and over and 80 and over, 2015 (percentage), by subregion
The differences in aging in the LAC countries can be explained by how far they have progressed in their demographic transition. Countries currently in a very advanced stage, such as Cuba and Uruguay, had the highest proportions of older persons in the subregion. As expected, in some countries other factors may also be in play, such as high rates of emigration for Puerto Rico.
Furthermore, as Saad argues (), population aging in LAC will not be a uniform process in all countries. In many of them, the young and working-age population will continue to be relevant to population growth even well into the 21st century. This will continue to make demands of the social sectors and pose a challenge for public policies.
Another notable characteristic of aging in the Region is related to the “aging of the aged.” According to the United Nations, among the world’s over-60 population, the proportion of people 80 years old or older increased from 9% to 14% between 1980 and 2015 (). This figure is predicted to remain quite stable between 2015 and 2030. Between 2030 and 2050, the percentage of the most elderly will increase from 14% to 20% ().
Globally, the 1.7% of the population aged 80 or older recorded in 2015 will grow to 4.5% in 2050, or 437 million people (). By 2100, there will be 942 million people in the world (8.4%). The proportion of the population aged 80 or over was lower in LAC (1.6%) and much higher in North America (3.8%) (Figure 11). In both subregions, the indicator will increase significantly by 2050 (5.7% and 8.6%, respectively). However, by 2100 it will be higher in LAC (14%) than in North America (11.8%).
Another current aging trend involves sex differentials. In 2015, there were 86 men for every 100 women aged 60 and over. This ratio falls to 63 men for every 100 women when considering the population 80 years and over. In the Americas, the sex differential for the older population is even more pronounced. On average, in the 60 and over population there are 83 men for every 100 women, and in the 80 and over population, 62 men for every 100 women. Among the subregions, the highest proportion of female older adults is found in LAC, especially in the Southern Cone.
This special feature—termed the “feminization of aging” given the high proportion of older adults who are women, especially at the most advanced ages—has very important implications for public policies, particularly those related to health. As indicated by the United Nations Population Fund (UNFPA):
“There is an urgent need to incorporate older women’s and men’s health issues into health policies. Although, on average, women live longer than men, they are also likely to live more years in ill health. Multiple pregnancies and inadequate support in childbirth, as well as inequalities earlier in life, such as poor access to health care, and lower educational and income levels, contribute to health problems in older age. Older women also face specific age-related health issues. Increases in life expectancy have led to more women living beyond menopause, increasing the risk of hormone-related conditions such as osteoporosis which is associated with higher risk of fractures in older women” (, p. 28).
New perspectives on the demographic dividend
One of the greatest expectations awakened by demographic trends in the Region is the opportunity to take advantage of the demographic dividend resulting from transformations in the population’s sex and age structure related to demographic transition, and in particular, reduced levels of fertility following a widespread decline in mortality.
As a country’s TFR declines, the child dependency ratio begins to fall—that is, the proportion of children under 15 compared to the working-age adult population (usually between 15 and 64 years old). The decline in this ratio creates a scenario that may be favorable for both families and countries. For families, having fewer people in the household may mean more resources are available to spend on well-being, health, and children’s education. For countries, fewer people to support may result in a sort of bonus, dividend, or window of opportunity for rapid economic growth, as long as this is duly backed by social policies and economic and monetary investments. Once people aged 65 or older begin to constitute an ever-larger proportion of the total population, which renews demographic dependency, this window is closed and the dividend ends ().
The degree of progress toward the demographic dividend depends on where countries are in their demographic transition. The World Bank () has identified four basic categories in the development of the demographic dividend:
- Countries in the stage prior to the demographic dividend are primarily low-income countries lagging in their key human development indicators and with current fertility levels of more than four births per woman.
- Countries in the initial stage of the demographic dividend are primarily middle-income countries that have passed through the transition in fertility. Fertility rates have declined to less than four births per woman and the proportion of working-age population may be increasing considerably.
- Countries in the advanced stage of the demographic dividend are primarily upper-middle-income countries whose fertility rates are normally above the replacement levels of 2.1 births per woman, but the fertility rate is still declining.
- Countries in the post-demographic dividend stage are primarily high-income countries where the fertility rate has fallen below replacement levels. In these countries, the percentage of working-age population continues to decline, while the older adult population is among the highest in the world.
In our Region, there are no countries in the stage prior to the demographic dividend. The LAC countries are almost equally divided between those in the first and second stages of the demographic dividend, while the countries of North America currently are in the post-dividend stage.
Furthermore, one issue that should be considered is that the demographic dividend in LAC will be of shorter duration than originally forecast. This was primarily because fertility declined more rapidly than anticipated. As indicated by the Latin American and Caribbean Demographic Center (known by its Spanish acronym, CELADE):
The greater-than-expected decline in fertility has a direct impact on the younger age groups in the population structure. While in 1990 it was projected that 28% of the region’s population would be under 15 years of age in 2015, this age group is now estimated to represent about 26% of the population. In absolute terms, in 1990 the region was projected to have 184.4 million persons aged under 15 years in 2015, versus the 160.4 million in the current estimate, which is down by 24 million persons from the previous projection. The slower growth of the under-15 population, combined with a lower mortality rate, has accelerated the process of population ageing […]. As a result of the foregoing, the demographic dividend will be of shorter duration than expected […]. According to current estimates and projections, the dependency ratio is lower than that estimated and projected in 1990, because the dependent under-15 portion of the population is smaller. The dividend is projected to end around 2027, after 61 years of steady decline in the total dependency ratio. The year 2027 will mark a turning point: as the demographic dividend comes to an end, the number of older persons will begin to rise sharply, and will come to exceed the number of under-15s in 2047, that is, 20 years after the dividend expires ( pp. 28).
A demographic process is still under way in the Region, with a window of opportunity that may close sooner than expected, increasing the need to promote measures to take full advantage of this moment. Having a young population does not guarantee economic growth in and of itself; what it offers is an opportunity. Thus, national governments with young populations can increase the demographic dividend by investing in health and education in order to maximize the skills and prospects of the future workforce. Countries with populations that are already aging can consolidate their economic gains by boosting productivity and strengthening the social safety net and other protections for older persons (). It should be noted that managing the economic and health needs of aging populations is already a challenge for developed countries ().
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Annex 1: Groupings of countries
Caribbean: Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Cuba, Curaçao, Dominica, Dominican Republic, French Guiana, Grenada, Guadeloupe, Guyana, Haiti, Jamaica, Martinique, Montserrat, Puerto Rico, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad and Tobago, Turks and Caicos Islands, United States Virgin Islands.
Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama.
Andean Area: Bolivia (Plurinational State of), Colombia, Ecuador, Peru, Venezuela (Bolivarian Republic of).
Southern Cone: Argentina, Chile, Paraguay, Uruguay.
North America: Bermuda, Canada, United States.
1. See section 4, “New perspectives on the demographic dividend.”
2. In Latin America and the Caribbean, the only exceptions are Argentina and Uruguay, which began their demographic transition at least a half century before the other countries. Cuba shares the trajectory of those two countries but started a bit later.
3. The aforementioned requirement is complemented by an absence of mortality.
4. Some countries have reversed historic trends to become receivers of population (e.g., Chile, Costa Rica, and Panama). Others have become receivers again after a break or a period in which they were sending out population (e.g., Argentina is one of the countries receiving the most international migrants, but in the early 2000s it experienced net negative migration flows).