Trinidad and Tobago
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 Trinidad and Tobago was 1 332 203 inhabitants; by 2021 this figure had risen to 1 525 663, representing a 14,5% increase. Regarding the country’s demographic profile, in 2020 people over 65 years of age accounted for 11,1% of the total population, an increase of 5,8 percentage points compared to the year 2000. In 2021, there were 102,7 women per 100 men and 57,5 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 69,6% of the total population of the country in 2021 (1 061 862 people). When these figures are added to the potentially passive population (294 444 under 15 years of age and 169 358 over 65 years of age), the result is a dependency ratio of 47,3 potentially passive people per 100 potentially active people. This ratio was 45,2 in 2000.
Life expectancy at birth was 73.8 years in 2021—lower than the average for the Region of the Americas and 6.3 years higher than in 2000.
Figure 1. Population pyramids, years 2000 and 2021
Between 2008 and 2011, the average number of years of schooling in Trinidad and Tobago increased by 3,3%, reaching an average of 10,6 years in the latest year for which information is available. The unemployment rate in 2021 was 4,8% for the total population. Disaggregated by sex, the rate was 4,9% for women and 4,8% for men. The literacy rate was 98,5.7% in 2010 (97,9% for men and 99.1% for women).
During the period 2000–2021, the country improved its score on the Human Development Index, with an increase of 13,8% from a score of 0.712 to a score of 0.810; during the same period, the index rose 15% internationally and 11% in Latin America (Figure 2).
Figure 2. Human Development Index in the Region of the Americas, 2021
In 2019, public expenditure on health accounted for 3,2% of gross domestic product (GDP) (Figure 3) and 10,2% of total public expenditure, while out-of-pocket spending on health accounted for 46,9% of total health expenditure.
Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2019
In 2017, 70,6% of people in Trinidad and Tobago had an Internet connection, representing a considerable increase from 2000, when 7,7% of the population had an Internet connection.
Maternal and child health
Infant and under-five mortality continues on a path of remarkable reduction, and immunization coverage in childhood is adequate, and it is very important that it does not fall in order to avoid the reappearance of preventable diseases. The levels of maternal mortality and adolescent fertility show a downward trend; in addition, the coverage of institutional deliveries and prenatal checkups is adequate. The central management level of maternal and perinatal health implemented the SIP+ system as a computerized support for surveillance and monitoring of results.
For the past two years, Trinidad and Tobago has met both the global and regional targets for maternal deaths. During the period 2017–2020, there was a substantial reduction in maternal deaths in the country from nine in 2015 to three in 2018 and two in 2020, of which one was in the private sector. This represents a fall in the maternal mortality ratio from 50–60 per 100 000 live births in 2015 to under 30 per 100 000 live births in 2018 (18.1); 2019 (32.1), and 2020 (26.7).
The recommended worldwide target for 2030 (Sustainable Developmental Goals) is 70 per 100 000 live births. However, the Pan American Health Organization (PAHO) has set for the Region of the Americas a rate of 30 per 100 000 live births.
Trinidad and Tobago has achieved these benchmarks over 12 years before the 2030 deadline and has strengthened the systems and resources to ensure that these gains are not reversed.
Furthermore, Trinidad and Tobago has achieved both regional and global 2030 targets with respect to the neonatal mortality rate. The reduction in neonatal mortality from 12.0 per 1000 live births in 2015 to under 9.0 per 1000 live births in 2017 to under 8 per 1000 live births in 2018 (7.9), 2019 (7.4), and 2020 (6.7). Therefore, Trinidad and Tobago has already achieved both the 2030 global neonatal mortality target set at less than 9 per 1000 live births and 7 for the PAHO Region.
Between 2000 and 2019, infant mortality in Trinidad and Tobago decreased from 21.1 to 11.5 deaths per 1000 live births, a decrease of 45.5%. The percentage of low-weight births (less than 2500 g) increased from 10.2% to 11% between 1998 and 2017, while exclusive breastfeeding in the child population up to 6 months of age was 21.5% in 2011, compare with 2.3% in 2000.
