Ecuador has a comprehensive publicly funded health system and national health insurance. Free medical care (with an extensive system of hospitals and regional health clinics) is available to all residents regardless of income, and without buying any type of medical insurance. An extensive and proactive program for public health includes actions such as teams of nurses going door-to-door offering influenza vaccines to residents. Isolated rural areas are also served by this system, as physicians, dentists, and nurses are obliged to perform one year of "rural service" in these communities. This service is mandatory for professional licensing in Ecuador.
The Human Rights Measurement Initiative[1] found that Ecuador, based on its level of income, fulfilled 92.6% of requirements for the right to health, 97.1% for the right to health concerning children, and 90.9% for the right to health concerning adults. Ecuador falls into the "fair" category when evaluating the right to reproductive health because the nation fulfilled only 89.8% of expectations, based on its level of income.[2]
Most Ecuadorians live within the Sierra, such as the cities of Quito and Cuenca, where health conditions most commonly associated with the tropics do not exist. For example, the types of mosquitoes which carry malaria and dengue fever cannot live at an altitude above 2,300 meters (according to the U.S. Centers for Disease Control), which is the minimum altitude throughout most of the Sierra.
Despite a lack of general agreement in the medical community about the prevalence of altitude-related conditions, some visitors to the highlands may experience symptoms. The lower atmospheric pressure of the Sierra can cause difficulty in breathing, nausea, and dizziness, but these conditions are typically not of long duration and require a period of reduced activity and conservative eating and drinking for acclimatization. Conversely, Ecuadorians who live most of their lives in the Sierra commonly require a brief period of readjustment after moving to sea level.
In the low-lying coastal regions and the Amazonian region, the predictable diseases of those climates exist. However, malaria and dengue fever are no longer epidemics in Ecuador. The potential for these diseases does exist, but mostly in isolated, economically depressed areas of the Amazon and seacoast. Life expectancy in Ecuador is approximately the same as in the United States.
For residents who are members of the Ecuadorian Institute of Social Security, an additional modern system of hospitals and clinics is provided through employee and employer payroll deductions or voluntary payments, as is the case with many expatriates residing in Ecuador. The monthly contribution for voluntary members for a family of two in this system is just over $80.[needs update] Employees contribute .0935[clarification needed] of their salaries for this coverage, but this also includes membership in the national pension system. Private health care is also available in the form of mostly smaller, doctor-owned health clinics. Private health insurance can be purchased but is largely used by middle- and upper-income groups.
Ecuador has benefited from the Cuban system of medical education, sending over 100 students per year (for over ten years) to the Escuela de Medicina Latinoamericana at no cost to the government of Ecuador or the students. The program requires that 50% of these students be women. Before returning to practice in Ecuador, it is common for these doctors to complete specialized residencies in the major cities of Argentina and Chile, among other countries. Additionally, Cuban nationals are numerous among the professors in the faculties of medicine in the major cities of Ecuador, including Quito, Guayaquil, Cuenca, and Ambato.
Health services
The current structure of the Ecuadorian public health care system dates back to 1967.[3][4] The Ministry of Public Health (Ministerio de Salud Publica del Ecuador, or MSP) is responsible for the regulation and creation of public health policies and health care plans, and is appointed directly by the President of the Republic. The philosophy of the Ministry of Public Health is to give social support and services to the most vulnerable populations[5] and its main plan of action lies around community health and preventive medicine.[5]
The Ecuadorian public health care system permits patients to be treated daily as outpatients in public general hospitals, with no previous appointment, by general practitioners and specialists. This is organized around the four basic specialties of pediatric medicine, gynecology, clinical medicine, and surgery.[6] Specialty hospitals are also part of the public health care system to target chronic diseases or a particular group of the population. For instance, there are oncology hospitals (SOLCA) to treat cancer patients, children's hospitals, psychiatric hospitals, gynecologic and maternity hospitals, geriatric hospitals, ophthalmology hospitals, and gastroenterology hospitals, among others.
