Guatemala

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 Guatemala was 11 735 894 inhabitants; by 2023 this figure had risen to 18 092 026, representing a 54.2% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 4.9% of the total population, an increase of 1.1 percentage points compared to the year 2000. In 2023, there were 102.1 women per 100 men and 15.5 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 63.2% of the total population of the country in 2023 (11 435 853 people). When we add these figures to the potentially passive population (5 763 500 under 15 years of age and 892 674 over 65 years of age), the result is a dependency ratio of 58.2 potentially passive people per 100 potentially active people. This ratio was 90.2 in 2000.

Life expectancy at birth in 2023 was 70.2 years, lower than the average for the Region of the Americas and 2.7 years higher that in 2000.

Figure 1. Population pyramids of Guatemala, years 2000 and 2023

Between 2002 and 2019, the average number of years of schooling in Guatemala increased by 47.6%, reaching an average of 5.7 years in the latest year for which information is available. The unemployment rate in 2022 was 2.6%. Disaggregated by sex, the rate was 3.4% for women and 2.2% for men. The literacy rate was 95.8% in 2021. In men, this figure was 95.4%; in women, 96.2%. In addition, 59.3% of the population were below the national poverty line in 2014, a decrease from 56.0% in 2000. In 2014, 8.8% 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 below the regional average of 3%.

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 14.0% (from a score of 0.55 to a score of 0.627); 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 2.48% of gross domestic product (GDP) (Figure 3) and 15.86% of total public expenditure, while out-of-pocket spending on health accounted for 56.29% of total health expenditure.

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

Digital coverage

In 2021, 50.8% of the population had an internet connection, representing a considerable increase from 2000, when 0.7% of the population had an internet connection.

Health situation

Maternal and child health

Between 2002 and 2019, infant mortality in Guatemala decreased from 38.8 to 19.9 deaths per 1000 live births, a decrease of 48.7% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 12.0% to 10.0% between 2002 and 2020, while exclusive breastfeeding in the child population up to 6 months of age was 39.2% in 1998 and 53.2% in 2015 (latest available data). 

Regarding the immunization strategy, measles vaccination coverage was 83% in 2022, a decrease of 3 percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 95.5 deaths per 100 000 live births, a reduction of 37.1% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 2.3 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 42.9% decrease, from 109.2 live births per 1000 women aged 15 to 19 years in 2000 to 62.4 in 2023. In 2020, 96.0% of births were attended by skilled birth personnel. In 2014, the only year for which there are data, the percentage of pregnant people who had four or more consultations for antenatal care decreased was 86%.

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 Guatemala. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.3 (1.5 in women and 3.3 in men).

In 2020, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 5.1 per 100 000 population. The age-adjusted mortality rate for HIV was 9.2 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 45.7%.

There were no reported cases of human rabies in the country in 2020.

Noncommunicable diseases and risk factors

In Guatemala in 2023, the prevalence of tobacco use among people aged 15 and older was 10.4%. In the same age group, the prevalence of overweight and obesity was 55.9% in 2016.

Also in 2016, 74.2% 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 21.2%, a decrease of 1.5 percentage points compared to 2000 (22.7%). The prevalence of diabetes mellitus, which stood at 7.4% in 2000, increased to 9.7% in 2014.

Mortality

In 2019, the adjusted rate of potentially preventable premature mortality in Guatemala was 348 deaths per 100 000 population, a decrease of 16.6% compared to the rate of 417.4 in 2000. This meant that, in 2019, the rate in the country was 53.5% higher 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 202.5 per 100 000 population in 2019, which is 47.7% higher than the regional average rate; and the rate for treatable causes was 145.4 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 7.4 per 1000 population in 2019, a decrease of 25.1% compared to 2000 (9.9 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 144.5 per 100 000 population (161.5 per 100 000 in men and 129.7 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 497.6 per 100 000 population (559.9 per 100 000 in men and 445.7 per 100 000 in women). The rate of age-adjusted mortality from external causes was 98.3 per 100 000 population (166.7 per 100 000 in men and 36.6 per 100 000 in women), including road traffic accidents (26.5 per 100 000 population), homicides (27 per 100 000 population) and suicides (6.2 per 100 000 population). In 2000, the percentage distribution of causes was 44.6% for noncommunicable diseases, 42.8% for communicable diseases, and 12.6% for external causes; in 2019, the percentages were 22.3%, 61.6%, and 16.1%, respectively (Figure 6).

Figure 6. Proportional mortality in Guatemala, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 17 per 100 000 men; lung cancer, 4.4 per 100 000; and colorectal cancer, 4.2 per 100 000. In women, these values were 8 deaths per 100 000 for breast cancer; 2.8 per 100 000 for lung cancer; and 4 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In Guatemala in 2020, there were a total of 138 012 cases of COVID-19, representing 7839.4 per million population. In 2021, there were 489 550.2 identified cases, equivalent to 27 807.4 per million population. In 2020, there were 4813 deaths directly caused by COVID-19 in people diagnosed with the disease, or 273.54 per million population; in 2021, 11 293 deaths were reported, or 641.5 per million. In 2020, Guatemala ranked 22nd in the Region of the Americas in terms of the number of deaths from COVID-19, and 39th in 2021, with a cumulative 914.7 deaths per million population over the two years (Figure 7). 

