Belize

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 Belize was 240 406 inhabitants; by 2023 this figure had risen to 410 825, representing a 70.9% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 5.2% of the total population, an increase of 1.3 percentage points compared to the year 2000. In 2023, there were 99. women per 100 men and 19.2 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 67.5% of the total population of the country in 2023 (277 284 people). When we add these figures to the potentially passive population (111 990 under 15 years of age and 21 552 over 65 years of age), the result is a dependency ratio of 48.2 potentially passive people per 100 potentially active people. This ratio was 78.2 in 2000.

Life expectancy at birth in 2023 was 74.6 years, lower than the average for the Region of the Americas and 6.1 years higher that in 2000.
 

Figure 1. Population pyramids, years 2000 and 2023

Between 2005 and 2020, the average number of years of schooling in Belize increased by 10.2%, reaching an average of 8.8 years in the latest year for which information is available. The unemployment rate in 2022 was 9.7%. Disaggregated by sex, the rate was 14.8% for women and 6.5% for men. The literacy rate was 88.3% in 2000 (88.1% for men and 88.5% for women). In 2019, 13.9% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is above the regional average of 3%.

During the period 2000–2021, the country improved its score on the Human Development Index, with an increase of 6.7% from a score of 0.640 to a score of 0.683; 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 4.97% of gross domestic product (GDP) (Figure 3) and 12.58% of total public expenditure, while out-of-pocket spending on health accounted for 21.92% of total health expenditure.

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

Digital coverage

In 2021, 62.0% of the population had an internet connection, representing a considerable increase from 2000, when 6.0% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2021, infant mortality in Belize decreased from 21.2 to 12.26 deaths per 1000 live births, a decrease of 42.2% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 14.1% to 9.5% between 2006 and 2021.

Regarding the immunization strategy, measles vaccination coverage was 81.0% in 2022, a decrease of 15.0 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 129.8 deaths per 100 000 live births, a reduction of 51.1% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 2.0 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 43.5% decrease, from 99.9 live births per 1000 women aged 15 to 19 years in 2000 to 56.4 in 2023. In 2021, 95.5% of births were attended by skilled birth personnel. while exclusive breastfeeding in the child population up to 6 months of age was 33.2% in 2016, compared with 9.3% in 2006.

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 18 new cases of tuberculosis per 100 000 population in Belize. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.9 (0.9 in women and 5 in men).

In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 45.5 per 100 000 population. The age-adjusted mortality rate for HIV was 33.6 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 34.1%.

There were no cases of human rabies in the country in 2020. Between 2010 and 2021, Belize achieved a 100% reduction in local malaria cases (from 150 cases to zero cases), with its last case reported in December 2018. Belize has maintained zero local cases for a third consecutive year, fulfilling a key eligibility for malaria-free certification by the World Health Organization.

Noncommunicable diseases and risk factors

In Belize in 2023, the prevalence of tobacco use among people aged 15 and older was 7.7%. In the same age group, the prevalence of overweight and obesity was 54.8% in 2016.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 22.7%, a decrease of 2.8 percentage points compared to 2000 (25.5%). The prevalence of diabetes mellitus, which stood at 9.5% in 2000, increased to 12.7% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Belize was 327.8 deaths per 100 000 population, a decrease of 24.3% from a rate of 432.8 in 2000. This meant that, in 2019, the rate in the country was 44.6% 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 204.4 per 100 000 population in 2019, which is 49.1% higher than the regional average rate; and the rate for treatable causes was 123.4 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 6.4 per 1000 population in 2019, a decrease of 24.7% compared to 2000 (8.5 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 90.4 per 100 000 population (104.7 per 100 000 in men and 76.3 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 452 per 100 000 population (506.7 per 100 000 in men and 76.3 per 100 000 in women). The rate of age-adjusted mortality from external causes was 98.3 per 100 000 population (166.1 per 100 000 in men and 32.3 per 100 000 in women), including road traffic accidents (23.6 per 100 000 population), homicides (40.2 per 100 000 population) and suicides (7.6 per 100 000 population). In 2000, the percentage distribution of causes was 72.3% for noncommunicable diseases, 14.4% for communicable diseases, and 13.4% for external causes; in 2019, the percentages were 70.5%, 14.1%, and 15.3%, respectively (Figure 6).

Figure 6. Proportional mortality in Belize, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 37.3 per 100 000 men; lung cancer, 17.5 per 100 000; and colorectal cancer, 7.2 per 100 000. In women, these values were 15.2 deaths per 100 000 for breast cancer, 5.7 per 100 000 for lung cancer, and 7.7 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In Belize in 2020, there were a total of 10 724 cases of COVID-19, representing 26 805 per million population. In 2021, there were 21 764 identified cases, equivalent to 54 400 per million population. In 2020, there were 242 deaths directly caused by COVID-19 in people diagnosed with the disease, or 892 per million population; in 2021, 357 deaths were reported, or 892 per million. In 2020, Belize ranked 12th in the Region of the Americas in terms of the number of deaths from COVID-19, and 28th in 2021, with a cumulative 1495 deaths per million population over the two years (Figure 7).

