Antigua and Barbuda

The Health in the Americas+¹ 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 Antigua and Barbuda was 75 055 inhabitants; by 2023 this figure had risen to 94 298, representing a 25.6% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 11.1% of the total population, an increase of 3.9 percentage points compared to the year 2000. In 2023, there were 109.3 women per 100 men and 61.1 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 70.7% of the total population of the country in 2023 (66 666 people). When we add these figures to the potentially passive population (17 149 under 15 years of age and 10 484 over 65 years of age), the result is a dependency ratio of 41.4 potentially passive people per 100 potentially active people. This ratio was 54.0 in 2000.

Life expectancy at birth in 2023 was 79.4 years, higher than the average for the Region of the Americas and 4.8 years higher that in 2000.

Figure 1. Population pyramids, years 2000 and 2023

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

During the period 2010-2021, the country improved its score on the Human Development Index, with a decrease of 0.3% (from a score of 0.79 to a score of 0.788); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2021

In 2020, public expenditure on health accounted for 3.38% of gross domestic product (GDP) (Figure 3) and 12.64% of total public expenditure, while out-of-pocket spending on health accounted for 23.17% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020

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 2020, infant mortality in Antigua and Barbuda decreased from 21.6 to 7 deaths per 1000 live births, a decrease of 67.6% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 7.6% to 4.6% between 2002 and 2020.

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

The maternal mortality ratio for 2020 was estimated at 21.2 deaths per 100 000 live births, a reduction of 58.6% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 1.6 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 50.8% decrease, from 63.4 live births per 1000 women aged 15 to 19 years in 2000 to 31.2 in 2023. In 2020, 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. Maternal mortality per 100 000 live births in Antigua and Barbuda, 2000–2020

Communicable diseases

In 2021, there were 4 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 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 55.8 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 2021, 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 among people aged 15 and older was 48% in 2016.

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 health situation and the COVID-19 pandemic

In Antigua and Barbuda in 2020, there were a total of 159 cases of COVID-19, representing 1 705.7 per million population. In 2021, there were 4 362 identified cases, equivalent to 46 794.8 per million population. In 2022, there were 9 008 identified cases, equivalent to 96 636.3 per million population. In 2020, there were five deaths directly caused by COVID-19 in people diagnosed with the disease, or 53.6 per million population; in 2021, 119 deaths were reported, or 1 276.6 per million; in 2022, 145 deaths were reported or 1 555.5 In 2020, Antigua and Barbuda ranked 41st in the Region of the Americas in terms of the number of deaths from COVID-19, and 37th in 2021, with a cumulative 1393.3 deaths per million population over the two years (Figure 6).

According to estimates by the World Health Organization, there was a total of -55 excess deaths in 2020, or -59 per 100 000 population;² a total of 26 deaths were estimated in 2021, for an excess mortality rate of 27.9 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 65.3% of the country's population. As of 20 April 2022 (latest available data), 63% of the population had completed the vaccination schedule. The vaccination campaign began on 20 March 2021, and six types of COVID-19 vaccine have been used to date.

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Prospects

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).³ 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 Coverage⁴ 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 2060.⁵ 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.⁶ 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.

COVID-19 pandemic response

Antigua and Barbuda escaped community transmission of COVID-19 until early 2021 and has since seen four outbreak peaks, and with most of the 130 confirmed deaths by May 2022 concentrated in these outbreak periods. The vaccination program in cooperation with international partners represents a major ongoing COVID-19 policy. To reduce infection among healthcare workers, PAHO trained hospital staff in exposure risk assessment, provided equipment and other supplies, and strengthened capacity to manage critically ill COVID-19 patients.⁷ COVID-19 is one example of an external pressure, and these pressures are recognized as a major risk to ongoing healthcare improvements. Extreme weather events are another external pressure that have long been a threat to Antigua and Barbuda. In 2017, Antigua and Barbuda was affected by three major hurricanes: Irma, Jose, and Maria. Hurricane Irma was the strongest storm ever to hit the Caribbean Leeward Islands. It made landfall on Barbuda on 6 September, damaging or destroying almost all infrastructure in Barbuda, forcing evacuation of the population.⁸ By the end of 2018, only some residents of Barbuda had returned. The recovery assessment concluded that the total damage of the Hurricanes Irma and Maria for Antigua and Barbuda came to US$136 million, while recovery costs amounted $222 million.⁹ In response, a national adaptation plan has been drafted, which has three areas of focus: infrastructure, finance, and protected areas. The report does not have a specific focus on health. Key recommendations from a multisectoral assessment of health in the face of climate change¹⁰ included the development and implementation of a health and climate change strategy, an assessment of health vulnerabilities, addressing barriers to international climate change finance, and building climate-resilient healthcare facilities. Food and water security was seen as a key challenge.

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.