- Overall Context
- Leading Health Challenges
- Health Situation and Trends
- Full Article
Jamaica is the largest English-speaking and third-largest island in the Caribbean, with a land area of 11,424 km2. It is located 150 km south of Cuba and 160 km west of Haiti. Volcanic in origin, Jamaica has three landforms: the eastern mountains, the central valleys and plateaus, and a narrow, discontinuous coastal plain, where agricultural production is concentrated. The Blue Mountain Peak, the island’s highest point, has an elevation of 2,256 m. The country is divided into 3 counties further divided into 14 parishes; Kingston, the capital, is located on the southeast coast and Montego Bay, the second largest city, on the northwest coast.
Jamaica’s estimated population increased by 0.9% between 2010 and 2015 to 2,728,907 (49.5% males) (), with population density increasing by 0.8% to 238 persons per km2 over the same period. From 2011 to 2015, the population continued to show signs of aging as the country progressed through the intermediate stages of the demographic transition. There was a 10.9% decline in the 0-14-year age group to 613,144, due to a sustained reduction in the number of births. The 15-19-year age group decreased by 6.9%. All other age groups showed increases, with 50-59-year and over 60-year age groups showing the largest percentage change with increases of 15% (278,403) and 10% (341,071), respectively (). In 2015, the sex ratio was 98.1 males to 100 females. As age increases, this ratio decreases, ranging from 103.0 males per 100 females in the 0-14-year age group to 97.9 for the working age group (15–64 years) and 88.6 for the dependent elderly (65+ years). The aging of the population will continue in light of the current trend in fertility and mortality patterns, with a further decline in population growth if trends in births, deaths, and migration continue. Figure 1 shows the change in population structure between 1990 and 2015. The age dependency ratio (proportion of dependents per 100 working-age population) was 46.0% in 2014 and 48.6% in 2015 ().
Figure 1. Population structure, by age and sex, Jamaica, 1990 and 2015
Jamaica’s population increased by 17.1% between 1990 and 2015. In 1990, the population had an expansive structure, heavily weighted with age groups under 30 years of age. By 2015, the structure became regressive in relation to decreases in birth rate and mortality, especially in the last two decades.
Source: Pan American Health Organization, based on data from the United Nations Department of Economic and Social Affairs. Population Division, New York, 2015. Updated 2015.
According to the 2011 Population and Housing Census, approximately 54.0% of the population resided in urban areas, reflecting a 7.2% increase compared to the previous census in 2001 (). In 2015, the largest proportion of the population lived in Kingston and St. Andrew parishes (24.6%), with St. Catherine parish ranking second with 19.0% ().
Between 2010 and 2015, Jamaica’s growth and the macroeconomic situation continued to operate within the ambit of Vision 2030, Jamaica’s 21-year National Development Plan (), which seeks to put the country on a path to achieve developed-country status. Vision 2030 is aligned with the 2030 Agenda for Sustainable Development and emphasizes the centrality of health in the stated goals and expected outcomes.
In 2015, Jamaica recorded improvements in most of the indicators for economic and social development. Jamaican authorities and the International Monetary Fund undertook a four-year Extended Fund Facility for fiscal years 2013/14 to 2015/16. The agreement requires implementation of an economic reform program () to reduce the debt-to-GDP ratio from 140% to 95% in 7 years and the public sector wage bill as a percentage of GDP to 9% by fiscal year 2015/16, including a reduction in the public sector establishment. Real value-added growth was 0.8% in 2015, the third consecutive year of growth (), following an increase of 0.5% in 2014 (). Inflation declined to 3.7% in 2015 relative to 6.4% in 2014 (). At the end of 2015, per capita GDP was US$ 5,140 compared to US$ 4,900 in 2010. The Human Development Index for 2014 was 0.719 (in the high human development category) ().
From 2011 to 2015, the labor force grew by 5.2% to 1,316,575, with the total unemployment rate increasing from 12.6% to 13.5%. The number of persons employed in 2015 increased by 10,875 or 1.0% over 2014 (). Labor market reform with employment creation remained a priority for the government, and included the development of an Information Communication Technology/Business Process Outsourcing Strategic Plan.
The National Trade Policy was finalized in December 2015 to strengthen the foreign trade regime and integration into the international trading system. Major bilateral trade agreements, such as with the European Union (EU) and the Caribbean Community (CARICOM), were monitored to minimize their impact on critical sectors. Ratification of the World Trade Organization’s Trade Facilitation Agreement was approved in December 2015.
Total health expenditure as a percentage of GDP fluctuated between 5.2% in 2008 and 5.9% in 2014. Government expenditures on health increased from 56.3% of total health outlays in 2010 to 62.3% in 2014. Out-of-pocket expenditure (as a percentage of total health expenditure) was reduced by 5.7% between 2013 (25.4%) and 2014 (19.7%).
Leading Environmental Problems
Jamaica’s vulnerability to multiple natural and human-induced hazards, such as hurricanes, earthquakes, floods, drought, and fires, and their related impact on the social and economic fabric of society, has been a major challenge to the attainment of sustainable development. Social issues such as poverty, the location of human settlements in high-risk areas, environmental degradation, and poorly constructed infrastructure and housing have compounded this vulnerability ().
