Costa Rica - Country Profile

By PAHO/OPS, 13 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 Costa Rica was 3 937 739 inhabitants; by 2024 this figure had risen to 5 129 910, representing a 30.3% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 12.2% of the total population, an increase of 6.7 percentage points compared to the year 2000. In 2024, there were 102.4 women per 100 men and 65. 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 69.0% of the total population of the country in 2024 (3 538 385 people). When we add these figures to the potentially passive population ( 964 386 under 15 years of age and 627 140 over 65 years of age), the result is a dependency ratio of 45.0 potentially passive people per 100 potentially active people. This ratio was 58.0 in 2000.

Life expectancy at birth in 2024 was 81 years, higher than the average for the Region of the Americas and 3.7 years higher that in 2000 (77.3).

Figure 1. Population pyramids of Costa Rica, years 2000 and 2024

Between 2007 and 2020, the average number of years of schooling in Costa Rica increased by 9.9%, reaching an average of 8.8 years in the latest year for which information is available. The unemployment rate in 2023 was 8.5%. Disaggregated by sex, the rate was 10.4% for women and 7.3% for men. The literacy rate was 99.5% in 2021. In men, this figure was 99.6%; in women, 99.5%. In addition, 25.5% of the population were below the national poverty line in 2022, a decrease from 24.8% in 2011. In 2022, 0.9% 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 13.7% (from a score of 0.709 to a score of 0.806); 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 5.3% of gross domestic product (GDP) (Figure 3) and 25.37% of total public expenditure, while out-of-pocket spending on health accounted for 20.74% of total health expenditure.

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

Digital coverage

In 2021, 82.8% of the population had an internet connection, representing a considerable increase from 2000, when 5.8% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2019, infant mortality in Costa Rica decreased from 10.2 to 8.25 deaths per 1000 live births, a decrease of 19.1% (Figure 4). The percentage of low-weight births (less than 2500 g) increased from 5.6% to 7.1% between 2002 and 2020, while exclusive breastfeeding in the child population up to 6 months of age was 32.5%, the same value as in 2011.

Regarding the immunization strategy, measles vaccination coverage was 90% in 2022, an increase of 8 percentage points from 2000.

Figure 4. Infant mortality per 1000 live births, 1995–2019

The maternal mortality ratio in 2020 was estimated at 22.0 deaths per 100 000 live births, representing a 42.9% 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 1.3 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 70.2% decrease, from 83.4 live births per 1000 women aged 15 to 19 years in 2000 to 24.8 in 2024. In 2016, 97.9% of births were attended by skilled birth personnel. Between 2010 and 2016 the percentage of pregnant people who had four or more consultations for antenatal care decreased from 87% to 76.6%.

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

Communicable diseases

In 2022, there were 8 new cases of tuberculosis per 100 000 population in Costa Rica. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 0.5 (0.3 in women and 0.8 in men).

In 2022, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 17.1 per 100 000 population. The age-adjusted mortality rate for HIV was 3.5 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 13%. There were no cases of human rabies in the country in 2022.

Noncommunicable diseases and risk factors

In Costa Rica in 2023, the prevalence of tobacco use among people aged 15 and older was 7.9%. In the same age group, the prevalence of overweight and obesity was 66.9% in 2022. Also in 2016, 92.1% 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 18.7%, a decrease of 3.7 percentage points compared to 2000 (22.4%). The prevalence of diabetes mellitus, which stood at 7.0% in 2000, increased to 8.9% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Costa Rica was 155.9 deaths per 100 000 population, a decrease of 22.1% from a rate of 200.1 in 2000. This meant that, in 2019, the rate in the country was 31.2% 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 87.4 per 100 000 population in 2019, which is 36.3% lower than the regional average rate; and the rate for treatable causes was 68.4 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 3.9 per 1000 population in 2019, a decrease of 22% compared to 2000 (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 29.9 per 100 000 population (37.6 per 100 000 in men and 22.9 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 310.2 per 100 000 population (363.5 per 100 000 in men and 263.7 per 100 000 in women). The rate of age-adjusted mortality from external causes was 46.7 per 100 000 population (76.8 per 100 000 in men and 16.9 per 100 000 in women), including road traffic accidents (14 per 100 000 population), homicides (12 per 100 000 population) and suicides (7.6 per 100 000 population). In 2000, the percentage distribution of causes was 78.9% for noncommunicable diseases, 8.9% for communicable diseases, and 12.1% for external causes; in 2019, the percentages were 82.0%, 7.1%, and 10.9%, respectively (Figure 6).

Figure 6. Proportional mortality in Costa Rica, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 15.4 per 100 000 men; lung cancer, 7.7 per 100 000; and colorectal cancer, 10.6 per 100 000. In women, these values were 12 deaths per 100 000 for breast cancer, 3.7 per 100 000 for lung cancer, and 9.5 per 100 000 for colorectal cancer.

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.