According to estimates by the World Health Organization, there was a total of 121 excess deaths in 2020, or 31 per 100 000 population;² a total of 575 deaths were estimated in 2021, for an excess mortality rate of 142 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 59.6% of the country's population. As of 2July 2022 (latest available data), 52.7% of the population had completed the vaccination schedule. The vaccination campaign began on 20 March 2021, and five 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 Framework for Belize (2010–2030), known as Horizon 2030, set out a long-term road map for development focused on youth, inclusivity, and the need to create "One Belize - Un Belice," and development based on intersectoral collaboration. Two key health strategies in this development were a focus on health in the community throughout the life cycle and achieving universal access to health care – an adoption of the global move toward universal health coverage.³ The subsequent Belize Health Sector Strategic Plan (2014–2024) builds on these key strategies with objectives to strengthen the national primary healthcare system, human resources in health, health information systems, and health system quality control. Improvements in health service management and health financing are specifically designed to help achieve universal health coverage.⁴ The focus on primary care deliberately targets health behavior as a more efficient and sustainable model of health care. The focus on shared responsibility and multisectoral collaborations recognizes that health is a social product and that health problems stem directly and indirectly from root social and economic determinants. Joint working is therefore an indirect attempt to tackle health inequalities, with persistent inequalities recognized between urban and rural populations of Belize and between ethnicities across the country.

Efforts have begun on primary care capacity-building, particularly to address hypertension as the major precursor to cardiovascular disease. Interventions to address unhealthy diets are ongoing but multisectoral actions are needed to promote healthy eating among the general population. Several projects to bolster universal health coverage are ongoing. For example, the Health Sector Reform Project has implemented health system decentralization, and currently the model is being reviewed with the objective of improving efficiency and effectiveness geared toward an improvement of the quality of care.

The community health workers program spearheaded by the Health Education and Community Participation Bureau is currently focusing on improved training for community health workers, and an increase in their number and regional coverage. The national health insurance scheme has been operating for two decades, in the southside of Belize City and the south of the country, with recent expansion to selected areas in the north. The scheme is a joint public-private partnership for providing health services, with an emphasis on expanded access to diagnostic and treatment.

Equity in health service delivery has been recognized as a priority, and is being tackled with several initiatives, including an expansion of the health workforce in key areas (general practitioners, medical specialties, medical laboratory technologists, and nurses), expansion of the national health insurance scheme to the northern health region, improvement of community health facilities, and training for healthcare personnel in evidence-based healthcare.

Challenges related to population health

Belize has a relatively young population but is aging and the pace of this aging is predicted to increase. In 1980, the proportion of Belize’s population aged 65 and older was 4.5%. This proportion remained static in the intervening 40 years, nudging up to an estimated 5.0% by 2020, but is predicted to rise dramatically to 16.8% by 2060.⁵ This future increase of 11.8 percentage points represents a rapid rise in older adults that 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 Belize’s important progress in reducing the burden of infectious diseases.

The burden of maternal and neonatal disorders, respiratory infections, and HIV/AIDS and other sexually transmitted infections have all reduced, with the disease burden shifting towards noncommunicable diseases. Cardiovascular diseases, diabetes, and cancers in 2019 were the top three causes of death and disability, collectively accounting for around one-quarter of all healthy life lost.⁶ The burden of self-harm and violence, unintentional injuries, and transport injuries collectively accounted for 18.4% of all healthy life lost in 2019, with self-harm and violence of particular concern, rising by almost 50% since 2000.

Mental disorders continue to increase in importance. Solutions to each of these challenges require multisectoral cooperation. Although the noncommunicable disease burden on the health system and on communities has not been economically quantified, the increasing noncommunicable disease disability among working age populations hints at the growing national impact. Rehabilitation services after, for example, heart attacks and strokes stand out as a key health priority that needs urgent attention.

COVID-19 pandemic response

External pressures are recognized as a major risk to the ongoing healthcare reform. Climate change is a notable example from the National Development Framework, and the financial crisis of 2009 and the COVID-19 pandemic in 2020-2021 have adversely affected the economic stability across the Small Island Developing States of the Caribbean. Belize experienced three major COVID-19 outbreak surges between April 2020 and May 2022, with most of the 677 confirmed deaths by May 2022 concentrated in these outbreak periods.

Early in the pandemic, the Government of Belize identified several areas of vulnerability in the health system in the context of the pandemic: (1) shortages of equipment and supplies for COVID-19 testing; (2) inadequate facilities for case surveillance at point of entry; (3) critical gaps in availability of nurses, medical officers, lab technicians, and other personnel; (4) lack of sufficient personal protective equipment (PPE) and medical equipment; (5) potential disruption of care for critical groups (women of reproductive age, chronic disease patients, and victims of gender violence) due to increased demand from COVID-19 patients; and (6) low capacity to properly manage medical waste.⁷

The major ongoing COVID-19 policy is the further scale-up and implementation of the vaccination program in cooperation with international partners. Capacity-building for COVID-19 clinical management, infection control and prevention, surveillance, and laboratory services have been given priority. The procurement of hospital equipment has been a significant collaboration with United Nations agencies.

Measures to reduce inequalities in health

Health inequalities have been highlighted, between urban and rural populations of Belize and between ethnicities across the country. Reducing these inequalities is being addressed via a range of interventions such as the improved imaging equipment, expansion of the national health insurance scheme, as well as increased health workers and facilities. Although improvements are being made at the regional level, it is recognized that further input is required at the community level. Specialty services at these hospitals are provided through unsustained efforts done by the regional hospitals. At the regional level, expansion of clinical laboratory services has continued. Important interventions are being implemented in the areas of surveillance, diagnosis, and treatment to address HIV, tuberculosis, and malaria.

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.