Pan American Health Organization

Aruba

  • Overall Context
  • Leading Health Challenges
  • Health Situation and Trends
  • Prospects
  • References
  • Full Article
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Overall Context

Flag of ArubaAruba is part of the Lesser Antilles. It is the western-most island of the Leeward Islands, located in the Caribbean, some 25 km off the coast of Venezuela. It has a landmass of 180 km2 (31 km long and 8 km wide) (). Aruba was part of the Netherlands Antilles until 1986, when it became an independent country within the Kingdom of the Netherlands. The island is autonomous in terms of the administration and management of public policies, but is under the authority of the Kingdom of Netherlands for issues related to defense, foreign affairs, and the administration of the justice ().

Demographics

According to 2014 data, Aruba had a population of 108,374, with an annual growth rate of 0.99% and a population density of 602 per km2. Many foreigners live in the country, most of them from other Dutch Caribbean islands, the Netherlands, Colombia, Venezuela, and the Dominican Republic ().

Aruba has a population pyramid in transition, due to the age group older than 45 years. This structure reflects a reduction in fertility rates, migratory movements, and the increase in life expectancy to older ages. Figure 1 shows the changes in Aruba’s population structure between 1995 and 2015.

The male/female ratio is 89.8:100. In 2011, life expectancy at birth was 76.9 years (73.9 for men and 79.8 for women); the total fertility rate was 1.9 children per woman, and the crude birth rate was 10.6 births per 1,000 population ().

Figure 1. Population structure, by age and sex, Aruba, 1990 and 2015

Between 1990 and 2015, the size of the population grew by 67.2%. In 1990, there was an expansive trend in the over-30 age groups, with stationary growth in people under 25 and a wider structure between those two groups, reflecting a combination of natural growth and migration. In 2015, the pyramid structure shifted toward those over the age of 50, with a combination of constrictive and stationary trends in younger age groups, which reflects an aging population, natural growth with lower fertility, and migration.

Source: Pan American Health Organization, based on data from the UN Department of Economic and Social Affairs. Population Division. 2015 Revision. New York; 2015.

The Economy

According to Central Bank figures, in 2015 the tourism sector drove the country’s economic activity. That year, the country hosted 1,831,954 tourists, 5.3% more than in 2014 (). Of those visitors, 66.9% were tourists who remained overnight, and 33.1% came from cruise ships.

That same year, the decline in petroleum prices and lower consumption levels had eased inflationary pressures, which led to an inflation rate of 0.5%. Consumption and investment suffered negative growth rates. Declining investments were primarily due to delays in large-scale projects, such as the renovation of the hospital and the construction of the new port for container ships in Barcadera. Aruba’s economy is expected to continue to grow in the next few years, based on investment projects in hotel construction and other infrastructure, the hospital’s renovation, the reopening of the refinery, and alternative energy projects ().

By the end of 2015, Aruba’s total debt accounted for 82.2% of the Gross Domestic Product (GDP), with most government spending allocated to health, social protection, and education (). Between 1999 and 2009, government spending allocated to the social sector averaged 61% of the total budget .

The standard of living is high, and all residents, including documented immigrants, are enrolled in social security and covered by health insurance. Primary and secondary education is free, and there is a pension program that guarantees a minimum income for the elderly based on their length of residence.

Social Determinants of Health

According to the last census, in 2010 adult literacy was 99.4% (99.5% for women and 99.3% for men), with a 99% enrollment rate in primary education and a completion rate of 94.8%. Seven out of every ten adolescents attend secondary school. The gender parity index is close to 1.0 for primary and secondary education and 1.4 for tertiary education, with women scoring better ().

Combating overweight, obesity, and other health-related problems is the main objective of Aruba’s National Plan for 2009 2018 (). Further, the 2010 2013 National Strategic Plan for Sports and Physical Activity has become the framework for boosting the country’s sports activities. Its purpose was to have the population acquire the habit of engaging in physical activity as a way to bring about its balanced and healthy lifestyle, as well as to enhance competitive sports ().

Aruba’s National Security Plan for 2008 2012 ranks international drug trade and trafficking and their impact as fourth among six serious threats to national security, and calls on relevant sectors and stakeholders to engage in eradicating them (). As of the end of 2012, there were 2,226 registered patients who were addicted to alcohol and/or illegal drugs ().

The Health System

The country’s health insurance system provides universal coverage through a network of service providers organized into primary, secondary, and tertiary levels of care; services tend to be more curative than preventive. Family doctors are the cornerstone of the primary care level, which is based on a model geared to the diagnosis, monitoring, and management of patients. Patients are referred to the Dr. Horacio Oduber General Hospital, which has 288 beds and a 79% occupancy rate. The average hospital stay is 6.9 days, with 12 admissions per 1,000 population (). The hospital is currently undergoing expansion and remodeling in order to meet higher demand for quality health services, primarily due to the aging population and to the rise in noncommunicable diseases. The hospital includes the San Nicolas Medical Institute, which functions as a self-contained, comprehensive national center for outpatient care focusing on noncommunicable diseases.

