Antigua and Barbuda - Country Profile

By PAHO/OPS, 18 September, 2022

The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. 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 Antigua and Barbuda was 74 912 inhabitants; by 2024 this figure had risen to 93 772, representing a 25.2% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 11.8% of the total population, an increase of 4.4 percentage points compared to the year 2000. In 2024, there were 110.1 women per 100 men and 66.2 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 70.4% of the total population of the country in 2024 (66 030 people). When we add these figures to the potentially passive population (16 691 under 15 years of age and 11 051 over 65 years of age), the result is a dependency ratio of 42.0 potentially passive people per 100 potentially active people. This ratio was 54.1 in 2000.

Life expectancy at birth in 2024 was 77.8 years, higher than the average for the Region of the Americas and 3 years higher that in 2000 (74.8).

Figure 1. Population pyramids, years 2000 and 2024

The literacy rate was 99% in 2015 (98.4% for men and 99.4% for women).

During the period 2007-2022, the country improved its score on the Human Development Index, with an increase of 1.2% (from a score of 0.816 to a score of 0.826); during the same period, the index rose 14.6% internationally and 11.2% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2022

In 2021, public expenditure on health accounted for 3.93% of gross domestic product (GDP) (Figure 3) and 15.54% of total public expenditure, while out-of-pocket spending on health accounted for 19.16% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2021

Digital coverage

In 2021, 95.7% of the population had an internet connection, representing a considerable increase from 2000, when 6.5% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2022, infant mortality in Antigua and Barbuda decreased from 21.6 to 7.5 deaths per 1000 live births, a decrease of 65.3% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 7.6% to 11.6% between 2002 and 2022.

Regarding the immunization strategy, measles vaccination coverage was 100.0% in 2022, an increase of five percentage points from 2000.

The maternal mortality ratio in 2020 was estimated at 21.2 deaths per 100 000 live births, representing a 58.6% decrease compared to the estimated value in 2000 (Figure 5). In relation to fertility, it is estimated that in 2024 women had an average of 1.6 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 48.1% decrease, from 61.9 live births per 1000 women aged 15 to 19 years in 2000 to 32.1 in 2024. In 2022, 99.0% of births were attended by skilled birth personnel. Between 2010 and 2017 the percentage of pregnant people who received antenatal care decreased from 100% to 83.3%.

Figure 4. Infant mortality per 1000 live births, 1995-2022

Figure 5. Maternal mortality per 100 000 live births in Antigua and Barbuda, 2000–2020

Communicable diseases

In 2022, there were 1 new cases of tuberculosis per 100 000 population in Antigua and Barbuda. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.5 (0.3 in women and 0.7 in men).

In 2022, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 48.5 per 100 000 population. The age-adjusted mortality rate for HIV was 5.2 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 61.2%. Up to 2022, there were no reported cases of human rabies in the country.

Noncommunicable diseases and risk factors

In Antigua and Barbuda, the prevalence of overweight and obesity was 62.7% in 2022.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 23.4%, an increase of 0.3 percentage points compared to 2000 (23.1%). The prevalence of diabetes mellitus, which stood at 7.7% in 2000, increased to 11.5% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Antigua and Barbuda was 197.8 deaths per 100 000 population, a decrease of 28% from a rate of 274.6 in 2000. This meant that, in 2019, the rate in the country was 12.7% lower than the average rate reported for the Region of the Americas as a whole. Among potentially avoidable premature mortality, the rate for preventable causes was 81.4 per 100 000 population in 2019, which is 40.6% lower than the regional average rate; and the rate for treatable causes was 116.4 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 6 per 1000 population in 2019, a decrease of 9.1% compared to 2000 (6.6 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 59.3 per 100 000 population (69.9 per 100 000 in men and 50 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 501.6 per 100 000 population (548.5 per 100 000 in men and 462.2 per 100 000 in women). The rate of age-adjusted mortality from external causes was 34.5 per 100 000 population (55.3 per 100 000 in men and 15.4 per 100 000 in women), including road traffic accidents (0 per 100 000 population), homicides (2.4 per 100 000 population) and suicides (0.3 per 100 000 population). In 2000, the percentage distribution of causes was 79.8% for noncommunicable diseases, 13.5% for communicable diseases, and 6.6% for external causes; in 2019, the percentages were 84.8%, 9.8%, and 5.4%, respectively (Figure 5).

Figure 6. Proportional mortality in Antigua and Barbuda, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 52.9 per 100 000 men; lung cancer, 9.9 per 100 000; and colorectal cancer, 11 per 100 000. In women, these values were 42.1 deaths per 100 000 for breast cancer, 2.6 per 100 000 for lung cancer, and 16.9 per 100 000 for colorectal cancer.

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.

