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Colombia General Indicators of Health
Colombia's leading health indicators indicated
consistent
improvement over the long term. During the 1950s, life
expectancy
at birth was under fifty years for the average citizen. In
1988
this indicator had reached approximately sixty-eight years
for
females and sixty-four years for males. The estimated life
expectancy range for the rural population was 10 percent
to 30
percent below the national average, varying regionally. In
the
eastern plains, the Amazon Basin, the southern rural
Caribbean
coastal region, and especially in the southern and
northern Pacific
coast, the rate of improvement in life expectancy was
substantially
lower than the national average; in some of the poorest
areas, no
perceptible change had occurred between the 1950s and the
1980s.
Higher life expectancies were closely correlated with
the
"spatial" distribution of the population. The higher the
level of
urbanization, the greater the average life expectancy. The
five
major cities--with nearly 30 percent of the population--in
the
early 1980s reported average life expectancies nearly 10
percent
above the national average. Analysts anticipated that
projected
increases in urbanization in the 1990s would have a
positive impact
on the life expectancy of the nation as a whole.
In 1984 analysts estimated Colombia's infant mortality
rate at
52 per 1,000 live births (see
table 6, Appendix). The
annual rate
of decrease fluctuated between 2.4 percent and 2.9 percent
during
the 1950-84 period, peaking during the second half of the
1970s.
Some observers suggested that this pattern was closely
associated
with greater public expenditures for nutrition and basic
care for
pregnant women and newborns in rural areas.
Despite these improvements, Colombia's infant mortality
indicators were among the poorest of the major Latin
American
countries. Colombia's figure stood substantially above
these
countries' norm of 42.8 per 1,000 live births and was more
than 200
percent greater than the lowest level recorded for
national infant
mortality in the region (19.5 per 1,000 live births)
during the
first half of the 1980s.
Moreover, complementary data suggested that infants and
children were the least protected segment of the
population.
Although Colombia's death rate declined 51 percent from
1970 to
1985, infant mortality diminished only 19.8 percent over
the same
period. Indeed, despite the gradual improvement of infant
health
indicators, the benefits of better medical care and living
conditions were strongly concentrated in the upper levels
of the
age pyramid. Infant death rates also were higher in rural
areas.
Moreover, maternal mortality was high by Latin American
standards.
Between 20 and 30 percent of maternal deaths were related
to
complications arising from induced abortion, the vast
majority of
them performed outside the formal medical system because
of legal,
cultural, and religious sanctions.
Nutrition in Colombian society improved significantly
after the
1950s. The average nutrient and caloric intake improved in
quality
and quantity, as did the performance of the main
indicators of
nutritional status, such as height, weight, and
malnutritionrelated mortality and morbidity. The improvements resulted
from
increased agricultural productivity in the early 1970s,
modernization of eating habits, higher levels of
nutritional
awareness, and explicit public policies supporting
nutritional
programs aimed at the poorest segments of society
(see The Politics of Health: Priorities, Institutions, and Public Policy
, this ch.).
In the 1980s, the health and hazard causes for death
were, to
a significant degree, considered preventable, treatable,
or
curable. Most infant and child deaths were linked to
diarrheal
diseases, digestive tract infections, nutritional
disorders, and
complications related to immunizable viruses. Many adult
deaths
resulted from "social pathologies," including homicide and
accidents. In addition, as their society aged, Colombians
were
exhibiting a surge in diseases common to the
industrialized world,
such as coronary and heart disorders, hypertension-related
illnesses, and cancer.
One-fifth of all infant and child deaths (zero to four
years of
age) resulted from diarrheal and infectious digestive
disorders
accompanied by the inevitable dehydration complications.
These
diseases were associated with poor sanitation and living
conditions, malnutrition, and lack of parental nutritional
awareness. Another fifth of infant mortality originated in
complications associated with delivery and birth. This
mortality
reflected the low level of basic health care for rural
pregnant
women, which was also associated with high levels of
maternal
mortality. Respiratory diseases caused another fifth of
the deaths
in children under four.
