Country Report: Bermuda
Bermuda is a self-governing British Overseas Territory in the Region of the Americas. It consists of seven main islands connected by bridges and more than 100 smaller islands, with a combined land area of approximately 53 km2. The territory is divided into nine parishes. The capital, Hamilton, is located in Pembroke, the most densely populated parish.
Bermuda is governed by the Westminster model of parliamentary democracy.
The estimated population in 2016 was 61,695, with a male-to-female ratio of 91 males to 100 females. In 1990, the population pyramid had regressive characteristics but was stationary below the age of 30. Since then, it has become stationary. Life expectancy at birth in 2016 was 81.23 years (77.5 in men and 85.1 in women).
The territory has one of the world’s highest per capita incomes, with a per capita GDP of US$ 96,018 in 2015. The principal economic sectors are international business, tourism, and construction.
- The “Well Bermuda” National Health Promotion Strategy, developed in 2008, was the territory’s first concerted effort to create a joint approach to health promotion and a shared vision for health promoters across all sectors.
- Bermuda’s health strategy for the period 2014-2019 is based on the vision of “healthy people in healthy communities.” Its purpose is to provide a framework for restructuring the health system to improve the quality of health care, increase access, and contain health costs.
- In July 2016, the Tobacco Control Act 2015 replaced the Tobacco Products (Public Health) Act of 1987. The new law seeks to protect children from tobacco products, strengthen provisions to control tobacco use, and control the sale and use of e-cigarettes and cigarette rolling papers in order to reduce exposure to chronic disease risk factors.
Figure 1. Distribution of the population by age and sex, Bermuda, 1991 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2015
Source: Pan American Health Organization. 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 population is expected to decline by 4% during this decade (2010-2020) due to emigration.
- In 2007, 11% of the population was under the low-income threshold, an indicator created by the Bermuda Department of Statistics after extensive research to produce a measure that could replace the poverty line model.
- Unemployment was 7% in 2015. Between 2012 and 2015, the annual rate fluctuated between 6% and 9%, with men experiencing slightly higher unemployment rates than women.
- Education is public and free at the primary and secondary levels. There is one institution of higher education, but most Bermudians emigrate to continue their studies.
- Bermuda has one of the largest reinsurance industries in the world. The territory complies with global antimoney laundering and anti-terrorist financing standards and does not have banking secrecy laws.
- In 2013, 60% of households owned a computer, 73% had a landline telephone, and 88% had at least one cell phone.
- The Department of Environment and Natural Resources was established in 2016 to protect Bermuda's environment and responsibly manage its natural resources to meet the environmental, economic, and social needs of the community.
- The territory is exposed to severe weather events, as well as pandemics, major oil spills, air crashes, serious cruise ship incidents, and tsunamis, among other hazards.
- Bermuda’s Emergency Measures Organization prepares all government departments and nongovernmental institutions for natural and man-made disasters and coordinates emergency response and recovery when emergencies occur. Strict building codes are enforced to mitigate hurricane destruction.
HEALTH SITUATION AND THE HEALTH SYSTEM
- There have been no reports of maternal deaths in recent years. The total number of deaths of residents reported in 2015 was 466, resulting in a mortality rate of 663.86 per 100,000 population.
- In 2015, the infant mortality rate was 3.4 per 1,000 live births (two infant deaths); in 2014 one infant death was reported. There were two stillbirths in 2014 and three in 2013.
- In 2015, 36% of deaths were caused by circulatory system diseases and 28% by neoplasms. These two groups of causes together accounted for almost two-thirds of total deaths.
- In 2014, more than 95% of the population had at least one risk factor for a non-communicable disease. The principal risk factors were insufficient consumption of fruits and vegetables (82%), overweight and obesity (75%), and alcohol use (64%). High cholesterol (34%), hypertension (33%), and physical inactivity (27%) were also cause for concern. A reported 14% of the population smokes.
- Injuries and poisoning were the leading causes of hospitalization (26.8%), followed by respiratory system diseases (12.6%). Cases of malnutrition are exceptional and occur mostly in older persons.
- Bermuda has not experienced any critical health problems related to emerging and reemerging diseases, neglected diseases and other poverty-related infections, or tuberculosis.
- In 2016, the first imported case of Zika virus was confirmed. All cases of malaria and dengue have been sporadic and imported. Influenza A(H1N1) continues to circulate in the archipelago.