Although fully equipped general hospitals are found in the major cities or capitals of the provinces, there are basic hospitals in the smaller towns and canton cities for family care consultation and treatment in pediatrics, gynecology, clinical medicine, and surgery.[6]
Community health care centers (centros de salud), or day hospitals, are found inside metropolitan areas of cities and in rural areas. These day hospitals give care to patients whose hospitalization is less than 24 hours.[6]
Most of the rural communities in Ecuador have a sizable population of indigenous people; the doctors assigned to those communities, also called "rural doctors", are in charge of small clinics to meet the needs of these patients in the same fashion as the day hospitals in the major cities. The care given in rural hospitals is required to respect the culture of the community.[6]
The MSP provides health services to 30 percent of the Ecuadorian population. The Institute of Social Security covers 18 percent of the population. Two percent is covered by the Armed Forces. Non-governmental organizations (NGOs) cover about five percent. Private services cover 20 percent.[7]
In 2011, there were 1.7 medical practitioners per 1,000 in population.[8]
History
Development of life expectancy in Ecuador since 1960
1830s – Surveys in urban areas show a range of 5 to 108 infant deaths per 1000 live births, whereas those in rural areas vary from 90 to 200.
1867 – Alejo Lascano Bahamonde founds the Faculty of Medicine in Guayaquil, the first faculty of medicine in the city.
1950s – Intestinal ailments and respiratory diseases (including bronchitis, emphysema, asthma, and pneumonia) cause roughly 3/4 of all infant deaths.
1959 – The Ecuadorian government conducts a national survey to determine conclusions about the malnutrition rates in Ecuador.
1960s – More limited studies about malnutrition rates are conducted.
late 1960s – 40% of preschool children show some degree of malnutrition. 30% of children under 12 years of age are malnourished and 15% are anemic.
late 1980s – Childhood mortality decreases to 0.9%.[9]
1991 – Health officials in Ecuador, Bolivia, and Chile banned the entry of uncooked food from Peru, particularly fish, which reduced the spread of many diseases in Ecuador.[10]
2010 – Dengue hemorrhagic fever epidemic in Ecuador.[11]
Statistics
According to the World Health Organization (WHO), in Ecuador in 2019 the average life expectancy at birth if 76 years for males and 80 years for females. Childhood mortality (probability of dying by age 5) was 13.43 per 1,000 live births. Mortality for adults between 15–60 years (per 1,000 population) was 206 for males and 123 for females.[12]
Diseases
Many diseases are prevalent in Ecuador, mainly due to environmental conditions, geographical location, and lack of health care. Specific health problems that are common in Ecuador include infant mortality, acute respiratory infection, diarrhea, dengue fever, malaria, tuberculosis, HIV/AIDS, health problems due to smoking, and malnutrition.[7] According to WHO data on confirmed cases of malaria, Ecuador had 8,464 cases per 100,000 population in 2007 and 544 cases in 2012.[needs update?] Changes in living conditions and health care appear to have had a significant effect on this condition.
In Ecuador, there are approximately 14,000 cases of tuberculosis per year.[11] The HIV prevalence rate is 3 cases for every 1,000 people.[13] Stunting from chronic malnutrition affects 26% of children under 5.[13] There are approximately 686 malaria cases per 100,000 people.
Nutrition overview
Currently worldwide there has been a rapid increase in the prevalence of non-communicable diseases, which in part is explained by an important health issue which it is malnutrition.[14]
Prevalence of obesity worldwide.
For decades malnutrition has been understood mostly as undernutrition in low- and middle-income countries (LMICs).[15] Although undernutrition decreased significantly from the early 1990s,[16] the prevalence of obesity in the world has nearly tripled since 1975.[17]
The coexistence of obesity and stunting is what has recently been named as the double burden of malnutrition.[18]
In Ecuador according to the latest systematic review study (2019),[19] the prevalence of obesity in children (age under 5 years) was 8.1% (95% CI 6.9, 9.3), 10.7% (95% CI 9.6, 11.7) in children (age 5-11 years), and 10.5% (95% CI 9.2, 11.8) in adolescent (age 12- 18 years). Adult populations (age >19 years) had a higher obesity rate of 44.2% (95% CI 43.1, 45.4). Concomitantly, the prevalence of stunting in children aged under 5 years was 23.2% (95% CI 23.3, 23.5), a wide range (14.9-44%) in children (age 5-11 years) and in adolescents, varied between 19 and 24.8%[20]
Double burden of malnutrition in Ecuador
Prevalence in children (by age)
Under 5
5-11 years
12-18 years
Stunting
8.1%
14.9-44%
10.5%
Obesity
23.2%
10.7%
19-24.8%
The double burden of malnutrition its mainly related due to the economic and sociodemographic growth causing a modification of the diet patterns increasing the consumption of high energy aliments rich in fat and nutrient poor, combined with a sedentary lifestyle.[21] According to the WHO, it is crucial to integrate dual duties to be able to coordinate a simultaneous approach focused on ending malnutrition.[22][23]
Social components
