Martinique Saint Lucia Saint Vincent and the Grenadines Barbados Grenada Trinidad and SAINT VINCENT Tobago Venezuela AND THE GRENADINES Saint Vincent ^ Kingstown Bequia Mustique Canouan Mayreau Union Island Palm Island Petit Saint Vincent 0210 0Miles Sources: Second Administrative Level Boundaries Dataset (SALB), a dataset that forms part of the United Nations Geographic Database, available at: http://www.who.int/whosis/database/gis/salb/salb_home.htm, and the Digital Chart of the World (DCW) located at: http://www.maproom.psu.edu/dcw. The boundaries and names shown here are intended for illustration purposes only, and do not imply official endorsement or acceptance by the Pan American Health Organization. aint Vincent and the Grenadines is a multi-island state in the Lesser Antilles; the coun- try’s 32 islands, inlets, and cays cover a 345-km2 land area. The volcanic island of Saint SVincent, which accounts for most of the land area, is where 91% of the country’s popu- lation lives. La Soufriere Volcano last erupted in 1979. The Grenadines includes seven inhabited islands—Bequia, Canouan, Mayreau, Union Island, Mustique, Palm Island, and Petit Saint Vin- cent. Sea transport links all the islands; airport facilities are available on Saint Vincent and in Be- quia, Canouan, Mustique, and Union Island. GENERAL CONTEXT AND HEALTH The report also concluded that the country showed high levels DETERMINANTS of inequality. In 2001, the Government committed itself to ad- dress the doubly debilitating conditions of mass poverty and in- The country has a tropical climate, with temperatures averaging equality, and established the National Economic and Social De- between 72° and 80° F and rainfall averaging 80 inches along the velopment Council to oversee and guide the poverty reduction coast and 160 in the central range; the rainy season falls between strategy. In 2002, the draft Interim Poverty Reduction Strategy May and November.Saint Vincent and the Grenadines is susceptible Paper, a blueprint for developing policies and programs to ad- to hurricanes,tropical storms,volcanic eruptions,and earthquakes. dress the central elements of poverty reduction in the short, medium, and long terms, was completed. The overall employment rate3 declined from 80.2% to 78.9% Social, Political, and Economic Determinants between 1991 and 2001. Unemployment among males increased Saint Vincent and the Grenadines gained political independ- from 18.4% in 1991 to 22.1% in 2001; among females, it de- ence from Great Britain in 1979 and is governed as a Westminster- creased from 32.1% to 18.6% in the same period.The percentage style parliamentary democracy. The country is politically stable of the population working in agriculture, construction, and and free and fair elections are held every five years. The official wholesale industries declined from 49.1% of the labor force in language is English. The leading religious denominations are An- glican (17.8%), Pentecostal (17.6%), and Methodist (10.9%). 1991 to 41.6% in 2001. This drop was mainly due to a 37% de- Between 2000 and 2004,Saint Vincent and the Grenadines’GDP cline in employment in agriculture. Fishing and manufacturing grew from US$ 285 million to US $349 million. GDP growth aver- industries declined between 1991 and 2001. In 2001, 52% of the aged 5.1% per year in 2000–2004, resulting mainly from resilience labor force was in the age group 15–43 years old as compared in the construction, transportation, banking and insurance, elec- with 60% in 1991. tricity and water, communications, and wholesale and retail sec- The unemployment rate in 2001 was 21%. The country’s size, tors.The removal of preferential tariffs and quotas on bananas,the limited economic diversification, and extreme vulnerability to country’s main export crop, has led to losses in the agricultural hurricanes triggered income insecurity and economic volatility at sector.The Government has acknowledged the need to develop the national and household levels. According to a World Bank docu- services and tourism sectors to offset those losses. There were ment,the impact was particularly felt by the poor and the indigent 77,631 tourist arrivals in 2002, nearly 7,000 more than in 2001. poor, who were unable to tap savings or were not reached by the In 2000–2004, the government annual budget ranged from government’s social protection programs in times of hardship. US$ 150 million to US$ 180 million. The literacy rate in 2001–2005 was estimated at 96% overall, The 1996 Poverty Assessment Report concluded that 37.5% of with equal levels for males and females. Saint Vincent and the the population (43,875 persons) was poor1 and 25.7% (30,069 Grenadines’ educational system offers primary, secondary, and persons) was classified as indigent poor.2 tertiary education levels.Since 2003,the Government has granted universal access to secondary education for all children. There 1Poverty is defined as insufficient diet and a lack of other goods and services nec- essary for effective functioning in a society. 