Wakeup Call for Costa Rica
By Brian Kennedy and Jose Miguel Alfaro
When it comes to health indicators in Costa Rica, the record shows both great progress of which the nation can be justly proud, and potential threats to that progress that should be monitored and addressed prudently.
The good news is that Costa Rica is achieving respectable outcomes when it comes to life expectancy and relatively low infant mortality. Currently, the nation’s life expectancy rate is 76.5 years for men and 81.2 years for women. These numbers are almost identical to those of the United States, a country that spends the highest per capita on healthcare expenditure in the world. Of the middle income countries, Costa Rica is among the highest performers in the area of healthcare. Additionally, when compared to other Central American nations, Costa Rica leads them all decisively in every health indicator—a truly impressive performance that has many looking to Costa Rica as a model to emulate. What is behind Costa Rica’s impressive performance? Simply put: preventative medicine.
Fiscally, preventative policies have been made possible and enhanced by the fact that Costa Rica has no army and the high military expenditures that it would require. Therefore, the government is able to allocate more generous resources to support healthcare and education. For several decades, Costa Rica has invested in preventative medicine on the community level and has worthy results to show for it. At the local level, Costa Ricans are encouraged to establish an ongoing relationship with community health centers to address their ongoing health needs. Meticulous records are kept that allow health practitioners to monitor and treat patients before they become seriously ill. Pregnant women are expected to have routine medical and prenatal exams, and, upon delivering, their infants are monitored and treated accordingly. When a medical condition requires additional essential or specialized treatment in a major medical center, the community health practitioners almost always initiate a transfer. Thus, Costa Rica has become a practicing advocate of an effective health care system centered on prevention, unlike many counties where individuals often seek medical care only when they are sick—a practice common in many nations, including the United States.
The bad news is that recent indicators warn that, without vigilance, Costa Rica’s enviable record could begin to regress, wiping out much of the progress. It is estimated that 60 % of women in Costa Ricaare overweight. The prevalence of citizens with type II diabetes was 4.6% in 1995 – a figure that’s expected to rise to 6.9% in the next decade Unchecked, both numbers would grow, and the nation would have a health crisis in less than a decade – along with the fiscal costs that would inevitably accompany such a situation.
The spread of obesity and diabetes is exacerbated by the relatively inexpensive and now widely available fast food operators that have invaded the nation. It is a challenge to drive in San Jose and not see fast food restaurants enticing Costa Ricans to consume less nutritious, high-calorie foods that are gradually endangering their health. Like the citizens of other nations, Costa Ricans are now exposed to a wide variety of imported media, with a disproportionately large segment disseminated from the United States. Not surprisingly, social researchers have found that the consumption of imported fast food products provides instant gratification, along with a perception of assimilating “cool” aspects of Western culture.
Medical researchers have determined that obese people cut eight years from their life expectancy, and type II diabetes costs seven years. Individuals with both conditions will likely lose about 11 years from their projected lifespan. In the absence of a concerted, government-led effort to encourage healthier eating habits, Costa Rica may find itself in a similar situation to Arabian Gulf countries where one out of four male adults already has type II diabetes.
To confront this challenge, Costa Rica can draw upon its exemplary model of preventative medicine. It must be proactive and aggressive in formulating policies to combat obesity and diabetes as threats to its national security from within. The government should enact programs that will educate the public on the benefits of a healthy, balanced diet and the serious consequences of poor nutrition. In addition, the government should consider imposing health taxes on fast food products and use the revenues to finance the educational initiatives. Many countries have imposed such taxes on tobacco products because of their impact on public health. Fast food is potentially just as threatening to the wellbeing of consumers and should be approached in a similar way.
This is a wakeup call to Costa Rica. The time to act is now.
Brian Kennedy is the President and CEO of the Buck Institute for Research on Aging in Novato, California. Jose Miguel Alfaro is lawyer and former Vice President of Costa Rica