Barbados

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 Barbados was 264 657 inhabitants; by 2023 this figure had risen to 281 995, representing a 6.6% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 16.8% of the total population, an increase of 5.6 percentage points compared to the year 2000. In 2023, there were 108.4 women per 100 men and 101.1 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 66.6% of the total population of the country in 2023 (187 704 people). When we add these figures to the potentially passive population (46 877 under 15 years of age and 47 416 over 65 years of age), the result is a dependency ratio of 50.2 potentially passive people per 100 potentially active people. This ratio was 49.4 in 2000.

Life expectancy at birth in 2023 was 77.9 years, higher than the average for the Region of the Americas and 3.8 years higher that in 2000.

Figure 1. Population pyramids, years 2000 and 2023

In 2000, the average number of years of schooling in Barbados reached 9 years in the latest year for which information is available.  The unemployment rate in 2022 was 8.2%. Disaggregated by sex, the rate was 7.3% for women and 9.2% for men. Disaggregated by sex, the rate was 11.5% for women and 9.3% for men. The literacy rate was 99.8% in 2014. 

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 4.5% (from a score of 0.756 to a score of 0.79); 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 3.75% of gross domestic product (GDP) (Figure 3) and 11.2% of total public expenditure, while out-of-pocket spending on health accounted for 40.59% of total health expenditure.

Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2020

Digital coverage

In 2021, 85.8% of the population had an internet connection, representing a considerable increase from 2000, when 4.0% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2019, infant mortality in Barbados decreased from 13.4 to 8.6 deaths per 1000 live births, a decrease of 35.8% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 11.0% to 11.8% between 2003 and 2020, while exclusive breastfeeding in the child population up to 6 months of age was 19.7%, the same value as in 2012.

Regarding the immunization strategy, measles vaccination coverage was 85.0% in 2022, a decrease of 9 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 39.1 deaths per 100 000 live births, a reduction of 19.3% 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 23.4% decrease, from 53.1 live births per 1000 women aged 15 to 19 years in 2000 to 40.7 in 2023. In 2020, 98.4% of births were attended by skilled birth personnel. Between 2011 and 2020, the percentage of pregnant people who received antenatal care increased from 89% to 90%.

Figure 4. Maternal mortality per 100 000 live births in Barbados, 2000–2017

Communicable diseases

In 2020, there were 2.1 new cases of tuberculosis per 100 000 population in Barbados. In the same year, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.3 (0.2 in women and 0.3 in men).

In 2019, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 35.7 per 100 000 population. The age-adjusted mortality rate for HIV was 8.4 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 85.4%.

Noncommunicable diseases and risk factors

In Barbados in 2023, the prevalence of tobacco use among people aged 15 and older was 6.9%. In the same age group, the prevalence of overweight and obesity was 52.4% in 2016.

Also in 2016, 42.9% 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 24.4%, a decrease of 1.7 percentage points compared to 2000 (26.1%). The prevalence of diabetes mellitus, which stood at 9.1% in 2000, increased to 12.2% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Barbados was 198.5 deaths per 100 000 population, a decrease of 29.5% from a rate of 281.5 in 2000. This meant that, in 2019, the rate in the country was 12.4% 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 88.6 per 100 000 population in 2019, which is 35.4% lower than the regional average rate; and the rate for treatable causes was 109.8 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 6 per 1 000 population in 2019, a decrease of 8.4% compared to 2000 (6.5 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 82.7 per 100 000 population (93.3 per 100 000 in men and 73.0 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 477 per 100 000 population (533.4 per 100 000 in men and 430.9 per 100 000 in women). The rate of age-adjusted mortality from external causes was 36.9 per 100 000 population (52.4 per 100 000 in men and 22.1 per 100 000 in women), including road traffic accidents (8 per 100 000 population), homicides (10.2 per 100 000 population), and suicides (0.3 per 100 000 population). In 2000, the percentage distribution of causes was 80.6% for noncommunicable diseases, 15.9% for communicable diseases, and 3.4% for external causes; in 2019, the percentages were 82.8%, 12.9%, and 4.3%, respectively (Figure 5).

