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close this bookThe Nutrition and Health Transition of Democratic Costa Rica (INFDC, 1995, 228 p.)
View the document(introduction...)
View the documentContributors to this volume
View the documentIntroduction
close this folder1. Health policies and strategies
View the document(introduction...)
View the documentA brief description of Costa Rica
View the documentPublic health development
View the documentThe decade of the 1970s
View the documentThe decade of the 1980s
View the documentFinal reflections
View the documentReferences
close this folder2. Development of the social security institute
View the document(introduction...)
View the documentBackground
View the documentSocial security in Costa Rica
View the documentThe extension of direct insurance
View the documentExtension of insurance to the family
View the documentThe financial crisis
View the documentThe constitutional amendment
View the documentToward universalization
View the documentDevelopment of human resources
View the documentThe integration
View the documentThe new health care models
View the documentFinal comments
close this folder3. Development and characteristics of health and nutrition services for urban and rural communities of Costa Rica
View the document(introduction...)
View the documentIntroduction
View the documentBackground information on community outreach programs
View the documentMethodological characteristics of the Costa Rican health programs
View the documentNutrition programs
View the documentImpact of the programs on the health of children living in rural areas
View the documentConclusions
View the documentReferences
View the documentBibliography
close this folder4. Evolution of an epidemiological profile
View the document(introduction...)
View the documentIntroduction
View the documentStages of a process
View the documentThe first four decades of the century
View the documentThe period between 1940 and 1970
View the documentThe decade of the 1970s
View the documentThe decade of the 1980s
View the documentThe last decade of the century
View the documentFinal comments
View the documentReferences
close this folder5. Socioeconomic factors for the understanding of health policy during the 1970s
View the document(introduction...)
View the documentIntroduction
View the documentRecognition of social demands and the regulation of the conflict during the 1930s and 1940s
View the documentThe social government in the new development strategy of Costa Rica during the 1950s and 1960s
View the documentThe consolidated social government
View the documentFinal reflections
View the documentAcknowledgement
View the documentReferences
close this folder6. Problems and challenges of the health sector during the 1980s
View the document(introduction...)
View the documentIntroduction
View the documentSome problems of the health sector in the 1980s
View the documentBalance of the 1980s and perspectives for the 1990s in the health sector
View the documentReferences
View the documentAppendix 1 - Glossary
close this folderAppendix 2 - Supplementary reading list
View the document(introduction...)
View the documentEnglish-language supplementary reading list
View the documentSpanish-language supplementary reading list
View the documentSupplementary reading list - INCAP publications
close this folderAppendix 3 - Health conditions in Costa Rica 1994
View the documentGeneral information
View the documentSpecific health problems

Introduction

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.