- From 1982, when the first AIDS case was reported in Bermuda, until the end of 2015, 767 people were diagnosed with HIV. Of these, 565 were diagnosed with AIDS and 464 died.
- Bermuda completed the validation process for elimination of mother-to-child transmission of syphilis and congenital syphilis in 2016. The territory has a low incidence of tuberculosis.
- In 2015, the highest number of cases of sexually transmitted infections (STIs) was reported in the group aged 20-24 years. Chlamydia accounted for nearly three-quarters of all STI cases.
- Chronic conditions constitute a major burden of disease. In 2010, there were 1,213 people aged 65 or older who suffered from a chronic health condition that affected some aspect of their quality of life. The six leading causes of disability are hypertension, impaired vision, arthritis, heart disease, diabetes, and impaired mobility.
- The Mental Health Plan 2010 promotes patient-centered care through services provided in the community. It includes three main segments, each with supporting strategies: expanding the community-based care model, implementing service improvements, and reforming forensic mental health services.
- The health care sector comprises one general hospital (the King Edward VII Memorial Hospital) that includes an urgent care center (the Lamb Foggo Urgent Care Centre); one psychiatric hospital (the MidAtlantic Wellness Institute); 17 long-term care facilities; 193 outpatient care facilities; 16 ancillary services (including patient transport, emergency rescue, and medical and diagnostic laboratories); 18 retailers and suppliers of medical products; and 18 providers of preventive care.
- The Ministry of Health, as the state health authority, works in collaboration with the Bermuda Health Council, the Department of Health, the Bermuda Hospitals Board, and the Health Insurance Department.
- The Department of Health provides primary and preventive services to children; family planning and prenatal care to women of reproductive age; occupational health services to the uniformed services; and comprehensive primary health care to the territory’s incarcerated population.
- The Bermuda Health Council is a quasi-autonomous nongovernmental organization that monitors the health system’s performance and coordinates health system stakeholders to ensure access to health insurance and safe, high-quality care.
- The Bermuda Hospitals Board, also quasi-autonomous, was established in 1970. Its chief executive is responsible for the King Edward VII Memorial Hospital, the Mid-Atlantic Wellness Institute, and the Lamb Foggo Urgent Care Centre.
- In 2015, Bermuda spent 12.4% of its GDP on health care (US$ 11,188 per capita). The health system is financed from four principal sources: public and private health insurance plans (60%), government subsidies and grants (29%), out-of-pocket payments (10%), and charitable donations (1%). Government funding also supports programs to ensure that vulnerable populations have access to health care.
- In 2013, well-off households spent 3% of their income on health care, while less well-off households spent nearly 20%.
- The Office of the Registrar General provides vital statistics on births and deaths. The Epidemiology and Surveillance Unit of the Ministry of Health provides information on selected causes of death, communicable disease summaries, and risk factor surveys.
- The Bermuda Health Council provides information on health financing and regulation. The Health Information Management Services under the Bermuda Hospitals Board provides information on the utilization of hospital services.
- All physicians, dentists, pharmacists, nurses, and allied health professionals must be licensed and registered to practice and must obtain continuing education hours.
- In 2014, more than 2,000 people worked in health-related professions, 65% of whom were Bermudians. To combat the nursing shortage, a nursing program has been established at Bermuda College.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The increase in the elderly population, a result of rising life expectancy, means that more people will reach retirement age and a greater proportion of dependent elderly people will need to be supported by the working population. This will place more demands on the health care system, while issues such as quality of life, access to health care and health care costs will become increasingly critical.
- The economy is expected to further improve, based on the sustained growth of tourism and international business—dominated by the insurance and reinsurance sector—and higher investment in construction.
- Priorities in the Bermuda Police Service Strategic Plan for 2016-2018 include tackling crime and antisocial behavior, promoting community participation, making the roads safer, and optimizing technology to enhance rapid response capabilities and protect vulnerable people.
- Human resources development and the creation of problem-solving capacity in health is a priority for the territory. To this end, efforts are under way to broaden the scope and quality of oversight and regulation of health care providers and associated businesses and to improve coordination of care across the health care system.
- The Bermuda Health Strategy 2014-2019 is aimed at developing an integrated public-private electronic health system shared, including laboratories and diagnostic facilities.
- This health strategy also provides for greater regulatory control of health technologies, including high-cost diagnostic and therapeutic equipment, to ensure cost-efficient use.
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