Country Report: Belize
Belize is the only English-speaking country in Central America. It has a territory of 22,966 km2 and borders Mexico, Guatemala, and the Caribbean Sea. An estimated 31% of the population lives along the coast, with the remainder scattered widely throughout the country’s interior. Some 45% of the population is urban.
In 2015, Belize had a population of 375,900. Since 1990, the country’s population pyramid has maintained its expansive structure, although it is becoming stationary in the under-25 population due to lower fertility and premature mortality.
Life expectancy in 2015 was estimated at 73.7 years (71.1 for men and 76.6 for women).
Some 14.2% of the population is foreign-born. Belize is a small developing upper-middle-income country, with a GDP per capita of US$ 4,829 in 2016.
Its socioeconomic and health progress is reflected in a human development index score of 0.715 in 2015. The economy is dependent on agricultural exports.
- The Ministry of Health is making efforts to address the health needs identified through demographic and epidemiological data. Mental health and geriatric health are two problematic areas.
- The health system itself must also address its difficulty recruiting and retaining essential health personnel to tend to the rising population and number of tourists and meet all their needs.
- Issues such as depression, suicide, drug addiction, alcohol abuse, violence, and sexual abuse are growing concerns. The prescription and sale of antidepressants is widespread in the country.
- Health interventions to control and reduce lifestyle-related diseases include the provision of basic medicines and greater efforts to promote disease prevention and healthy lifestyles.
- Other Government agencies are involved in many and diverse interventions to reduce the incidence of homicides, gang violence, and personal injury that consume an undetermined portion of the public health budget.
- The Government is also implementing a road safety project to help reduce the incidence of traffic fatalities.
Figure 1. Distribution of the population by age and sex, Belize, 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
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- The national unemployment rate was 8% in 2016; the rate among youth and women was about three times higher.
- In 2016, 96.1% of the population had access to drinking water and 87.1% had access to sanitation facilities. More than half of the country’s population is covered by a modern, environmentally sound solid waste disposal system.
- The literacy rate among the adult population in 2010 was 84.1% for women and 75.2% for men.
- In 2009, 41.3% of the population was living below the poverty line. This percentage included 15.8% of the population regarded as indigent or in extreme poverty. The child poverty rate of 50% exceeded the national average, while the poverty rate among the elderly was lower than the national average, reflecting the success of Government programs. Above-average poverty rates were also noted among the indigenous Maya, with a poverty rate of 68%—the worst among all ethnic groups.
- The most vulnerable populations are indigenous groups, Afrodescendants, and the the lesbian, gay, bisexual, and transgender (LGBT) population.
- The homicide rate was 44.7 per 100,000 population in 2013. Most homicides are the result of urban gang warfare. Human trafficking is also a serious problem.
- Belize is vulnerable to rising sea levels as a result of climate change. Other effects include changes in water quality and availability, and greater frequency and intensity of extreme weather events.
- More than half the country’s population is covered by a modern solid waste disposal system that is environmentally sound and prioritizes human health and safety. The system covers an area of the country known as the Western Corridor, a continuum of population centers that includes the majority of the country’s urban areas.
- Rapid population growth imposes an undue burden on the public health infrastructure.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In 2011, for the first time, no maternal deaths were reported. However, in 2012 there were 3, for a ratio of 42 deaths per 100,000 live births.
- The infant mortality rate averaged 15 deaths per 1,000 live births from 2001 to 2005, increasing to 18 in the period 2006-2010, and decreasing to 15.7 in 2012.
- The leading causes of death in recent years were chronic noncommunicable diseases. Diabetes, cardiovascular disease, cancers, and chronic respiratory diseases are responsible for around 40% of deaths annually.
- Injuries and external causes are responsible for 28% of deaths, and communicable diseases, including HIV infection and acute respiratory tract infections, 20%.
- In people under 70, 47% of deaths from chronic noncommunicable diseases were regarded as premature deaths.
- The incidence of cancer in 2012 was 59 cases per 100,000 population. The incidence of breast cancer and cervical cancer was 29.9 and 21.4 per 100,000 population, respectively, while prostate cancer incidence was 15.3 per 100,000.
- The increase in homicides has a great impact on male mortality trends.
- Children age 5-14 are at greater risk of dying from fire, drowning, and motor vehicle accidents. However, the leading causes of death in children under 1 are hypoxia, birth asphyxia, respiratory conditions, and other conditions originating in the perinatal period, as well as birth defects. One of the leading causes of death in young adults aged 20-29 is HIV.
