Country Report: Jamaica
Jamaica is the largest English-speaking and third-largest island in the Caribbean, with an area of 11,424 km2. It is located 150 km south of Cuba and 160 km west of Haiti. The country is divided into three counties, which are further divided into 14 parishes or municipalities.
The estimated population in 2015 was 2.8 million. The current population structure reflects signs of aging as the country has progressed through the intermediate stages of the demographic transition, moving toward a regressive structure over the past two decades.
Life expectancy at birth in 2011 was 74.2 years (71.3 in men, 76.3 in women).
In 2015, Jamaica recorded improvements in most indicators of economic and social development. At the end of 2015, its per capita gross domestic product (GDP) was US$ 5,140. The human development index for 2014 was 0.719.
- A new Social Protection Strategy that included a Social Safety Network Reform Program was implemented to deliver appropriate interventions and improve sustained outcomes for the poor and vulnerable.
- The proposed national housing policy was amended in 2015 to provide a comprehensive framework to guide the housing sector.
- Labor market reform with employment creation has remained a Government priority. This reform has included the preparation of a strategic plan for outsourcing business processes and information and communications technology.
- The Program of Advancement through Health and Education has functioned as a conditional cash transfer program, providing grants to some 380,010 registered beneficiaries at the end of 2015. It is linked to attendance at health and education services, based on established criteria.
- Children at risk were monitored by the Office of the Children’s Registry, which received 11,749 reports of child abuse in 2014. There were 55 reports of child trafficking in 2014. Another priority initiative was the Disabilities Act, passed in 2014, which has provisions to safeguard and enhance the welfare of persons with disabilities.
Figure 1. Distribution of the population by age and sex, Jamaica, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2011
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
- In 2015, the total unemployment rate was 13.5%.
- The educational reform of 2015 provides for free education from early childhood through primary school. The literacy rate in 2015 was 91.7%. In 2013, the Gender Parity Index (ratio of girls to boys) was 1.04 at the secondary level and 2.29 at the tertiary level.
- In 2012, 70% of households had piped drinking water (94.2% urban and 49.1% rural), 12.4% used rainwater collected in tanks, and 2.5% used rivers or springs. Nearly all households (99.8%) had access to improved sanitation. In 2012, the housing quality index for Jamaica was 72%.
- The overall crime rate was 644 per 100,000 population in 2015, and the homicide rate was 44 per 100,000 population.
- Several factors contribute to poor air quality, including emissions or air pollutants from industrial plants, motor vehicles, open burning of sugarcane fields, and fires at solid waste disposal sites.
- A total of 778,175 tons of solid waste were disposed of in 2015, with per capita waste generation estimated at 1.2 kg/day. In 2012, most households (63.4%) used a refuse collection service, while 31.9% burned their trash.
- The country is constantly exposed to natural hazards such as hurricanes, earthquakes, floods, droughts, and fires, and their social and economic impact has been a major challenge. According to the Environmental Vulnerability Index, Jamaica is one of 35 countries in the world with extreme environmental vulnerability.
HEALTH SITUATION AND THE HEALTH SYSTEM
- The maternal mortality ratio was 108.1 per 100,000 live births in 2014. The leading causes of death were hypertensive disorders in pregnancy (19%) and hemorrhage (18%).
- In 2012, the total birth rate was 16 per 1,000 women of reproductive age, while in adolescents aged 15-19 years, the rate was 72 births per 1,000 women.
- In 2011, the infant mortality rate (under 1 year of age) and under-5 mortality rate were 19.1 and 17.4 per 1,000 live births, respectively. The leading causes of death were respiratory and cardiovascular disorders specific to the perinatal period.
- The Expanded Program on Immunization provided the following coverage in 2015: BCG, 100%; poliomyelitis, 92%; DPT/DT, 91%; Haemophilus influenzae type b (HiB), 92%; hepatitis B, 92%; and triple viral vaccine (measles, mumps, and rubella, 2 doses), 83%.
- The rate of exclusive breastfeeding for infants under 6 months increased from 15% in 2005 to 24% in 2011.
- There has been no autochthonous transmission of malaria since 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, which was notified in December 2015 but never confirmed.
- In 2015, dengue remained endemic, with outbreaks having occurred in 2007, 2010, and 2012. All four serotypes circulate on the island, and Aedes aegypti is the only dengue vector found in Jamaica. There were 118 reported cases in 2015 (26 laboratory-confirmed) and 2,316 reported cases in 2016 (190 laboratory-confirmed).
- The first confirmed case of chikungunya virus infection 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).
- The first case of Zika virus infection was confirmed in January 2016. By the end of that year, 203 laboratory-confirmed cases had been recorded. A total of 698 suspected Zika cases in pregnant women were reported to the Ministry of Health, 78 of which were laboratory-confirmed (PCR test). In 2015, 37 cases of influenza were confirmed.
- No cases of cholera have been detected in Jamaica since the last recorded cases in 1852, but active surveillance continues in view of the outbreak in neighboring countries.