Elderly persons who cannot continue to live at home may be institutionalized in three geriatric homes with some 250 beds, all told. Most patients receive physical and psychiatric care coordinated by specialists assisted by a team of nurses.

Leading Health Challenges

Critical Health Problems

Dengue, one of the country’s health priorities, was detected in 1970, with the worst epidemic occurring in 1986. The highest incidence occurred in 2011, with 2,850 reported cases ().

Most of the cases of hepatitis B reported between 2003 and 2011 were men between the ages of 25 and 44. The majority of the cases were imported.

According to data from the Central Statistics Bureau Health Monitor, the most frequent form of transmission for the human immunodeficiency virus (HIV) was heterosexual contact (59%), followed by men having sex with men (29%); those 25 44 years old were the most affected. In 2010 3,162 HIV screening tests were administered at the national laboratory, 23 of which (0.55%) were positive. In 2011, there was one case of mother-to-child transmission ().

With regard to teenage pregnancy, between 2006 and 2011 the percentage of live births among mothers under the age of 20 ranged from 12.1% to 13.5%. In 2012, 12% of children had teenage mothers, compared to 11.3% in 2013. In 2011, the birth rate among 15 19-year-olds was 39 live births per 1,000 population, compared to 36 in 2012 and 33.7 in 2013 ().

Chronic Conditions

Between 2005 and 2012, chronic, noncommunicable diseases were the leading cause of morbidity and mortality. According to the 2006 STEPS survey for Aruba, an increase in the prevalence of noncommunicable diseases such as heart disease, stroke, and cancer, and risk factors such as hypertension, elevated blood glucose, and high cholesterol was confirmed in the 55 to 64 year age group ().

Between 2000 and 2010, the leading cause of death was linked to diseases of the circulatory system, which were responsible for 33% of total deaths in that period, followed by malignant neoplasms, which accounted for 25% of total deaths.

According to the 2006 STEPS survey, 16.2% of people 25 64 years old used tobacco (twice as many men as women) (). According to a health survey of young adults conducted in 2012, 27.9% of youth in high schools had used tobacco at least once ().

In 2010, the greatest number of potential years of life lost (PYLL) was due to external causes, mainly traffic accidents, with 1,077 PYLL for men, surpassing the number of cases due to ischemic heart disease (559.3 PYLL) for that population group.

Human Resources

In 2013, Aruba had 43 general practitioners and 78 specialists (1.82 per 1,000 population); there were 0.35 dentists per 1,000 population. In 2010, the ratio of general surgeons to population was 1 per 21,520 and 1 per 35,867 for psychiatrists. In general, health service providers are contracted by the general health insurance fund (Algemene Ziektekosten Verzekering, or AZV), including all primary care physicians, specialists, and most dentists, physical therapists, and midwives ().

Aruba has no national medical school, so most health professionals are trained in the Netherlands, the United States, Colombia, and Costa Rica. There are three foreign medical schools in Aruba, but their graduates cannot practice on the island. The country risks “brain drain” through the emigration of its health professionals, as professionals who study and graduate abroad tend to remain there to take advantage of better employment opportunities and higher salaries.

The Environment and Human Security

Aruba has no natural source of fresh drinking water and there is very little rain. Drinking water is produced through desalination (reverse osmosis) of ocean water at the country’s desalination plant, which is the second largest in the world. The water distributed by the network is safe and high quality, and is supplied to all residents and businesses, thus providing 100% water and sanitation coverage. The sewer system is adequate and all households have their own septic tank ().

Aging

The percentage of people aged 60 and older increased from 7% in 2000 to 17.9% in 2014. During that period, the age group under 14 declined from 23.1% to 19.2% (). In 2013, the dependency ratio was 57.6%.

Monitoring the Health System’s Organization, Provision of Care, and Performance

Aruba’s Public Health Law, in effect since 1989, states that the Ministry of Health is charged with monitoring the quality of public health and medical services. The law also mandates that the Department of Public Health carry out the surveillance, monitoring, and inspection of various aspects of health care. Since 2008, this department has worked on revising and updating the country’s health policies and regulations (). Health spending has been steadily increasing, from 6.76% of GDP in 2000 to 11.3% in 2010 . Health care is primarily funded by tax contributions and premiums paid by employers and employees to the AZV. Since 2011, health insurance quotas have accounted for an ever-greater proportion of the national budget, allowing the proportion of tax contributions to diminish without decreasing the overall health sector’s budget; available funds were allocated to health-related social projects such as infrastructure to promote physical activity among the population. In December 2014, legislation mandated a 1% tax on goods and services as a way to reduce the state contribution to general health insurance.

The primary health care program known as the “Health Bus,” launched in September 2012, expanded coverage for individuals and families, as well as their access to schools, businesses, and communities engaged in promotion, prevention, timely diagnosis, control, and outpatient treatment activities. From September 2012 to August 2013, 6,682 people (6.5% of the population) were seen by Aruba’s “Health Bus,” which made it possible to identify the overweight and obese population and investigate diseases such as hypertension and diabetes mellitus, as well as educate the population about risk factors, control of noncommunicable diseases, adherence to treatment, and promotion of a healthy lifestyle ().