Country COVID-19 Perspective

Measures to achieve universal health coverage

The National Strategic Plan for Health (2016–2020) highlighted chronic disease as the key health challenge along with new and ongoing communicable diseases (such as dengue, Zika, and chikungunya viruses). The report noted challenges related to declining health financing, shortages of health professionals, and fragmented health planning operations that contributed to national health policies not being translated into strategic actions. Ongoing cooperation with the World Health Organization (WHO), Pan American Health Organization (PAHO), and others is focusing on health system strengthening with universal access and coverage through improved governance and sustainable financing – an adoption of the global move toward universal health coverage. A range of strategies have been highlighted that place the operations of primary care at the center of the push for universal health coverage, focusing on improved maternal and child health, and targeted health programs for adolescent health, male health, and the health of older persons. The 2014 National Strategy for Universal Health Coverage solidified the tenets of the Government’s universal health coverage strategy with four broad lines of action: expanding equitable access to comprehensive, qualitative, and community-orientated health services; strengthening stewardship and governance; increasing and improving financing without out-of-pocket expenditures; and intersectoral action to tackle the social determinants of health. The National Strategic Plan for Health recognized that relationships with traditional and nontraditional international development partners will be critical to advancing progress toward universal health coverage.

Challenges related to population health

Antigua and Barbuda is aging and the pace of this aging is predicted to increase. In 1980, the proportion of Antigua and Barbuda's population aged 65 and older was 5.5%. This proportion increased to an estimated 9.3% by 2020, and is predicted to more than double to 22.7% by 2060. This future increase of 13.4 percentage points represents a rapid rise in older adults, and is above the regional averages for the Caribbean of 10.7 percentage points, and matching the average for the Americas of 13.7 percentage points. The disease burden is increasingly dominated by noncommunicable diseases. Cardiovascular diseases, diabetes, and cancers in 2019 were the top three causes of death and disability, collectively accounting for 43% of all healthy life lost. Including all other noncommunicable diseases raises this burden to over 80% of all healthy life lost. There has been further progress in reducing the burden of maternal and neonatal disorders and HIV/AIDS, which together in 2019 accounted for just 4% of healthy life lost, down by over 50% since 2000. Solutions to the prevention and control of noncommunicable diseases require multisectoral cooperation.

References

1. Pan American Health Organization. Health in the Americas+. Washington, DC: PAHO; 2022. Available from: https://hia.paho.org

2. World Health Organization. Global excess deaths associated with COVID-19 (modelled estimates). Geneva: WHO; 2022. Available from: https://www.who.int/data/sets/global-excess-deaths-associated-with-covid-19-modelled-estimates.

3. Government of Antigua and Barbuda, Ministry of Health and the Environment. Investing for Wellness National Strategic Plan for Health Antigua and Barbuda 2016–2020. Government of Antigua and Barbuda, Ministry of Health and the Environment; [date unknown]. Available from: https://pancap.org/pc/pcc/media/pancap_document/National-Strategic-Plan-for-Health-Antigua-and-Barbuda-29-March-2016-1.pdf.

4. Government of Antigua and Barbuda. Antigua and Barbuda’s report on the Draft Strategy for Universal Health Coverage (UHC). 2014. Government of Antigua and Barbuda; 2014. Available from: https://www.paho.org/en/documents/antigua-and-barbudas-report-strategy-universal-health-coverage.

5. United Nations, Department of Economic and Social Affairs, Population Division. World population prospects 2019, Online Edition. Rev. 1. New York: UN; 2019 [cited 13 September 2022]. Available from: https://population.un.org/wpp/publications/.

6. Institute for Health Metrics and Evaluation. Antigua and Barbuda profile. Seattle: IHME, University of Washington; 2021 [cited 17 September 2022]. Available from: http://www.healthdata.org/antigua-and-barbuda.

7. Pan American Health Organization. Annual Report 2020. Universal health and the pandemic – resilient health systems. Barbados and the Eastern Caribbean Countries. Washington, DC: PAHO; 2021. Available from: https://iris.paho.org/handle/10665.2/55054.

8. Cangialosi JP, Latto AS, Berg R. National Hurricane Center Tropical Cyclone Report, Hurricane Irma. US National Hurricane Center; 2021. Available from: https://www.nhc.noaa.gov/data/tcr/AL112017_Irma.pdf.

9. ACP-EU Natural Disaster Risk Reduction Program. Hurricane Irma and Maria recovery needs assessment for Antigua and Barbuda. ACP-EU Natural Disaster Risk Reduction Program; 2017 [cited 17 September 2022]. Available from: https://www.gfdrr.org/en/publication/hurricane-irma-and-maria-recovery-needs-assessment-antigua-and-barbuda.

10. World Health Organization, United Nations Framework Convention on Climate Change. Health and climate change: country profile, 2020 Antigua and Barbuda. Geneva: WHO; 2020. Available from: https://apps.who.int/iris/handle/10665/336273.