Health Policies, Plans, and Programs
A number of policies were introduced or updated to ensure food and nutrition security and to streamline the work of all stakeholders. The Baby-Friendly Hospital Initiative was launched in 1993 to promote and support breastfeeding. Ten hospitals were accredited in this program between 1996 and 2001, one hospital was reaccredited in 2015, and there are plans for at least four hospitals per year to be accredited/reaccredited. The rates for exclusive breastfeeding for infants under 6 months increased from 15% in 2005 to 24% in 2011 (). The International Code of Marketing of Breast-milk Substitutes was not formally monitored, and adherence to restrictions on direct marketing was voluntary. In 2015, the government’s School Feeding Programme provided meals for over 312,000 students, supplying at least one-third of a child’s daily caloric requirements. Improved school attendance, alleviation of hunger, and enhanced learning capacity were ensured for the students in the program ().
Social Determinants of Health
A multi-sector, multi-stakeholder approach to improving the social determinants of health was the standard for the work of the government. The Programme of Advancement through Health and Education (PATH) functioned as a conditional cash transfer program, providing grants to some 380,010 registered beneficiaries at the end of 2015 (a 2% increase over 2014), and is linked to attendance for health and education services based on set criteria ().
The Health in All Policies (HiAP) approach was institutionalized with ongoing involvement of the health sector in multi-sector collaborations to develop policies and plans, such as for the National Youth Policy (2015-2030) and the National Policy for Gender Equality (2011).
Poverty spiked to an estimated 17.6% of the population in 2010 and further increased to 19.9% in 2012. In 2016, the poverty level was 18.7% (see Table 1). The government placed special emphasis on the development of a revised National Policy on Poverty and a Strategic Poverty Programme in 2013. A new Social Protection Strategy including a Social Safety Network Reform Programme was implemented to deliver appropriate interventions and improve sustained outcomes for the poor and vulnerable ().
Table 1. Incidence of individual poverty,a by place of residence, Jamaica, 2006-2012
|Kingston metropolitan area||9.4||6.2||7.0||12.8||14.4||n/ab||19.7|
a Per capita adult equivalent expenditure method was used to determine incidence of poverty.
b n/a: data not available.
Source: Jamaica, Ministry of Health, Policy and Planning Division, 2016.
The Draft National Housing Policy was amended in 2015 to provide a comprehensive framework to guide the housing sector. The National Housing Trust provided access to housing by implementing new policy initiatives in 2015, such as increased loan limits and reduced interest rates for new mortgagors (). In 2012, the housing quality index for Jamaica was 72%). There has been a relative decline in the use of wood as a housing material for external walls, while concrete block and steel has been on the rise. “Separate house detached” is the most prevalent type of dwelling (81.6%) ().
The country pursues several efforts to improve education. The Education System Transformation Programme led policy and program reforms, including the National Lifelong Learning Policy and the National Curriculum Policy (). Current legislation provides for free education from early childhood through primary school. Jamaica’s literacy rate was 91.7% in 2015 (). In 2015, the gross enrollment rates for preprimary, primary, secondary, and tertiary schools in the public and private education systems were 99.8%, 99.4%, 97.3%, and 28.3%, respectively (). In 2013, the Gender Parity Index (ratio of girls to boys) was 1.04 for the secondary level and 2.29 for the tertiary level ().
Children at risk were monitored by the Office of the Children’s Registry, which received 11,749 reports of child abuse in 2014, a 6.6% increase over 2013. Of these reports, 73% were first-time reports and neglect was the most common (50%). There were 55 reports of child trafficking in 2014, compared to 5 in 2013. Another priority initiative was the Disabilities Act, passed in 2014, which makes provisions to safeguard and enhance the welfare of persons with disabilities ().
The Health System
The Ministry of Health is responsible for health care delivery island-wide. Headed by the Minister, the Ministry provides policy and strategic guidance on public health and regulatory matters, such as drugs, chemicals, and quarantine control, and has the mandate to develop policy guidelines and supporting legislation in keeping with the overall goal and objectives of government.
The Ministry’s Head Office comprises five divisions: Technical Services, Policy Planning and Development, Standards and Regulations, Human Resource Management, and Corporate Services and Financial Management and Accounting Services. The health system is decentralized, with four Regional Health Authorities responsible for service delivery, as stated in the National Health Services Act of 1997. Regional Directors provide day-to-day administration of the Regional Health Authorities and report to the Boards of Management, with Board Chairmen appointed by and reporting directly to the Minister.
Health service delivery in the public sector is provided through a network of primary (first level of contact), secondary, and tertiary care facilities. There are five levels of health centers (Types 1-5) and four levels of hospitals (Types A, B, C, and Specialist). In 2015, there were 318 primary care health centers linked through a referral system to the secondary and tertiary care levels. Twenty-four hospitals and one quasi-government hospital (the University Hospital of the West Indies) have a total bed complement of 4,865. Five of these are specialized hospitals, which also provide training for health professionals. Departments and agencies that provide support services include the National Public Health Laboratory, and the National Health Fund, which is a major contributor to health financing ().
There is a large private health sector with primary and secondary care facilities and diagnostic services. In 2015, there were 10 private hospitals with approximately 200 beds. Referrals from the public to private sector facilities and vice versa remained a feature of service delivery, particularly for diagnostic and therapeutic care.
Leading Health Challenges
Critical Health Problems
In 2015, dengue remained endemic, with outbreaks occurring in 2007, 2010, and 2012. All four serotypes have circulated in the island and Aedes aegypti is the only dengue vector found in Jamaica. There were 118 suspected cases for 2015 and 2,316 for 2016, with 26 and 190 laboratory-confirmed cases for the same years (). The Integrated Management Strategy for Dengue Prevention and Control was implemented in 2012.
The first confirmed case of chikungunya fever in Jamaica was an imported case in July 2014; the first autochthonous case was confirmed in August of that year. By the end of 2015, 5,180 cases of chikungunya had been reported (97 laboratory-confirmed). Cases were found in individuals ranging in age from 3 days to 95 years old, with a median age of 26 years. Most of the hospitalizations (24%) were in children under 1 year old, with 31% in children up to 4 years. The expectation was that cases of chikungunya fever would follow a similar seasonal pattern to that of dengue fever.
