Inter-American Social Protection Observatory Life expectancy and health: current social security determinants

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2 Inter-American Social Protection Observatory 2016 Life expectancy and health: current social security determinants Introduction Signed during the mid-20 th century, the Universal Declaration of Human Rights and the International Labour Organization s Convention Nº 102 on Social Security 1 mandated that society provide social security in order to ensure that individuals and households have access to medical care, and minimum social-protection floors especially vis-à-vis old age, unemployment, illness, disability, workplace accidents, maternity or the loss of the family breadwinner. ILO Convention Nº 102 establishes that social security right holders have a right to the following: 1. Medical care 2. In-cash, illness benefits 3. Unemployment benefits 4. Old age benefits 5. Employment injury 6. Family benefits 7. Maternity benefits 8. Disability benefits 9. Survivor benefits With the exception of unemployment benefits, all of the coverage is addressed the biological needs of the human being, which represent the economic and social vulnerabilities that individuals face given the reduction in their capacity to generate income or maintain subsistence levels due to the loss of their ability to remain productive. As a result, the Inter-American Social Protection Observatory 2016 (ISPO 2016) has focused its analysis on the functional capacity of individuals and the life expectancy rate, factors which are directly related to health, which is defined by the World Health Organization as the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The ISPO 2016 analysis is presented on the basis of hemisphere, sub region and nation. The Observatory is also comprised of database indicators which are disaggregated by age group, gender, risk-factor prevalence and cause of death in 1 Article 22 of the Universal Declaration of Human Rights states that Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-oation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his sonality. ILO Convention 102; Convention concerning Minimum Standards of Social Security (adopted in 1952, entered into force in 1955). 2

3 accordance with the mandate issued at the IV Extraordinary General Assembly of the Inter-American Conference on Social Security held in São Paulo, Brazil. Whereas social security is mandated in all of the CISS member-states, each national social security sector involves differences in terms of coverage, organizational structures and organizational maturity in terms of service delivery which are the result of a variety of national economic, social and political factors. While sorting data by sub region provides an opportunity to further analyze these factors, as well as identify major trends within the sector, it does not constitute a satisfactory substitute for country-by-country analysis. Analyzing life expectancy and health as social-security determinants involved the entire population of the nations in question which, under optimal conditions, possessed some type of social security coverage. The ISPO 2016 included Mexico within the Central America sub region whereas it s demographic and epidemiological characteristics, as well as the type of preventable risk factors by sex and by age, are more in line with populations within this region than with North America. This strategy was also employed during the research and studies carried out on the burden of disease and risk factors. The CISS region is comprised of 37 nations within the Americas which are grouped into six Sub regions. When broken down by sub region, 39.6 Hemisphere s population is in North America, 30% in the Southern Cone, 18% in Central America, 11.7% in the Andean sub region and 0.1% in the Caribbean. It should be noted that 82 population within the Americas is limited to six nations: the US, Brazil, Mexico, Colombia, Argentina and Canada. The remaining 18 population is distributed throughout the remaining 31 nations. Another important factor is the CISS region s life expectancy, which is the highest in the world at 77 years. The Americas are followed by Europe and the Western Pacific at 76 years. According to the World Health Organization, Africa possesses the lowest life expectancy in the world, which currently averages 58 years. With the exception of Haiti and Bolivia, which average 63 and 68 years respectively, life expectancy rates within the Americas are on par with those of medium-high and high income nations. This indicator may be reasonably interpreted as the result of the social protection and social security policies carried out within the Hemisphere. However, the improvements in life expectancy rates have also produced new challenges for social security systems. 3

4 Map 1 Socioeconomic indicators by CISS region and sub region Source: Inter-American Social Protection Observatory, as well as data from World Bank, World Health Organization and Human Development Index. The life course and social security An individual s life is determined by biological conditions and the impact upon same by their respective economic, political, social and cultural environments. As a result, the life trajectory is comprised of a variety of independent spheres or domains (schooling, training, employment, reproduction, labor mobility and retirement) in which social security plays an important role in terms of an individual s ability to enjoy living conditions which tend towards optimal development (Elder and Shanahan, 2006). Apart from any institutional inputs, social security currently involves two determinants: population s life expectancy and the functional capacity of an individual s body, in terms of their biological characteristics. 4

5 Figure 1 Life course in social security Source: Inter-American Social Protection Observatory a) Life expectancy Life expectancy at birth Life expectancy is a synthesized indicator which is directly related to factors such as income, healthcare services, labor categories, social security coverage. It demonstrates the current gap between individuals in terms of gender, economic strata, nationality and quality-of-life levels. Life expectancy is not a static concept. It has evolved throughout human history primarily upon the basis of improvements in the health of individuals and reductions in the overall death rate. During the Middle Ages, the Life Expectancy was 35 years. By the 18 th century, it had risen to 40. Thanks to advances such as penicillin, vaccination and improvements in living conditions during the second half of the 20 th century, it rose to between 50 and 65 years. This iod of history also saw the evolution of social security measures which established coverage and benefits criteria based on the life expectancy rates of the time. However, as of 2010, the international life expectancy rate is currently averaging 71 years. In fact, in nations such as Japan, it has reached 83 years. 5

6 The current life expectancy at birth (LEB) rates throughout the CISS region demonstrate significant differences between its respective sub regions. The LEB for North America is 79.3 years, while in the Andean sub region it is The Southern Cone averages 75.4, Central America 74.7, and the Caribbean 72.2 years. Figure 2 Life expectancy at birth North America Andean Southern Subregion Cone Central America Caribbean Source: Inter-American Social Protection Observatory, as well as 2015 data from the World Health Organization Healthy Life Expectancy Due to the importance of accurate quality-of-life measurements for healthcare and social security systems, especially in terms of the over-60 population and its increasing relevance vis-à-vis higher life expectancy rates, a healthy life expectancy indicator was created. The health adjusted life expectancy indicator, or HALE, measures a population s health by taking into account mortality and morbidity. It adjusts overall life expectancy by the amount of time lived in less than fect health. An individual s quality of life level drops significantly in correlation to the years of healthy life lost due to illness, disability or premature death. The current international average of years of healthy life lost is nine years, while within the Americas it is 10 years. However, in relative terms, the indicator very least throughout the Hemisphere. The Caribbean currently has the highest centage of healthy life lost, at 15.8% of LEB. The Andean sub region averages 13.4%, while the remaining three sub regions vary between 12 and 12.6%. 6

7 Table 1 Healthy life expectancy Sub region Life expectancy at birth Healthy life expectancy Percentage of years lost due to illness, disability or premature death North America Andean sub region Southern Cone Central America Caribbean Source: Inter-American Social Protection Observatory, as well as 2015 data from the World Health Organization. Population aging Population aging within the Americas is an important factor in terms of social security and the sustainability of its economies in the coming decades. The average median age within the Hemisphere is currently 32 years. However, 40 nations which comprise the CISS region currently possess a median age which is above 32 years, which only serves to underline the speed with which their respective populations are aging. Additionally, whereas developed nations underwent population aging over a iod of between 100 and 150 years, the developing world is undergoing this demographic shift four times faster; a factor which severely impedes a nation s ability to employ mechanisms designed to cushion this impact, as well as provide the economic subsidies required to meet increases in demand. Figure 3 Median age, by nation

8 Source: Inter-American Social Protection Observatory, as well as 2015 data from the World Health Organization. Within the Americas, 10 nations are already well within the parameters of what is termed advanced or highly-advanced population aging. Incipient aging 1. Belize 2. Bolivia 3. Guatemala 4. Haiti 5. Honduras 6. Nicaragua 7. Paraguay Moderate aging 1. Colombia 2. Ecuador 3. El Salvador 4. Jamaica 5. Panama 6. Peru 7. Dominican Republic 8. Venezuela Low Aging index High Birth rate Table 2 Stages of population aging Moderately advanced aging 1. Bahamas 2. Brazil 3. Costa Rica 4. Mexico 5. St. Lucia 8 Advanced aging 1. Argentina 2. Chile 3. Guadalupe 4. Trinidad and Tobago 5. Uruguay Highly-advanced aging 1. Barbados 2. Cuba 3. Puerto Rico 4. US 5. Canada Very low Aging index Medium Aging index High Aging index Very high Aging index Very high Medium Low Very low Birth rate Birth rate Birth rate Birth rate Ageing index: Calculated as sons 60 years old over hundred sons under age 15. Population aging stage: calculated by combining aging index index and global rate Source: Inter- American Social Protection Observatory, in addition to data from El envejecimiento y las sonas de edad: Indicadores para América Latina y el Caribe (CEPAL, 2011). When analyzed by sub region, North America has a median age of 37.3 years, the Southern Cone 30.3 years, the Caribbean 29.6 years, the Andean sub region 26.8 years, and Central America 25.9 years. Life expectancy at 60 Increasing life expectancy combined with drops in the birth rate and rapidly aging populations, has become a major challenge to measures designed to ensure sustainable social security and social protection in the coming years. In addition to being a patently biological indicator, population aging is extremely relevant in terms of sociodemographic, economic, political, cultural and subjective issues. Each of these factor types complicate attempts to analyze population aging and demonstrate the multifaceted nature of the issue itself. Within the Americas, the population aged 60 and over will increase from 133 million in 2013 to 285 million in This is to say, this age group will increase from 14.1 total population, as a 2013, to over 25 Americas by the year The current life expectancy at 60 within the hemisphere is 23.5 years; i.e., individuals have a high possibility of living to 83 years of age or beyond. However, it is highly probable that these individuals will live out their last 10 years battling

