The Bahamas

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 Bahamas was 325 014 inhabitants; by 2023 this figure had risen to 412 623, representing a 27.0% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 9.3% of the total population, an increase of 4.3 percentage points compared to the year 2000. In 2023, there were 109.6 women per 100 men and 50.2 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 72.2% of the total population of the country in 2023 (298 025 people). When we add these figures to the potentially passive population (76 291 under 15 years of age and 38 308 over 65 years of age), the result is a dependency ratio of 38.5 potentially passive people per 100 potentially active people. This ratio was 53.6 in 2000.

Life expectancy at birth in 2023 was 74.5 years, lower than the average for the Region of the Americas and 2.5 years higher that in 2000.

Figure 1. Population pyramids, years 2000 and 2023

Between 2000 and 2010, the average number of years of schooling in The Bahamas increased by 7.4%, reaching an average of 11.9 years in the latest year for which information is available. The unemployment rate in 2021 was 13.2% for the total population. Disaggregated by sex, the rate was 13.4% for women and 13% for men.

During the period 2000–2021, the country improved its score on the Human Development Index, with an increase of 1.6% from a score of 0.799 to a score of 0.812; during the same period, the index rose 15% internationally and 11% 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 4.6% of gross domestic product (GDP) (Figure 3) and 15.7% of total public expenditure, while out-of-pocket spending on health accounted for 21.73% of total health expenditure.

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

Digital coverage

In 2021, 94.3% of the population had an internet connection, representing a considerable increase from 2000, when 8.0% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2020, infant mortality in Bahamas increased from 14.8 to 16.2 deaths per 1000 live births, a decrease of 9.5% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 9.9% to 10.2% between 2000 and 2020.

Regarding the immunization strategy, measles vaccination coverage was 80.0% in 2022, a decrease of 13 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 77.1 deaths per 100 000 live births, a reduction of 26.6% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 1.4 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 48.7% decrease, from 47.8 live births per 1000 women aged 15 to 19 years in 2000 to 24.5 in 2023. In 2018, 99.0% of births were attended by skilled birth personnel. Between 2004 and 2018 the percentage of pregnant people who received antenatal care increased from 81.6% to 88%.

Figure 4. Infant mortality per 1000 live births, 1995–2020

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2021, there were 11 new cases of tuberculosis per 100 000 population in Bahamas. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.08 (0.09 in women and 0.08 in men).

In 2019, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 34.1 per 100 000 population. The age-adjusted mortality rate for HIV was 32.6 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 77.5%.

There were no cases of human rabies in the country in 2020.

Noncommunicable diseases and risk factors

In The Bahamas in 2023, the prevalence of tobacco use among people aged 15 and older was 10.7%. In the same age group, the prevalence of overweight and obesity was 64.4% in 2016.

Also in 2016, 43.3% of the population reported insufficient physical activity.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 20.9%, a decrease of 5.7 percentage points compared to 2000 (26.6%). The prevalence of diabetes mellitus, which stood at 10.4% in 2000, increased to 12.5% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in The Bahamas was 324.5 deaths per 100 000 population, a decrease of 26.9% from a rate of 443.9 in 2000. This meant that, in 2019, the rate in the country was 43.1% higher 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 171.5 per 100 000 population in 2019, which is 25.1% higher than the regional average rate; and the rate for treatable causes was 153 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 7 per 1000 population in 2019, a decrease of 12.5% compared to 2000 (8 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 74.9 per 100 000 population (90.6 per 100 000 in men and 61.2 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 525.4 per 100 000 population (623.8 per 100 000 in men and 446.5 per 100 000 in women). The rate of age-adjusted mortality from external causes was 91.8 per 100 000 population (148.8 per 100 000 in men and 39.1 per 100 000 in women), including road traffic accidents (7.4 per 100 000 population), homicides (36.4 per 100 000 population) and suicides (3.4 per 100 000 population). In 2000, the percentage distribution of causes was 60.1% for noncommunicable diseases, 29.2% for communicable diseases, and 10.8% for external causes; in 2019, the percentages were 75.4%, 10.7%, and 13.9%, respectively (Figure 6).

Figure 6. Proportional mortality in the Bahamas, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 44.7 per 100 000 men; lung cancer, 12 per 100 000; and colorectal cancer, 14.6 per 100 000. In women, these values were 30.8 deaths per 100 000 for breast cancer, 3.9 per 100 000 for lung cancer, and 8.4 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In The Bahamas in 2020, there were a total of 7871 cases of COVID-19, representing 19 286 per million population. In 2021, there were 17 125 identified cases, equivalent to 41 960.7 per million population. In 2020, there were 180 deaths directly caused by COVID-19 in people diagnosed with the disease, or 441.1 per million population; in 2021, 547deaths were reported, or 1340.3 per million. In 2020, The Bahamas ranked 15th in the Region of the Americas in terms of the number of deaths from COVID-19, and again 15th in 2021, with a cumulative 1781 deaths per million population over the two years (Figure 7).

