The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.
Environmental and social determinants of health
In 2000 the total population of Puerto Rico was 3 827 108 inhabitants; by 2023 this figure had risen to 3 260 314, representing a 14.8% decrease. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 23.4% of the total population, an increase of 12.2 percentage points compared to the year 2000. In 2023, there were 112.3 women per 100 men and 175.5 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 63.3% of the total population of the country in 2023 (2 064 519 people). When we add these figures to the potentially passive population (434 016 under 15 years of age and 761 780 over 65 years of age), the result is a dependency ratio of 57.9 potentially passive people per 100 potentially active people. This ratio was 54.2 in 2000.
Life expectancy at birth in 2023 was 79.9 years, higher than the average for the Region of the Americas and 4.0 years higher that in 2000.
Figure 1. Population pyramids of Puerto Rico, years 2000 and 2023
Between 2000 and 2017, the average number of years of schooling in Puerto Rico increased by 15.2%, reaching an average of 12.9 years in the latest year for which information is available. The unemployment rate in 2022 was 6.0%. Disaggregated by sex, the rate was 5% for women and 6.7% for men. The literacy rate was 92.4% in 2021. Equally distributed in men and women, 92.4%.
Figure 2. Human Development Index in the Region of the Americas, 2021
In 2019, 77.7% of the population had an internet connection, representing a considerable increase from 2000, when 10.5% of the population had an internet connection.
Maternal and child health
Between 2000 and 2019, infant mortality in Puerto Rico decreased from 10.2 to 6.6 deaths per 1000 live births, a decrease of 35.3% (Figure 3). The percentage of low-weight births (less than 2500 g) decreased from 10.6% to 10.1% between 2000 and 2019.
The maternal mortality ratio for 2020 was estimated at 34.3 deaths per 100 000 live births, a reduction of 57.0% from the estimated value for 2000 (Figure 4). In relation to fertility, it is estimated that in 2023 women had an average of 1.3 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 77.3% decrease, from 74.1 live births per 1000 women aged 15 to 19 years in 2000 to 16.8 in 2023. In 2019, 99.8% of births were attended by skilled birth personnel. Between 2000 and 2018 the percentage of pregnant people who had four or more consultations for antenatal care increased from 95% to 99.2%.
Figure 3. Infant mortality per 1000 live births, 1995–2020
Figure 4. Maternal mortality per 100 000 live births, 2000–2020
In 2021, there were 1 new cases of tuberculosis per 100 000 population in Puerto Rico.
In 2019, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 11.4 per 100 000 population. There were no reported cases of human rabies in the country in 2020.
The health situation and the COVID-19 pandemic
In 2020, Puerto Rico ranked 13th in the Region of the Americas in terms of the number of deaths from COVID-19, and 11th in 2022, with a cumulative 1555.5 deaths per million population for the two years (Figure 3).
As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 96% of the country's population. As of 17 August 2022 (latest available data), 83% of the population had completed the vaccination schedule.
Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023
Measures to achieve universal health coverage
One of the top priorities for the Puerto Rico Department of Health (DSPR) is for everyone to be able to exercise the right to health. This can be clearly seen in the vision of the DSPR, as embodied in the Strategic Plan 2020-2025, which expressly states the aspiration to become an "agency that safeguards the right to health and promotes a preventive, integrated, accessible, and equitable system that adequately addresses the public health needs of the communities of Puerto Rico." At the same time, it recognizes the value of social justice as the primary motivation for establishing the conditions necessary for people to lead a dignified life, ensuring that their rights are safeguarded and their needs are met. To this end, the institutional efforts of the Department are aimed primarily at planning and implementing effective actions leading to expanded coverage of health services throughout the national territory, in terms of scope, quality, and effectiveness.
Puerto Rico’s health system provides for services through public and private nonprofit or for-profit entities. According to data from the Centers for Disease Control and Prevention, as of 2020, 92.5% of the island's inhabitants said they had some form of medical coverage. Of this group, approximately 1.5 million people currently receive Medicaid Program benefits, whose funds are managed by the DSPR.
This federal initiative aims to increase access to health coverage to protect primarily low-income individuals and families, particularly through the Vital Health Plan, which is administered directly by the Puerto Rico Health Insurance Administration.
Challenges related to population health
The evolving characteristics and circumstances of the COVID-19 pandemic clearly continue to be a prominent factor in the immediate challenges facing Puerto Rico's public health system. Given this scenario, the DSPR's top priority is to keep Puerto Rico's population safe from the continuing risk posed by the pandemic.
Another institutional priority going forward is to ensure that chronic diseases receive quality, efficiently delivered health care. Although in recent years the DSPR has concentrated efforts on responding to the COVID-19 pandemic, it has also simultaneously coordinated policies and initiatives aimed at providing care for chronic diseases. The management and treatment of chronic diseases constitutes one of the largest items in the Government of Puerto Rico's annual public health budget, and it is expected that this allocation will continue to increase in the coming years, due to the aging population.
COVID-19 pandemic response
Puerto Rico formulated and implemented its strategic policy to respond to the emergency in a proactive and integrated manner. Starting in early 2020, the country launched a series of initiatives aimed specifically at saving as many lives as possible. The DSPR's plans for combating the pandemic included an agenda to prevent and respond to COVID-19, comprising 12 lines of action aimed at reducing transmission of the virus, saving lives, and protecting vulnerable populations. This urgent approach consists of 23 integrated strategies to strengthen the national health system.
Measures to reduce inequalities in health
Achieving health equity is one of the DSPR's greatest challenges and highest priorities. This conviction is clearly reflected in the institutional mission established by the Department for 2020–2025, which states: “The Department of Health designs and implements public health policies and strategies that promote, evaluate, and achieve healthy communities, adopting a comprehensive approach to people and the factors that affect their health.”
The DSPR has recognized the operational importance of regarding the right to health and equity in health as guiding principles in institutional efforts to transform and re-conceive the health system, based on two fundamental pillars: disease prevention and social justice. The Strategic Plan is a fundamental element in the long-term effort to transform Puerto Rico's health system. In working to achieve these goals, the DSPR is promoting a series of changes in public policy and multisectoral coordination. In the Strategic Plan 2020–2025, it proposes five strategic priorities to guide institutional actions:
- Equity and social determinants of health.
- Governance in public health and health informatics.
- Emergency preparedness and response.
- Organizational development, strengthening, and sustainability.
- Quality and outcomes in public health.
National strategy to address inequalities in health
One of the DSPR's current initiatives is to develop a Strategic Plan for Health Equity. This effort, led by the Rural Health and Health Equity Program, stems from the realization that Puerto Rico's public health guidelines and plans lack a framework that includes the social determinants of health that affect the population. This plan seeks to incorporate in national planning processes an analysis of the most vulnerable population groups and the key concepts necessary for addressing them with an intersectoral approach. The goal is to ensure that all public policies implemented in the future take into consideration elements essential to addressing inequalities; that they promote equity in health; and that each identified social determinant be treated individually.
The Ten-Year Health Sector Plan 2016–2026 constitutes a further frame of reference for reducing health disparities. This health improvement plan serves as the basic planning and public policy document, and has been developed in collaboration with stakeholders in the country's public health system. This collaborative effort attempts to identify, analyze, and address priority public health issues. Each thematic issue in the plan is matched with its respective goals, strategies, objectives, and indicators, in order to achieve tangible improvements in the specific public health indicators identified in the Health Status Assessment. The current plan addresses access to quality health services as one of the document's four key areas. Other aims include reducing health care disparities in the population. Lastly, a review of the Ten-Year Plan is also scheduled in the near term.