The first Zika virus case was confirmed in January 2016. By the end of 2016, there were 203 laboratory-confirmed cases. There were 698 suspected Zika cases among pregnant women reported to the Ministry of Health, of which 78 were laboratory confirmed (PCR test). Of the 170 notifications of infants suspected of presenting with congenital syndrome associated with Zika virus infection, 50 were classified as suspected cases; 3 infants were classified as probable cases of congenital syndrome associated with Zika().
The Ministry of Health Zika Preparedness and Response Plan was implemented, focusing on heightened awareness of the population, training of health care workers, and mosquito control().
In 2016, the National Influenza Centre confirmed 160 influenza cases, compared to 37 cases in 2015. In 2016, influenza A(H1N1)pdm09 was the predominant circulating virus, accounting for 50% of cases (). There was a 24.5% increase in reports of severe acute respiratory illnesses in 2016 (1,056 cases) over 2015. The seasonal influenza vaccine was only available to frontline health care workers in the public sector, although their participation in the vaccination drive was voluntary and limited; influenza vaccine is also available in the private sector.
No cases of suspected or confirmed cholera have been detected in Jamaica since the last recorded cases in 1852. Vigilance has been maintained in view of the ongoing transmission of cholera in neighboring countries ().
There has been no autochthonous transmission of malaria since 2009, following an outbreak due to Plasmodium falciparum (2006-2009). In 2013, Jamaica was reinstated on the World Health Organization (WHO) Official Register of areas where malaria eradication has been achieved. No cases of yellow fever have been recorded since 1852 and no case of Chagas disease has been seen in Jamaica. There was a single case of cutaneous leishmaniasis in a traveler from a country in the Americas, which was notified in December 2015 and was never confirmed ().
There were 117 reports of multidrug-resistant infections in 2015, including 20 cases (17%) of methicillin-resistant Staphylococcus aureus (MRSA). Other organisms isolated included Klebsiella pneumonia (53 cases), Acinetobacter species (14 cases), and Serratia marcescens (10 cases). Increases in multidrug-resistant cases occurred at two hospitals in 2015. A surveillance system for hospital-acquired infections was developed in 2015 ().
Neglected Diseases and Other Infections Related to Poverty
Jamaica has achieved elimination of leprosy. Three cases were detected in 2015, compared with 8 in 2011. The Western and Southern regions accounted for 88% (15 cases) of all leprosy cases detected from 2011 to 2015 ().
From 2011 to 2015, there were 1,659 notifications of suspected cases of tuberculosis. Of these, 32.6% were confirmed, and the highest confirmation rate (51.2%) was in 2015. The majority of cases were in young adults (25–34 years old), with the fewest in the 5-14-year age group. In 2015, all age groups recorded an increase in cases, with an average of 114.7 new cases per annum from 2006-2015. Between 2011 and 2015, less than 25% of persons screened were coinfected with HIV. The treatment success rate ranged from a high of 77% in 2013 to 22% in 2015 (). Noncompliance and inadequate monitoring of directly observed therapy, short course (DOTS) had a negative impact on treatment success rates.
Jamaica has an estimated HIV prevalence of 1.6% among the general population, and an estimated 29,000 persons are currently living with HIV in Jamaica; approximately 16% are unaware of their status. Between January 1982 and December 2015, 34,125 cases of HIV were reported to the Ministry of Health. Of these, 9,517 (27.9%) are known to have died.
The Ministry of Health began monitoring cases of advanced HIV in July 2005 as a way to assess the need for treatment at an earlier stage of the disease. In 2015, 686 persons with advanced HIV (349 males and 337 females) were reported, compared to 764 in 2014 ().
Jamaica has scaled up its HIV prevention program with the adoption of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets and with increased access to treatment and care services, including decentralized CD4 cell count monitoring . However, loss to follow-up among HIV patients has emerged as a challenge (). Factors such as inconsistent condom use and poverty have been found to be underlying factors driving the epidemic ().
According to the 2016 Global Nutrition Report (), Jamaica is on course for meeting only one of the global nutrition targets, that of reducing wasting in children. The country is showing some progress in meeting the targets of reducing stunting and overweight and achieving exclusive breastfeeding, and is off course in reducing anemia in women of reproductive age. In children under age 5, 3% were affected by wasting, 5.7% were affected by stunting, and 7.8% were overweight in 2012. Prevalence of low birthweight was 11.3% in 2011. The rate of exclusive breastfeeding of infants at age 6 months was 23.8%, and 24.4% of women of reproductive age suffered from anemia in 2011. Prevalence of overweight or obesity was 18% among children aged 6-10 years old, and 22%-25% among children 10-15 years old.
From 2010 to 2014, the five leading causes of death were due to noncommunicable diseases (NCDs) and injuries (). Premature mortality due to NCDs for both sexes between the ages of 30 and 70 was 17%, which is higher than the regional average of 15% (). Jamaica was not on track to meet the regional NCD goal of a 15% reduction in premature mortality by 2019. The trend in premature mortality has remained stable since 2010.
Efforts to reduce risk factors included implementation of three tobacco demand-reduction interventions, that is, tobacco taxation policy, establishing smoke-free environments, and providing health warnings. In 2013, the Ministry of Health implemented new tobacco control regulations.
