Country Report: Cayman Islands
The Cayman Islands is a British Overseas Territory made up of three islands: Grand Cayman, Cayman Brac, and Little Cayman. The territory is located in the western Caribbean Sea, approximately 240 km south of Cuba and 270 km northwest of Jamaica. George Town, the capital, is on Grand Cayman, the largest and most populous of the islands.
The total population in 2015 was 60,413, with 56.7% native to the islands. The crude birth rate was 11.0 live births per 1,000 population. Between 1990 and 2015, the population increased by 129.2%. In 1990, the population pyramid had an expansive upper portion but was stationary below the age of 35. In 2015, the structure was essentially stationary, although wider in the working-age groups. The main industries are financial services, tourism, and real estate sales and development. There are no direct taxes in the Caymans.
Nominal gross domestic product (GDP) per capita in 2015 was US$ 57,298. Economic development has been pursued through a series of interventions and policy initiatives, including support for small business, aimed at diversifying the economy and creating employment.
- The National Health Policy and Strategic Plan outlines the vision, values, strategic orientations, and objectives with regard to health and the health system. Its motto is "Health and Well-being for All in the Cayman Islands."
- The Cayman Islands is committed to having a health system that ensures access to the highest-quality care at an affordable and sustainable cost for all residents.
- The Mental Health Law was amended in 2013 to provide better care for persons with serious psychiatric disorders or mental impairment. The Mental Health Commission was also established that year to provide oversight on matters related to mental health and well-being, which includes protecting the rights of patients; providing support and advocacy for people living with mental illness and their families; and general education on mental health legislation.
- The Cayman Islands has adopted a comprehensive action plan to combat the damaging effects of climate change. A policy on climate change has been drafted in order to achieve a climate-resilient economy with a low carbon footprint that addresses the vulnerability of the Caribbean islands to natural disasters caused by climate change.
Figure 1. Distribution of the population by age and sex, Cayman Islands, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2013
Source: Pan-American Health Organization, World Health Organization, and PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- Against a backdrop of economic recovery, improvements in labor market indicators continued in 2015, with a further reduction in unemployment.
- The unemployment rate fell from 7.9% in 2014 to 6.2% in 2015.
- In 2015, GDP grew by nearly 2.0%—lower than the 2.4% growth in 2014 but higher than the average growth of 1.6% between 2010 and 2014.
- The government provides free primary and secondary education.
- In 2015, 97% of households had access to an improved water supply; 91% of them had piped water and 6% were supplied through other improved methods. The traditional water supply through wells and cisterns has been replaced with desalinated piped water in both Grand Cayman and Cayman Brac.
- Improved sanitation coverage was 96%. There are 3 landfills, which by April 2011 had handled approximately 69,011 tons of waste.
- The territory is particularly vulnerable to the rise in sea level and intense hurricanes.
- Cayman Islands has a small agricultural sector. Most foodstuffs are imported from North America, Jamaica, and the United Kingdom.
- Public expenditure on health care as a percentage of the total government budget increased from 23% in 2011 to over 25% in 2015.
- In 2011, the Cayman Islands passed the Gender Equality Law, which prohibits discrimination in employment and related areas and serves as enabling legislation to uphold the principles of the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW).
HEALTH SITUATION AND THE HEALTH SYSTEM
- No maternal deaths were reported in 2015. That year, coverage of prenatal care with skilled birth attendants (more than four visits) was 98.8%, while 99.7% of deliveries occurred in hospitals.
- In 2015, no deaths of children under 1 year of age were reported. In 2014, the infant mortality rate was 4.2 deaths per 1,000 live births, corresponding to the neonatal period.
- In 2015, 170 deaths were reported in the Cayman Islands, for a crude death rate of 2.9 deaths per 1,000 population. The majority occurred in the 80-89-year age group. Circulatory system diseases were responsible for 30% of all deaths
- From 1985, when the first case of AIDS was reported in the Cayman Islands, through November 2014, 145 cases of HIV were reported, 74 people developed AIDS, and 46 died; 67 people are currently living with HIV. The territory is in the process of verifying and documenting the elimination of mother-to-child transmission of HIV and congenital syphilis.
- No cases of hepatitis B were reported in 2015. There were 34 reported cases of chickenpox and 287 cases of conjunctivitis that year. Childhood immunizations are administered free of charge to all residents.
- No cases of tuberculosis were reported in 2014, but there were 7 cases in 2015 (1 local and 6 imported). There were 2 imported cases of malaria in 2013, no reported cases in 2014, and 5 imported cases in 2015.