Country COVID-19 Perspective

The health situation and the COVID-19 pandemic

In Costa Rica in 2020, there were a total of 168 114 cases of COVID-19, representing 23 627 per million population. In 2021, there were 403 367 identified cases, equivalent to 78 284 per million population. In 2022, there were a total of 540 488 cases of COVID-19. In 2020, there were 2171 deaths directly caused by COVID-19 in people diagnosed with the disease, or 421.34 per million population; in 2021, 5168 deaths were reported, or 1006 per million. In 2022, 1576 deaths due to COVID-19 were reported, for a rate of 104 896 cases per million population. In 2020, Costa Rica ranked 16th in the Region of the Americas in terms of the number of deaths from COVID-19, and 24th in 2021, with a cumulative 1733 deaths per million population over the two years (Figure 7).

According to estimates by the World Health Organization, there was a total of 1375 excess deaths in 2020, or 27 per 100 000 population; a total of 8274 deaths were estimated in 2021, for an excess mortality rate of 161 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 86.1% of the country's population. As of 20 April 2022 (latest available data), 80% of the population had completed the vaccination schedule. The vaccination campaign began on 20 December 2020, and three 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

Measures to achieve universal health coverage

The Costa Rica Ministry of Health, as the governing body of the health sector, has an organizational and functional structure designed to promote institutional, inter-institutional, and intersectoral coordination. Based on its cross-cutting axes—social participation; a focus on gender, equality, and non-discrimination; human rights; transparency; and intersectoral work— the National Health Plan 2016–2020 guides the methodology used by the Ministry of Health to have an impact on the determinants of health in the Costa Rican population through different programs and projects.

The system is based on primary health care and is supported by a solid normative, organizational, institutional, and resource distribution framework (including

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.

Country COVID-19 Perspective

and economic resources), which allows the Ministry to carry out intersectoral health projects in any part of the country, addressing the determinants of health. The Ministry implements policies, programs, and projects focused on individuals and communities, with the aim of expanding equitable access to health.

Challenges related to population health

The Ministry of Health is addressing the following challenges:

Achieve universal health coverage, emphasizing interculturality.
Improve accessibility, quality, and equity in health care by establishing systems for continuous measurement of access barriers to health services.
Strengthen the Ministry's own leadership and governance through the development of systems for continuous monitoring and evaluation of the health model, based on the national monitoring framework for universal access to health, and generate the necessary social participation mechanisms for different social groups to take part in health-related decision making.
Assess priorities in primary health care.
Increase efficient use of resources and financial sustainability, and verify the existence of alternative sources of financing for health services, as well as methodologies to evaluate the level of financial protection offered by the current health model.
Conduct an assessment of the essential public health functions.
Implement non-traditional care strategies for chronic diseases.
Strengthen prevention of vector-borne diseases through the formation of working groups to address and eliminate local transmission of malaria.

COVID-19 pandemic response

The COVID-19 pandemic has been a priority for the government elected for the four-year period 2018–2022. As part of strengthening its leading role, a technical team for health risk management (reporting to the General Directorate of Health) was created through an executive decree that restructured the organic regulations of the Ministry of Health.

This technical team is the coordinating body for the General Directorate of Health and is responsible for exercising the functions of the Ministry of Health in response to public health emergencies, with a multi-hazard approach and within the corresponding institutional framework. The team is also responsible for preparedness activities, institutional and inter-institutional action, operational management, monitoring and alerts, and information management.

Regional technical teams reporting to the regional director were also created to serve as a formal coordination body at the regional level. These teams address risk management and emergency care according to the potential impact of public health threats and emergencies.

Measures to reduce inequalities in health

With a view to reducing inequalities in health, the following studies have been undertaken.

Study of health accounts, analyzing relevant aspects such as the focus of health expenditure, out-of-pocket spending, and health accounts.
Analysis of public health expenditure on COVID-19 in Costa Rica in 2020. This was the first study to estimate the health care-related expenditure during the COVID-19 pandemic using the methodology of the SHA2011 health accounts system.
Several studies on the determinants of health in the Afro-Costa Rican and indigenous populations.
Update of the methodology used to analyze the health situation, complementing the action plans and considering the social, economic, cultural, and family contexts, among other determinants.
Evaluation of the essential public health functions in order to ensure inter-institutional and intersectoral work on the gaps in each function, make progress in addressing inequalities, and contribute to universal health, with a rights- and people-centered approach.

National strategy to address inequalities in health

The Institutional Strategic Plan 2016–2020 of the Ministry of Health contains the objectives of the strategy to address inequalities in health:

Consolidate the right to health through the principles of equity, quality, opportunity, and social participation.
Formulate, implement, and monitor projects that contribute to the achievement of institutional objectives by addressing the determinants of health and through social participation.
Strengthen adherence to healthy lifestyles through the participation of institutions, social actors, and the population, with a view to improving the general state of health.
Implement strategies for negotiation and consultation with institutions, social actors, and the general population in order to create conditions that favor healthy practices.
Develop short-, medium-, and long-term strategic and operational plans based on results-based management in order to efficiently and effectively achieve the essential public health functions.
Promote a quality-based institutional culture through the deployment of a quality management system that allows continuous improvement of processes and activities at the three levels of management (central, regional, and local).
Strengthen human resources for health, as well as health expenditure and health financing, through a situation analysis that informs decision making.
Reduce the technological, institutional, and extra-institutional gap by promoting information and communication technologies to develop stewardship in health.
Strengthen the registry and control of health-related products in order to guarantee their safety, efficacy, and quality through the enforcement of current regulations.
Ensure that financial resources are allocated in accordance with strategic and operational planning.