Since the 1960s, Jamaica has continued the transition from a hospital-focused mental health service to one that is community-based, in partnership with all sectors. The emphasis is on the promotion of mental health, early diagnosis and treatment of mental disorders (across age groups), and psychosocial and vocational rehabilitation. In 2015, 18,991 patients were seen in the community mental health service, an 8.3% reduction from 2010. The burden of mental disorders in 2014 expressed as disability-adjusted life years was 3,107 per 100,000 population (). The suicide rate in 2014 was 1.2 per 100,000 population, and attempted suicides increased by 265% (141 in 2011 to 515 in 2014) . For child and adolescent mental health services, the number of client visits increased by 433% from 2000 to 2011; 9,000 patients were seen in 2015, a 12.5% increase from 2012. The main diagnoses included major depression, anxiety disorders, learning disorders, and child abuse.
In 2015, there were a total of 1,166 doctors, 92 dentists, and 3,849 nurses employed in the public sector. They are concentrated in the South East Regional Health District, where approximately 50% of the population resides and the specialist hospitals are located. The density of doctors and nurses in Jamaica is 0.43 and 1.4 per 1,000 population, respectively. In 2013, 23 graduate nurses were deployed to health facilities for guided clinical practice, and 8 nursing managers and 32 ICU and 14 cardiothoracic nurses were trained. With support of the EU-funded Programme for the Reduction of Maternal and Child Mortality (PROMAC) project, 45 nurses were training in the Bachelor’s Degree in Critical Care and Post-basic Midwifery Nursing at the University of Technology and 2 nutritionists were candidates for the Post-graduate Diploma in Education for Neonatology Nutrition. Twenty nurses completed training in critical care and 32 in neonatology in the Ministry of Health in-service training program. Migration of health professionals continued, particularly among specialized registered nurses, with active recruitment taking place in Jamaica for overseas markets ().
Health Knowledge, Technology, and Information
Since 2010, the Ministry of Health has strengthened the National Health Information System using the Health Metrics Network Framework and Standards (). A multi-sectoral Health Information and Technologies Steering Committee directed and coordinated activities, including the 2011 National Health Information System Assessment and the development of the National Health Information System Strengthening and E-Health Strategic Plan for 2014-2018. The E-Health Pilot Project launched in 2014 used open-source software for a patient administration system. The use of web technologies to enhance disease surveillance and communication with citizens included the Surveillance Self-Reporting Online Survey and social media applications such as Facebook, Twitter, and Instagram. The Standards and Regulation Division of the Ministry of Health and the Bureau of Standards established norms for the use of medical technology.
The Ministry of Health Resource Centre (MHRC) provides access to online databases and has facilitated increased access to information for its clients through the Social and Economic Information Network (SECIN) and Scientific Technical Information Network (STIN), as well as through interlibrary loans, referrals, and virtual reference services.
The Environment and Human Security
Since 1995, Jamaica has been a party to the United Nations Framework Convention on Climate Change (UNFCCC). In 2015, the government prepared and submitted its Intended Nationally Determined Contribution (INDC) to the UNFCCC, which outlined the country’s proposed efforts to reduce greenhouse gas emissions, in keeping with Jamaica’s National Energy Policy for 2009-2030. The Climate Change Policy Framework for Jamaica was finalized in 2015.
New environmental legislation and amendments to existing acts included the Natural Resources Conservation (Wastewater and Sludge) Regulations (2013) () and the Fishing Industry (Special Fishery Conservation Area) Regulations (2012). In 2015, the Forestry Department and its partners focused on reforestation activities and a gap analysis of the current National Forest Management and Conservation Plan. The Forest Policy was tabled in Parliament as a green paper (). The Water Resources Authority continued to manage, protect, and control allocation and use of Jamaica’s surface and underground water resources as mandated by the Water Resources Act of 1995 and guided by the Water Sector Policy 2004 (). The Online Hydrologic Web Map, maintained by the Water Resources Authority, was updated in 2015.
In 2015, habitat loss, climate change, resource over-exploitation, invasive alien species, and general pollution were the main threats to biodiversity. The El Niño effect, while minimizing the number and severity of weather systems, created serious drought conditions for the island from 2011-2015. In 2015, the country received less than the 30-year mean of rainfall and drought conditions persisted for six months (). Between 1990 and 2000, Jamaica lost 1.7% (6,000 hectares) of its forest cover at an annual deforestation rate of 1.2% . In 2010, the Forestry Department stated that the rate was 1.0% and that approximately 30% (333,000 hectares) of Jamaica remained classified as forest.
According to the Environmental Vulnerability Index, Jamaica is as one of the 35 extremely environmentally vulnerable countries in the world and has suffered from a number of natural disasters historically. The Disaster Risk Management Act, passed in 2014, made new provisions for the management and mitigation of disasters and the reduction of associated risks.
The main contributors to poor outdoor air quality in 2015 included emissions or air pollutants from industrial facilities, motor vehicles, open burning of sugarcane fields, and fires at solid waste disposal sites. Population growth, energy use, the number of vehicles in the country, and poor domestic and industrial practices exacerbated this pollution. Jamaica had 77 air-quality monitoring stations in the public and private sectors in 2015 (a 63% increase over 2010), with monitoring of ambient concentrations of criteria air pollutants (except lead) on a routine basis. Air pollution incidents increased by 150% from 2011 to 2015, when there were 30 incidents (). National and agency response plans and protocols were utilized for all incidents.
The National Implementation Plan for Management of Persistent Organic Pollutants was revised in 2011, based on the Stockholm Convention, which Jamaica signed in 2001.
Water, Sanitation, and Solid Waste Disposal
Jamaicans rely on various sources for their water. In 2012, some 70% of households had piped water in their yards or dwellings, 12.4% utilized rainwater collected in tanks, and 2.5% used rivers or springs as their source of drinking water. In urban areas, 94.2% of residents had access to piped water, compared to 49.1% in rural areas (). Preparation of the Rural Water Supply Development Strategy was advanced in 2015.
