Campbell Barr Epsy, Marmot Michael
Gobierno de la República de Costa Rica San José Costa Rica Gobierno de la República de Costa Rica, San José, Costa Rica.
Institute of Health Equity, University College London Londres Reino Unido Institute of Health Equity, University College London, Londres, Reino Unido.
Rev Panam Salud Publica. 2021 Aug 31;45:e101. doi: 10.26633/RPSP.2021.101. eCollection 2021.
Costa Rica has long been a country of special interest in the Americas and in global health because of its good health. The United Nations Development Programme ranks countries according to their level of human development based on life expectancy, education and national income. Although Costa Rica is ranked at 63 and classified as 'High', in terms of health it belongs in the 'Very High' group. In 2018 mean life expectancy for the 'Very High' countries was 79.5, while in Costa Rica it was 80. In 2018, under five mortality was 8.8/1000 live births, lower than countries ranked in the 'Very High' human development group. Expected years of schooling in Costa Rica is 15.4, closer to the average, 16.4 years, of the 'Very High' human development group than the average of the 'High' group. The country is much healthier than would be predicted by its national income; rather, other features of society's development are likely to have played a key role in the development of good health. These include (i) the decision to cease investment in national defence, which freed up money to invest in health, education and the welfare of the population; (ii) the decision to create a universal health system financed by the State, employers and workers in the 1940s; and (iii) the educational system, that generated opportunities to lift important sectors of the population out of poverty, allowing them to have basic sanitary conditions that increase their possibilities to live longer and in better conditions. Despite these advances, inequalities in terms of income and social conditions persist, presenting challenges in the field of health, particularly for lower-income populations and those of African and indigenous descent. These inequalities must be addressed using decisions based on scientific evidence, a greater use of disaggregated data to reveal progress in addressing these inequalities, and with a broader articulation of the health sector with policies that act on the social determinants of health.
由于国民健康状况良好，哥斯达黎加长期以来一直是美洲和全球健康领域特别受关注的国家。联合国开发计划署根据各国的预期寿命、教育水平和国民收入来对国家的人类发展水平进行排名。尽管哥斯达黎加排名第63位，被归类为“高人类发展水平国家”，但就健康状况而言，它属于“非常高”的类别。2018年，“非常高”类别国家的平均预期寿命为79.5岁，而哥斯达黎加为80岁。2018年，五岁以下儿童死亡率为每1000例活产8.8例，低于“非常高”人类发展水平组的国家。哥斯达黎加的预期受教育年限为15.4年，比“高”人类发展水平组的平均水平更接近“非常高”人类发展水平组的平均水平16.4年。该国的健康状况比其国民收入所预测的要好得多；相反，社会发展的其他特征可能在良好健康状况的发展中发挥了关键作用。这些特征包括：（i）停止国防投资的决定，这释放了资金用于投资健康、教育和民众福利；（ii）在20世纪40年代决定建立由国家、雇主和工人资助的全民健康系统；（iii）教育系统，该系统为提升部分重要人口群体摆脱贫困创造了机会，使他们能够拥有基本卫生条件，从而增加了他们长寿和生活得更好的可能性。尽管取得了这些进展，但收入和社会条件方面的不平等依然存在，给健康领域带来了挑战，特别是对低收入人群以及非洲和土著后裔而言。必须通过基于科学证据的决策、更多地使用分类数据以揭示在解决这些不平等方面的进展，以及更广泛地将卫生部门与作用于健康社会决定因素的政策相结合来应对这些不平等。