Violent criminal attacks and homicide--referred to in
Colombia
as "blood deaths"--accounted for 45 percent of deaths in
persons
between fifteen and forty-four years of age. The high rate
of
homicide and violent deaths was associated with the
structural
problems of poor law enforcement, high levels of social
and
political violence, and criminal activities related to
narcotics
production and distribution
(see Post-National Front Political Developments
, ch. 4;
Internal Security Problems
, ch. 5).
The impact
of violence was exacerbated by a health care system that
was
designed to handle "normal" or "formal" health disorders
and not
well suited for emergency medical care. Colombians
considered the
poor quality of emergency treatment as one of the major
flaws of
their nation's health care system.
The major causes of death for those over forty-four
years of
age were coronary and heart degenerative disorders,
cancer, and
cerebrovascular diseases. Diet--composed of sugars,
starches,
salted food, and fats high in cholesterol--along with the
prevalence of smoking and alcohol consumption contributed
to the
unusually high incidence of these maladies.
In the early 1980s, the most prevalent illnesses
striking
Colombians were respiratory infections, ophthalmological
and vision
problems, digestive tract parasitic diseases, acute upper
respiratory tract infections, peripheral vascular problems
such as
varicose veins, and malnutrition disorders. Over 14.2
million cases
of individual illness were attributed to these diseases.
In the 1980s, the duality of the Colombian health
profile was
also present in the social and regional distribution of
morbidity.
The poorest segments and regions suffered the most from
preventable
and curable causes, such as gastrointestinal disorders and
certain
types of respiratory ailments, whereas the incidence of
the
degenerative and chronic diseases--typical of urban
dwellers and
higher-income earners--was relatively low in comparison.
Tropical
diseases continued to be endemic to certain areas of the
country.
Because of the acceleration of migratory flows to the
unexplored
tropical hinterland, diseases such as malaria, dengue, and
yellow
fever were increasing. Malaria affected approximately 15
percent of
the population--equivalent to roughly one-half of all
rural
inhabitants.
In the late 1980s, geriatric issues increasingly
challenged the
country's health care system. The combination of
increasing life
expectancy, reduction of fertility rates, and diminishing
mortality
rates produced an older society. Those persons over
forty-five
increased from 13.5 percent of the population in the
mid-1960s to
17 percent in the late 1980s. In absolute terms, this
trend meant
that more than 4.6 million people in 1990 would enter a
period of
life characterized by major health concerns related to
chronic,
catastrophic, and degenerative diseases. The proportional
increase
in these types of ailments demanded a specific framework
for health
care, medical technology, and professional specialization
that was
not widely available in the public health system.
Acquired immune deficiency syndrome (AIDS) was another
major
health challenge in the late 1980s. Like many other
less-developed
countries, Colombia was sluggish in tackling the issue of
AIDS
within its borders and recognizing it as a potentially
disastrous
health threat. The cultural environment--strongly
influenced by
traditional values toward sexuality, virility, and
homosexuality--
slowed public debate, distorted factual information about
the
incidence and spread of the virus, and inhibited the
formulation of
policy and preventive guidelines. In the first quarter of
1988, the
official number of confirmed cases of AIDS was fifty-nine.
By April
that figure had to be revised upward to 153 confirmed
cases.
Some sources contended, however, that this dramatic
increase
showed only a fraction of the total cases. New projections
in 1988
suggested that there were 7,650 AIDS carriers. Of that
total, 2
percent suffered the terminal stages of the disease, 25
percent
were experiencing related opportunistic illnesses, and the
remaining 73 percent were in the asymptomatic stage. A
doubling of
the total number of positive carriers was expected to
occur within
six months to one year because of the high levels of
underreporting, the weakness of preventive measures, and
the high
incidence of carriers among female prostitutes.
The high cost of health care for AIDS victims would
seriously
strain the already scarce resources available to treat
other
diseases. Analysts believed that major funding and
resources would
not be channeled into the fight against AIDS. As of 1988,
the
Colombian government had taken few steps beyond attempting
to
protect the national blood supply.
Data as of December 1988
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