Country Report: Aruba
Aruba, an island with a landmass of 180 km2 and lying about 25 km off the coast of Venezuela in the Caribbean Sea, is an autonomous country within the Kingdom of the Netherlands. It was part of the Netherlands Antilles until 1986, when it became an autonomous country within the Kingdom of the Netherlands. The island is autonomous in terms of administration and management of public policies, but is under the authority of the Kingdom of Netherlands in areas such as defense, foreign affairs, and the administration of justice.
In 2014, Aruba had a population of 108,374. Between 1990 and 2015, the population grew by 67.2%. In 1990, its population pyramid was beginning to develop a stationary trend in people under 30. The population pyramid is currently exhibiting a regressive trend, with greater expansion in the working-age population. This structure is influenced by immigration, which is particularly concentrated in the working-age population.
In 2011, life expectancy at birth was 76.9 years (73.9 for men and 79.8 for women).
Tourism is the leading economic activity. In 2015, the country received 1.8 million tourists (66% stayed overnight and the rest came from cruise ships).
- Aruba's policies and plans are aimed at achieving social progress and advances in health, taking aspects of community promotion and prevention into consideration that include sectors other than the health sector.
- The objective of the Aruba National Plan 2009-2018 is to combat overweight, obesity, and other health-related problems.
- The 2010-2013 National Strategic Plan for Sports and Physical Activity became the frame of reference for the country's main sports activities. The plan focused on getting the entire population involved in physical activity, thus helping to ensure a balanced and healthy lifestyle, as well as promoting competitive sports.
- In Aruba, women complete secondary schooling and an increasing number of women attend institutions of higher education. Thus, female education has become a health and development determinant for women and makes a significant contribution to the country.
- Aruba's National Security Plan for 2008-2012 addressed the main security threats facing the country. Its objectives include the prevention and control of international drug trafficking and its effects on the population, with a call for intersectoral action.
- The Ministry of Health and Sports coordinates policies aimed at the prevention and control of mental, social, and physical dependency linked to illegal drug use.
Figure 1. Distribution of the population by age and sex, Aruba, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization, World Health Organization, and PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Note: The country's population data for 2015 is based on national estimates prepared by Aruba's Central Bureau of Statistics.
Source: UN Population and Statistics Divisions, 1990; PAHO; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- Primary and secondary education are free. The country has a pension program that guarantees income for older adults based on their length of residence.
- In 2010, the adult literacy rate was 99.4%. There was a 99% enrollment rate in primary education and a completion rate of 94.8%. Seven out of ten adolescents attend secondary school.
- Drinking water is produced through desalination of ocean water in a processing plant. The water distributed by the network is safe for consumption and 100% water and sanitation coverage is provided.
- The sewerage system is adequate, and all households have their own septic tank.
- The standard of living is high, and all residents, including documented immigrants, are enrolled in social security and covered by health insurance.
- Aruba's National Security Plan for 2008-2012 ranks international drug trafficking and its effects as the fourth leading threat to national security, among six serious threats. The Plan calls on pertinent sectors and stakeholders to take part in the eradication of these activities.
HEALTH SITUATION AND THE HEALTH SYSTEM
- Coverage of prenatal care is 99%, and 96% of births occurr in institutional settings.
- Oral contraceptives are the most commonly used birth control method (42.4%), followed by condoms (42.3%), injectable contraceptives (12.7%), and intrauterine devices (2.5%).
- Between 2006 and 2013, the percentage of live births among mothers under the age of 20 ranged from 11% to 13.5% of the total.
- No maternal deaths were reported from 2006 to 2010. Between 2011 and 2013, only one maternal death was reported each year.
- In 2013, there were nine deaths in the under-1 age group, five of which occurred in the perinatal period.
- During their first year of life, 98% of children are vaccinated against diphtheria, tetanus, and whooping cough (DPT3), poliomyelitis (Polio-3), and mumps, measles, and rubella (MMR).
- Between 2008 and 2012, there were no reported cases of acute flaccid paralysis, tetanus, diphtheria, rubella, or congenital rubella. One case of whooping cough was recorded per year from 2010 to 2012. In 2011, one case of mumps, one case of measles (in a child under the age of 1), and 16 cases of nonspecific viral hepatitis were reported. That same year, there were two cases of hepatitis A, compared to 13 cases in 2012, two in 2013, and nine in 2014.
- Overall mortality in 2012 was 5.7 per 1,000 population. the main causes being circulatory system diseases (32% in men and 29% in women) and neoplasms (22% in men and 27% in women).
- In 2014, circulatory system diseases represented 32% of deaths and neoplasms, 26%. The two causes were responsible for almost 60% of total deaths.
- In 2010, malignant neoplasms were the leading cause of death, with a mortality rate of 104.3 per 100,000 population (129.4 in men and 90.0 in women). From 2000 to 2009, the most common malignant neoplasms in men were in the trachea, bronchi, and lungs (70.2%), while 97.8% of deaths from neoplasms in women were due to breast cancer.
- The ischemic cardiopathy mortality rate was 35.9 per 100,000 population (66.9 for men and 15.7 for women).
