Colombia - Country Profile

By PAHO/OPS, 02 September, 2022

The Health in the Americas+ 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 Colombia was 39 089 934 inhabitants; by 2024 this figure had risen to 52 886 363, representing a 35.3% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 9.8% of the total population, an increase of 5.2 percentage points compared to the year 2000. In 2024, there were 102.7 women per 100 men and 48.2 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 69.9% of the total population of the country in 2024 (36 993 721 people). When we add these figures to the potentially passive population (10 721 184 under 15 years of age and 5 171 459 over 65 years of age), the result is a dependency ratio of 43.0 potentially passive people per 100 potentially active people. This ratio was 58.8 in 2000.

Life expectancy at birth in 2024 was 77.9 years, higher than the average for the Region of the Americas and 7 years higher that in 2000 (70.9).

Figure 1. Population pyramids of Colombia, years 2000 and 2024

Between 2004 and 2020, the average number of years of schooling in Colombia increased by 25.3%, reaching an average of 8.9 years in the latest year for which information is available. The unemployment rate in 2023 was 9.4%. Disaggregated by sex, the rate was 11.8% for women and 7.7% for men. The literacy rate was 98.9% in 2022. In men, this figure was 99.2%; in women, 98.6%. In addition, 36.6% of the population were below the national poverty line in 2022, a decrease from 39.7% in 2021. In 2022, 6.0% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 2.15 per day; this is below the regional average of 2.6%.

During the period 2000-2022, the country improved its score on the Human Development Index, with an increase of 12.8% (from a score of 0.672 to a score of 0.758); during the same period, the index rose 14.6% internationally and 11.2% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2022

In 2021, public expenditure on health accounted for 6.55% of gross domestic product (GDP) (Figure 3) and 19.01% of total public expenditure, while out-of-pocket spending on health accounted for 13.67% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2021

Digital coverage

In 2021, 73% of the population had an internet connection, representing a considerable increase from 2000, when 2.2% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2021, infant mortality in Colombia decreased from 25.8 to 10.94 deaths per 1000 live births, a decrease of 57.6% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 7.6% to 9.9% between 2002 and 2021, while exclusive breastfeeding in the child population up to 6 months of age increased from 25.8% in 2000 to 46.8% in 2005 (the latest year for which information is available).

Regarding the immunization strategy, measles vaccination coverage was 88.0% in 2022, an increase of .0 percentage points from 2000.

The maternal mortality ratio in 2020 was estimated at 74.8 deaths per 100 000 live births, representing a 19.3% reduction compared to the estimated value in 2000 (Figure 5). In relation to fertility, it is estimated that in 2024 women had an average of 1.6 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 38.2% decrease, from 94.5 live births per 1000 women aged 15 to 19 years in 2000 to 58.4 in 2024. In 2021, 97.4% of births were attended by skilled birth personnel. Between 2000 and 2019 the percentage of pregnant people who had four or more consultations for antenatal care increased from 72.6% to 83.9%.

Figure 4. Infant mortality per 1000 live births, 1995–2021

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

Communicable diseases

In 2022, there were 32 new cases of tuberculosis per 100 000 population in Colombia. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.4 (1.2 in women and 3.8 in men).

In 2022, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 25 per 100 000 population. The age-adjusted mortality rate for HIV was 5.1 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 7.4%. There was one reported case of human rabies in the country in 2022.

Noncommunicable diseases and risk factors

In Colombia in 2023, the prevalence of tobacco use among people aged 15 and older was 7.8%. In the same age group, the prevalence of overweight and obesity was 59.7% in 2022.

Also in 2016, 44% 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 19.2 %, a decrease of 4.3 percentage points compared to 2000 (23.5%). The prevalence of diabetes mellitus, which stood at 7.2% in 2000, increased to 8.5% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Colombia was 183.7 deaths per 100 000 population, a decrease of 46.1% compared to the rate of 340.9 in 2000. This meant that, in 2019, the rate in the country was 19% lower than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 113.2 per 100 000 population in 2019, which is 17.4% lower than the regional average rate; and the rate for treatable causes was 70.5 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 4.4 per 1000 population in 2019, a decrease of 31.2% compared to 2000 (6.4 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 48 per 100 000 population (56.7 per 100 000 in men and 40.4 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 327 per 100 000 population (370.6 per 100 000 in men and 292.9 per 100 000 in women). The rate of age-adjusted mortality from external causes was 63.7 per 100 000 population (112.4 per 100 000 in men and 18.1 per 100 000 in women), including road traffic accidents (14.7 per 100 000 population), homicides (36.6 per 100 000 population), and suicides (3.7 per 100 000 population). In 2000, the percentage distribution of causes was 66.1% for noncommunicable diseases, 11.2% for communicable diseases, and 22.7% for external causes; in 2019, the percentages were 74.5%, 10.9%, and 14.5%, respectively (Figure 6).

Figure 6. Proportional mortality in Colombia, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 15 per 100 000 men; lung cancer, 12.7 per 100 000; and colorectal cancer, 8.5 per 100 000. In women, these values were 12.5 per 100 000 for breast cancer; 7.4 per 100 000 for lung cancer; and 7.7 per 100 000 for colorectal cancer.