Prospects

Despite its health system’s advances, Aruba faces significant health problems. Among these are the country’s aging population, the predominance of chronic, noncommunicable diseases and their risk factors, and drug and alcohol use by its young people. As these problems continue to evolve over time, various challenges will undoubtedly emerge in the implementation of public policies aimed at their prevention, control, and treatment.

The efforts made to reduce childhood overweight and obesity by promoting sports are impressive, but if results are to endure, these efforts must be sustained and must be able to reach the entire population, including the elderly. Lifestyle choices, development challenges, and other social determinants affect drug-use among adolescents and young adults, and require comprehensive and intersectoral actions. To support health promotion and health care within the framework of universal health, more and better public health infrastructure is imperative, as well as cooperation with institutions that provide health training (academic and practical) for human resources.

In Aruba the number of pregnancies among adolescents has progressively declined in recent years; this calls for an in-depth analysis of this data must be analyzed in greater detail and for its wide dissemination. Furthermore, the facts that women now complete schooling and are increasingly attending higher education institutions is a positive determining factor in terms of women’s health and development.

Aruba must continue to strengthen its strategies aimed at health promotion, disease prevention, and treatment and must engage all stakeholders in the system in order to fully address chronic, noncommunicable diseases and their risk factors.

References

1. Pan American Health Organization. Health in the Americas 2012. Washington, D.C.: PAHO; 2013. Available from: https://www.paho.org/salud-en-las-americas-2012/index.php?option=com_content&view=article&id=19:aruba&Itemid=130&lang=en.

2. Central Bureau of Statistics (Aruba). Statistical yearbook 2014. Oranjestad: CBS; 2015. Available from: http://cbs.aw/wp/wp-content/uploads/2016/10/05-02-H-Statistical-Yearbook-2014.pdf.

3. Central Bureau of Statistics (Aruba). Statistical yearbook 2012. Oranjestad: CBS; 2013. Available from: http://cbs.aw/wp/wp-content/uploads/2015/09/Statistical-YB-2012-final.pdf.

4. Central Bureau of Statistics (Aruba). Statistical yearbook 2013. Oranjestad: CBS; 2014. Available from: http://cbs.aw/wp/wp-content/uploads/2014/10/SY-2013-final.pdf.

5. Central Bank of Aruba. State of the economy 2015. Oranjestad: CBA; 2016. Available from: http://www.cbaruba.org/cba/readBlob.do?id=3810.

6. United Nations. UNSTATS: Millennium Development Goals indicators-Aruba, 2010 [Internet]. New York: UN; 2012. Available from: https://unstats.un.org/unsd/mdg/Data.aspx.

7. Government of Aruba, Special Committee on Obesity. National Plan Aruba 2009-2018: for the fight against overweight, obesity and related health issues. Oranjestad: GOA; 2008. Available from: http://www.hls.aw/main/images/Plan%20National%20Aruba%202009-2018%20.pdf.

8. Ministry of Public Health and Sports (Aruba). Aruba den movecion: National Strategic Plan for Sports and Physical Activity 2010-2013. Oranjestad: MPHS; 2010.

9. Department of Economic Affairs, Commerce, and Industry (Aruba). National Security Plan Aruba: 2008-2012. Oranjestad: DEACI; 2008. Available from: http://www.arubaeconomicaffairs.aw/National_Security_Plan_-_English_version.pdf.

10. Diaz H. Baseline assessment of the drug problem in Aruba. Oranjestad: University of Aruba, Center for Research and Development; 2012.

11. Central Bureau of Statistics (Aruba). Health monitor 2013. Oranjestad: CBS; 2014. Available from: http://cbs.aw/wp/wp-content/uploads/2015/09/Health-Monitor-2013.pdf.

12. Central Bureau of Statistics (Aruba). STEPS Aruba 2006: risky living-an analysis of the risk factors underlying the main chronic diseases in Aruba. Oranjestad: CBS; 2013. Available from: http://cbs.aw/wp/index.php/2013/02/27/steps-aruba-2006/.

13. Central Bureau of Statistics (Aruba). STEPS Aruba 2006: chronic disease risk factor surveillance-data book. Oranjestad: CBS; 2013. http://cbs.aw/wp/index.php/2013/02/27/steps-aruba-2006/.

14. Department of Public Health (Aruba). Youth health survey: Aruba 2012. Oranjestad: DPH; 2013. Available from: http://despa.gov.aw/images/pdf/YouthHealthSurveyAruba2012.pdf.

15. Instituto Biba Saludabel y Activo (Aruba). “Health Bus”: one year of service to Aruba’s population. Oranjestad: IBiSA; 2013. Available from: https://www.ibisaaruba.com.

16. Department of Public Health, Youth Health Care Unit (Aruba). Annual anthropometric research. Oranjestad: DPH; 2013.

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Reference/Note:

1. The Health Monitor is published every four years by the Central Bureau of Statistics, Ministry of Public Health and Sports. It reports on the health conditions of the Aruban population.

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