9 age-related disabilities or chronic degenerative diseases brought on by unhealthy lifestyles or age. Figure 4 Life expectancy at 60 Caribbean North America Andean subregion Central America Southern Cone Source: Inter-American Social Protection Observatory, as well as 2015 data from the World Health Organization. On average, life expectancy at 60 rates throughout the Americas vary little despite differences in terms of development. This dynamic represents a major challenge for the Hemisphere s less developed economies. b) Functional capacity of the body and preventable risk factors The biological nature of humans makes them vulnerable throughout the entire lifecycle, from birth to old age. All societies are comprised of communities, groups of individuals, families or individuals who possess higher possibilities of facing disease, accidents and premature death. In terms of reducing the vulnerability of the aforementioned groups and individuals, social security has played an important role in reducing risk levels. Biological, environmental (physical or psychosocial) and economic risk factors have undergone paradigm shifts throughout history. In recent history, noncommunicable diseases and their concomitant risk factors have become increasingly relevant given their magnitude, as well as the impact they have on individual quality-of-life levels and the overall sustainability of social security systems within the medium term. Among high income nations, non-communicable diseases caused 83.2% of deaths, while injuries cost 9.2% and communicable disease 7.2%. 9

10 Within the Americas, causes of death follow along the same trajectories as upmiddle income nations. Non-communicable disease accounting for 78.3% of deaths, followed by injuries at 11.1%, and communicable disease at 10.6%. Although communicable disease plays a fairly significant role in the Andean sub region (17.1%), Southern Cone (13.0%) and Central America (12.7%), these diseases possess a high correlation to national development levels. Additionally, nations within the Andean sub region and Central America at the highest levels of death due to injury (intentional and non-intentional). Figure 5 categorized by disease type, (%) North america 81.2 Caribbean Southern Cone Central America Andean sub region Non-communicable disease (%) Communicable disease (%) Injuries (%) Source: Inter-American Social Protection Observatory, as well as 2015 data from the World Health Organization. Impact of health on social security systems Health is a fundamental resource which mits individuals to live productively in terms of their sonal, social and economic lives. Healthcare coverage a pillar of social security which requires ever-increasing outlays of human and economic resources within public health systems, primarily due to increases in life expectancy and shifts in the epidemiological paradigm. The difference in life expectancy rates of men and women is an important factor for social security. While the life expectancy of men is currently 74 years, women currently possess a rate of 80 years. This difference of five years exacerbates the fact that women comprise the more vulnerable population due to lower labor market participation rates and/or higher dependency levels. 10

11 The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Within the Americas, this indicator has undergone two major shifts during the last two decades. Years of life lost due to premature death have decreased substantially, even as years of life lost due to disability have increased significantly. This dynamic has resulted in lower early-death rates and increases in the demand for medical care and health care coverage. Table 3 Years of healthy life lost, 2010 versus 1999 Years of healthy life lost (YLLs) Years living with disability (YLDs) Increase within CISS, Increase within North America, Increase within Central America, Increase within the Caribbean, Increase within the Andean sub region, Increase within the Southern Cone, % 7.77% -4.77% 1.69% % 7.63% 54.56% 57.39% 61.95% 54.94% 32.48% 47.90% Years of life lost due to premature mortality -7.44% -1.55% % -6.43% % 0.08% Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). Impact of non-communicable disease on social security Historically, high-income nations were the logical primary targets of noncommunicable disease. However, middle-income nations such as those which comprise the majority of the Americas now report non-communicable disease as the leading cause of death and disability due to the economic growth, epidemiological shifts and population aging which they have undergone, in addition to improvements made to their respective public health and medical care systems. By the year 2050, it is expected that the burden of non-communicable disease will increase especially rapidly due to the growth of older adult populations. The majority of non-communicable diseases are chronic in nature. In consequence, they require costly treatment regimens and prolonged individual medical care by increasingly specialized healthcare professionals. This has a direct impact on national income, economic development and growth, and individual quality-of-life levels due to drops in productivity, long-term disability and increased public outlays on healthcare and social security. Social security systems are facing considerable increases in costs and in terms of service delivery primarily due to three non-communicable diseases: cardiovascular disease, cancer and diabetes. Due to the magnitude involved, these diseases are considered epidemics. Given the high cost of treating these individuals and the 11

12 impact they have on individual quality of life levels, they merit special attention within society. It is important to note that aging, in and of itself, is not a direct cause of these diseases. However, as an individual ages they are less able to combat their onset. A small proportion of individuals suffering from these diseases do so because of a genetic predisposition for same during their life cycle. But the majority develop these conditions due to unhealthy lifestyle decision-making. such as high blood pressure, overweight and obesity, and high blood glucose levels are both controllable and avoidable. An individual s ability to counteract them will significantly reduce their probability of developing any or all of these three conditions within the middle term. Cardiovascular disease is the leading cause of death involving preventable risk factors. The Caribbean currently leads the Americas in terms of this noncommunicable disease. Figure 6 Cardiovascular disease, by sub region and age group (Prevalence rate deaths in 2013) to 14 years 15 to 49 years 50 to 69 years 70 and over CISS Subregión América del Norte Central America Caribbean Andean sub region Southern Cone Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). Table 4 Cardiovascular disease, by sub region and age group 12

13 (Prevalence rate deaths in 2013) Age group CISS North America Central America Caribbean Andean sub region Southern Cone 5 to years 15 to years 50 to years 70 and over 2, , , , , ,273.5 Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). Cancer is the second-leading cause of death due to preventable risk factors. The Caribbean, North America and the Southern Cone lead the Americas in terms of prevalence. Figure 7 Cancer, by sub region and age group (Prevalence rate deaths in 2013) to 14 years 15 to 49 years 50 to 69 years 70 and over CISS Subregión América del Norte Central America Caribbean Andean sub region Southern Cone Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). Table 5 Cancer, by sub region and age group (Prevalence rate deaths in 2013) Age group CISS North Central Caribbean Andean sub Southern America America region Cone 5 to 14 years

14 15 to 49 years to 69 years and over , , , ,143.6 Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). Diabetes is the third-leading cause of death due to preventable risk factors. Although prevalence rates are fairly similar throughout the Americas, growth rates differ by sub region. Figure 8 Diabetes, by sub region and age group (Prevalence rate deaths in 2013) to 14 years 15 to 49 years 50 to 69 years 70 and over CISS Subregión América del Norte Central America Caribbean Andean sub region Southern Cone Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). Table 6 Diabetes, by sub region and age group (Prevalence rate deaths in 2013) Age group CISS North America Central America Caribbean Andean sub region Southern Cone 5 to 14 years to 49 years to 69 years and over

15 Source: Inter-American Social Protection Observatory, as well as Global Burden of Disease (Institute for Health Metrics and Evaluation, 2015). All things being equal, early diagnosis aimed at conserving the functional capacity of an individual s body and increasing healthy life expectancy may serve to increase the short-term as well as middle-term viability and sustainability of social security systems. Analysis by sub region provides an opportunity to evaluate the general trends which exist among the causes and effects of social security determinants. However, this approach in no way constitutes an adequate substitute for countryby-country analysis, whereas each nation given its unique economic, social, political, cultural and organizational characteristics, as well as its respective development trajectory possesses a unique set of behaviors in terms of the indicators involved. In the section of the Inter-American Social Protection Observatory entitled Preventable risk factors, by gender, age and nation, readers will find a database which provides an opportunity to analyze issues in terms of a specific nation and/or form comparative analyses on the basis of sub region or the Americas as a whole. 15

16 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE REGION CISS 2 Demographic indicators, 2013 Total population 3 931,965 million inhabitants Life expectancy at birth (LEB) 75.2 years Health life expectancy at birth (HLEB) years (9.7 years less than life expectancy at Birth) Median age 30.0 years Life expectancy for over-60 year population 22.2 years Over-60 years population 14.3% (133,234 million inhabitants) Macroeconomic indicators, 2013 Per capita GDP $21, Per capita GDP-PPP outlay on healthcare $2,558.2 Total outlay on healthcare 7.5% Public outlay on healthcare 4.2% Private outlay on healthcare 2.3% Others outlays on healthcare 0.9% Human development indicators, 2013 Human Development Index 0,757 HDI Adjusted for inequality (HDI-I) 0,565 Gini coefficient, (Optimal: below a 39.0), 2012 Communicable diseases 14.1% Non-communicable diseases 74.8% Injuries 11.2% 1. Cardiovascular diseases of death by sex, 2013 total Percentage total Percentage Percentage female 919, , , % 27.8% 34.3% 2.Neoplasms 512, , , % 16.0% 18.4% 3.Diabetes 352, , , % 10.0% 13.9% 4. Diarrhea/LRI/Other 226, , , % 7.1% 8.2% 5. Chronic respiratory diseases 6. Self-harm & intersonal violence 7. Neurological disorders 176,383 98,775 77, % 6.0% 5.8% 172, ,296 21, % 9.1% 1.6% 135,868 67,753 68, % 4.1% 5.1% 8. Transport injuries 120,319 93,940 26, % 5.7% 2.0% 9. Cirrhosis 109,712 77,381 32, % 4.7% 2.4% 10. Unintentional injuries 109,120 70,655 38, % 4.3% 2.9% 11. Digestive diseases 83,642 41,877 41, % 2.5% 3.1% 12. Neonatal disorders 79,001 45,884 33, % 2.8% 2.5% TOTAL 2,995,871 1,651,504 1,344, % 100.0% 100.0% 2 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Only it includes countries members of the CISS. 4 Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 16

17 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,051, ,170, % Years lived with disability (YLD) 18,548,188 28,668, % Years of life lost (YLL) 107,502,977 99,501, % ,193, % Concept Disability adjusted life years (DALY) Grow rate ,384,405 75,744, % Years lived with disability (YLD) 10,529,572 15,411, % Years of life lost (YLL) 65,854,837 60,332, % 2,499,185 2,731, % Concept Disability adjusted life years (DALY) Grow rate ,666,757 52,425, % Years lived with disability (YLD) 8,018,616 13,256, % Years of life lost (YLL) 41,648,140 39,169, % 2,072,668 2,462, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 128,170, % 28,668, % 99,501, % 5,193, % 75,744, % 15,411, % 60,332, % 2,731, % 52,425, % 13,256, % 39,169, % 2,462, % 17

18 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Communicable, maternal, neonatal, and nutritional diseases Others 8.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Communicable, maternal, neonatal, and nutritional diseases Others 8.3 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes

19 Total population Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Neoplasms High fasting plasma glucose Self-harm & intersonal violence Unsafe sex Other non-communicable Child and maternal malnutrition Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Air pollution Neoplasms Unsafe sex Self-harm & intersonal violence High fasting plasma glucose Other non-communicable Child and maternal malnutrition Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Neoplasms Air pollution Unintentional injuries High fasting plasma glucose Other non-communicable Unsafe sex Self-harm & intersonal violence Child and maternal malnutrition Diabetes Others