Regarding the immunization strategy, measles vaccination coverage was 99% in 2019, an increase of 9 percentage points over 2000.
The maternal mortality ratio for 2017 was estimated at 67 deaths per 100 000 live births, a reduction of 17.3% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that women have an average of 1.7 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 33.8% decrease, from 42 live births per 1000 women aged 15 to 19 years in 2000 to 27.8 in 2021. Between 2012 and 2017 the percentage of pregnant people who received antenatal care remained unchanged at 100%. In 2017, 100% of births were attended by skilled birth personnel.
Figure 4. Maternal mortality per 100 000 live births in Trinidad and Tobago, 2000–2017
With respect to communicable diseases, it will be important to continue to reduce mortality due to human immunodeficiency virus (HIV) and to reduce the incidence of tuberculosis, for which policies to promote access to medicines and strengthen the primary healthcare strategy are necessary.
In 2020, there were 16 new cases of tuberculosis per 100 000 population in Trinidad and Tobago. In the same year, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 1,2 (0,2 in women and 2,2 in men).
In 2018, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 38,1 per 100 000 population. The age-adjusted mortality rate for HIV was 12,3 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 65,1%.
Noncommunicable diseases and risk factors
Chronic health problems, particularly diabetes, will continue to generate a substantial burden of disease on the population. Mention should also be made of a slight increase in the prevalence of arterial hypertension in recent years. Interventions to promote healthy habits and higher levels of physical activity could be two of the pillars of the response to these problems. The HEARTS program for the management of cardiovascular risk factors, promoted by the World Health Organization (WHO), started in the country in 2019 and has since increased the scale of implementation to the present day.
In Trinidad and Tobago the prevalence of overweight and obesity was 46% in 2016.
Also in 2016, 76,4% 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 25,8%, an increase of 2,6 percentage points compared to 2000 (23,2%). The prevalence of diabetes mellitus, which stood at 7,1% in 2000, increased to 11,7% in 2014.
In 2019, the adjusted rate of potentially avoidable premature mortality in Trinidad and Tobago was 287,2 deaths per 100 000 population, a decrease of 39,3% from a rate of 473,3 in 2000. Among potentially avoidable premature mortality, the rate for preventable causes was 153,9 per 100 000 population in 2019, which is 12.3% higher than the regional average rate; and the rate for treatable causes was 133,3 per 100 000 population, above the regional average of 89.6. The overall age-adjusted mortality rate was 5,5 per 1000 population in 2019, a decrease of 38,6% compared to 2000 (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 48,1 per 100 000 population (52,8 per 100 000 in men and 44,2 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 437,1 per 100 000 population (545,5 per 100 000 in men and 351,4 per 100 000 in women). The rate of age-adjusted mortality from external causes was 68,5 per 100 000 population (116,6 per 100 000 in men and 21,1 per 100 000 in women), including road traffic accidents (9,1 per 100 000 population), homicides (39,1 per 100 000 population), and suicides (8,3 per 100 000 population). In 2000, the percentage distribution of causes was 79,3% for noncommunicable diseases, 12,8% for communicable diseases, and 7,9% for external causes; in 2019, the percentages were 82,7%, 7%, and 10,4%, respectively (Figure 5).
Figure 5. Proportional mortality in Trinidad and Tobago, 2000 and 2019
Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 43,7 per 100 000 men; lung cancer, 24,4 per 100 000; and colorectal cancer, 12,5 per 100 000. In women, these values were 27,4 deaths per 100 000 for breast cancer, 7 per 100 000 for lung cancer, and 9,2 per 100 000 for colorectal cancer.
The health situation and the COVID-19 pandemic
In 2020, Trinidad and Tobago ranked 35th in the Region of the Americas in terms of the number of deaths from COVID-19, and 5th in 2021, with a cumulative 2850 deaths per million population over the two years (Figure 6).
