Aruba INTRODUCTION Aruba was part of the Netherlands Antilles until 1986, when it became an autonomous country Aruba is one of the Leeward Islands of the Lesser within the Kingdom of the Netherlands. The Queen Antilles island chain in the Caribbean. It lies some of the Netherlands appoints the Governor of Aruba 32 km from the northern coast of Venezuela. The as her representative for a six-year term. The Aruba island is 31 km long and 8 km wide, with a landmass constitution provides for the election of 21 members of 180 km2. The climate is arid, with a mean of Parliament, headed by the Prime Minister. The temperature of 28u C (82u F), and rainfall averages Prime Minister’s Cabinet has six members. There 500 mm a year (falling mainly between October and are eight administrative districts, with the capital in January). Oranjestad. Aruba’s two official languages are Dutch Health in the Americas, 2012 Edition: Country Volume N ’ Pan American Health Organization, 2012 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME and Papiamento, a Creole language spoken by most number of adults 60 years and older more than of the population; English and Spanish are taught in doubled, comprising 15.1% of the population. The schools and spoken widely. Aruba maintains strong age dependency ratio (proportion of dependents per economic, cultural, and political ties with its partners 100 people working) was 41.7. in the Kingdom of the Netherlands (1). Aruba’s population structure has a pyramid In 2009, the real gross domestic product shape for age groups older than 45 years and an (GDP) was US$ 1.62 million. The per capita inverted pyramid for age groups 20–45 years old. GDP (in purchasing power parity [PPP]) in 2009 The proportion of age groups younger than 15 years was US$ 15,181 (2) compared to US$ 16,657 in old has been declining. This irregular shape reflects a 2008. Aruba is characterized by an open economy, reduction in fertility rates and migration movements dependent on imports from and exports to other (2, 5, 6). Figure 1 presents a comparison of the countries, as well as tourism, banking, and transpor- population structure in 1990 and in 2010. tation (3). In 2010, the services sector, especially the tourism industry, represented the main economic activity (51.4% of GDP). Earnings from tourism HEALTH DETERMINANTS AND amounted to US$ 1.2 billion in 2010, significantly INEQUALITIES contributing to the country’s social and economic development. Aruba experienced an economic reces- Monthly income per capita from employment in sion in 2008 and 2009, triggered by the international Aruba was US$ 1,543 in 2006. The lowest income economic crisis and the closing of the local oil decile earned US$ 562 per month while the top refinery. The Aruban economy was expected to decile earned US$ 2,778 (7). In 2010, half of rebound in 2011, with investment projects such as households (50.5%) had a monthly income between hotel construction and improvements in infrastruc- US$ 1,681 and US$ 5,040, 28.7% of households ture, including the renovation of the hospital and the earned between US$ 841 and US$ 1,680, and 12.2% reopening of the refinery (4). earned US$ 840 or less. Under 10% earned more Aruba has several providers of fixed, mobile, than US$ 5,000 per month (8). and Internet telecommunications. In 2010, 42% of In 2010, there were 34,880 households in the population used the Internet. Aruba with an average size of 3.1 persons and 28 In 2010, the estimated population was 107,795. collective living quarters such as homes for the The population grew by 5.2% between 2006 and elderly, at-risk youths, or persons with disabilities (7, 2010, with annual net migration of 6.0% (more 9). The proportion of working-age Arubans who men migrated out of the country than did women) were employed in 2007 was 62.4%, and youth (2). A wide range of foreign nationals reside in employment (ages 15–24) was 23.3% (10). the country, most coming from Colombia, the In 2009, adult literacy was 99.4% (99.3% for Dominican Republic, and Venezuela. The sex ratio men and 99.5% for women) (10). In that same year, is 92 men per 100 women. In 2010, total life the total net enrollment ratio in primary education expectancy at birth was 75.5 years (72.5 for men and was 96.8% (95.0% for boys and 98.4% for girls) and 78.6 for women); the total fertility rate was 1.9 the primary completion rate was 94.8%. In 2006, children per woman and the crude birth rate was there were 34 primary schools, 13 secondary schools, 12.8 births per 1,000 population (1, 2, 5). and two higher-learning institutions—the Aruba In 2000, 23.1% of the population was under Pedagogic Institute and the University of Aruba (5, 14 years old, and 7.0% was 60 years old and older. 