According to estimates by the World Health Organization, there was a total of 334 excess deaths in 2020, or 85 per 100 000 population;² a total of 667 deaths were estimated in 2021, for an excess mortality rate of 168 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 42.3% of the country's population. As of 2 July 2022 (latest available data), 40.6% of the population had completed the vaccination schedule. The vaccination campaign began on 20 March 2021, and four 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 Development Plan of The Bahamas (Vision 2040) sets out a long-term road map for development, including a vision for a modern, sustainable, and universally accessible healthcare system that is wellness-focused and delivers continuously improving outcomes. This universal accessibility represents an adoption of the global move toward universal health coverage.³ The associated National Health Services Strategic Plan (2010 –2020) sets out detailed objectives.⁴ The objectives included a shift to multisectoral collaboration that recognizes the need for health in all policies and as a key tool for increasing health system resilience to external pressures. This focus on multisectoral collaboration recognizes that health is a social product and that health problems stem directly and indirectly from root social and economic determinants.

Challenges related to population health

The Bahamas population is aging, and the pace of this aging is predicted to increase. In 1980, the proportion of The Bahamas population aged 65 and older was 4.1%. This proportion increased to an estimated 7.7% by 2020, and is predicted to rise to 19.9% by 2060.⁵ This future 40-year increase of 12.1 percentage points is above the regional average for the Caribbean of 10.7 percentage points, but below the average for the Americas of 13.7 percentage points. This demographic transition is in part due to important progress in reducing the burden of infectious diseases. In 2000, HIV/AIDS was the main cause of death and disability in The Bahamas, accounting for 14% of all healthy life lost. By 2019, this burden had been reduced by two-thirds, to 4.8% of all healthy life lost. Cardiovascular diseases, cancers, and diabetes in 2019 were the top three causes of death and disability, collectively accounting for 38.4% of all healthy life lost.⁶ The burden of self-harm and violence, and unintentional injuries collectively accounted for 11.8% of all healthy life lost in 2019, a rise of one-third since 2000. Solutions to each of these challenges require multisectoral cooperation.

COVID-19 pandemic and disaster response

The country remains in recovery following the devastation on the islands of Abaco and Grand Bahama due to Hurricane Dorian, which has resulted in a redistribution of government funds.⁷ Government priorities for health include strengthening the stewardship and governance of the health system in conjunction with improving system integration and cohesion. A new Strategic Plan for Health (2023–2028) is planned, and combating chronic noncommunicable diseases, strengthening human resources for health, and advancing digital transformation have been highlighted as priorities. A range of strategic actions have been highlighted that will improve access to care; these include the expansion of services by extending opening hours and adoption of telehealth/telemedicine technologies, implementation of strategies aimed at eliminating/reducing out-of-pocket expenses in the public sector and social security, and policies aimed at ensuring universal access and strengthening the model of care. The Bahamas experienced four extended COVID-19 outbreak surges between April 2020 and May 2022, with most of the 810 confirmed deaths by May 2022 concentrated in these outbreak periods. The major ongoing COVID-19 policy is the further scale-up and implementation of the vaccination program in cooperation with international partners. COVID-19 is one example of an external pressure, and these pressures are recognized as a major risk to the ongoing healthcare reform. Extreme weather events are another type of external pressure that has long been a threat to the islands of The Bahamas. Hurricane Dorian in 2019 followed by COVID-19 from 2020 have highlighted again the urgent need to strengthen linkages and build resilient capacity for coping with the joint challenges of climate change and health. These linkages and capacity deficits are visible in the areas of (1) climate change and health policy; (2) health workforce; (3) community and civil society engagement; (4) climate resilient health infrastructure; (5) data collection, information and technology; and (6) financing for climate change and health issues. Priorities for health related to COVID-19 are the strengthening of public health surveillance to detect cases early using expanded testing and contact-tracing activities, and developing new legislation and regulations to govern the pandemic.

Measures to reduce inequalities in health

The dispersed nature of The Bahamas archipelago presents a unique and key equity challenge for healthcare service delivery and impacts accessibility, patient transfers, the scope and mix of services available, and the availability of health professionals to deliver quality and equitable care to all. The strategic plan objectives also focus on maintaining healthy individuals through life course – particularly through primary care strengthening, improving noncommunicable disease outcomes, improving mental health services and realigning human resources in health for the changing national disease profile. The strategy includes the need for improved information and information systems to aid decision-making. Joint working to achieve universal health coverage can also be considered an indirect attempt to tackle health inequalities.

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.