RESUMEN
Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as 'High', in terms of health it belongs in the 'Very High' group. In 2018 mean life expectancy for the 'Very High' countries was 79.5, while in Costa Rica it was 80. In 2018, under five mortality was 8.8/1000 live births, lower than countries ranked in the 'Very High' human development group. Expected years of schooling in Costa Rica is 15.4, closer to the average, 16.4 years, of the 'Very High' human development group than the average of the 'High' group. The country is much healthier than would be predicted by its national income; rather, other features of society's development are likely to have played a key role in the development of good health. These include (i) the decision to cease investment in national defence, which freed up money to invest in health, education and the welfare of the population; (ii) the decision to create a universal health system financed by the State, employers and workers in the 1940s; and (iii) the educational system, that generated opportunities to lift important sectors of the population out of poverty, allowing them to have basic sanitary conditions that increase their possibilities to live longer and in better conditions. Despite these advances, inequalities in terms of income and social conditions persist, presenting challenges in the field of health, particularly for lower-income populations and those of African and indigenous descent. These inequalities must be addressed using decisions based on scientific evidence, a greater use of disaggregated data to reveal progress in addressing these inequalities, and with a broader articulation of the health sector with policies that act on the social determinants of health.
RESUMEN
Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as 'High', in terms of health it belongs in the 'Very High' group. In 2018 mean life expectancy for the 'Very High' countries was 79.5, while in Costa Rica it was 80. In 2018, under five mortality was 8.8/1000 live births, lower than countries ranked in the 'Very High' human development group. Expected years of schooling in Costa Rica is 15.4, closer to the average, 16.4 years, of the 'Very High' human development group than the average of the 'High' group. The country is much healthier than would be predicted by its national income; rather, other features of society's development are likely to have played a key role in the development of good health. These include (i) the decision to cease investment in national defence, which freed up money to invest in health, education and the welfare of the population; (ii) the decision to create a universal health system financed by the State, employers and workers in the 1940s; and (iii) the educational system, that generated opportunities to lift important sectors of the population out of poverty, allowing them to have basic sanitary conditions that increase their possibilities to live longer and in better conditions. Despite these advances, inequalities in terms of income and social conditions persist, presenting challenges in the field of health, particularly for lower-income populations and those of African and indigenous descent. These inequalities must be addressed using decisions based on scientific evidence, a greater use of disaggregated data to reveal progress in addressing these inequalities, and with a broader articulation of the health sector with policies that act on the social determinants of health.
Costa Rica es un país de especial interés en las Américas y en la salud mundial debido a su buena salud. El Programa de las Naciones Unidas para el Desarrollo clasifica a los países según su nivel de desarrollo humano con base en la esperanza de vida, la educación y el ingreso nacional. Aunque Costa Rica está clasificada en el puesto 63 y clasificada dentro del grupo 'Alto', en términos de salud pertenece al grupo 'Muy alto'. En 2018 la esperanza de vida media de los países del grupo 'Muy alto' era de 79,5 años, mientras que en Costa Rica era de 80. En 2018, la mortalidad en menores de cinco años era de 8,8/1000 nacidos vivos, inferior a la de los países clasificados en el grupo de desarrollo humano 'Muy alto'. Los años de escolaridad esperados en Costa Rica son 15,4, más cercanos al promedio, 16,4 años, del grupo de desarrollo humano 'Muy alto' que el promedio del grupo 'Alto'. El país es mucho más saludable de lo que podría predecirse por su ingreso nacional; más bien, es probable que otras características del desarrollo de la sociedad hayan desempeñado un papel fundamental en el desarrollo de la buena salud. Entre ellas figuran: (i) la decisión de dejar de invertir en la defensa nacional, que liberó dinero para invertir en salud, educación y bienestar de la población; (ii) la decisión de crear un sistema de salud universal financiado por el Estado, los empleadores y los trabajadores en el decenio de 1940; y (iii) el sistema educativo, que generó oportunidades para sacar de la pobreza a importantes sectores de la población, permitiéndoles disponer de condiciones sanitarias básicas que aumentan sus posibilidades de vivir más y en mejores condiciones. A pesar de estos avances, persisten desigualdades en términos de ingresos y condiciones sociales, lo que plantea desafíos en el ámbito de la salud, en particular para las poblaciones de menores ingresos y las de ascendencia africana e indígena. Estas desigualdades deben abordarse mediante decisiones basadas en pruebas científicas, un mayor uso de datos desagregados que revelen los progresos realizados para hacer frente a esas desigualdades, y una mayor articulación del sector de la salud con las políticas que actúan sobre los determinantes sociales de la salud.