20 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Transport injuries High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes Unsafe sex Unintentional injuries Smoking HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High systolic blood pressure Cardiovascular diseases High body-mass index Neoplasms Smoking Unintentional injuries High fasting plasma glucose Cirrhosis High total cholesterol Diabetes Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Diabetes Alcohol and drug use Self-harm & intersonal violence Unsafe sex Transport injuries High fasting plasma glucose HIV/AIDS Smoking Diarrheal/LRI/other Others

21 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Transport injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Cirrhosis High fasting plasma glucose Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Chronic respiratory diseases Smoking Diarrheal/LRI/other Low glomerular filtration rate Cirrhosis High total cholesterol Digestive diseases Others

22 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms High fasting plasma glucose Diabetes High body-mass index Chronic respiratory diseases Smoking Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Diabetes High fasting plasma glucose Chronic respiratory diseases High body-mass index Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Air pollution Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Smoking Chronic respiratory diseases High total cholesterol Digestive diseases Others

23 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence Low glomerular filtration rate Neurological disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Diabetes High fasting plasma glucose Self-harm & intersonal violence High body-mass index Diarrheal/LRI/other Alcohol and drug use Chronic respiratory diseases Low glomerular filtration rate Transport injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Smoking Neurological disorders Alcohol and drug use Digestive diseases Others

24 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SUB-REGION AMERICA DEL NORTE 56 Demographic indicators, 2013 Total population 355,233 million inhabitants Life expectancy at birth (LEB) 79.3 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 37.3 years Life expectancy for over-60 year population 24.8 years Over-60 years population 20% (71,398 million inhabitants) Macroeconomic indicators, 2013 Per capita GDP $51, Per capita GDP-PPP outlay on healthcare $8, Total outlay on healthcare 14.0% Public outlay on healthcare 7.9% Private outlay on healthcare 1.8% Others outlays on healthcare 4.3% Human development indicators, 2013 Human Development Index 0,913 HDI Adjusted for inequality (HDI-I) 0,755 Gini coefficient, (Optimal: below a 39.0), 2012 Communicable diseases 6.3% Non-communicable diseases 84.5% Injuries 8.6% of death by sex, 2013 total Percentage total Percentage Percentage female 1. Cardiovascular diseases 953, , , % 32.0% 35.0% 2.Neoplasms 713, , , % 26.5% 23.6% 3. Neurological disorders 361, , , % 10.7% 14.7% 4.Diabetes 209, , , % 7.2% 7.5% 5. Chronic respiratory diseases 198, ,664 95, % 7.1% 6.8% 6. Diarrhea/LRI/Other 107,719 50,411 57, % 3.5% 4.1% 7. Unintentional injuries 79,631 42,735 36, % 3.0% 2.6% 8. Self-harm & intersonal violence 63,707 49,953 13, % 3.5% 1.0% 9. Cirrhosis 57,416 36,218 21, % 2.5% 1.5% 10. Digestive diseases 53,082 22, % 1.6% 2.2% 11. Transport injuries 50,447 35, % 2.4% 1.1% TOTAL 2,848,378 1,438,310 1,410, % 100.0% 100.0% 5 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS The Countries of this sub region are: Canada and United States of American. 7 Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 24

25 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,198,573 68,108, % Years lived with disability (YLD) 9,995,816 15,732, % Years of life lost (YLL) 53,202,759 52,375, % 3,013,640 3,180, % Concept Disability adjusted life years (DALY) Grow rate ,944,506 39,762, % Years lived with disability (YLD) 5,647,016 8,294, % Years of life lost (YLL) 33,297,492 31,467, % 1,602,010 1,608, % Concept Disability adjusted life years (DALY) Grow rate ,254,067 28,345, % Years lived with disability (YLD) 4,348,800 7,437, % Years of life lost (YLL) 19,905,267 20,907, % 1,411,630 1,571, % Years of healthy life lost, centage growth by sex CONCEPT Total DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % 68,108, % 15,732, % 52,375, % 3,180, % 39,762, % 8,294, % 31,467, % 1,608, % 28,346, % 7,437, % 20,907, % 1,571, % 25

26 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries Unsafe sex Diarrheal/LRI/other High fasting plasma glucose Transport injuries Air pollution Diabetes Unsafe water, sanitation and handwashing Neoplasms Others 6.7 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries Unsafe sex Diarrheal/LRI/other High fasting plasma glucose Transport injuries Air pollution Diabetes Unsafe water, sanitation and handwashing Neoplasms Others Others Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Unsafe sex Unintentional injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Transport injuries Air pollution Neoplasms

27 7. Unsafe water, sanitation and handwashing Diabetes Others 6.6 Total population 5 to 14 years of age 1. Alcohol and drug use Transport injuries High fasting plasma glucose Neoplasms Low glomerular filtration rate Unintentional injuries Sexual abuse and violence Self-harm & intersonal violence Unsafe water, sanitation and handwashing Other non-communicable Air pollution Diabetes High systolic blood pressure Diarrheal/LRI/other Others to 14 years of age 1. Alcohol and drug use Transport injuries High fasting plasma glucose Neoplasms Low glomerular filtration rate Unintentional injuries Sexual abuse and violence Self-harm & intersonal violence Air pollution Other non-communicable High systolic blood pressure Diabetes Unsafe water, sanitation and handwashing Cardiovascular diseases Others to 14 years of age 1. Alcohol and drug use Neoplasms High fasting plasma glucose Transport injuries Low glomerular filtration rate Unintentional injuries Unsafe water, sanitation and handwashing Other non-communicable Air pollution Diabetes Sexual abuse and violence Self-harm & intersonal violence High systolic blood pressure Diarrheal/LRI/other

28 Others 14.7 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence High body-mass index Cardiovascular diseases Smoking Transport injuries High systolic blood pressure Mental & substance use disorders High total cholesterol Diabetes High fasting plasma glucose Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Transport injuries Smoking Neoplasms High systolic blood pressure Mental & substance use disorders High total cholesterol Unintentional injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. Alcohol and drug use Neoplasms High body-mass index Cardiovascular diseases Dietary risks Self-harm & intersonal violence Smoking Transport injuries High systolic blood pressure Mental & substance use disorders Sexual abuse and violence Diabetes High total cholesterol Cirrhosis

29 Others 18.0 Total population 50 to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases High fasting plasma glucose Cirrhosis Alcohol and drug use Neurological disorders High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Neoplasms Smoking Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases Alcohol and drug use Cirrhosis High fasting plasma glucose Self-harm & intersonal violence High total cholesterol Neurological disorders Others to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases High fasting plasma glucose Neurological disorders Alcohol and drug use Cirrhosis High total cholesterol Diarrheal/LRI/other

30 Others 9.9 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Neurological disorders 1, High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, Smoking 1, Neoplasms 1, High systolic blood pressure Neurological disorders 1, High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Unintentional injuries Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neurological disorders 1, Smoking Neoplasms High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries

31 Others 5.0 Total population 1. Dietary risks Cardiovascular diseases All age 2. Smoking Neoplasms High systolic blood pressure Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. Smoking Neoplasms High systolic blood pressure Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other High total cholesterol Self-harm & intersonal violence Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low physical activity Unintentional injuries

32 Others 8.9 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SUB-REGION AMERICA CENTRAL 89 Demographic indicators, 2013 Total population million inhabitants Life expectancy at birth (LEB) 74.7 years Health life expectancy at birth (HLEB) years (8.5 years less than life expectancy at Birth) Median age 25.9 years Life expectancy for over-60 year population 21.2 years Over-60 years population 9.4% (15,632 million inhabitants) Macroeconomic indicators, 2013 Per capita GDP $14, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 7.6% Public outlay on healthcare 4.5% Private outlay on healthcare 2.8% Others outlays on healthcare 0.3% Human development indicators, 2013 Human Development Index 0,729 HDI Adjusted for inequality (HDI-I) 0,553 Gini coefficient, (Optimal: below a 39.0), 2012 Communicable diseases 12.5% Non-communicable diseases 74.6% Injuries 12.8% of death by sex, Cardiovascular diseases total Percentage total Percentage Percentage female 321, , , % 24.5% 29.9% 2. Neoplasms 185,604 91,839 93, % 13.7% 17.8% 3.Diabetes 183,319 89,592 93, % 13.4% 17.8% 4. Self-harm & intersonal violence 86,278 75,972 10, % 11.4% 2.0% 5. Diarrhea/LRI/Other 75,922 40,225 35, % 6.0% 6.8% 6. Chronic respiratory diseases 75,908 40,450 35, % 6.0% 6.7% 7. Cirrhosis 57,095 40,238 16, % 6.0% 3.2% 8. Neurological disorders 54,574 27,035 27, % 4.0% 5.2% 9. Transport injuries 49,355 38,859 10, % 5.8% 2.0% 10. Unintentional injuries 41,593 28,707 12, % 4.3% 2.4% 8 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS The Countries of this sub region are: Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Nicaragua and Panama. 10 Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 32

33 11. Digestive diseases 36,671 17,931 18, % 2.7% 3.6% 12. Other noncommunicable 27,513 14,477 13, % 2.2% 2.5% TOTAL 1,195, , , % 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,215,191 27,821, % Years lived with disability (YLD) 3,829,470 6,201, % Years of life lost (YLL) 25,385,722 21,618, % 619, , % Concept Disability adjusted life years (DALY) Grow rate ,756,676 16,289, % Years lived with disability (YLD) 2,169,774 3,169, % Years of life lost (YLL) 14,586,903 13,119, % 350, , % Concept Disability adjusted life years (DALY) Grow rate ,458,515 11,531, % Years lived with disability (YLD) 1,659,696 3,032, % Years of life lost (YLL) 10,798,819 8,499, % 268, , % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 27,821, % 6,201, % 21,618, % 842, % 16,289, % 3,169, % 13,119, % 478, % 11,531, % 3,032, % 8,499, % 363, % 33

34 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Neoplasms Others 8.7 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Neoplasms Others 8.5 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies

35 6. Low glomerular filtration rate Neoplasms Alcohol and drug use Diabetes Others 9.1 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Air pollution Unintentional injuries High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Other non-communicable Unsafe sex Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries Alcohol and drug use Unintentional injuries Low glomerular filtration rate Neoplasms Air pollution Diarrheal/LRI/other High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Other non-communicable Child and maternal malnutrition Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other Low glomerular filtration rate Neoplasms Alcohol and drug use Transport injuries Air pollution Unintentional injuries High fasting plasma glucose Other non-communicable High systolic blood pressure Self-harm & intersonal violence

36 7. Unsafe sex Diabetes Others 19.3 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Neoplasms High fasting plasma glucose Cardiovascular diseases High systolic blood pressure Diabetes Low glomerular filtration rate Unintentional injuries Unsafe sex Cirrhosis Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Cardiovascular diseases High fasting plasma glucose Unintentional injuries High systolic blood pressure Neoplasms High total cholesterol Cirrhosis Low glomerular filtration rate Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High fasting plasma glucose Diabetes Alcohol and drug use Self-harm & intersonal violence High systolic blood pressure Transport injuries Unsafe sex Diarrheal/LRI/other

37 7. Low glomerular filtration rate Maternal disorders Others 22.8 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High fasting plasma glucose Diabetes High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Smoking Diarrheal/LRI/other Alcohol and drug use Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Neoplasms High body-mass index Cirrhosis Smoking Self-harm & intersonal violence Alcohol and drug use Chronic respiratory diseases Low glomerular filtration rate Transport injuries Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Diabetes High fasting plasma glucose Cardiovascular diseases High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Child and maternal malnutrition Diarrheal/LRI/other

38 7. High total cholesterol Digestive diseases Others 9.0 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Diabetes High fasting plasma glucose Neoplasms High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Smoking Diarrheal/LRI/other Air pollution Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes Smoking Chronic respiratory diseases High body-mass index Neurological disorders Low glomerular filtration rate Digestive diseases Air pollution Cirrhosis Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Diabetes High fasting plasma glucose Neoplasms High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Air pollution Diarrheal/LRI/other

39 7. Smoking Digestive diseases Others 9.5 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes High body-mass index Self-harm & intersonal violence Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Chronic respiratory diseases Smoking Cirrhosis Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes High body-mass index Self-harm & intersonal violence Alcohol and drug use Chronic respiratory diseases Smoking Cirrhosis Low glomerular filtration rate Diarrheal/LRI/other Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders

40 7. Smoking Digestive diseases Others 18.2 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SUB-REGION CARIBE 1112 Demographic indicators, 2013 Total population 35,694 million of inhabitants Life expectancy at birth (LEB) 72.2 years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at birth) Median age 29.6 years Life expectancy for over-60 year population 20.7 years Over-60 years population 11.8% (4,206 million of inhabitants) Macroeconomic indicators, 2013 Per capita GDP $12, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.9% Public outlay on healthcare 4.1% Private outlay on healthcare 2.0% Others outlays on healthcare 0.8% Human development indicators, 2013 Human Development Index 0,674 HDI Adjusted for inequality (HDI-I) 0,415 Gini coefficient, (Optimal: below a 39.0), 2012 Communicable diseases 8.3% Non-communicable diseases 81.2% Injuries 10.5% of death by sex, 2013 total Percentage total Percentage Percentage female 1.cardiovascular diseases 123,437 58,431 65, % 34.2% 40.8% 2.Neoplasms 57,803 31,386 26, % 18.4% 16.6% 3.Diabetes 29,403 12,790 16, % 7.5% 10.4% 4.Diarrhea/LRI/Other 28,438 14,738 13, % 8.6% 8.6% 5.Neonatal disorders 15,472 7,749 7, % 4.5% 4.8% 6.HIV/AIDS 13,527 7,604 6, % 4.5% 4.3% 7. Unintentional injuries 13,081 7,292 5, % 4.3% 3.6% 8. Chronic respiratory diseases 9. Neonatal disorders 11,712 7,073 4, % 4.1% 2.9% 10,728 6,050 4, % 3.5% 2.9% 11 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS The Countries of this sub region are: Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, Belize, Cuba, Dominica, Grenada, Guadeloupe, Haiti, Turks and Caicos, British Virgin Islands, Dominican Republic, Saint Vincent and the Grenadines, San Kitts and Nevis, Saint Lucia, Trinidad and Tobago. 13 Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 40

41 10. Self-harm & intersonal violence 11. Transport injuries 12. Digestive diseases 9,328 7,373 1, % 4.3% 1.2% 8,859 6,335 2, % 3.7% 1.6% 7,410 3,944 3, % 2.3% 2.2% TOTAL 329, , , % 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,978,351 8,113, % Years lived with disability (YLD) 1,056,329 1,636, % Years of life lost (YLL) 6,922,022 6,476, % 211, , % Concept Disability adjusted life years (DALY) Grow rate ,474,030 4,441, % Years lived with disability (YLD) 561, , % Years of life lost (YLL) 3,912,070 3,611, % 113, , % Concept Disability adjusted life years (DALY) Grow rate ,504,321 3,672, % Years lived with disability (YLD) 494, , % Years of life lost (YLL) 3,009,952 2,865, % 97, , % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 8,113, % 1,636, % 6,476, % 293, % 4,441, % 829, % 3,611, % 151, % 3,672, % 806, % 2,865, % 142, % 41

42 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Unsafe sex Other non-communicable Air pollution Nutritional deficiencies Alcohol and drug use Unintentional injuries Smoking Communicable, maternal, neonatal, and nutritional diseases Low glomerular filtration rate Cardiovascular diseases Others 7.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Unsafe sex Other non-communicable Air pollution Nutritional deficiencies Alcohol and drug use Unintentional injuries Smoking Communicable, maternal, neonatal, and nutritional diseases Low glomerular filtration rate Cardiovascular diseases Others Others Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Unsafe sex Other non-communicable

43 4. Air pollution Nutritional deficiencies Smoking Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Unintentional injuries Low glomerular filtration rate Cardiovascular diseases Others 7.7 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Unsafe sex Transport injuries Air pollution HIV/AIDS Low glomerular filtration rate Neoplasms Child and maternal malnutrition Cardiovascular diseases High fasting plasma glucose Other non-communicable Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Unsafe sex Transport injuries Air pollution HIV/AIDS Low glomerular filtration rate Neoplasms Child and maternal malnutrition Other non-communicable High fasting plasma glucose Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other Unsafe sex HIV/AIDS Air pollution Unintentional injuries

44 4. Child and maternal malnutrition Transport injuries Alcohol and drug use Neoplasms Low glomerular filtration rate Cardiovascular diseases High fasting plasma glucose Diabetes Others 29.1 Total population 15 to 49 years of age 1. Unsafe sex HIV/AIDS Alcohol and drug use Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Self-harm & intersonal violence High body-mass index Transport injuries Smoking Unintentional injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Unsafe sex HIV/AIDS Dietary risks Cardiovascular diseases High systolic blood pressure Transport injuries High body-mass index Neoplasms Smoking Unintentional injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. Unsafe sex HIV/AIDS Dietary risks Neoplasms High body-mass index Cardiovascular diseases

45 4. High systolic blood pressure Diabetes Alcohol and drug use Neonatal disorders High fasting plasma glucose Diarrheal/LRI/other Smoking Self-harm & intersonal violence Others 20.6 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose HIV/AIDS Air pollution Cirrhosis Low physical activity Chronic respiratory diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms Smoking Diabetes High body-mass index Diarrheal/LRI/other High fasting plasma glucose Cirrhosis Alcohol and drug use HIV/AIDS Low physical activity Chronic respiratory diseases Others to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High body-mass index Diabetes

46 4. High fasting plasma glucose Diarrheal/LRI/other Smoking HIV/AIDS Air pollution Chronic respiratory diseases Low physical activity Cirrhosis Others 11.2 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High body-mass index Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Low physical activity Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, Smoking 1, Neurological disorders High fasting plasma glucose Diarrheal/LRI/other High body-mass index Diabetes Low glomerular filtration rate Chronic respiratory diseases Low physical activity Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Neoplasms High body-mass index 1, Diabetes

47 4. High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Smoking Unintentional injuries Low physical activity Chronic respiratory diseases Others 6.6 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose Neurological disorders Low glomerular filtration rate HIV/AIDS Low physical activity Unintentional injuries Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms Smoking Diarrheal/LRI/other High body-mass index Diabetes High fasting plasma glucose Neurological disorders Alcohol and drug use HIV/AIDS Low physical activity Self-harm & intersonal violence Others 24.0 All age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High body-mass index Diabetes

48 4. High fasting plasma glucose Diarrheal/LRI/other Smoking Neurological disorders Low glomerular filtration rate HIV/AIDS Low physical activity Unintentional injuries Others 16.9 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SUB-REGION AMERICA ANDINA 1415 Demographic indicators, 2013 Total population 105,106 million of inhabitants Life expectancy at birth (LEB) 76.2 years Health life expectancy at birth (HLEB) years (10.3 years less than life expectancy at birth) Median age 26.8 years Life expectancy for over-60 year population 23 years Over-60 years population 9.4% (9,887 million of inhabitants) Macroeconomic indicators, 2013 Per capita GDP $11, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.4% Public outlay on healthcare 4.2% Private outlay on healthcare 1.8% Others outlays on healthcare 0.3% Human development indicators, 2013 Human Development Index 0,713 HDI Adjusted for inequality (HDI-I) 0,531 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 18.4% Non-communicable diseases 69.6% Injuries 12.0% of death by sex, 2013 total Percentage total Percentage Percentage female 1.cardiovascular diseases 60,197 29,609 30, % 21.2% 25.0% 2.Neoplasms 47,599 22,422 25, % 16.1% 20.6% 3. Diarrhea/LRI/Other 37,488 19,088 18, % 13.7% 15.0% 4. Diabetes 25,056 12,068 12, % 8.7% 10.6% 5. Unintentional injuries 6. Chronic respiratory diseases 15,965 9,904 6, % 7.1% 5.0% 14,289 7,869 6, % 5.6% 5.2% 7. Transport injuries 13,024 9,567 3, % 6.9% 2.8% 14 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS The Countries of this sub region are: Bolivia, Ecuador, Peru and Colombia. 16 Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 48