Afro-Ecuadorian children and Indigenous children are more likely to grow up in poverty and, as a result, face medical problems. Rates of chronic malnutrition are worse for Indigenous children.[13]
Ecuador is divided into four geographic regions; the Andes, the Amazon Basin, the Coast, and the Galapagos Islands. Harsh climates in each region pose several threats to human health.[24] Due to the lack of oxygen in the Andes because of high altitude, altitude sickness may arise, primarily in tourists coming from low-altitude regions.[25]
The Amazon's many species do pose threats to human health. Diseases like malaria and yellow fever can be transferred to humans by infected mosquitoes. Deforestation in the Amazon causes an increase in the number of cases of malaria because deforestation creates more breeding grounds for mosquitoes.[26]
Access to clean drinking water is also an issue in Ecuador.[27] Water-borne diseases like cholera can be transferred to humans through frequently drinking water that is not cleaned and filtered. Not treating wastewater and not having proper sewer systems pose the same threats.[28] 26.6% of households in Ecuador do not have access to safe drinking water.[29] On a national level, only 23.3% of wastewater is treated.[30] 60% of households have sewer systems.[31]
There are high amounts of air pollution in Ecuador. This can result in air-borne illnesses and respiratory problems.[32]
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition.
India's population in 2021 as per World Bank is 1.39 billion. Being the world's most populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues.
Stunted growth, also known as stunting or linear growth failure, is defined as impaired growth and development manifested by low height-for-age. It is a primary manifestation of malnutrition and recurrent infections, such as diarrhea and helminthiasis, in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother. The definition of stunting according to the World Health Organization (WHO) is for the "height-for-age" value to be less than two standard deviations of the median of WHO Child Growth Standards. Stunted growth is usually associated with poverty, unsanitary environmental conditions, maternal undernutrition, frequent illness, and/or inappropriate feeding practice and care during early years of life.
Diseases of poverty are diseases that are more prevalent in low-income populations. They include infectious diseases, as well as diseases related to malnutrition and poor health behaviour. Poverty is one of the major social determinants of health. The World Health Report (2002) states that diseases of poverty account for 45% of the disease burden in the countries with high poverty rate which are preventable or treatable with existing interventions. Diseases of poverty are often co-morbid and ubiquitous with malnutrition. Poverty increases the chances of having these diseases as the deprivation of shelter, safe drinking water, nutritious food, sanitation, and access to health services contributes towards poor health behaviour. At the same time, these diseases act as a barrier for economic growth to affected people and families caring for them which in turn results into increased poverty in the community. These diseases produced in part by poverty are in contrast to diseases of affluence, which are diseases thought to be a result of increasing wealth in a society.
Pakistan is the fifth most populous country in the world with population approaching 225 million. It is a developing country struggling in many domains due to which the health system has suffered a lot. As a result of that, Pakistan is ranked 122nd out of 190 countries in the World Health Organization performance report.
Health in Indonesia is affected by a number of factors. Indonesia has over 26,000 health care facilities; 2,000 hospitals, 9,000 community health centres and private clinics, 1,100 dentist clinics and 1,000 opticians. The country lacks doctors with only 0.4 doctors per 1,000 population. In 2018, Indonesia's healthcare spending was US$38.3 billion, 4.18% of their GDP, and is expected to rise to US$51 billion in 2020.
Sudan is still one of the largest countries in Africa, even after the split of the Northern and Southern parts. It is one of the most densely populated countries in the region and is home to over 37.9 million people.
Thailand has had "a long and successful history of health development," according to the World Health Organization. Life expectancy is averaged at seventy years. Non-communicable diseases form the major burden of morbidity and mortality, while infectious diseases including malaria and tuberculosis, as well as traffic accidents, are also important public health issues.
Singapore is one of the wealthiest countries in the world, with a gross domestic product (GDP) per capita of more than $57,000. Life expectancy at birth is 82.3 and infant mortality is 2.7 per 1000 live births. The population is ageing and by 2030, 20% will be over 65. However it is estimated that about 85% of those over 65 are healthy and reasonably active. Singapore has a universal health care system.
The quality of health in Cambodia is rising along with its growing economy. The public health care system has a high priority from the Cambodian government and with international help and assistance, Cambodia has seen some major and continuous improvements in the health profile of its population since the 1980s, with a steadily rising life expectancy.
Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world. Consequently, Bangladesh faces challenges and opportunities in regards to public health. A remarkable metamorphosis has unfolded in Bangladesh, encompassing the demographic, health, and nutritional dimensions of its populace.
Despite India's 50% increase in GDP since 2013, more than one third of the world's malnourished children live in India. Among these, half of the children under three years old are underweight.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index .Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
Health in Mozambique has a complex history, influenced by the social, economic, and political changes that the country has experienced. Before the Mozambican Civil War, healthcare was heavily influenced by the Portuguese. After the civil war, the conflict affected the country's health status and ability to provide services to its people, breeding the host of health challenges the country faces in present day.
Even though Panama has one of the fastest growing economies in the western hemisphere, an estimated 500,000 people are in extreme poverty. Panama has major socioeconomic and health inequalities between the country’s urban and rural populations. The indigenous population lives in more disadvantaged conditions and experiences greater vulnerability in health. In general, the population living in more marginalized areas has less service coverage and less access to health care.
Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.
Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.
Hospitals and small medical centers and posts are found throughout the island of Madagascar, although they are concentrated in urban areas and particularly in Antananarivo. In addition to the high expense of medical care relative to the average Malagasy income, the prevalence of trained medical professionals remains extremely low.
Child health and nutrition in Africa is concerned with the health care of children through adolescents in the various countries of Africa. The right to health and a nutritious and sufficient diet are internationally recognized human rights that are protected by international treaties. Millennium Development Goals (MDGs) 1, 4, 5 and 6 highlight, respectively, how poverty, hunger, child mortality, maternal health, the eradication of HIV/AIDS, malaria, tuberculosis and other diseases are of particular significance in the context of child health.
The COVID-19 pandemic has had many impacts on global health beyond those caused by the COVID-19 disease itself. It has led to a reduction in hospital visits for other reasons. There have been 38 per cent fewer hospital visits for heart attack symptoms in the United States and 40 per cent fewer in Spain. The head of cardiology at the University of Arizona said, "My worry is some of these people are dying at home because they're too scared to go to the hospital." There is also concern that people with strokes and appendicitis are not seeking timely treatment. Shortages of medical supplies have impacted people with various conditions.
1 2 Organization, World Health (2005). Dengue, dengue haemorrhagic fever and dengue shock syndrome in the context of the integrated management of childhood illness. World Health Organization. hdl:10665/69230.
↑ Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet. 2020 Jan;395(10217):65–74.
↑ Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, et al. The double burden of malnutrition: aetiological pathways and consequences for health. The Lancet. 2020 Jan;395(10217):75–88.
↑ Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet. 2020 Jan;395(10217):65–74.
↑ Hajri T, Angamarca-Armijos V, Caceres L. Prevalence of stunting and obesity in Ecuador: a systematic review. Public Health Nutrition. 2020 Jul 29;1–14.
↑ Popkin BM, Corvalan C, Grummer-Strawn LM. Dynamics of the double burden of malnutrition and the changing nutrition reality. The Lancet. 2020 Jan;395(10217):65–74.
↑ Hajri T, Angamarca-Armijos V, Caceres L. Prevalence of stunting and obesity in Ecuador: a systematic review. Public Health Nutrition. 2020 Jul 29;1–14.
↑ Hajri T, Angamarca-Armijos V, Caceres L. Prevalence of stunting and obesity in Ecuador: a systematic review. Public Health Nutrition. 2020 Jul 29;1–14.
↑ Wells JC, Sawaya AL, Wibaek R, Mwangome M, Poullas MS, Yajnik CS, et al. The double burden of malnutrition: aetiological pathways and consequences for health. The Lancet. 2020 Jan;395(10217):75–88.
↑ Hawkes C, Ruel MT, Salm L, Sinclair B, Branca F. Double-duty actions: seizing programme and policy opportunities to address malnutrition in all its forms. The Lancet. 2020 Jan;395(10218):142–55.
↑ Nugent R, Levin C, Hale J, Hutchinson B. Economic effects of the double burden of malnutrition. The Lancet. 2020 Jan;395(10218):156–64.
↑ Jurado, Jorge; Southgate, Douglas (July 1999). "Dealing with air pollution in Latin America: the case of Quito, Ecuador". Environment and Development Economics. 4 (3): 375–388. doi:10.1017/S1355770X99000248. S2CID154359064.
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