According to estimates by the World Health Organization,  there were a total of 8750 excess deaths in 2020, or 50.4 per 100 000 population. A total of 40 647 deaths were estimated in 2021, for an excess mortality rate of 230.8 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 45.1% of the country's population. As of 2 July 2022 (latest available data), 35% 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 Ministry of Public Health and Social Assistance (MSPAS) of Guatemala defines the National Strategy for Integrated Health Services Networks  as a strategy for universal access to health and universal health coverage in the country. It has also finalized ministerial agreements to form executive, technical, and operational commissions to implement the strategy.

At present, the country has implemented a care and management model based on primary health care, which is the specific objective of the Integrated Health Services Networks. It includes a gender and intercultural approach and prioritizes areas of health that enjoy the support of international cooperation.

Challenges related to population health

One of the main challenges facing Guatemala’s public policies is to restore essential programs that may have been neglected due to the emergency situation caused by the COVID-19 pandemic. To this end, efforts have been intensified with respect to priority programs, response capacity at the first level of care, primary health care, and combating malnutrition.

COVID-19 pandemic response

The pandemic response plan includes measures to incorporate the country in the Pandemic influenza preparedness framework for the sharing of influenza viruses and access to vaccines and other benefits (also known as the Pandemic Influenza Preparedness Framework, or PIP Framework) for 2022-2023. This initiative is an effort to improve laboratory and surveillance capacity; estimate the burden of influenza on an annual basis; use various tools to strengthen risk communication and community participation; and evaluate, review, and update pandemic preparedness and response plans. Currently, these activities are being carried out under the leadership of the Department of Epidemiology and the National Health Laboratory. By their nature they are intersectoral, and their implementation involves various agencies, including the sentinel surveillance centers for severe acute respiratory infections and influenza-type diseases, and the network of decentralized laboratories.

Guatemala has been part of the COVID-19 Genomic Surveillance Regional Network of the Pan American Health Organization  since 2020, which has allowed it to access training on SARS-CoV-2 genomic sequencing, send samples to other collaborating centers, and access the necessary laboratory supplies. The country procured equipment and reagents for local sequencing and, together with the National Health Laboratory, developed a plan to expand technical capacities, improve data analysis, and ensure that the processes are sustainable, in order to increase the number of pathogens that can be sequenced in the country.

Lastly, the country participates actively in the Severe Acute Respiratory Infections Network (also known as SARInet).  The enhanced capacities developed as a result of this participation have made it possible for Guatemala to conduct studies on the effectiveness of COVID-19 vaccines, as part of the protocol for the Evaluation of Vaccine Effectiveness in Latin America and the Caribbean (REVELAC-i protocol).  The purpose of these initiatives is to provide the country with the necessary skills and capacities to conduct studies of this type on a regular basis.

Measures to reduce inequalities in health

The country's public authorities assumed a commitment to address health inequalities, as set forth in the 2030 Agenda for Sustainable Development.  To this end, during 2016 and 2017, with the support of the United Nations System and the leadership of the National Council for Urban and Rural Development (CONADUR), an exercise was conducted to link the 2030 Agenda with the K'atun National Development Plan: Our Guatemala 2032,  in an effort to meet the of sustainable development objectives and goals for the country. The Secretariat of Planning and Programming, of the Office of the President, has estimated that the objectives of the two instruments (the 2030 Agenda and the National Development Plan) are 90% aligned.

National strategy to address inequalities in health

In the exercise conducted with CONADUR between 2016 and 2019, effective development interventions were identified for inclusion in government planning and budgeting processes. 

Information on the country's participation in the voluntary review, proposed in the 2030 Agenda  , highlights 10 priority goals for the health sector (six strategic goals and four concerning implementation); as well as 20 indicators for increasing life expectancy at birth, reducing maternal and infant mortality, reducing, preventing, and treating diseases, and guaranteeing long-term coverage of health and welfare services.

At the same time, the Institutional Strategic Plan 2018–2032  presents the strategic results achieved to date, with their chain of results, strategic actions, and outcomes for maternal and infant mortality in priority territories; control of sexually transmitted infections and HIV/AIDS; elimination of malaria; reduction in mortality and incidence of tuberculosis; and reduction in morbidity and mortality from arboviruses. This plan had to be aligned with implementation of the Great National Crusade for Nutrition  and the COVID-19 pandemic strategy, as reflected in the operational plans of the Ministry of Public Health and Social Assistance (MSPAS) and of the General Directorate of the Integral Health Care System (DGSIAS), which is responsible for implementing the primary health care and management model.

Lastly, the DGSIAS operational plan for 2022 is aligned with the General Government Policy 2020–2024, particularly in the social development area, which establishes as a priority “combating poverty, strengthening social protection for the most vulnerable, and access to education, health services, and decent housing.” 

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.