Nearly all households (99.8%) had access to improved sanitation in 2012, and toilets were used in 73.8% of households (). Pit latrine usage increased from 23% in 2011 to 26% in 2012. Relative to 2010, the proportion of Quintile 1 households with a water closet increased by 5.3% ().
The total volume of solid waste disposed of in 2015 was 778,175 tonnes, with per capita waste generation estimated to be 1.2 kg/day, a 0.2 kg increase relative to 2014 (). In 2012, most households (63.4%) used a garbage collection service and 31.9% burned their trash, compared to 63.5% and 33.5%, respectively, in 2008 .
Hazardous Waste and Pesticides
Hazardous waste totaling 1.8 Ml of oily sludge (waste hydrocarbon /emulsion water) was generated by bauxite companies and power generation companies in 2015, 1.9 Ml less than in 2014. As of this writing, Jamaica has no comprehensive mechanism or policy for the management of hazardous waste. The absence of facilities for the treatment and disposal of hazardous waste means that most such waste is deposited in the normal waste stream, ending up at landfills or in the sea (). Export and import applications were approved under the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal in 2015 ().
The Nuclear Safety and Radiation Protection Act (2015) was passed to regulate the use of ionizing radiation and nuclear technology in the health sector and other sectors. The International Atomic Energy Agency continued to support relevant sectors ().
There were 3,106.00 tonnes of pesticides imported in Jamaica for fiscal years 2012/2013, and 3,056.31 tonnes in 2010, regulated by the Pesticides Control Authority of the Ministry of Health. The agricultural sector continued to review pesticide use and practices. The Ministry of Agriculture and Fisheries continued to guide the Plant Health Surveillance and Pest Response Systems.
The Food and Nutrition Security Policy (2013) focused on food availability, access and utilization, and the stability of food supply. The National Food Safety Policy (2013) established a single system to ensure that food safety standards are applied at all stages of production and distribution, from “farm to fork.”
Gastroenteritis syndrome, which may be an indicator of food- and waterborne disease in a community, remained within endemic levels for 2015 ().
The National Security Policy (2014) addressed crime and violence to achieve sustainable safety and security in Jamaica. The strategic priorities for reducing crime included an organizational review of the Jamaica Constabulary Force; the establishment of the Counter-Terrorism and Organised Crime Investigation Branch, for areas such as gang suppression; and the Transnational Crime and Narcotics Division, for the trafficking of drugs, firearms, and persons. The overall crime rate declined between 2011 (932/100,000 population) and 2015 (644/100,000), and between 2014 and 2015 there was a 39.4% decline in the total number of crimes. The murder rate declined from 54/100,000 population in 2010 to 44/100,000 population in 2015. The Dangerous Drugs Act of 2015 decriminalized possession of up to 2 oz of marijuana and resulted in the reduction of drug-related crime (). Key initiatives were introduced to combat human trafficking, including the development of a dedicated database, that resulted in Jamaica’s first conviction for human trafficking in 2015 ().
Road traffic fatality rates declined from 11.83 deaths/100,000 inhabitants in 2010 to 9.59 in 2012 and increased to 12.20 and 14.0 deaths/100,000 inhabitants in 2014 and 2015, respectively. Males accounted for 80% of the fatalities each year between 2010 and 2015. The highest number of deaths in this period occurred among pedestrians, except in 2015, when the most common category was motorcycle riders ().
Life expectancy at birth was 74.2 years in 2011; there was disparity between males and females, with rates of 71.3 and 76.3 years, respectively.
A 2012 study of the health and social status of the over-60 population highlighted the burden of NCDs in this growing segment of the Jamaican population (). Of those surveyed for the study, 76.4% had at least one chronic disease and 46.9% had comorbidities. Hypertension was reported by 61.4% in the survey (compared to 32.8% nationally) and diabetes was reported by 26.2% (compared to 13.37% nationally). Gender differences were significant for both diseases: 49.2% of males and 72.5% of females had hypertension, and 19.6% of males and 32.3% of females had diabetes. The majority (84%) accessed health care regularly, mainly primary health care in the public and private sectors, and 22.6% reported they had accessed hospital services. Main health needs were for pharmaceuticals and diagnostic services that were not covered in the public system, and for health care related to the increasing prevalence of stroke, diabetes-related complications, and dementia. Most persons 60 and over were not working in the formal workforce. Of those surveyed, 23% received a National Insurance Pension, 15.4% a government pension, and 9.1% a private pension. Tobacco use was reported by 25.4% of the survey group (75% males) and 21.4% reported regular alcohol consumption (at least 2 drinks per week). A total of 63.3% of this group reported physical exercise, at an average of 5 to 7 times per week, especially walking, which was in keeping with the fact that 60% lived in rural areas.
The destinations of choice for Jamaican international migrants remained the United States of America, the United Kingdom, and Canada. During 2013, a total of 24,744 persons migrated to these countries, which was 4.4% below 2012. The 2011 Population and Housing Census revealed that 26.4% of the population lived outside their parish of birth (). In 2011, 55% of internal migrants were female, with the majority in the 20-29-year age group. There was no significant impact on health care due to this internal migration pattern.
Monitoring the Health System’s Organization, Provision of Care, and Performance
The utilization of the public health service remained high, with no increase in support systems, such as staff and diagnostic and therapeutic care. Patient discharges from public hospitals declined by less than 1% between 2010 (190,064) and 2015 (191,333). The majority of discharges (29%) were for obstetric causes. The performance of the Regional Health Authorities was measured i) against Service Level Agreements signed with the Ministry of Health (), and ii) utilizing a client complaint mechanism ().
