Bahamas INTRODUCTION industries that contribute the most to the national economy. The Commonwealth of the Bahamas is an archipe- The Commonwealth of the Bahamas gained its lagic nation of approximately 700 islands and 2,400 independence from the United Kingdom in 1973. The cays and rocks, with a land mass of 13,878 km2 Bahamas is governed by a parliamentary democracy spread across 259,000 km2 of ocean (1). It is located based on the Westminster model, with a Governor off the southeast coast of Florida and the northeast General who represents the monarchy; a bicameral coast of Cuba. The main islands are Grand Bahama legislature that includes an elected parliament; and an and New Providence, where the capital, Nassau, is independent judiciary. The Government is led by a located. Tourism and financial services are the Prime Minister. Local governance of the islands other Health in the Americas, 2012 Edition: Country Volume N ’ Pan American Health Organization, 2012 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME than New Providence is provided by elected district 2001. In 2009, 12% of the employed workforce was councils (1). non-Bahamian. The Government of the Bahamas supports Preliminary projections from the 2010 popu- many health-related initiatives, both regionally and lation and housing count estimated a total internationally. These have included the Framework population of 353,658, a 16.48% increase over Convention on Tobacco Control (FCTC), the 2000 population. There was a resultant Caribbean Cooperation in Health (CCH), the increase in the population density per square mile, Caribbean Community (CARICOM) Council for from 56.7 in 2000 to 66.9 in 2010. The population Human and Social Development (COHSOD), and distribution changed little over that period, with the Regional Initiative for the Elimination of the exception of Exuma and the Cays, where the Mother-to-Child Transmission of HIV and population more than doubled, from 3,571 to Congenital Syphilis in Latin America and the 7,314 persons (5). Most of the country’s population Caribbean. (85%) resides in the most urbanized islands, New The per capita gross domestic product (GDP) Providence and Grand Bahama. Figure 1 shows in the Bahamas is one of the highest in the Americas. the population structure for the Bahamas in 1990 The exchange rate with the United States dollar and in 2010 (6). (US$) has remained constant at 1:1 since 1972. In Life expectancy increased substantially between 2009, the per capita GDP was US$ 20,311.80 (2). 1980 and 2008, growing from 64.3 to 71.0 years for The two largest sectors of the GDP are tourism males and from 72.1 to 76.7 years for females. This (50%) and financial services (15%). Between 2004 has resulted in an aging population, where only and 2008 the country experienced a steady increase 25.1% of the population was under the age of 15 in average household income, from US$ 39,626 to years in 2008, down from 28.4% in 2003. The US$ 43,459 (3). While income has increased, the estimated age-dependency ratio fell from 52.9 in distribution of wealth has remained disparate, with a 2000 to 45.3 in 2010 (3). Gini coefficient, calculated by the Department of Statistics of the Bahamas, of 44% in 2009. The 2001 Bahamas Survey of Living Conditions indicated a HEALTH DETERMINANTS AND poverty rate of 9.3% that year (1). Also in 2001, 5.1% INEQUALITIES of households were below the annual poverty line1 of US$ 2,863 per person. The adult literacy rate in 2005 was 95.8% (males Between 2006 and 2008, the national unem- 95.0% and females 96.7%). Education accounted for ployment rate rose only slightly, from 7.6% in 2006, 18% of public expenditures (4.8% of the GDP) to 7.9% in 2007, and to 8.7% in 2008. The global during the 2006/2007 school year. School attendance economic crisis helped push the unemployment rate is compulsory for children between 5 and 16 years. to 14.2% in 2009, however (4). Government-run primary and secondary education is Although unemployment is almost equal in free and universal through the country. During the men and women, its distribution varies among other 2006/2007 school year, the overall enrollment rate population groups in the Bahamas. In 2009, the stood at 97.2%. There were 76,255 students (49% highest rates of unemployment (32%) were experi- female and 51% male) enrolled (50,395 in public enced by adults under 25 years of age. schools and 25,860 in private institutions) (7). In 2009, 64% of the employed labor force In 2010, 15% of the country’s population worked in the private sector, compared to 62% in resided in rural areas, that is, outside the urban centers of New Providence and Grand Bahama. The 1 This poverty line represents the minimum amount of rural communities ranged in size from as many as money necessary to purchase an adequate diet, with some 17,000 residents to as few as 70. Males allowances for nonfood needs. accounted for 51% of the rural population. $54 BAHAMAS FIGURE 1. Population structure, by age and sex,a the Bahamas, 1990 and 2010. 