49 8. Cirrhosis 11,958 7,518 4, % 5.4% 3.6% 9. Neonatal disorders 11,174 6,471 4, % 4.6% 3.8% 10. Digestive diseases 8,489 4, % 3.2% 3.3% 11. Neurological disorders 12. Self-harm & intersonal violence 8,292 3, % 2.8% 3.6% 8,272 6, % 4.7% 1.4% TOTAL 261, , , % 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,820,403 13,538, % Years lived with disability (YLD) 2,113,955 2,800, % Years of life lost (YLL) 13,706,448 10,737, % , % Concept Disability adjusted life years (DALY) Grow rate ,763,748 8,619, % Years lived with disability (YLD) 1,215,772 1,850, % Years of life lost (YLL) 8,547,976 6,768, % 206, , % Concept Disability adjusted life years (DALY) Grow rate ,056,655 4,919, % Years lived with disability (YLD) 898, , % Years of life lost (YLL) 5,158,472 3,968, % 145, , % CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 13,538, % 2,800, % 10,737, % 430, % 8,619, % 1,850, % 6,768, % 241, % 49

50 4,919, % 950, % 3,968, % 188, % Years of healthy life lost, centage growth by sex Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable Unsafe sex Unintentional injuries Smoking Transport injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes Others 8.3 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable Unsafe sex Unintentional injuries Smoking Transport injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes Others 8.2 Children under 5 50

51 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable Unsafe sex Unintentional injuries Smoking Transport injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes Others 8.4 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Air pollution Neoplasms Unsafe sex Cardiovascular diseases Child and maternal malnutrition Other non-communicable High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries Alcohol and drug use Unintentional injuries Low glomerular filtration rate Diarrheal/LRI/other Air pollution Neoplasms Unsafe sex Cardiovascular diseases Child and maternal malnutrition Other non-communicable High systolic blood pressure Self-harm & intersonal violence Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries

52 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Transport injuries Air pollution Neoplasms Unsafe sex Cardiovascular diseases Child and maternal malnutrition Diabetes High fasting plasma glucose Other non-communicable Others 18.6 Total population 15 to 49 years of age 1. Alcohol and drug use Transport injuries Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Self-harm & intersonal violence Unsafe sex Unintentional injuries High fasting plasma glucose HIV/AIDS High total cholesterol Diarrheal/LRI/other Others to 49 years of age 1. Alcohol and drug use Transport injuries Dietary risks Self-harm & intersonal violence High systolic blood pressure Unintentional injuries High body-mass index Cardiovascular diseases Smoking Neoplasms High total cholesterol HIV/AIDS High fasting plasma glucose Diarrheal/LRI/other Others to 49 years of age 1. Dietary risks Neoplasms

53 2. High body-mass index Cardiovascular diseases Alcohol and drug use Transport injuries Unsafe sex Unintentional injuries High systolic blood pressure Diabetes High fasting plasma glucose Neonatal disorders Low glomerular filtration rate Diarrheal/LRI/other Others 23.3 Total population 50 to 69 years of age 1. Dietary risks Neoplasms High systolic blood pressure Cardiovascular diseases High body-mass index Diabetes Alcohol and drug use Cirrhosis High fasting plasma glucose Diarrheal/LRI/other Smoking Transport injuries Low glomerular filtration rate Chronic respiratory diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms Alcohol and drug use Diabetes High body-mass index Cirrhosis Smoking Diarrheal/LRI/other High fasting plasma glucose Transport injuries Low glomerular filtration rate Chronic respiratory diseases Others to 69 years of age 1. High body-mass index Neoplasms

54 2. Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Cirrhosis Smoking Digestive disease Alcohol and drug use Chronic respiratory diseases Others 12.1 Total population 70 years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Neoplasms 1, High fasting plasma glucose Diarrheal/LRI/other High body-mass index Diabetes Low glomerular filtration rate Chronic respiratory diseases Smoking Neurological disorders Air pollution Digestive disease Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 1, High systolic blood pressure Neoplasms 1, Smoking Diarrheal/LRI/other High fasting plasma glucose Diabetes Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders High body-mass index Cirrhosis Others years of age and over 1. High systolic blood pressure Cardiovascular diseases 1,

55 2. Dietary risks Neoplasms High body-mass index Diarrheal/LRI/other High fasting plasma glucose Diabetes Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders Smoking Digestive disease Others 11.2 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diarrheal/LRI/other High fasting plasma glucose Diabetes Alcohol and drug use Unintentional injuries Low glomerular filtration rate Chronic respiratory diseases Smoking Transport injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Alcohol and drug use Diarrheal/LRI/other Smoking Diabetes High fasting plasma glucose Unintentional injuries High body-mass index Transport injuries Low glomerular filtration rate Chronic respiratory diseases Others 27.8 All age 1. Dietary risks Cardiovascular diseases

56 2. High systolic blood pressure Neoplasms High body-mass index Diarrheal/LRI/other High fasting plasma glucose Diabetes Low glomerular filtration rate Chronic respiratory diseases Air pollution Unintentional injuries Smoking Neonatal disorders Others 21.8 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SUB-REGION CONO SUR 1718 Demographic indicators, 2013 Total population 269,637 million of inhabitants Life expectancy at birth (LEB) 73.8 years Health life expectancy at birth (HLEB) years (8.5 years less than life expectancy at birth) Median age 30.2 years Life expectancy for over-60 year population 22.1 years Over-60 years population 11.8% (31,915 million inhabitants) Macroeconomic indicators, 2013 Per capita GDP $16, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 8.5% Public outlay on healthcare 4.6% Private outlay on healthcare 2.7% Others outlays on healthcare 1.2% Human development indicators, 2013 Human Development Index 0,756 HDI Adjusted for inequality (HDI-I) 0,570 Gini coefficient, (Optimal: below a 39.0), 2012 Communicable diseases 10.8% Non-communicable diseases 79.2% Injuries 10.0% of death by sex, Cardiovascular diseases total Percentage total Percentage Percentage female 143,974 67,177 76, % 28.3% 34.6% 2.Neoplasms 106,488 57,279 49, % 24.1% 22.2% 3. Chronic respiratory diseases 4. Diarrhea/LRI/Other 43,333 24,705 18, % 10.4% 8.4% 35,125 16,508 18, % 7.0% 8.4% 5.Diabetes 33,663 16,676 16, % 7.0% 7.6% 6. Neurological disorders 30,806 12,476 18, % 5.3% 8.3% 17 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS The Countries of this sub region are: Argentina, Brazil, Chile, Uruguay and Paraguay. 19 Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 56

57 7. Unintentional injuries 15,011 8,912 6, % 3.8% 2.7% 8.Cirrhosis 12,171 8,609 3, % 3.6% 1.6% 9. Digestive diseases 10. Transport injuries 11. Self-harm & intersonal violence 12. Other noncommunicable 11,109 5,209 5, % 2.2% 2.7% 10,813 8, % 3.4% 1.3% 10,157 8,359 1, % 3.5% 0.8% 6,680 3,255 3, % 1.4% 1.5% TOTAL 459, , , % 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,838,644 10,589, % Years lived with disability (YLD) 1,552,618 2,296, % Years of life lost (YLL) 8,286,026 8,292, % , % Concept Disability adjusted life years (DALY) Grow rate ,445,445 6,632, % Years lived with disability (YLD) 935,050 1,267, % Years of life lost (YLL) 5,510,396 5,364, % 226, , % Concept Disability adjusted life years (DALY) Grow rate ,393,199 3,957, % Years lived with disability (YLD) 617,568 1,028, % Years of life lost (YLL) 2,775,630 2,928, % 149, , % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % 57

58 Total 10,589, % 2,296, % 8,292, % 447, % 6,632, % 1,267, % 5,364, % 252, % 3,957, % 1,028, % 2,928, % 195, % Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Air pollution Diabetes Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Others 6.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Air pollution Unintentional injuries Alcohol and drug use Diabetes Smoking Neoplasms Low glomerular filtration rate Transport injuries Others 6.2 Chil dre 58

59 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Air pollution Diabetes Alcohol and drug use Neoplasms Low glomerular filtration rate Cardiovascular diseases Others 6.6 Total population 5 to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Unsafe water, sanitation and handwashing Unintentional injuries 4. High fasting plasma glucose Diarrheal/LRI/other Unsafe sex Other non-communicable Air pollution Self-harm & intersonal violence High systolic blood pressure Diabetes Others to 14 years of age 1. Alcohol and drug use Transport injuries Low glomerular filtration rate Neoplasms Unsafe water, sanitation and 3. Unintentional injuries handwashing High fasting plasma glucose 4. Self-harm & intersonal 0.1 violence Air pollution Diarrheal/LRI/other Unsafe sex Other non-communicable Sexual abuse and violence Diabetes Others

60 5 to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Unsafe water, sanitation and handwashing Unintentional injuries 4. High fasting plasma glucose Diarrheal/LRI/other Unsafe sex Other non-communicable Air pollution Self-harm & intersonal violence High systolic blood pressure Diabetes Others 18.3 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence High body-mass index Cardiovascular diseases Smoking Transport injuries High systolic blood pressure Unintentional injuries Unsafe sex Cirrhosis High total cholesterol HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries Smoking Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Unintentional injuries High total cholesterol Mental and substance use disorders Unsafe sex HIV/AIDS Others to 60

61 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Smoking Self-harm & intersonal violence Alcohol and drug use Transport injuries Unsafe sex Diabetes High systolic blood pressure Diarrheal/LRI/other High fasting plasma glucose Unintentional injuries Others 20.2 Total population 50 to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases Alcohol and drug use Cirrhosis High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Unintentional injuries Others to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Chronic respiratory diseases High body-mass index Diabetes Alcohol and drug use Cirrhosis High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Unintentional injuries Others