The Ministry of Health continued to develop supportive legislation and policies based on a priority agenda. Legislation reviewed and /or developed included the Nurses and Midwives (Amendment) Bill, and the Pharmacy Bill ().
The country continues to move toward universal health, with a focus on health system strengthening and improved access to services. The no-user-fee policy, introduced in 2008, had reversed the policy of fees for hospital care. In 2013, the Ministry of Health instructed all hospitals to reestablish billing mechanisms for those enrolled in health insurance schemes ().
The policy priorities of the Ministry’s Strategic Business Plan for the years 2013-2016 and 2015-2018 () were to enhance health sector governance; ensure access to health care services; provide quality assurance in the delivery of health services to the population; and reduce injury, disability, and premature deaths from preventable illness. The Ministry of Health priority programs and projects were guided by Vision 2030, with implementation of sequential, three-year, socioeconomic policy medium-term frameworks (MTFs) and a robust monitoring and evaluation framework. The MTFs for 2012-2015 and 2015-2018 included family health and communicable and noncommunicable diseases, with a National Strategic and Action Plan for the Prevention and Control of NCDs in Jamaica, 2013-2018. Vision 2030 is aligned with the Sustainable Development Goals (SDGs). The EU PROMAC project aimed to reduce mortality in children under age 5 by equipping neonatal intensive care units in regional hospitals, training specialized health staff, and procuring ambulances. The program also assisted in refurbishing and improving infrastructure of selected health facilities ().
Health Situation and Trends
Health of Population Groups
Maternal and Reproductive Health
The total fertility rate declined from 4.5 children born per woman in 1975 to 2.4 in 2008. There was a 48.8% decline in family planning visits from 2011 to 2013 (151,891 visits in 2013, with 92% female and 8% male visits). Of the 40,560 new acceptors of contraception in 2013, most (48.6%) chose injectable progestin (such as Depo-Provera).
The maternal mortality ratio was 113.3 deaths per 100,000 live births in 2010, with a slight decrease to 108.1 in 2014. There was a 17.7% decline from 2010 to 2012 and a subsequent 28.8% increase from 2012 to 2014. The main causes of maternal mortality were hypertensive disorders during pregnancy (19%) and hemorrhage (18%). The main risk factors identified included anemia, hypertension, sickle cell disease, uterine fibroids, multiparity, and cardiac disease.
The mortality rate for infants (children under 1 year old) was 17.4 per 1,000 live births in 2011, while the rate for children under 5 years old was 19.1 per 1,000 live births. The infant mortality rate has continued to decrease, from 62 per 1,000 live births in 1960.
The Expanded Programme on Immunization (EPI) remained the flagship program of the Ministry of Health, providing the following coverage in 2015: 100% bacille Calmette-Guerin (BCG); 92% polio; 92% diphtheria, pertussis, and tetanus (DPT/DT); 92% Haemophilus influenzae type b (Hib); 92% hepatitis B; and 83% measles, mumps and rubella (MMR) (2 doses). The Southern Region had the highest overall coverage for vaccines. Since 2012, the target of 95% coverage was only achieved for the BCG vaccine in 2015.
No vaccines have been introduced into the routine schedule since 2013, but there are plans to introduce the human papilloma (HPV) vaccine in the future. Maintenance of the elimination of measles, rubella, congenital rubella syndrome (CRS), and polio remain a priority for the Ministry of Health.
Children under 10 years old accounted for 21.4% of injuries at emergency departments in 2015, compared to 22.2% in 2014 ().
Health of Adolescents
The Ministry of Health continued its emphasis on the Adolescent Health and Empowerment Programme. The main health issues affecting this group were injuries, violence, mental health, and sexual and reproductive health. In 2014, HIV prevalence among girls and boys aged 10-14 years was estimated to be 0.1%, mainly resulting from mother-to-child transmission (). For adolescent girls and boys aged 15-19 years, the prevalence was 0.4% and 0.5%, respectively. Among gay and bisexual adolescent boys, the estimated prevalence was 14%, and for transgender adolescents it was 27% ().
The main contributing factors to adolescent pregnancy in Jamaica are the early age of sexual debut, the low use of contraceptives by sexually active adolescents, and coerced sex. In 2012, the birth rate per 1,000 women aged 15-19 years was 72, compared to 16 for the general population.
Health of Adults
In the 20-64-year age group (59% of the population), the prevalence of chronic diseases was of growing concern. Hypertension was the leading cause of visits to primary care facilities, with an increase of 13%, from 179,745 in 2011 to 203,112 visits in 2015. Of persons who sought care at emergency departments, 45% were in the 20-64-year age group and 72% sought care for unintentional injuries ().
There was a 12.7% increase in the number of deaths from 2013 (17,350) to 2014 (19,557). Diseases of the circulatory system claimed 6,476 lives in 2014, with 50.9% being female. Cerebrovascular disease, hypertensive disease, and diabetes mellitus were among the five leading causes of deaths for both males and females over 5 years old. In 2014, most cancer deaths in men were from cancer of the prostate (676); for women, most cancer deaths were due to cancers of the breast (393) and the cervix uteri (167) ().
For children under 5 years old, respiratory and cardiovascular disorders specific to the perinatal period was the leading cause of death for the 2011-2014 period.
In terms of vaccine-preventable diseases, the last cases of indigenous transmission of measles, CRS, and rubella were in 1991, 1998, and 2000, respectively, with certification of elimination received in July 2011. The last reported case of polio was in 1982.