3The overall employment rate is the employed population as a percentage of the 2The indigent poor are persons who are not able to meet their basic food needs. economically active population. 631 HEALTH IN THE AMERICAS, 2007.VOLUME II–COUNTRIES are 28 primary and 21 secondary public schools in the country, 1991. The census also showed that the female-to-male ratio was plus 3 private primary schools and 4 private secondary schools. 1:1.02. (See Figure 1.) School enrollment was 96% for the age group 5–9 years old and According to the 2001 census, African descendents accounted 94% for 10–14-year-olds. Preschool enrollment was only 33% in for 72.8% of the population,mixed ethnicities for 20%,Caribs for 2001. Although there were no full-time tertiary institutions on 3.6%, and East Indians for 1.4%. Caribs and other indigenous the island, 5.4% of the population has attained tertiary degrees. peoples live predominantly along the country’s northeast. There were no observable differences in the number of males and In 2001–2004, there were 3,097 deaths, for an average of females pursuing university education. 774 deaths per year.In 2001,there were 765 deaths.The five lead- The Central Water and Sewerage Authority distributes potable ing causes based on defined causes of death were malignant water to about 90% of the country’s population.According to the neoplasms (133), diabetes mellitus (103), cerebrovascular acci- 2001 census, the water supply for 52.2% of households was pub- dents (60), ischemic heart diseases (45), and HIV/AIDS (34). licly supplied into the home; for 17%,publicly supplied water was Diabetes, ischemic heart disease, cerebrovascular accidents, hy- piped into the yard; for 20.8%, water was privately piped into the pertensive diseases, and malignant neoplasms were the five non- dwelling; and for 10%, mainly households on the Grenadines, communicable diseases that accounted for around 50% of total water came from private catchments. deaths annually. In 2003 there were 774 deaths. The five leading Food safety continued to be an issue of great concern in the causes of death were diabetes mellitus (120), malignant neo- country. Between 2001 and 2005, the number of food establish- plasms (119), heart disease (102), hypertension (101), and cere- ments increased, but there was no system for registering and li- brovascular accidents (51); together, these causes accounted for censing them. Food handlers’ clinics conducted twice per year at 62.4% of total deaths. district health centers provided education and information on Diabetes accounted for 71 female deaths and 49 male deaths; food safety; attendance is voluntary. 55 females and 46 males died of hypertension.Nearly equal num- In 2001, 52% of the households used a combination “water bers of males and females died from ischemic heart disease and closet linked to cesspit” and “water closet linked to sewer,”an in- cerebrovascular disease; economically and socially deprived crease compared with the 32% reported in 1991. Concomitant women were particularly vulnerable to these two diseases. with this increase, the number of households using pit latrines The leading cause of death in males was malignant neo- fell from 62% in 1991 to 44% in 2001. Saint Vincent and the plasms; in 2001–2003 malignant neoplasms of the prostate was Grenadines has two sanitary landfills, one located at Belle Isle on the fifth leading cause of death among males, with 91 deaths.An the island’s leeward side and the other at Diamond, on the wind- analysis of mortality data for 2003 showed that there were 69 ward side. deaths from malignant neoplasms among males, compared to 49 All households in Saint Vincent have their garbage collected deaths among females. The most common site for malignant once a week; households in the Grenadines have collection twice neoplasm in males was the prostate. Cardiac-related conditions a week. have steadily increased in Saint Vincent and the Grenadines over Squatting continues to be widespread. Persons who settle in the years; in 2004,1,205 cases were reported.Chronic obstructive squatting areas usually have no access to potable water or sani- pulmonary diseases were responsible for 23 deaths in males and tary facilities.The areas where they live also are noted for vermin 5 deaths in females. In 2003, 40 males died from cirrhosis of the and rodent infestations, as well as the presence of other disease liver, alcoholic cardiomyopathy, alcoholic hepatitis, acute pancre- carrying organisms. Overcrowding, which allows for the easy atitis, and gastrointestinal hemorrhage; only 16 females died spread of communicable diseases, is a common feature in these from these diseases that year. settlements. Data from public health care facilities revealed that injuries from poisoning and other consequences of external causes ac- counted for 827 visits.