- The first case of chikungunya virus infection in the Cayman Islands was confirmed in June 2014. There were 44 cases (28 imported and 16 local) in 2014, and 6 in 2015 (all imported). As of November 2016, a total of 30 cases of Zika virus infection had been confirmed, 20 of which were local and 10 imported.
- In 2014, 5,818 cases of influenza-like illnesses were reported, and 5,955 in 2015.
- The results of a survey in 2012 indicated that, based on their body mass index, 36.6% of respondents were obese and 70.6% were overweight. Furthermore, 15.8% had hypertension (blood pressure level of 140 mmHg or above) and were not on medication for this condition. Of those surveyed, 42.9% reported having three or more risk factors for noncommunicable diseases.
- In the same survey, 34% of respondents reported a low level of physical activity. More men than women were active, and young people were more active than older ones.
- The Ministry of Health and Culture has primary responsibility for developing health policies and programs and for providing health services through its various departments and agencies. The Health Services Authority is the sole provider of public health care services at the primary, secondary, and tertiary levels.
- This network of services includes the 124-bed Cayman Islands Hospital on Grand Cayman, the 18-bed Faith Hospital on Cayman Brac, primary health care and public health services delivered through Faith Hospital on Cayman Brac, five district health clinics on Grand Cayman, a district health clinic on Little Cayman, and school health clinics.
- Cayman Islands Hospital and Faith Hospital offer inpatient and outpatient services, including some specialized services. There are two private hospitals in the Cayman Islands: Chrissie Tomlinson Memorial Hospital and Health City Cayman Islands. The former, which opened in 2000, is an 18-bed medical/surgical hospital specializing in surgical care. It offers diagnostic and imaging services, family practice, and pediatric medical care.
- Health City Cayman Islands is a tertiary care hospital in operation since 2014. It specializes in chronic and acute cardiac, orthopedic, bariatric, neurological, and pediatric cases. Located on Grand Cayman, it is designed to offer quality care and be accessible to residents of the territory and travelers from abroad.
- The Health Insurance Law, which was amended in 2013, requires every resident of the Cayman Islands to have health insurance coverage. Employers are obligated to provide a standard medical coverage plan, which includes a basic basket of compulsory benefits for employees and their dependent family members who reside in the Cayman Islands. Employees contribute a maximum of 50% of the cost.
- Self-employed individuals must provide health insurance for themselves and their dependents. This coverage must be obtained from one of the nine approved health insurance providers.
- The Cayman Islands National Insurance Company (CINICO), a government-owned insurance company, was established in 2004 to provide health insurance coverage to civil servants, pensioners, sailors, veterans, and their dependents.
- CINICO also provides coverage to the indigent, the elderly, and people who are unable to obtain coverage through private insurers. It also provides health insurance coverage for certain Government entities and public enterprises.
- In 2015, the Cayman Islands’ health workforce included 330 doctors (5.5 per 1,000 population), 442 nurses (7.3 per 1,000), 48 dentists (0.8 per 1,000), and 494 other health professionals registered and licensed to practice, among other things, as physical and occupational therapists, psychologists, and pharmacists.
- The private sector employs 56% of medical professionals. The growth of medical tourism has increased the number of health workers over the past 4 years.
- There is limited use of information and communication technology and social media for virtual collaboration between the health sector and other sectors and departments, or for broadening the scope of technical cooperation. Private-sector health care providers use health information systems that are not integrated with the public system.
- The Cayman Islands Health Services Authority’s strategic plan for 2010-2018 emphasizes access to quality health care, which includes increasing access to primary health care and improving community health through a network of lay providers.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The Cayman Islands has always supported the premise that health is an important element of sustainable development. The territory has made great progress in improving the quality of health care for its population.
- Although all residents are required to have health insurance coverage, rising health costs continue to pose a challenge to health care financing. There is a need to address the escalating costs and design a sustainable financing model to ensure the future viability of the system.
- In 2017, the Ministry of Health began reviewing the National Health Policy and Strategic Plan 2012-2017, with a view to developing action plans for subsequent implementation.
- The Mental Health Policy, to be finalized in 2017, will address priority areas for action in an effort to improve the health and well-being of people who suffer from mental illness. In the third quarter of 2017, work is expected to begin on construction of a residential psychiatric center to care for chronically ill patients.
- The main barriers to providing psychiatric care are the lack of a residential mental health facility that can admit patients and a shortage of outpatient services for children, adolescents, and young adults.
- The Health Services Authority has developed a patient portal, whose functions will be expanded to give patients access to diagnostic information and appointment scheduling.
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