1990 2010 80+ 80+ 75-79 75-79 70-74 70-74 65-69 65-69 60-64 60-64 55-59 55-59 50-54 50-54 45-49 45-49 40-44 40-44 35-39 35-39 30-34 30-34 25-29 25-29 20-24 20-24 15-19 15-19 10-14 10-14 5-9 5-9 0-4 0-4 12108866442200 10 1212 10 8 6 4 2 0 0 2 4 6 8 10 12 Percentage Percentage Males Females Males Females Source: 1990, Department of Statistics, Bahamas Ministry of Finance; 2010, Bahamas Ministry of Health. a Each age group’s percentage represents its proportion of the total for each sex. The vast majority (83%) of Bahamians in the programs, as well as fewer illnesses in the four lowest (poorest) economic quintile resided in the two weeks prior to the 2006 Household Expenditure more densely populated areas of New Providence Survey (8). That said, rural residents had a longer and Grand Bahama. (Total expenditures quintiles average length of stay at the country’s main referral are used as a proxy for income.) According to the center, Princess Margaret Hospital, located in 2004 Household Expenditure Survey, the poorest Nassau, in the island of New Providence. The Bahamians reported fewer illnesses (7%) than did the average length of stay for rural Bahamians was 10 to nation as a whole (12%). Yet, those persons in the 15 days, compared to 6 days for Bahamians overall. lowest economic quintile also were disproportio- Rural residents also accounted for 15.5% of hospital nately affected by both intentional and unintentional discharges in 2007 (10) from the Princess Margaret injuries. Of survey respondents who had suffered an Hospital. The three leading causes of discharge injury due to a gunshot, 70% were in the lowest diagnoses were diseases of the circulatory system economic quintile. Similarly, the rate of uninten- (15.5% of discharges); infectious and parasitic disease tional injuries (vehicular accidents) was twice as great (13.3%); and injuries, poisoning, and certain other for that group as for the nation as a whole (8). The consequences of external causes (9.5%). poorest population was also more likely to cite cost On average, economically disadvantaged (3%) and insufficient time (8%) as barriers to seeking Bahamians endured a greater disease burden than medical care, as compared to Bahamians overall did other Bahamians. And, when those poorer (1% and 1.4%, respectively), and they also reported individuals presented with the same condition, they greater rates of receiving public welfare assistance had a longer average length of stay (11). for outpatient services (29%) as compared to the In 2006, approximately 2.9% of the population national average (13%). Estimates from the 2011 reported having a physical or mental disability. Labor Force and Household Survey (with a sample Among individuals who had a self-reported dis- size of 190,075 persons, including 27,505 rural ability, 19.7% of the disabilities were related to sight, residents) indicated that the rural communities of hearing, or speech; 37.3% to limbs; 24.6% to mental the Bahamas had a lower average unemployment disabilities; and 18.3% to multiple disabilities. A rate than did the country as a whole, 9.0% versus total of 24.2% of individuals with disabilities 14.2% (9). In addition, rural residents had greater reported having the disability from birth, compared participation rates in several social protection to 19.6% developing it as an elder (65 or older). $55 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME Disabled individuals were more likely to cite cost ROAD SAFETY (8.2%) as a barrier to accessing medical care than were Bahamians overall (1.0%). Disabled persons The Government of the Bahamas is addressing road also had greater rates of public assistance for both safety through major road improvement initiatives, outpatient services (29.0%) and inpatient services with financial assistance coming from the Inter- (22.9%) compared to national rates (13.0% and American Development Bank (13). 11.2%, respectively). Disabled Bahamians were disproportionately burdened by illness, with a rate of 25.1%, more than twice as high as the national CLIMATE CHANGE average of 11.6%. Disabled individuals were also more likely to report unintended injuries (at school As a small island developing state, the Bahamas is or workplace) than those without disabilities (8). particularly vulnerable to the effects of climate change.