- Dengue is one of the priority diseases in Aruba. In 2011, 2,850 cases were reported. Between 2006 and 2013, the four subtypes of dengue virus were in circulation in a pattern of yearly outbreaks (3,502 cases in 2006, 3,210 in 2009, and 2,850 in 2011). In 2014, only 833 cases were reported and the most-affected population group was people aged 25-64.
- In 2016, up to epidemiological week 47, there were eight cases of laboratory-confirmed chikungunya virus, 929 cases confirmed by epidemiological link, and 859 clinical cases. With regard to the Zika virus, up to epidemiological week 47 of that same year, 28 laboratory-confirmed cases had been reported, with 652 confirmed by epidemiological link and 624 clinical cases.
- Between 2008 and 2014, six imported cases of malaria were reported. No cases of cholera were reported in that same period.
- From 1984 to 2014, the average incidence of HIV was 26 new cases per year, ranging from 12 to 28 cases annually. In 2010, the prevalence of HIV infection was 0.4%, with 435 people infected.
- Between 2000 and 2014, 298 cases of human immunodeficiency virus (HIV) were registered (74 in women and 224 in men). The most frequent form of transmission was heterosexual contact (59%). In 2011, there was one case of mother-to-child transmission.
- From 2008 to 2014, 56 cases of pulmonary tuberculosis were reported.
- Between 2003 and 2011, on average, there were 35 new cases of hepatitis B each year. Males aged 25-44 were the most affected group. The majority of cases were imported. In 2014, 12 cases of hepatitis B and two cases of hepatitis C were reported.
- From 2005 to 2012, noncommunicable diseases were the leading cause of morbidity and mortality.
- In 2006, 8.3% of the population aged 25-64 had diabetes (9.2% of women and 7% of men). The prevalence of hypertension was 19.8% in men and 12.2% in women in the 25-64 age group.
- 16.2% of people aged 25-64 were smokers.
- Between January and August 2013, 1,600 people over 18 years of age were overweight (prevalence of 38.9%). Of this group, the prevalence of obesity was 38.2%.
- Overweight in the preschool population was 11% in 2008-2009, the same figure as for school-age children in 2011-2012. Obesity in that population fluctuated between 10% and 11% throughout the study period.
- The Ministry of Health and Sports coordinates policies aimed at halting mental, social, and physical dependency linked to drug use.
- The Anti-Drug Foundation of Aruba (FADA) is the nongovernmental organization most active in the prevention of illegal substance use. The Foundation organizes public awareness campaigns, conferences, and programs for young people, parents, and workers. The country also has the Addiction Management Foundation of Aruba (FMAA), which is dedicated to treating addiction and rehabilitation.
- Aruba's Public Health Law, in effect since 1989, mandates that the Department of Public Health monitor, control, and inspect health care.
- The biggest government expenditure is on health, followed by social protection and education. In 2010, the budget allocated to health represented 11.3% of the gross domestic product.
- Health care is primarily funded by taxes and the premiums paid by employers and employees to the general health insurance fund. Starting in December 2014, a 1.0% tax on goods and services was mandated by Aruba's Public Health Law to reduce the State's contribution to general health insurance.
- The health insurance system provides universal coverage through a network of service providers organized into the three levels of care.
- Family doctors comprise the first level of care, based on a model geared toward patient diagnosis, monitoring, and case management.
- 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 12.0 admissions per 1,000 population.
- The hospital includes the San Nicolás Medical Institute (ImSan), which is an autonomous comprehensive national center for outpatient care that primarily treats noncommunicable chronic diseases.
- The older adult population can be institutionalized in three geriatric homes that have a total of 250 beds. The majority of people admitted also receive health care.
- In 2013, Aruba had 43 general practitioners and 78 specialists (1.82 physicians per 1,000 population and 0.33 dentists per 1,000 population). The general health insurance fund contracts these professionals, including primary care physicians, specialists, and most dentists, physical therapists, and midwives.
- Aruba does not have a national medical school; most health professionals are trained abroad. The country runs the risk of professional emigration, primarily because the professionals who study and graduate abroad tend to remain where there are more opportunities and higher salaries.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- Since 2011, the health insurance's proportion of the budget has increased, and in December 2014, a 1.0% tax on goods and services was mandated by Aruba's Public Health Law in order to reduce the State's contribution to general health insurance.
- The health insurance system provides universal coverage through a network of service providers organized into the three levels of care, although there are more curative than preventive services.
- In Aruba, the number of adolescent pregnancies has progressively declined in recent years, which is why the respective data should be analyzed and widely disseminated.
- Although economic and social statistics reflect a certain stability in the country, much remains to be done to address major health problems and challenges such as the aging population, the predominance of noncommunicable diseases, and risk factors such as obesity and drug and alcohol use among young people.
- Efforts have been made to reduce childhood obesity by promoting sports, but they must be sustained over time and must reach the entire population, including older adults. In order to address drug use, which impacts adolescents and young adults, risk prevention methods require comprehensive and intersectoral initiatives that target lifestyles and other social determinants.
- There is a need for better public health infrastructure and training for human resources for health in order to support health promotion and health care more effectively within the framework of universal health.
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