62 50 to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Cirrhosis High total cholesterol Digestive diseases Others 9.4 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, Smoking Chronic respiratory diseases High body-mass index Neurological disorders High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Diabetes High total cholesterol Digestive diseases Others years of age and over 1. Smoking 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High systolic blood pressure 1, Chronic respiratory diseases 1, High body-mass index Diarrheal/LRI/other High fasting plasma glucose Neurological disorders Alcohol and drug use Diabetes Low glomerular filtration rate Digestive diseases Others

63 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms High body-mass index Neurological disorders High fasting plasma glucose Chronic respiratory diseases Smoking Diarrheal/LRI/other Low glomerular filtration rate Diabetes High total cholesterol Digestive diseases Others 6.8 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Chronic respiratory diseases High body-mass index Diarrheal/LRI/other High fasting plasma glucose Diabetes Alcohol and drug use Neurological disorders Low glomerular filtration rate Unintentional injuries Others Smoking Cardiovascular diseases All age 2. Dietary risks Neoplasms High systolic blood pressure Chronic respiratory diseases High body-mass index Diabetes Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Neurological disorders High total cholesterol Unintentional injuries Others

64 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Chronic respiratory diseases Smoking Diarrheal/LRI/other High fasting plasma glucose Neurological disorders Low glomerular filtration rate Diabetes High total cholesterol Unintentional injuries Others

65 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE ANGUILLA 20 Demographic indicators, 2013 Total population 16,418 inhabitants Life expectancy at birth (LEB) 81.3 years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 34.1 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) Over 65 year population 8.5% (1,343 inhabitants) General mortality rate 500 Macroeconomic indicators, 2013 Per capita GDP 12,200 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 1. Ischemic heart disease 15, % 2. Stroke 9, % 3. Diabetes 4, % 4. Lower respiratory infection 3, % 5. HIV/AIDS 3, % 6. Hytensive health disease 2, % 7. Road injuries 2, % 8. Prostate cancer 2, % 9. Preterm birth complications 1, % 10. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 1. Physiological risks 72% 2. Dietary risks 15% High body-mass index 146% 3. Alcohol and drug use 10% High blood glucose levels 113% 4. Physical inactivity 7% Low bone mineral density 95% 5. Smoking 6% 2. Alcohol and drug use 86% 6. Malnutrition 5% Drug use 146% 7. Injuries 4% Alcohol use 67% 8. Other risks 11% 3. Injuries 33% Total 100% 4. Dietary risks 29% 20 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 1

66 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE ANTIGUA Y BARBUDA 22 Demographic indicators, 2013 Total population 90 hundred inhabitants Life expectancy at birth (LEB) 71 years Health life expectancy at birth (HLEB) years (7 years less than life expectancy at Birth) Median age 31 years Life expectancy for over-60 year population 22 years Over-60 years population 13% (12 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $21, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 4.9% Public outlay on healthcare 3.2% Private outlay on healthcare 1.3% Others outlays on healthcare 0.4% Human development indicators, 2013 Human Development Index 0,774 (High Human development, 61 st 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d (Optimal: below a 39.0), 2012 Communicable diseases n.d Non-communicable diseases n.d Injuries n.d of death by sex, 2013 total Percentage total Percentage Percentage female 1. Cardiovascular diseases % 33.0% 40.3% 2.Neoplasms % 17.5% 16.3% 3.Diabetes % 14.0% 17.7% 4. Diarrhea/LRI/Other % 5.4% 6.1% 5. Neurological disorders % 5.0% 5.3% 6. Unintentional injuries % 3.9% 2.3% 7. Chronic respiratory diseases 8. Self-harm & intersonal violence % 3.9% 1.9% % 4.7% 1.1% 9.HVI/AIDS % 3.2% 1.3% 10. Digestive diseases % 2.3% 2.3% 11. Transport injuries % 3.2% 1.1% 12.Others noncommunicable % 1.6% 2.3% 13. Neonatal disorders % 2.3% 1.9% TOTAL % 100.0% 100.0% 22 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 3

67 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,729 14, % Years lived with disability (YLD) 2,339 4, % Years of life lost (YLL) 7,388 10, % % Concept Disability adjusted life years (DALY) Grow rate ,709 8, % Years lived with disability (YLD) 1,288 2, % Years of life lost (YLL) 4,419 6, % % Concept Disability adjusted life years (DALY) Grow rate ,020 6, % Years lived with disability (YLD) 1,051 2, % Years of life lost (YLL) 2,969 4, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 14, % 4, % 10, % % 8, % 2, % 6, % % 6, % 2, % 4, % % 4

68 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies High fasting plasma glucose Diabetes Alcohol and drug use Cardiovascular diseases Others 5.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies High fasting plasma glucose Diabetes Alcohol and drug use Cardiovascular diseases Others 5.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies High fasting plasma glucose Diabetes Alcohol and drug use Cardiovascular diseases Others 5.3 5

69 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable Air pollution Cardiovascular diseases High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Child and maternal malnutrition Neoplasms High fasting plasma glucose Other non-communicable Air pollution Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Unintentional injuries Alcohol and drug use Neoplasms High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable Air pollution Cardiovascular diseases High systolic blood pressure Diabetes Others

70 Total population 15 to 49 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Self-harm & intersonal violence Unsafe sex Diabetes Alcohol and drug use HIV/AIDS High fasting plasma glucose Transport injuries High total cholesterol Unintentional injuries Others to 49 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Self-harm & intersonal violence Alcohol and drug use HIV/AIDS High body-mass index Transport injuries Unsafe sex Neoplasms High fasting plasma glucose Unintentional injuries High total cholesterol Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes Unsafe sex HIV/AIDS High fasting plasma glucose Self-harm & intersonal violence Low glomerular filtration rate Transport injuries Alcohol and drug use Diarrheal/LRI/other Others

71 Total population 15 to 49 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Self-harm & intersonal violence Unsafe sex Diabetes Alcohol and drug use HIV/AIDS High fasting plasma glucose Transport injuries High total cholesterol Unintentional injuries Others to 49 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Self-harm & intersonal violence Alcohol and drug use HIV/AIDS High body-mass index Transport injuries Unsafe sex Neoplasms High fasting plasma glucose Unintentional injuries High total cholesterol Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes Unsafe sex HIV/AIDS High fasting plasma glucose Self-harm & intersonal violence Low glomerular filtration rate Transport injuries Alcohol and drug use Diarrheal/LRI/other Others

72 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms 1, High body-mass index Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Chronic respiratory diseases High total cholesterol Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Smoking Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms High body-mass index 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Digestive diseases High total cholesterol Unintentional injuries Others 6.7 9

73 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Unintentional injuries High total cholesterol Chronic respiratory diseases Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Self-harm & intersonal violence Smoking Chronic respiratory diseases Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Unintentional injuries High total cholesterol Other non-communicable Others

74 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE ARGENTINA 24 Demographic indicators, 2013 Total population 41,446 hundred inhabitants Life expectancy at birth (LEB) 76 years Health life expectancy at birth (HLEB) years (9 years less than life expectancy at Birth) Median age 31 years Life expectancy for over-60 year population 22 years Over-60 years population 15% (6,217 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $15, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 7.3% Public outlay on healthcare 4.9% Private outlay on healthcare 1.5% Others outlays on healthcare 0.8% Human development indicators, 2013 Human Development Index 0,808 (High Human development, 49 th 187) HDI Adjusted for inequality (HDI-I) 0,680 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 11.8% Non-communicable diseases 79.6% Injuries 8.7% of death by sex, 2013 total Percentage total Percentage Percentage female 1. Cardiovascular diseases 103,413 47,824 55, % 28.80% 35.83% 2.Neoplasms 71,024 38,480 32, % 23.17% 20.98% 3. Chronic respiratory diseases 34,669 19,903 14, % 11.99% 9.52% 4. Diarrhea/LRI/Other 27,351 12,816 14, % 7.72% 9.37% 5. Diabetes 23,305 11,756 11, % 7.08% 7.44% 6. Neurological disorders 7. Unintentional injuries 17,236 7,307 9, % 4.40% 6.40% 11,076 6,454 4, % 3.89% 2.98% 8. Transport injuries 7,529 5,477 2, % 3.30% 1.32% 9. Digestive diseases 7,397 3,530 3, % 2.13% 2.49% 10. Cirrhosis 6,898 4,908 1, % 2.96% 1.28% 11. Self-harm & intersonal violence 12. Others noncommunicable 6,381 5,198 1, % 3.13% 0.76% 4,916 2,404 2, % 1.45% 1.62% TOTAL 321, , , % 100.0% 100.0% 24 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 11

75 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,005,513 7,491, % Years lived with disability (YLD) 1,060,535 1,546, % Years of life lost (YLL) 5,944,977 5,944, % , % Concept Disability adjusted life years (DALY) Grow rate ,606,950 4,670, % Years lived with disability (YLD) 630, , % Years of life lost (YLL) 3,976,901 3,831, % 162, , % Concept Disability adjusted life years (DALY) Grow rate ,398,563 2,820, % Years lived with disability (YLD) 430, , % Years of life lost (YLL) 1,968,076 2,112, % 103, , % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 7,491, % 1,546, % 5,944, % 318, % 4,670, % 839, % 3,831, % 178, % 2,820, % 707, % 2,112, % 140, % 12

76 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Alcohol and drug use Diabetes Air pollution Neoplasms Low glomerular filtration rate Cardiovascular diseases Others 6.7 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Smoking Diabetes Air pollution Neoplasms Low glomerular filtration rate Transport injuries Others 6.5 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Alcohol and drug use Diabetes Air pollution Cardiovascular diseases Low glomerular filtration rate Neoplasms Others

77 Total population 5 to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Unsafe water, sanitation and handwashing Unintentional injuries 4. High fasting plasma glucose Diarrheal/LRI/other Unsafe sex Other non-communicable Air pollution Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Alcohol and drug use Transport injuries Low glomerular filtration rate Unintentional injuries Unsafe water, sanitation and handwashing Neoplasms 4. High fasting plasma glucose Diarrheal/LRI/other Air pollution Self-harm & intersonal violence Unsafe sex Other non-communicable Sexual abuse and violence Cardiovascular diseases Others to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Unintentional injuries Unsafe water, sanitation and handwashing Diarrheal/LRI/other 5. Unsafe sex Other non-communicable Air pollution Diabetes High systolic blood pressure Cardiovascular diseases Others

