Bermuda

The Health in the Americas+¹ country and territory 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 Bermuda was 61 371 inhabitants; by 2021 this figure had risen to 64,185, representing a 4.6% increase. Regarding the territory's demographic profile, in 2021 people over 65 years of age accounted for 19.7% of the total population, an increase of 9.1 percentage points compared to the year 2000. In 2021, there were 107.3 women per 100 men and 132.1 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the territory'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 65.4% of the total population of the territory in 2021 (41 990 people). When these figures are added to the potentially passive population (9563 under 15 years of age and 12 633 over 65 years of age), the result is a dependency ratio of 52.9 potentially passive people per 100 potentially active people. This ratio was 41.9 in 2000.

Life expectancy at birth was 81.8 years in 2021—higher than the average for the Region of the Americas and 2.9 years higher than in 2000.

Figure 1. Population pyramids of Bermuda, years 2000 and 2020

Between 2000 and 2016, the average number of years of schooling in Bermuda decreased by 2.71%, reaching an average of 12.5 years in the latest year for which information is available.

Digital coverage

In 2017, 98.4% of Bermudans had an Internet connection, representing a considerable increase from 2000, when 42.9% of the population had an Internet connection.

Health situation

Maternal and child health

Between 2000 and 2018, infant mortality in Bermuda fluctuated but ended the period at 1.9 deaths per 1000 live births (Figure 2). The percentage of low-weight births (less than 2500 g) increased from 7.8% to 9.8% between 2000 and 2018.

Regarding the immunization strategy, measles vaccination coverage was 92% in 2021 an increase of 17 percentage points over 2002.

In the specific case of adolescent fertility, there was a 77.64% decrease, from 33.19 live births per 1000 women aged 15 to 19 years in 2000 to 7.42 in 2022. Between 2000 and 2018 the percentage of pregnant people who received antenatal care increased from 99.6% to 100%. In 2018, 99.4% of births were attended by skilled birth personnel.

Figure 2. Infant mortality per 1000 live births, 1995–2020

Communicable diseases

In 2020, there were 4.8 new cases of tuberculosis per 100 000 population in Bermuda.

In 2018, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 7 per 100 000 population. The age-adjusted mortality rate for HIV was 3.1 per 100 000 population in 2018, with an overall HIV prevalence is 0.5 %. Bermuda was certified as having eliminated mother-to-child transmission of HIV and syphilis in 2017, and recertified in 2019.

Noncommunicable diseases and risk factors

In Bermuda, the prevalence of overweight and obesity was 74.6% in 2014.

Also in 2014, 17.1% of the population reported insufficient physical activity.

The health situation and the COVID-19 pandemic

In Bermuda in 2020, there were a total of 604 COVID-19, representing 9418 per million population. In 2021, there were 90,686 identified cases, equivalent to 1715.8 per million population. In 2022, the number of cases doubled as there were 181,762 identified cases, equivalent to 2307.7 per million population. In 2020, there were 10 deaths directly caused by COVID-19 in people diagnosed with the disease, or 156 per million population; in 2021, 110 deaths were reported, or 1559 per million; in 2022, 38 deaths were reported, or 593 per million.

In 2020, Bermuda ranked 30th in the Region of the Americas in terms of the number of deaths from COVID-19, and 12th in 2021 and 8th in 2022.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 77.7% of the territory's population. As of 2 July 2022 (latest available data), 66.2% of the population had completed the vaccination schedule. The vaccination campaign began on 20 January 2021, and two types of COVID-19 vaccine have been used to date.

Prospects

Measures to achieve universal health coverage

The Bermuda Health Strategy 2022–2027 highlights the high cost of health care as the major challenge to equitable access to quality care among the population. The Bermuda Health Strategy 2022–-2027 outlines the mission of the Ministry of Health and Wellness as: “Ensuring that all people have equitable access to needed informative, preventive, curative, rehabilitative and palliative essential health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services and critical medicine.”

The Bermuda Health Strategy 2022–2027 outlines the high-level steps and the timelines for a phased approach from highest-priority essential services and benefits toward the territory’s vision of a stronger, sustainable healthcare system. Plans are under way for the adoption of universal health coverage by developing and piloting integrated pathways for essential care as an exemplar for establishing universal health coverage and developing a national digital health strategy to align and drive wider opportunities in advance of Bermuda’s electronic health records implementation. One of the seven strategic goals is aimed at improving access to healthcare coverage and, in collaboration with the Country Office of the Pan American Health Organization (PAHO), work continues to advance the financing strategies for universal health coverage.

Challenges related to population health

Bermuda has a life expectancy of 81.8 years, which is higher than the average for the region of the Americas. Immunization rates for measles have increased by 25% since 2002, reaching 100% in 2019. However, Bermuda’s health outcomes do not reflect the amount currently spent on health, publicly or privately, as about 35% of the population are unable to access quality healthcare without financial hardship. This figure includes those who are uninsured (12%) and people who are unable to afford health insurance or are underinsured (23%).

COVID-19 pandemic response

The PAHO Country Office worked closely with the Ministry of Health to develop the PAHO COVID-19 Preparedness and Response Plan. This plan charts the way for national health sector responses, emphasizing surveillance and laboratory diagnosis using a national health emergency framework and points of entry, which serve as hubs for information-sharing and limiting cross-border transmission of SARS-CoV-2. Work continues to support the territory’s COVID-19 response, and next steps include:

• Prepare a COVID-19 strategic plan for health sector response and recovery.
• Strengthen health systems to respond to COVID-19, while maintaining essential health services.
• Implement risk communication and community engagement strategies to support priorities and enhance behavior change.
• Enhance supply chains for lifesaving modalities, therapeutics, and vaccines.
• Procure and deploy vaccines, in particular for groups in situations of vulnerability.
• Strengthen pandemic preparedness for the health sector and across sectors, in keeping with the International Health Regulations (2005) and other global and regional imperatives.

Measures to reduce inequalities in health

Bermuda spends 11.6% of GDP on health, representing the third highest in the Organisation for Economic Co-operation and Development. Health expenditure grew by 92% between 2006 and 2017. However, as mentioned above, Bermuda’s health outcomes do not reflect the amount currently spent on health, publicly or privately. The economic burden must be addressed. The Government of Bermuda has stated its commitment to strengthening its health system to provide affordable access to essential health coverage for all residents.

The Bermuda Health Strategy 2022–2027 provides a three-year road map (see above). The following actions are planned:

• Develop and pilot integrated essential care pathways for essential care as an exemplar to establishing universal health coverage and delivering better value.
• Initiate new working groups including people, payors, and professionals to build a pan-system structure for stewardship and collaboration.
• Agree on starting points: updated national health accounts, identify pan-system value opportunities, the impact of status quo, health needs assessment, and new system measures.
• Establish the economic case for healthcare strengthening and universal health coverage to support the wider economic case for Bermuda.
• Develop a national digital health strategy to align and drive wider opportunities in advance of the territory’s electronic health record implementation.
• Develop options for consolidating government health plans to deliver value with initial financial assessment and impact modeling.

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.