According to estimates by the World Health Organization, there was a total of 92 excess deaths in 2020, or 6 per 100 000 population; a total of 1941 deaths were estimated in 2021, for an excess mortality rate of 127,2 per 100 000.
As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 53.4% of the country's population. As of 2 July 2022 (latest available data), 51% 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 6. Cumulative COVID-19 deaths in the Region of the Americas, to 31 December 2022
In relation to the response to the COVID-19 pandemic, it is still necessary to advance with the coverage of the initial immunization scheme, aiming to protect the entire population The main functions of four hospitals (Couva, Caura, Arima General, and Fortin) were reoriented to respond to the volume of critically ill patients. In addition to vaccination, hygiene, and distancing measures, the authorities have emphasized the promotion of mental health, self-care, and stress-coping skills, while stressing a message of social responsibility and the fight against stigmatization and discrimination.
Measures to achieve universal health coverage
In 2016 the Government of the Republic of Trinidad and Tobago detailed the country’s ongoing development agenda. The document, known as Vision 2030, established the development priorities until 2030, closely aligned to the global Sustainable Development Goals. These priorities recognized population aging as a national challenge and set a number of healthcare goals against a vision where quality health care is available to all – an adoption of the global move toward universal health coverage. Key goals related to improving health and health care can be grouped into three broad themes. First, and closely linked to provision of universal health coverage, is the further development of social protections for poverty alleviation among vulnerable and socially marginalized groups, and also with a focus on children, persons with disabilities, and the needs of the increasing numbers of older adults. The second goal is a focus on health system accessibility and quality of car, through modernization, sustainable healthcare financing, and performance management. A third goal is empowering people to live healthy lives with a focus on preventive health care. On the back of this development agenda, the Government of the Republic of Trinidad and Tobago produced a strategy for the prevention and control of noncommunicable diseases. The strategy embraced universal health coverage, evidence-based decision-making, and multisectoral action, and had a focus on health promotion and prevention-focused integrated care. Five-year targets included improving the profiles of key health behaviors (reducing salt, alcohol, and tobacco use, and encouraging physical activity), improving noncommunicable disease management using the comprehensive care model to reduce adverse outcomes, increasing disease surveillance, and developing a health-in-all-policies framework across government.
Challenges related to population health
Trinidad and Tobago is aging and the pace of this aging is predicted to increase by 26.2% by 2060. In 1980, the proportion of Trinidad and Tobago’s population aged 65 and older was 5.4%. This proportion increased to an estimated 11.5% by 2020, and is predicted to more than double to 26.2% by 2060. This future increase of 14.7 percentage points represents a rapid rise in older adults, and is above the regional averages for the Caribbean of 10.7 percentage points, and for the Americas of 13.7 percentage points. The disease burden is dominated by noncommunicable diseases. Cardiovascular diseases, diabetes, and cancers in 2019 were the top three causes of death and disability, collectively accounting for almost half of all healthy life lost. The burden of mental disorders, self-harm, and violence has increased, collectively accounting for 10% of all healthy life lost in 2019. Solutions to each of these challenges require multisectoral cooperation.
COVID-19 pandemic response
Regional and global external pressures are recognized as a major risk to the ongoing healthcare improvements. Vision 2030 places the environment, including resilience in the face of climate change, at the center of future development. The financial crisis of 2009 and the COVID-19 pandemic in 2020–2021 are two examples of external pressures and have tested the agility of the healthcare system. They have adversely affected economic stability across the Small Island Developing States of the Caribbean. By May 2022, in the 24 months since the arrival of COVID-19 in Trinidad and Tobago, there had been 3916 coronavirus-related deaths. The deaths have broadly tracked the case burden, with 25% of all deaths occurring between April and July 2021 (the second national outbreak) and 53% since November 2021 (the third national outbreak). A major ongoing COVID-19 policy is the further scale-up and implementation of the vaccination program in cooperation with regional and international partners.