Country Report: Curaçao
Curaçao is located in the southern Caribbean Sea, 65 km north of Venezuela. It became an autonomous country within the Kingdom of The Netherlands in 2010, having been part of the Netherlands Antilles.
In 2016, Curaçao had 158,986 inhabitants, with a male/female ratio of 84:100, explained mainly by immigration, predominately by women, for employment purposes, especially in age groups of 30-60 years. Life expectancy is 74.8 years for men and 81.0 years for women.
The population grew by 7.7% from 1990 to 2015. In 1990, the population structure showed a slow expansionary trend. There is currently a higher concentration in the groups around 50 years of age, while population growth is stationary for groups under 40.
With a 2011 per capita gross domestic product (GDP) of US$ 27,781 (PPP), Curaçao is considered to have a high-income economy, with a standard of living among the highest in the Caribbean.
- Life expectancy in Curaçao has improved over time.
- Mortality in children under 1 year has fallen in recent years.
- Vaccination coverage in children born since 2007 is above 97% (evaluated on the basis of coverage of the MMR, Hib, and tOPV vaccines).
- One of the challenges is the growth of the elderly population.
- Leading causes of death are noncommunicable diseases, which are increasing in the elderly population.
- Health care costs are rising due to greater demands on the system.
- In 2005, Foreigner Care Foundation Curaçao estimated the undocumented immigrant population at 15,000.
Figure 1. Distribution of the population by age and sex, Curaçao, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization. PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Note: Population data for 2015 has been derived from national estimates by the Central Statistics Office, Curaçao.
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- Between 2001 and 2011, poverty declined from 34% to 25%. Households with an income below the poverty line are more likely to be headed by women, an unemployed person, a person with a low level of education, or a single person on welfare or state pension.
- The primary security concerns are petty theft and street crime. Like the other islands of the former Dutch Caribbean, Curaçao is a major transit point for drug trafficking, though there is intensive international collaboration to disrupt drug smuggling in the region.
- Air quality is impaired by the operations of the aging "Isla" oil refinery.
- Immigrants accounted for 24.0% of the population in 2011. They arrive mainly from The Netherlands (25.2%), the Dominican Republic (15.2%), and Colombia (12.7%). The undocumented immigrant population was estimated at 15,000 in 2005. The justice system strictly enforces robust measures to combat illegal immigration, making it difficult for undocumented immigrants to obtain health care.
HEALTH SITUATION AND THE HEALTH SYSTEM
- Considering the relatively small number of births and deaths in Curaçao, the indicators tend to fluctuate from year to year. No maternal deaths have been recorded in the past three years. During 2010-2015, the neonatal mortality rate varied from 8.9 to 4.4 deaths a year per 1,000 live births, and infant mortality from 12.8 to 7.6 deaths per 1,000 live births.
- In 2007, vaccine coverage under the national program was over 95% in the first year of life.
- Between 2003 and 2007 (the latest years for which information is available), cardiovascular disease was responsible for 37% of deaths, and tumors, 26%, for both men and women.
- The leading sites of malignant neoplasms among the male population were the prostate (26%), the lungs and bronchi (19%), and the colon (9%). Among the female population, they were the breast (26%), the colon (13%), and the ovaries (7%).
- The 2010-2011 dengue outbreak had 1,822 serologically confirmed cases of dengue and 4 deaths. No cases of malaria were reported between 2008 and 2012.
- In August 2014, the chikungunya virus was first reported on Curaçao, followed by a major outbreak during the 2014-2015 rainy season. The virus infected an estimated 20,000 people.
- In January 2016, Zika virus was first reported on Curacao; by May 2016, 208 laboratory-confirmed cases had been reported.
- In 2014, 94 new cases of HIV were reported, for a total of 1,830 HIV-positive individuals. From 2002 to 2010, 14 cases of leprosy were reported.
- In 2013, 19.9% of the population aged 18 and over reported hypertension (23.5% of women and 15.4% of men). That same year, 39.3% of men were overweight and 23.3% were obese, while for women in this population group, the rates were 34.7% and 32.6%, respectively.
- The main chronic conditions in adults aged 65 and over are hypertension (46%), diabetes mellitus (26%), and high cholesterol (23%); 78% of women and 68% of men in that age group reported living with at least one disease.
- Legislation introduced in 2015 prohibits smoking in enclosed public spaces, such as restaurants and bars. In 2013, 15.5% of persons aged 18 and over reported having used tobacco, and 10.1% were daily smokers.
- In 2013, 62% of people over the age of 18 had consumed alcohol in the past year and 4.7% reported daily alcohol consumption. Men drank more often than women (12.0% and 2.0%, respectively).
- The policy department of the Ministry of Health, Environment and Nature is responsible for governance of the health care system through the design, execution, and evaluation of policies, laws, and regulations. Preventive care is provided by general practitioners or community health organizations, such as the Public Health Bureau.
- There have been major health system reforms since 2010. New payment structures were introduced for some health care providers and pharmacies; a number of funds were integrated into a basic health insurance system (BZV); expenditure on medication was reduced; and a new general hospital was constructed in Otrobanda.
- In 2011, health expenditure was 16.6% of gross domestic product. Per capita health care expenditure was roughly US$ 3,355 per year.
- The basic health system (BZV) provides uniform medical care coverage to all those insured. The program is executed through the Social Insurance Bank (SVB), which is financed through income tax collections, with employers and employees contributing.
- Private insurance is often used for supplementary coverage. Dental services, which are generally not covered by social insurance, are less accessible.
- The health care system largely mirrors that of The Netherlands. It is structured into primary, secondary, and tertiary care sectors. Primary care includes care provided by general practitioners, paramedics, and pharmacists. Secondary care is provided at St. Elisabeth Hospital, the Adventist Hospital, private clinics of medical specialists, and the psychiatric hospital. Tertiary care includes care for long-term illnesses and disabilities and is usually provided in facilities with specialized care and comfort for extended stays. Clinical laboratory services are provided by the national laboratory and several private laboratories.
- In 2015, health care services were available through more than 400 providers; there were 119 medical specialists in the country, including 80 general practitioners, 63 physical therapists, 42 dentists, 36 psychologists, and 29 pharmacists.
- Although there are universities on the island that offer medical courses, Curaçao does not have an accredited medical school whose graduates are allowed to practice on the island. Health professionals are trained primarily in The Netherlands, the United States, and South America.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The populationfs health status has improved, as reflected in the gradually falling infant mortality indicators and increased life expectancy at birth. Health care has also improved, with vaccination coverage above 97% for children born after 2007.
- The populationfs improved health situation and longer life expectancy pose challenges related to the growing elderly population, which continues to change the epidemiological profile, with a significant rise in chronic noncommunicable diseases.
- Access to health services is a challenge that will increase in the coming years due to the anticipated heightened demand of a growing elderly population with a higher prevalence of chronic diseases. Heightened expectations surrounding the quality of care and use of innovative and costly health technologies are predicted.
- Immigration has affected the population structure, especially women (men/women ratio of 84/100 in 2016), particularly in the working-age population groups (30–60-year-olds).
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