Country COVID-19 Perspective

The health situation and the COVID-19 pandemic

In Colombia in 2020, there were a total of 1 614 822 cases of COVID-19, representing 31 736.1 per million population. In 2021, there were 3 523 781 identified cases, equivalent to 68 735.5 per million population. In 2020, there were 43 213 deaths directly caused by COVID-19 in people diagnosed with the disease, or 838.82 per million population; in 2021, 86 729 deaths were reported, or 1683.52 per million. In 2020, Colombia ranked eighth in the Region of the Americas in terms of the number of deaths from COVID-19, and seventh in 2021, with a cumulative 2522.3 deaths per million population over the two years (Figure 7).

According to estimates by the World Health Organization, there was a total of 53 936 excess deaths in 2020, or 106 per 100 000 population. A total of 110 734 deaths were estimated in 2021, for an excess mortality rate of 216 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 82.9% of the country's population. As of 20 April 2022 (latest available data), 69% of the population had completed the vaccination schedule. The vaccination campaign began on 20 February 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 Colombian health and social protection system's organizing principle is to guarantee health coverage through the General Social Security System (SGSSS). This operates through the Public Health Plan for Collective Interventions, the Integral Health Care Routes, and the Health Benefits Plan, financed by the Capitation Payment Unit. By December 2020, the Single Database of Members (BDUA)—displayed in the BDUA box of the Integrated Information System for Social Protection—provided relevant information on the 97.9% of the country's population that belongs to the SGSSS, not counting those in the Military Forces and National Police.

Among the central points of the country's agenda for the coming years, ensuring equity in health protection occupies a prominent place. Thus, public policies must focus on the population living in conditions of social vulnerability, particularly those in rural areas and the country's mobile populations.

The set of actions aimed at changing and improving the Colombian health system is set forth in the draft “Ten-Year Health Plan 2022-2031 (PDSP 2022-2031),” which seeks to “guarantee the fundamental right to health and improve the well-being and quality of life of the Colombian people, by impacting the social determinants of health through territorial, institutional, and social action in a coordinated, differential, and sustainable manner.” Public policy measures are designed to affect education, the quality of jobs, and access to health services, all of which are conducive to the future growth and development of the national health system.

Challenges related to population health

Among the main challenges that the country still faces is the need to increase inclusive and equitable economic and social development, as well as strengthening leadership in health, as an engine of national development and a factor in protecting people’s health and the health of the national economy. These two key areas of the national agenda are essential to intersectoral actions for a positive impact on the social determinants of health.

In Colombia, achieving health equity has become a guiding principle in public actions to guarantee the right to health for all people, regardless of their ability to pay.

Maintaining adequate financing of the health and social protection sector, and continuing to make the necessary adjustments to ensure the financial sustainability of the SGSSS are two additional key challenges in guaranteeing people's fundamental right to health in the medium and long term.

Lastly, public policies need to address the major gaps in access to high-quality health care, especially in rural areas and areas on the periphery of large urban centers, as well as in neighboring areas and those affected by conflicts. Consolidation of the health authority at the various levels of government (national, departmental, and municipal), as well as effective management of health with a territorial approach, will form the basis for developing a sustainable health system.

COVID-19 pandemic response

Public officials, having examined the challenges facing Colombia’s health system during the pandemic, emphasize the vital importance of strengthening the capacity to respond to any emergency situation, such as an epidemic or a pandemic. Within this framework, the list of essential actions includes:

Ensuring appropriate governance and financing of public health and strengthening mechanisms for coordination and inter-institutional cooperation.
Strengthening emergency preparedness and response capacities.
Providing for effective and equitable distribution of available vaccines.
Strengthening epidemiological surveillance systems and laboratories, including all matters related to zoonoses and environmental health.
Restoring essential health services and strengthening human resources for health.
Improving risk communication.

Measures to reduce inequalities in health

Colombia is implementing important regulations and public policies that reflect the State's interest in social protection, including the very definition of this concept. These include measures relating to baseline social protection (i.e., a universal minimum of protection) available to people living in conditions of economic and social vulnerability; contributory and non-contributory components of labor and social security; conditional and unconditional income transfer programs; and social promotion and social assistance programs. This applies not only within the framework of the social protection system, but also to other State administrative systems that require private involvement. All of these measures are aimed at achieving equity, integral human development, and citizens’ participation in their own well-being.

In this regard, the guiding principle of social protection is directly linked to the 2030 Agenda and its objectives, as well as those set forth by the International Labor Organization, which proposes “ending poverty, ensuring universal access to essential health services, and promoting full and productive employment and decent work for all." In summary, the 2030 Agenda aims to ensure that these public policies reach all Colombians.

In that context, the PDSP 2022–2031 implements the Agenda and monitors health through the following principles and policies:

A health system that provides the entire population with insurance coverage close to 95%, including plans with benefits for all members.
Free public-system health plans for the uninsured population.
Guaranteed access to health care for indigenous, Black, and Afro-Colombian populations, as well as Raizal and Palenquero communities and the Roma population, while developing health care for the victims of armed conflicts.
Operation of a national observatory on health equity aimed at analyzing, consolidating, and disseminating information; evaluating public policies; and coordinating and integrating key stakeholders and sectors, in order to promote initiatives to reduce social inequalities in health.

National strategy to address inequalities in health

The PDSP 2022–2031 envisages three major proposals to significantly impact the social determinants of health: (1) strengthening intersectoral coordination for managing the social determinants of health; (2) increasing intersectionality, recognizing that multiple differences increase the burden of health inequalities in specific historical, social, and cultural contexts; and (3) strengthening the integrated territorial management of public health, with a model that guides, coordinates, acknowledges, and harmonizes the interests of the different sectoral and intersectoral stakeholders when taking action to achieve the objectives and goals.