- The country has successfully eliminated leprosy. Three cases were detected in 2015, compared with 8 cases in 2011.
- From 2011 to 2015, 1,659 cases of presumptive tuberculosis were reported, 32.6% of which were confirmed. The majority were in young adults aged 25-34. On average, 114.7 new cases were recorded each year between 2006 and 2015. Less than 25% of patients screened were co-infected with HIV. The treatment success rate ranged from 77% in 2013 to 22% in 2015.
- Estimated HIV prevalence is 1.6% in the general population. Some 29,000 people 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 infection were reported to the Ministry of Health. Of these patients, 9,517 (27.9%) are known to have died.
- In 2012, 3% of children under 5 suffered from wasting, 5.7% exhibited stunting, and 7.8% were overweight. The 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. The prevalence of overweight or obesity was 18% in children aged 6-10 and 22%-25% in children aged 10-15.
- There was a 12.7% increase in the number of deaths from 2013 to 2014. The leading cause in 2014 was circulatory system diseases (30%). Cerebrovascular disease, hypertensive disease, and diabetes mellitus were among the five leading causes of death in both men and women. In 2014, most cancer deaths in men were from prostate cancer, while among women, breast and cervical cancer accounted for most cancer deaths.
- Road traffic fatality rates were 14.0 deaths per 100,000 population in 2015. Males accounted for 80% of the fatalities each year between 2010 and 2015. Pedestrians were the category with the most fatalities during this period, except in 2015, when it was motorcycle riders.
- In 2010, the diabetes rate was 11.5% in adults 18 years and older (9.8% in men and 13.2% in women). That same year, 22.9% of people over 18 had hypertension (25.4% of men, 20.5% of women), and 27% were obese (36% of women, 18% of men).
- A 2012 survey of the population over 60 found that 76.4% had at least one chronic disease and 46.9% had more than one, 61.4% suffered from hypertension, and 26.2% had diabetes. Smoking was reported by 25.4% of the survey group, and 21.4% reported regular alcohol consumption (at least two drinks per week).
- The age-standardized prevalence of tobacco use in the population aged 15 and older was 18.5% in 2010 (30.7% in men and 6.6% in women); prevalence in adolescents was 28.7%. For the population aged 15 and older, the agestandardized prevalence of alcohol use disorders was 6.5% in men, 1.8% in women, and 4.1% for both sexes in 2010.
- The suicide rate in 2014 was 1.2 per 100,000 population. Between 2011 and 2014, attempted suicides increased by 265%, going from 141 to 515.
- In 2015, there were a total of 1,166 doctors, 92 dentists, and 3,849 nurses employed in the public sector. Under the auspices of the Program for the Reduction of Maternal and Child Mortality (PROMAC), health professionals were trained for positions in strategic health development programs.
- The country continues to move toward universal health, with a focus on health system strengthening, the renewal of primary care, and improved access to services.
- The policy priorities of the Jamaica's Ministry of Health Strategic Plans for the years 2013-2016 and 2015-2018 were to improve health sector governance, ensure access to health services, provide quality assurance in the delivery of health services to the population, and reduce injuries, disabilities, and premature deaths from preventable illness.
- Total health expenditure as a percentage of GDP fluctuated between 5.2% in 2008 and 5.9% in 2014. Government expenditure on health increased from 56.3% of total health outlays in 2010 to 62.3% in 2014. Out-of-pocket expenditure corresponded to 19.7% of the total in 2014.
- Since 2010, the Ministry of Health has strengthened the National Health Information System using the Health Metrics Network framework and standards. A multisectoral Health Information and Technologies Steering Committee directs and coordinates the activities, including an evaluation of the National Health Information System in 2011 and the development of a strategic plan for strengthening the information system in 2014-2018.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- Between 1990 and 2015, Jamaica achieved socioeconomic and health progress. Its population currently faces a demographic and epidemiological transition, however, with accelerated population aging and the associated health burden.
- The country faces a triple burden of noncommunicable chronic diseases (NCDs), violence and injuries, and emerging and reemerging infectious diseases.
- Because of the active recruitment of health professionals in Jamaica for overseas markets, their emigration has continued, especially among specialized nurses with a university degree.
- Efforts to reduce risk factors have included implementation of three out of four tobacco-demand-reduction interventions, namely the adoption of tobacco taxation policies, smoke-free environments, and health warnings. The new Public Health Regulations were enacted in 2013.
- Major challenges include a regulatory framework that is inadequate to the tasks of reducing the principal risk factors, creating a supportive environment for behavioral change, and countering tobacco industry interference.
- The expected increase in the frequency of infectious disease outbreaks requires a new approach in the health emergencies program of the Ministry of Health.
- Universal health remains a priority to ensure the population’s ability to access quality care provided by trained staff with the appropriate mix of skills at upgraded facilities with the required levels of equipment, pharmaceuticals, and supplies and the requisite financial protection.
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