- The leading causes of death in people aged 30-49 are complications of HIV, traffic accidents, homicide, and injuries intentionally inflicted by other people.
- Diabetes and heart disease are among the leading causes of death in people 40 and over.
- The leading cause of death in people aged 50-59 is diabetes and its complications, followed by ischemic heart disease, hypertension, advanced HIV infection, and chronic liver disease and cirrhosis. The same holds true for people 60 and over.
- The three leading causes of morbidity account for nearly half of hospitalizations throughout the country. In order of frequency, they are: complications of pregnancy, childbirth, and the puerperium; injuries, poisoning, and certain other consequences of external causes; and acute respiratory infections.
- The communicable diseases of primary concern in the country include vector-borne diseases. The four serotypes of dengue have been confirmed in Belize, and the disease’s prevalence in urban communities is three times higher than in rural communities.
- The first case of Zika virus transmission was confirmed in May 2016. By the end of September 2016, there were 46 confirmed cases, including six pregnant women whose children were born without problems.
- Belize is in the pre-elimination phase of malaria control. Malaria decreased dramatically between 2007 and 2015, from 845 cases to 22.
- The annual TB incidence has remained stable over the past decade. There have been no confirmed cases of Chagas disease, and continuous screening of blood donors has improved surveillance of the disease.
- HIV/AIDS remains problematic, but sexually transmitted infections are not the leading causes of morbidity.
- In 2015, the crude diabetes prevalence rate was 14.2%, the highest in North America and the Caribbean.
- From a high of 90 deaths in 2001, fatal traffic accidents have gradually decreased to a low of 60 road fatalities in 2015, for a per capita rate of 18 per 100,000 population, one of the highest in Central America.
- In 1998, the Ministry of Health launched the health sector reform initiative, reorganizing its services into four health regions (Northern Region, Central Region, Western Region, and Southern Region), headed by regional health managers. All regional hospitals are located in urban areas. The rural population is served by a network of health clinics, health posts, and mobile health clinics.
- Through the introduction of the National Health Insurance Scheme, services are delivered through a network of primary care providers that has focused on the health of a defined geographic and population base identified as poor.
- Belize’s health system is heavily dependent on public financing. The Government has budgeted some US$ 126.4 million to the Ministry of Health, equivalent to 11% of the national budget and 3.5% of GDP.
- The lack of human resources for health is a critical problem in the health system. This scarcity is aggravated by the geographic distribution of these professionals, since most are based in urban areas, particularly in Belize City. The country has no medical school to train physicians, although some categories of nurses, laboratory technicians, pharmacists, and social workers are trained at the University of Belize.
- The Ministry of Health relies on a health information system to record patient data and integrates data sources electronically, thus facilitating data analysis and health information. The system covers the entire country and is considered up to date and accurate. The Ministry reports that despite the existence of its information system, there is still a gap in the quantity and quality of records, because physicians and staff members do not yet make full use of the system.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- Belize’s health system faces significant challenges in the short and medium term. These include an increase in chronic diseases as leading causes of mortality, emerging viral diseases that continue to pose a threat, rising costs stemming from urban violence, high rates of HIV infection, and difficulty recruiting and retaining personnel in the health sector. Given Belize’s extensive vulnerability, climate change poses additional risks to health and other sectors.
- The country’s economic structure, particularly growing tourism and ongoing dependence on export industries that employ a large number of seasonal migrant workers, results in the continuous transborder movement of people who may need services from the health system. The constant influx of seasonal immigrants parallels the movement of undocumented immigrants who settle in remote communities where access to medical care remains problematic.
- The chronic shortage and low retention rates of certain categories of health care professionals requires Belize to import such personnel, leading to recurrent expenditures to acclimate newly arrived health workers.
- Problems stemming from chronic noncommunicable diseases, particularly diabetes, and threats of viral infections require urgent priority action. Moreover, the allocation of public funds to the Ministry of Health and the administration of those funds should be evaluated to see if they are being optimized to effectively address these priorities.
- A major challenge for the country is consolidating health gains and reducing the social and health vulnerability of some population groups.
- The negative trends in Government revenue resulting from the adverse macroeconomic environment and rapidly rising public debt are a primary threat to the health system due to its heavy dependence on public financing.
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