78 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Cardiovascular diseases Smoking Self-harm & intersonal violence High body-mass index Transport injuries High systolic blood pressure Unintentional injuries Unsafe sex HIV/AIDS High total cholesterol Diarrheal/LRI/other Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases Smoking Transport injuries High body-mass index Neoplasms High systolic blood pressure Unintentional injuries High total cholesterol HIV/AIDS Sexual abuse and violence Mental and substances disorders Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases Smoking Transport injuries Alcohol and drug use Self-harm & intersonal violence Unsafe sex Diabetes High systolic blood pressure Diarrheal/LRI/other High fasting plasma glucose Unintentional injuries Others

79 Total population 50 to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Chronic respiratory diseases High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Cirrhosis High total cholesterol Unintentional injuries Others to 69 years of age 1. Smoking Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Chronic respiratory diseases High body-mass index Diabetes Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Cirrhosis High total cholesterol Unintentional injuries Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Smoking Diabetes High systolic blood pressure Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Cirrhosis High total cholesterol Digestive diseases Others

80 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Chronic respiratory diseases High body-mass index Diarrheal/LRI/other High fasting plasma glucose Neurological disorders Low glomerular filtration rate Diabetes High total cholesterol Unintentional injuries Others years of age and over 1. Smoking 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High systolic blood pressure 1, Chronic respiratory diseases 1, High body-mass index Diarrheal/LRI/other High fasting plasma glucose Diabetes Low glomerular filtration rate Neurological disorders Alcohol and drug use Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms High body-mass index Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Smoking Neurological disorders Low glomerular filtration rate Diabetes High total cholesterol Unintentional injuries Others

81 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Chronic respiratory diseases High body-mass index Diarrheal/LRI/other High fasting plasma glucose Diabetes Alcohol and drug use Neurological disorders High total cholesterol Unintentional injuries Others Smoking Cardiovascular diseases All age 2. Dietary risks Neoplasms High systolic blood pressure Chronic respiratory diseases High body-mass index Diarrheal/LRI/other Alcohol and drug use Diabetes High fasting plasma glucose Neurological disorders High total cholesterol Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Chronic respiratory diseases Smoking Diarrheal/LRI/other High fasting plasma glucose Diabetes High total cholesterol Neurological disorders Low glomerular filtration rate Unintentional injuries Others

82 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE ARUBA 26 Demographic indicators, 2013 Total population 112,162 inhabitants Life expectancy at birth (LEB) 76.6years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 39 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) Over 65 year population 12.7% (14,268 inhabitants) General mortality rate 520 Macroeconomic indicators, 2013 Per capita GDP 25,300 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 11. Ischemic heart disease 15, % 12. Stroke 9, % 13. Diabetes 4, % 14. Lower respiratory infection 3, % 15. HIV/AIDS 3, % 16. Hytensive health disease 2, % 17. Road injuries 2, % 18. Prostate cancer 2, % 19. Preterm birth complications 1, % 20. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 6. Physiological risks 72% 7. Dietary risks 15% High body-mass index 146% 8. Alcohol and drug use 10% High blood glucose levels 113% 9. Physical inactivity 7% Low bone mineral density 95% 10. Smoking 6% 3. Alcohol and drug use 86% 7. Malnutrition 5% Drug use 146% 9. Injuries 4% Alcohol use 67% 10. Other risks 11% 4. Injuries 33% Total 100% 5. Dietary risks 29% 26 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 19

83 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE BAHAMAS 28 Demographic indicators, 2013 Total population 377 hundred inhabitants Life expectancy at birth (LEB) 76 years Health life expectancy at birth (HLEB) years (9 years less than life expectancy at Birth) Median age 32 years Life expectancy for over-60 year population 21 years Over-60 years population 12% (45 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $23, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 7.3% Public outlay on healthcare 3.2% Private outlay on healthcare 2.2% Others outlays on healthcare 1.9% Human development indicators, 2013 Human Development Index 0,789 (High Human development, 51 th 187) HDI Adjusted for inequality (HDI-I) 0,676 Gini coefficient, 2012 n.d (Optimal: below 39.0), 2012 Communicable diseases 19.3% Non-communicable diseases 73.4% Injuries 7.3% of death by sex, 2013 total Percentage total Percentage Percentage female 1. Cardiovascular diseases 1, % 33.40% 40.59% 2.Neoplasms % 18.27% 18.90% 3.Diabetes % 12.13% 16.63% 4. Diarrhea/LRI/Other % 4.46% 4.84% 5. Neurological disorders % 3.91% 4.46% 6.HVI/AIDS % 5.44% 1.77% 7. Self-harm & intersonal violence % 5.72% 1.30% 8. Unintentional injuries % 3.84% 2.12% 9. Chronic respiratory diseases % 3.42% 2.04% 10. Transport injuries % 3.49% 1.11% 11. Digestive diseases % 2.29% 2.19% 12. Others noncommunicable % 1.44% 2.04% 13. Neonatal disorders % 2.23% 2.04% TOTAL 2,759 1,434 1, % 100.0% 100.0% 28 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 21

84 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,298 55, % Years lived with disability (YLD) 9,448 16, % Years of life lost (YLL) 40,851 39, % , % Concept Disability adjusted life years (DALY) Grow rate ,808 35, % Years lived with disability (YLD) 5,085 8, % Years of life lost (YLL) 26,724 26, % % Concept Disability adjusted life years (DALY) Grow rate ,490 20, % Years lived with disability (YLD) 4,363 7, % Years of life lost (YLL) 14,127 12, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 55, % 16, % 39, % 1, % 35, % 8, % 26, % % 20, % 7, % 12, % % 22

85 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Smoking Diabetes High fasting plasma glucose Cardiovascular diseases Others 4.7 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Smoking Diabetes High fasting plasma glucose Cardiovascular diseases Others 5.3 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Low glomerular filtration rate Diabetes Smoking Nutritional deficiencies High fasting plasma glucose Cardiovascular diseases Others

86 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable Air pollution Diabetes High systolic blood pressure Self-harm & intersonal violence Others to 14 years of age Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Neoplasms High fasting plasma glucose Diarrheal/LRI/other Child and maternal malnutrition Other non-communicable Air pollution Self-harm & intersonal violence High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Neoplasms Alcohol and drug use Unintentional injuries High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable High systolic blood pressure Diabetes Air pollution Cardiovascular diseases Others

87 Total population 15 to 49 years of age 1. High body-mass index Cardiovascular diseases Unsafe sex Self-harm & intersonal violence Dietary risks Neoplasms High systolic blood pressure HIV/AIDS Alcohol and drug use Diabetes High fasting plasma glucose Transport injuries Smoking Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Unsafe sex HIV/AIDS High body-mass index Cardiovascular diseases High systolic blood pressure Transport injuries Dietary risks Neoplasms Smoking Unintentional injuries High total cholesterol Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Unsafe sex Cardiovascular diseases Dietary risks Diabetes High systolic blood pressure HVI/AIDS High fasting plasma glucose Self-harm & intersonal violence Alcohol and drug use Unintentional injuries Low glomerular filtration rate Diarrheal/LRI/other Others

88 Total population 50 to 69 years of age 1. High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms Dietary risks Diabetes High fasting plasma glucose Cirrhosis Smoking HVI/AIDS High total cholesterol Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Others to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High body-mass index Diabetes Smoking HVI/AIDS High fasting plasma glucose Cirrhosis High total cholesterol Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms Dietary risks Diabetes High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Cirrhosis Low physical activity Digestive diseases Low glomerular filtration rate Chronic respiratory diseases Others

89 Total population 70 years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High body-mass index 1, Diabetes 1, High fasting plasma glucose 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Smoking Chronic respiratory diseases High total cholesterol Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High body-mass index 1, Diabetes 1, High fasting plasma glucose 1, Neurological disorders Smoking Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, High body-mass index 1, Diabetes 1, Dietary risks 1, Neoplasms High fasting plasma glucose 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Digestive diseases High total cholesterol Chronic respiratory diseases Others

90 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. High body-mass index Neoplasms Dietary risks Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Neurological disorders Low glomerular filtration rate HVI/AIDS High total cholesterol Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Self-harm & intersonal violence Smoking HVI/AIDS High total cholesterol Diarrheal/LRI/other Alcohol and drug use Neurological disorders Others High systolic blood pressure Cardiovascular diseases All age 2. High body-mass index Neoplasms Dietary risks Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Diabetes Low physical activity Neurological disorders High total cholesterol Unintentional injuries Others

91 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE BARBADOS 30 Demographic indicators, 2013 Total population 285 hundred inhabitants Life expectancy at birth (LEB) 78 years Health life expectancy at birth (HLEB) years (12 years less than life expectancy at Birth) Median age 37 years Life expectancy for over-60 year population 23 years Over-60 years population 16% (45 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $13, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 6.8% Public outlay on healthcare 4.1% Private outlay on healthcare 2.2% Others outlays on healthcare 0.5% Human development indicators, 2013 Human Development Index 0,776 (High Human development, 59 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d (Optimal: below 39.0), 2012 Communicable diseases 12.4% Non-communicable diseases 81.9% Injuries 5.7% of death by sex, 2013 Causa total Percentage total Percentage Percentage female 1. Cardiovascular diseases % 30.47% 37.30% 2.Neoplasms % 20.40% 18.20% 3.Diabetes % 15.28% 19.85% 4. Diarrhea/LRI/Other % 6.04% 6.87% 5. Neurological disorders % 5.86% 5.62% 6. Chronic respiratory diseases % 3.93% 1.99% 7. Unintentional injuries % 3.29% 1.99% 8. Digestive diseases % 2.33% 2.23% 9. Self-harm & intersonal violence 10. Others noncommunicable % 3.57% 0.81% % 1.56% 2.40% 11. HVI/AIDS % 2.47% 0.66% 12. Transport injuries % 2.47% 0.90% 13.Cirrhosis % 2.37% 1.16% TOTAL 2,303 1,093 1, % 100.0% 100.0% 30 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 29