11). The gender parity index for primary and By 2010, the age group under 14 years old had secondary education is close to 1.0, but it is 1.4 for declined to 18.9% of the population, while the tertiary education (10). $42 ARUBA FIGURE 1. Population structure, by age and sex,a Aruba, 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 12 10 8 6 4 2 0 024681012 12 10 8 6 4 2 0 024681012 Percentage Percentage Males Females Males Females Source: For 1990—United States Census Bureau. International Database, 2009 (updated December 2010); for 2010—Netherlands Antilles Central Bureau of Statistics. a Each age group’s percentage represents its proportion of the total for each sex. THE ENVIRONMENT AND HUMAN DISASTERS SECURITY Aruba lies outside the hurricane belt and usually ACCESS TO CLEAN WATER AND SANITATION experiences only the fringe effects of passing tropical storms. However, there is close surveillance of Aruba has no natural source of fresh drinking water hurricane and flooding alerts in the region and and very little rain. Drinking water is produced disaster preparedness programs are in place. through desalination of ocean water. The resulting distilled tap water is safe for consumption and is supplied to all inhabitants. FOOD AND NUTRITIONAL SECURITY W.E.B. Aruba N.V., which operates the world’s second largest desalination plant, supplies Food and nutritional security fall under the res- drinking water and electricity to the island’s residents ponsibility of the Department of Public Health’s and businesses. Veterinary Service and Hygiene departments. The Aruba has 100% water sanitation coverage for Veterinary Service inspects slaughterhouses and any households and businesses. Aruba’s sewer system is imported meat and poultry products at the point of adequate, and all households have their own septic entry. Aruba follows the regulations and requirements tank. San Nicolas, Oranjestad, and the hotels have in use for importing meat and poultry in the European their own sewage systems. Union. The Hygiene Department oversees the Mer- chandise Regulations, under which all other products imported for consumption, such as seafood, fruits, ROAD SAFETY vegetables, and drinks, are inspected. The Hygiene Department also inspects establishments that sell food Between 2000 and 2009, there were an average of to the public, such as restaurants. The Infectious 16.6 deaths due to road traffic accidents; 55% of Disease Service carries out surveillance of food handlers, them involved persons aged 25–44 years and 75.3% conducting a yearly screening for pathogens that cause were males. salmonellosis, shigellosis, or other foodborne diseases. If $43 HEALTH IN THE AMERICAS, 2012 N COUNTRY VOLUME cleared by the screening, food handlers then receive a births). The main causes of infant deaths were ‘‘green card’’ that certifies them to work in food conditions originating in the perinatal period. In that establishments. The Infectious Disease Service works period, there was only one death in the 1–4-year-old closely with the National Laboratory and the Depart- age group (a case of drowning) (2, 5). Vaccination ment of Public Health’s Epidemiology and Research coverage in 2009 was 98% for DPT3, 98% for Unit on the surveillance and control of foodborne polio 3, and 98% for MMR. diseases. Any increase is flagged in this system and the necessary measures are taken to contain its spread. Children (5–9 years old) Between 2007 and 2010 there were no deaths in FOOD SAFETY children 5–9 years old. In that period, the most common infectious There is close surveillance and inspection for food- disease reported in this age group was varicella, with borne diseases and of food handlers in Aruba, with a a total of 39 reported cases to the health authorities. special emphasis on tourist safety. Aruba is author- The next most common infections were diseases ized to give sanitation certification to cruise ships affecting the gastrointestinal tract, such as salmo- arriving in the country (12, 13, 14). nellosis, shigellosis, and enteritis caused by the Campylobacter bacteria. HEALTH CONDITIONS AND TRENDS Adolescents (10–19 years old) HEALTH PROBLEMS OF SPECIFIC POPULATION In 2007–2010, 4 deaths occurred in the 10–14-year GROUPS age group and 14 deaths in the 15–19-year age Maternal and Reproductive Health group; 71.4% of deaths in the age group 10–19 years were male.