|The Nutrition and Health Transition of Democratic Costa Rica (INFDC, 1995, 228 p.)|
|4. Evolution of an epidemiological profile|
Health has been a highly valued asset in the culture of Costa Rica, and throughout the twentieth century the government has paid an ever-increasing amount of attention to improving the health of the country. Government intervention in health was particularly successful during the 1970s, when health policies and strategies focused primarily on the protection of chose human groups that were more vulnerable and unprotected. During thee period, resources were used to solve the most vulnerable problems with the available technology. The outcomes of these actions were a substantial improvement of the public health and an accelerated process of epidemiological transition, under which the pathologies that characterize underdevelopment gave way to the diseases prevalent in industrialized nations in the absence of an equivalent economic growth. Under these conditions, mortality among youth declined substantially and shifted to older subgroups. This was accompanied by a decline in infectious diseases and an increase in chronic diseases, such as cardiovascular disease and cancer, and in accidental and violent deaths. These latter currently constitute about 60% of all deaths. In addition, the annual population growth rate, which in the 1960s was the second highest in the world at 4%, declined substantially to 2.5%. The fertility rate also declined and reached 119/1,000 coward the end of the 1980s. As a consequence of these changes, the population aged and the age structure was modified accordingly. Whereas the proportion of the population under 15 years of age declined from 45.7% at the beginning of the 1970s to 36.5% by the end of the 1980s, the proportion aged 50 years and older increased from 10% to 12% during the same period.
In order to have a better understanding of this transition and its acceleration during that decade, it is important to review the antecedents and the outstanding aspects of thee evolution. Although it would have been ideal to have morbidity data to make such an analysis, this is not possible, because the data for medical visits and hospital discharges are not easily obtained for the entire period and might not be sufficiently reliable. Even though the epidemiological surveillance systems that have been in place during the last two decades continuously provide information on those diseases that have to be reported routinely, similar information is not available for a considerable number of ocher diseases. For these reasons most of the statistics presented in this chapter are based on mortality estimates obtained from annual reports and internal documents from the Ministry of Health and from annual reports and other documents from the General Directorate of Census and Statistics. Even though during the first decades of this century there were problems with underreporting and the use of a different disease nomenclature that complicates their interpretation, birch and death records have been improving constantly; during the last four decades, their quality and coverage have been satisfactory, and they have been particularly reliable during the last three decades. An estimated 1% of births are recorded with a delay, 5% of deaths are not recorded or are recorded with a delay, and 71% of deaths are documented with a medical certificate. During the last 15 years, the proportion of reports with an improper definition of cause of death has declined substantially.
Since the beginning of this century, general and infant mortality estimates have allowed the evolution of these health phenomena to be documented and general conclusions to be reached regarding the possible impact of health policies and strategies. Throughout most of this century, infant mortality, which is one of the most sensitive indicators, has represented a very significant proportion of the total deaths.