Figure 5. Proportional mortality in Barbados, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 59.9 per 100 000 men; lung cancer, 16.9 per 100 000; and colorectal cancer, 23.7 per 100 000. In women, these values were 35.3 deaths per 100 000 for breast cancer, 13.0 per 100 000 for lung cancer, and 18.9 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

During 2020, there were a total of 372 cases of COVID-19 in Barbados, representing 1 323 per million population. In 2021, the number of identified cases amounted to 28 193, equivalent to 100 268 per million inhabitants, while in 2022, the number of reported cases was 73 554, corresponding to 261 594 cases per million inhabitants. With regard to deaths directly caused by COVID-19, in 2020, 7 deaths of persons diagnosed with COVID-19 were reported, or 25 per million inhabitants, while in 2021, 253 were reported, representing 900 deaths per million inhabitants and 299 total deaths by 2022, equivalent to 1 063 deaths per million inhabitants. In the Region of the Americas, Barbados ranked 43 in the number of deaths due to COVID-19 in 2020, moved to position 27 in 2021 and in 2022 ranked in third position, with a cumulative figure for the years of 1988 deaths per million population (Figure 7).

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 56.2% of the country's population. As of 20 April 2022 (latest available data), 53% of the population had completed the vaccination schedule. The vaccination campaign began on 20 January 2021, and five types of COVID-19 vaccine have been used to date.

Figure 6. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th 2023

Prospects

Measures to achieve universal health coverage

In 2005, the Barbados Government released its long-term strategic plan (2005–2025), placing people at the heart of development, and with plans for enhancing public health, and strengthening healthcare management and human resources for health.³ Successes in reducing the burden of communicable diseases, especially the burden of HIV/AIDS, further pushed the disease profile toward noncommunicable diseases, and new associated challenges. By 2015, the Barbados Ministry of Health had produced strategic plans for noncommunicable diseases⁴ and for preventing childhood obesity.⁵ These plans laid the foundation for a second 5-year strategy for preventing and controlling noncommunicable diseases.⁶ This latest strategy deliberately focuses on health promotion, risk factor reduction, and prevention of disease and disease complications, aiming to strengthen the primary healthcare approach, take advantage of Barbados’ network of polyclinics, enhance their functioning, and advance to universal health – an adoption of the global move toward universal health coverage.

This approach is in keeping with the shared vision of the draft Barbados National Strategic Plan for Health 2018-2022: “Healthy productive people and communities through excellent care for everyone, everywhere, every time.” The plan has various priority areas: (1) risk factor reduction including preventing childhood obesity, focusing on harmful alcohol use, tobacco control, food security and nutrition, and physical activity; (2) improved noncommunicable disease management using primary health care and the chronic care model, and specifically recognizing the increasing burden of multimorbidity; (3) using noncommunicable disease surveillance and research for evidence-based action, including to guide future noncommunicable disease prevention and control, including related to multimorbidity and health inequalities; (4) multisectoral partnerships that recognize the health in all policies approach, and which in particular will explore linkages with agriculture, climate change, between ministries, and with other Small Island Developing States; and (5) health communication for promoting noncommunicable disease prevention and control, involving civil society, young people, and people living with noncommunicable diseases.

Challenges related to population health

The Barbados population has one of the oldest age profiles in the Caribbean, and the pace of this aging is predicted to increase. In 1980, the proportion of Barbados’ population aged 65 and older was 10.6%. This proportion increased to an estimated 16.7% by 2020, and is predicted to almost double to 29.1% by 2060.⁷ This future increase of 12.4 percentage points represents a continued rapid rise in older adults, and remains above the regional averages for the Caribbean of 10.7 percentage points, but below 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 almost half of all healthy life lost.⁸ Including all other noncommunicable diseases raises this burden to over 80% of all healthy life lost. There has been important progress in reducing the burden of HIV/AIDS, which in 2019 accounted for just 1% of healthy life lost, down by almost three-quarters since 2000. Diabetes is a national concern. The burden of diabetes continues to increase, is driven by nationally high rates of obesity and physical inactivity, and requires lifelong comprehensive care that is onerous for those living with the condition and for healthcare financing. Solutions to the prevention and control of noncommunicable diseases require multisectoral cooperation.

COVID-19 pandemic response

Barbados experienced four extended COVID-19 outbreak surges between April 2020 and May 2022, with over 400 confirmed deaths by May 2022 concentrated in these outbreak periods. A major ongoing COVID-19 policy is the further scale-up and implementation of the vaccination program in cooperation with international partners. The World Bank approved a COVID-19 Response and Recover Loan in 2021, recognizing the severe socioeconomic impacts of COVID-19 on this heavily tourism-dependent country. The loan enables a program of structural reforms for strong post-COVID recovery. This will include focus on improving fiscal sustainability; strengthening the investment climate; promoting economic diversification, trade, and finance; and enhancing the economy’s resilience to natural disasters and climate change.

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.