Chronic, Noncommunicable Conditions
The most common malignant neoplasms in children 0 to 14 years old were leukemia and malignant neoplasms of the central nervous system. For adult males, the leading form of cancer was prostrate, and for women it was cancers of the breast and cervix ().
In 2010, for those 18 years and older, the age-standardized estimate for diabetes was 9.8% for men, 13.2% for women, and 11.5% overall (). Levels of diabetes were expected to increase because, based on current estimates, levels of overweight and obesity remain high.
According to a 2012 study, the prevalence of asthma in Jamaican children is high. Of the 2 to 17 year olds surveyed, 16.4% self-reported doctor-diagnosed asthma and 19.6% reported a current wheeze. Asthma was more common in males than in females ().
Hypertension was one of the most common NCDs in Jamaicans. In those 18 years and older, the 2010 age-adjusted estimate of increased blood pressure (systolic blood pressure [SBP] ≥ 140 and/or diastolic blood pressure [DBP] ≥ 90) was 25.4% for men, 20.5% for women, and 22.9% overall ().
Levels of overweight and obesity were high in Jamaica, and more prevalent in women than men. The age-adjusted estimated prevalence of overweight (body mass index [BMI] ≥ 25) in adults 18 years and older was 48.7% in men, 63.6% in women, and 56.3% overall in 2014 (). In 2014, among adults, 36% of females, 18% of males, and 27% overall were obese (). The prevalence of obesity in children ages 13 15 years old was 5.3% in boys, 6.7% in girls, and 6.0% overall in 2010.
Accidents and Violence
Accidents (unintentional injuries) accounted for 45,435 visits to the emergency departments at public hospitals in 2014. The top three types of accidents were falls (35%), accidental lacerations (30%), and motor vehicle crashes (24%). Between 2010 and 2014 there was a 6% decline in emergency department visits due to accidents. Violence represents a major public health threat, and accounted for 19,679 visits to emergency departments at public hospitals in 2014. The top three types of violence-related injuries were blunt injury (33.6%), intentional lacerations (20.1%), and stab wounds (9.7%). Between 2011 and 2014 there was a 16% decline in overall intentional injuries.
Risk and Protective Factors
The age-standardized prevalence of current tobacco smoking in the population over age 15 was 30.7% for males, 6.6% for females, and 18.3% overall in 2010. Prevalence in adolescents was 31.3% in boys, 24.6% in girls, and 28.7% overall (). Current smokeless tobacco use was 8.5% overall.
For the population 15 years and older, the age-standardized prevalence of alcohol use disorders was 6.5% in men, 1.8% in women, and 4.1% overall in 2010 ().
Prevalence of insufficient physical activity in adults 18 years and over was 23.9% for males, 31.8% for women, and 27.9% overall in 2010 ().
Advancing the health status of Jamaicans will continue to be guided by Vision 2030, the country’s National Development Plan. The 10-year Health Sector Development Plan will specifically detail the strategies and actions to meet priorities based on international, regional, and national imperatives. Gains from achievements toward the Millennium Development Goals form the basis for achieving the Sustainable Development Goals (SDGs).
Jamaica continued to face a triple burden of NCDs, violence and injuries, and emerging and reemerging infectious diseases. Between 2010 and 2014, the top five leading causes of deaths were NCDs and injuries, accounting for approximately 70% of deaths annually. The predicted increase in the frequency of outbreaks of infectious diseases requires reinforcement of the health emergencies program in the Ministry of Health, including the implementation of the International Health Regulations. Major challenges to reducing the prevalence of NCDs and premature mortality include an inadequate regulatory framework to address the reduction of the main risk factors and to create the supportive environment for behavior change. Other challenges are the global economic conditions that lead to increased cost of service delivery, including for essential medicines and technologies, and the cost of reforming the workforce.
Universal health remains a priority to ensure that the population is able to access i) quality care at upgraded facilities, by trained staff with the appropriate mix of skills, ii) required levels of equipment, pharmaceuticals, and supplies, and iii) the requisite financial protection. Increased public interaction with the health sector, including through social media, provides an opportunity to build the engagement of individuals and communities in support of priority health sector programs.
Restructuring technical services to ensure appropriate service delivery and accountability will be required, with a focus on strong public health leadership, and the development of time-sensitive health information technology, including linked, interactive databases that feed into international, regional, and national indicators. This will ensure evidence-based decision-making, which is critical for monitoring progress toward the SDGs, and the care and health status of the population.
Messages about social and other determinants of health should be conveyed so that all Jamaicans can play their part in attaining a high quality of life. Health must be positioned as integral to attaining Vision 2030.
1. Statistical Institute of Jamaica. Annual report 2015-2016. Kingston: STATIN; 2016. Available from: http://statinja.gov.jm/pdf/AnnualReport2015-2016%202017.pdf.
2. Planning Institute of Jamaica. Economic and social survey Jamaica 2015. Kingston: PIOJ; 2016.
3. Statistical Institute of Jamaica. 2011 population and housing census. Kingston: STATIN; 2012.
4. Planning Institute of Jamaica. Vision 2030 Jamaica: national development plan. Kingston: PIOJ; 2009. Available from: http://www.vision2030.gov.jm/Portals/0/NDP/Vision%202030%20Jamaica%20NDP%20Full%20No%20Cover%20(web).pdf.
5. Bank of Jamaica. Annual report 2015. Kingston: BOJ; 2015. Available from: http://www.boj.org.jm/uploads/pdf/boj_annual/boj_annual_2015.pdf.
6. United Nations Development Programme. Human development report 2015: work for human development. UNDP; 2015. New York: UNDP; 2015. Available from: http://hdr.undp.org/sites/default/files/2015_human_development_report.pdf.
7. Office of Disaster Preparedness and Emergency Management. How ODPEM actively prepares Jamaica for disasters. Kingston: OPDEM; 2008. Available from: http://www.odpem.org.jm/BePrepared/HowODPEMPreparesJa/tabid/72/Default.aspx.
8. International Food Policy Research Institute. Global nutrition report 2016: from promise to impact—ending malnutrition by 2030. Washington, D.C.: IFPRI; 2016. Available from: http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/130354/filename/130565.pdf.
9. Planning Institute of Jamaica. Economic and social survey Jamaica 2013. Kingston: PIOJ; 2014. Available from: http://intranet.cda.gov.jm/wp-content/uploads/2014/06/ESSJ-2013-FINAL-PDF.pdf.
10. Planning Institute of Jamaica. Economic and social survey Jamaica 2014. Kingston: PIOJ; 2015.
11. Planning Institute of Jamaica. Jamaica survey of living conditions 2012. Kingston: PIOJ; 2012. Available from: http://www.pioj.gov.jm/Portals/0/Social_Sector/Executive%20SummaryFinal.pdf.
12. United Nations Statistics Division. Millennium Development Goals indicators: metadata—gender parity index, Jamaica, 2013. New York: UNSD; 2016. Available from: http://unstats.un.org/unsd/mdg/Metadata.aspx?IndicatorId=9.
13. Ministry of Health (Jamaica). Weekly Epidemiology Bulletin. EW 52, 2016. Kingston: MOH: 2017. Available from: http://moh.gov.jm/wp-content/uploads/2017/02/Weekly-Bulletin-EW-52-2016.pdf.
14. Ministry of Health (Jamaica). Vitals: a quarterly report of the Ministry of Health: April 2017. Kingston: MOH: 2017.
15. Ministry of Health (Jamaica). National surveillance data. Kingston: MOH; 2015.
16. Ministry of Health (Jamaica). HIV epidemiological profile: facts and figures. Kingston: MOH; 2015. Available from: http://moh.gov.jm/wp-content/uploads/2017/05/2015-Epi-Update-Revised-Final.pdf.
17. World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: WHO; 2014. Available from: http://www.who.int/nmh/publications/ncd-status-report-2014/en/.
18. World Health Organization. Mental health atlas country profile 2014: Jamaica. Geneva: WHO; 2015. Available from: http://www.who.int/mental_health/evidence/atlas/profiles-2014/jam.pdf?ua=1.
19. National Environment and Planning Agency (Jamaica). Environmental and planning laws of Jamaica. Kingston: NEPA; 2016. Available from: http://nepa.gov.jm/new/legal_matters/laws/.
20. Planning Institute of Jamaica. Management of hazardous & solid wastes in Jamaica. Kingston: PIOJ; 2007. Available from: http://www.pioj.gov.jm/Portals/0/Sustainable_Development/Management_of_Wastes.pdf.
21. Jamaica Constabulary Force. Annual report 2015. Kingston: JCF;. 2015. Available from: https://issuu.com/jamaicaconstabularyforce2015/docs/annual_report_final_2015.
22. Ministry of Transport, Works and Housing (Jamaica). Traffic crash report. Kingston: MTWH; 2015. Available from: http://www.mtw.gov.jm/roadsafety/images/Reports_And_Statistics/2015/Crash_Report_May_2015.pdf.
23. Eldemire-Shearer D, Mitchell-Fearon K, Laws H, Waldron H, James K, Holder-Nevins DL. Ageing of Jamaica’s population—what are the implications for healthcare? West Indian Medical Journal 2014;63(1):3-8. doi: 10.7727/wimj.2014.003.
24. Ministry of Health (Jamaica). Annual report 2014/2015. Kingston: MOH; 2016.
25. Ministry of Health (Jamaica). Strategic business plan 2015-2018. Kingston: MOH; 2014. Available from: http://moh.gov.jm/wp-content/uploads/2015/07/Ministry-of-Healths-Strategic-Business-Plan-2015-2018.pdf.
26. Gibson T, Hanchard B, Waugh N, McNaughton D. Age-specific incidence of cancer in Kingston and St. Andrew, Jamaica, 2003-2007. West Indian Medical Journal. 2010;59(5):456-464. Available from: https://www.mona.uwi.edu/fms/wimj/article/1287.
27. Kahwa E, Waldron N, Younger N, Edwards N, Knight-Madden BK, Wint Y et al. Asthma and allergies in Jamaican children aged 2–17 years: a cross-sectional prevalence survey. British Medical Journal Open 2012;2(4):e001132. doi: 10.1136/bmjopen-2012-001132.
28. Pan American Health Organization. Report on tobacco control for the Region of the Americas: WHO Framework Convention on Tobacco Control: 10 years later. Washington, D.C.: PAHO; 2016. Available from: http://iris.paho.org/xmlui/bitstream/handle/123456789/28393/9789275118863_eng.pdf?sequence=1&isAllowed=y.
1. The elimination of leprosy is defined as having a prevalence of less than 1 case per 10,000 persons.
2. Persons with advanced HIV include persons with CD4 count < 350.
3. Ministry of Health. Annual surveillance data for maternal deaths, 2010, 2012, and 2014.
4. Statistical Institute of Jamaica, Censuses, Demographic and Social Statistics Division. Internal report. 2015.
5. Ministry of Health. Annual immunization coverage data, 2012 and 2015.
6. Ministry of Health. Annual immunization coverage data, 2012.
7. Ministry of Health. Monthly hospital summary reports, 2010, 2011, and 2014.