92 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,744 57, % Years lived with disability (YLD) 10,648 15, % Years of life lost (YLL) 41,097 42, % , % Concept Disability adjusted life years (DALY) Grow rate ,339 28, % Years lived with disability (YLD) 5,214 7, % Years of life lost (YLL) 22,126 20, % 1, % Concept Disability adjusted life years (DALY) Grow rate ,405 28, % Years lived with disability (YLD) 5,434 7, % Years of life lost (YLL) 18,971 21, % 1,252 1, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 57, % 15, % 42, % 2, % 28, % 7, % 20, % % 28, % 7, % 21, % 1, % 30

93 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Diabetes High fasting plasma glucose Cardiovascular diseases Others 4.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Diabetes Alcohol and drug use Cardiovascular diseases Others 4.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Diabetes High fasting plasma glucose Cardiovascular diseases Others

94 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable High systolic blood pressure Diabetes Air pollution Cardiovascular diseases Others to 14 years of age Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable High systolic blood pressure Self-harm & intersonal violence Air pollution Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Neoplasms Alcohol and drug use Unintentional injuries High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable High systolic blood pressure Diabetes Air pollution Cardiovascular diseases Others

95 Total population 15 to 49 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms Alcohol and drug use Self-harm & intersonal violence High systolic blood pressure Diabetes Unsafe sex HIV/AIDS High fasting plasma glucose Transport injuries High total cholesterol Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index HIV/AIDS High systolic blood pressure Neoplasms Unsafe sex Diabetes High fasting plasma glucose Unintentional injuries Smoking Transport injuries Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Self-harm & intersonal violence Unsafe sex HVI/AIDS Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Others

96 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Cirrhosis Low physical activity Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking Chronic respiratory diseases Low physical activity Diarrheal/LRI/other High total cholesterol Unintentional injuries Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Cirrhosis Low glomerular filtration rate Digestive diseases High total cholesterol Chronic respiratory diseases Others

97 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms 1, High body-mass index 1, Neurological disorders Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index Neurological disorders Smoking Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Low glomerular filtration rate Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms High body-mass index 1, Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Other non-communicable High total cholesterol Digestive diseases Others

98 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Smoking Neurological disorders Low physical activity Chronic respiratory diseases Low glomerular filtration rate Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High fasting plasma glucose Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Other non-communicable High total cholesterol Digestive diseases Others

99 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE BELIZE 32 Demographic indicators, 2013 Total population 332 hundred inhabitants Life expectancy at birth (LEB) 75 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 23 years Life expectancy for over-60 year population 21 years Over-60 years population 6% (20 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $8, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 5.4% Public outlay on healthcare 3.4% Private outlay on healthcare 1.4% Others outlays on healthcare 0.6% Human development indicators, 2013 Human Development Index 0,732 (High Human development, 59 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 16.0% Non-communicable diseases 71.6% Injuries 12.4% of death by sex, 2013 Causa total Percentage total Percentage Percentage female 1.Cardiovascular diseases % 27.8% 36.5% 2.Neoplasms % 15.5% 17.0% 3.Diabetes % 12.6% 18.0% 4.Diarrhea/LRI/Other % 6.0% 6.4% 5.Self-harm & intersonal violence % 8.6% 2.4% 6.Unintentional injuries % 5.2% 2.6% 7.Neonatal disorders % 4.1% 3.8% 8.Neurological disorders % 4.0% 3.8% 9.Transport injuries % 5.1% 1.8% 10. Chronic respiratory diseases % 4.4% 2.3% 11.HVI/AIDS % 4.5% 2.8% 12.Others noncommunicable % 2.4% 2.8% TOTAL 1, % 100.0% 100.0% 32 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 37

100 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,995 47, % Years lived with disability (YLD) 6,093 12, % Years of life lost (YLL) 20,899 34, % 737 1, % Concept Disability adjusted life years (DALY) Grow rate ,017 27, % Years lived with disability (YLD) 3,368 6, % Years of life lost (YLL) 12,646 20, % % Concept Disability adjusted life years (DALY) Grow rate ,978 20, % Years lived with disability (YLD) 2,725 6, % Years of life lost (YLL) 8,253 14, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 57, % 15, % 42, % 2, % 28, % 7, % 20, % % 28, % 7, % 21, % 1, % 38

101 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Smoking Diarrheal/LRI/other Unsafe sex Unintentional injuries Air pollution Nutritional deficiencies Low glomerular filtration rate Diabetes High fasting plasma glucose Cardiovascular diseases Others 6.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Smoking Diarrheal/LRI/other Unsafe sex Unintentional injuries Air pollution Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Cardiovascular diseases Others 6.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Smoking Diarrheal/LRI/other Unsafe sex Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Air pollution Diabetes Alcohol and drug use Cardiovascular diseases Others

102 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Child and maternal malnutrition Neoplasms High fasting plasma glucose Other non-communicable High systolic blood pressure Self-harm & intersonal violence Air pollution Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Child and maternal malnutrition Neoplasms High fasting plasma glucose Other non-communicable High systolic blood pressure Self-harm & intersonal violence Air pollution Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Neoplasms High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable High systolic blood pressure Cardiovascular diseases Air pollution Diabetes Others

103 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence High body-mass index Cardiovascular diseases Dietary risks Neoplasms High fasting plasma glucose Diabetes High systolic blood pressure HIV/AIDS High fasting plasma glucose Transport injuries Smoking Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Transport injuries High systolic blood pressure HIV/AIDS Unsafe sex Unintentional injuries High fasting plasma glucose Neoplasms Smoking Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Diabetes High fasting plasma glucose Self-harm & intersonal violence Alcohol and drug use HVI/AIDS High systolic blood pressure Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Others

104 Total population 50 to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Cirrhosis Smoking Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Alcohol and drug use Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Diabetes Smoking Cirrhosis High fasting plasma glucose Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence Low physical activity Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Diabetes High fasting plasma glucose Neoplasms High systolic blood pressure Diarrheal/LRI/other Low physical activity Cirrhosis Low glomerular filtration rate Digestive diseases High total cholesterol Chronic respiratory diseases Others

105 Total population 70 years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index 1, Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Chronic respiratory diseases Smoking Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, Smoking 1, Neurological disorders High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms 1, High body-mass index 1, Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Chronic respiratory diseases High total cholesterol Digestive diseases Others

106 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Self-harm & intersonal violence Alcohol and drug use Unintentional injuries Low glomerular filtration rate Neonatal disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes Smoking Self-harm & intersonal violence High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Low glomerular filtration rate Transport injuries Others High body-mass index Cardiovascular diseases All age 2. Dietary risks Diabetes High systolic blood pressure Neoplasms High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Neonatal disorders High total cholesterol Other non-communicable Others

107 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE BOLIVIA 34 Demographic indicators, 2013 Total population 10,671 hundred inhabitants Life expectancy at birth (LEB) 68 years Health life expectancy at birth (HLEB) 35 59years (9 years less than life expectancy at Birth) Median age 22 years Life expectancy for over-60 year population 19 years Over-60 years population 7% (747 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $6, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.1% Public outlay on healthcare 4.8% Private outlay on healthcare 1.2% Others outlays on healthcare 0.1% Human development indicators, 2013 Human Development Index 0,667 (High Human development, 113 th 187) HDI Adjusted for inequality (HDI-I) 0,470 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 23.5% Non-communicable diseases 66.1% Injuries 10.4% of death by sex, 2013 Causa total Percentage total Percentage Percentage female 1..Cardiovascular diseases 11,246 5,000 6, % 19.51% 25.16% 2. Neoplasms 7,662 3,347 4, % 13.06% 17.38% 3. Diarrhea/LRI/Other 6,440 3,197 3, % 12.47% 13.06% 4. Unintentional injuries 5,662 3,107 2, % 12.12% 10.29% 5.Diabetes 4,233 2,013 2, % 7.85% 8.94% 6. Transport injuries 3,804 2,241 1, % 8.74% 6.30% 7.Cirrhosis 3,027 1,745 1, % 6.81% 5.16% 8. Transport injuries 3,019 2, % 8.05% 3.85% 9. Chronic respiratory diseases 2,286 1,242 1, % 4.85% 4.21% 10.Digestive diseases 1, % 3.20% 3.69% 11.HIV/AIDS 1, % 3.34% 1.96% TOTAL 50,459 25,632 24, % 100.0% 100.0% 34 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 45

108 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,254,404 1,777, % Years lived with disability (YLD) 231, , % Years of life lost (YLL) 2,023,245 1,403, % , % Concept Disability adjusted life years (DALY) Grow rate ,236, , % Years lived with disability (YLD) 124, , % Years of life lost (YLL) 1,111, , % 21,909 21, % Concept Disability adjusted life years (DALY) Grow rate ,018, , % Years lived with disability (YLD) 106, , % Years of life lost (YLL) 911, , % 20,283 22, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,777, % 373, % 1,403, % 44, % 943, % 190, % 753, % 21, % 833, % 183, % 649, % 22, % 46

109 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Unsafe sex Unintentional injuries Air pollution Other non-communicable High fasting plasma glucose Transport injuries Alcohol and drug use Communicable, maternal, neonatal, and nutritional diseases Low glomerular filtration rate Cardiovascular diseases Others 7.8 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Unsafe sex Unintentional injuries Air pollution Other non-communicable High fasting plasma glucose Transport injuries Alcohol and drug use Cardiovascular diseases Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Others 7.7 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Unsafe sex Unintentional injuries Air pollution Other non-communicable High fasting plasma glucose Transport injuries Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Cardiovascular diseases Others

110 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Unsafe sex Diarrheal/LRI/other Low glomerular filtration rate Neoplasms Air pollution Cardiovascular diseases Child and maternal malnutrition Diabetes High fasting plasma glucose Other non-communicable Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Unsafe sex Diarrheal/LRI/other Air pollution Neoplasms Low glomerular filtration rate Cardiovascular diseases High fasting plasma glucose Diabetes Child and maternal malnutrition Other non-communicable Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Unsafe sex Diarrheal/LRI/other Low glomerular filtration rate Cardiovascular diseases Child and maternal malnutrition Neoplasms Air pollution Diabetes High fasting plasma glucose Other non-communicable Others

111 Total population 15 to 49 years of age 1. Alcohol and drug use Unintentional injuries Dietary risks Transport injuries High body-mass index Neoplasms High systolic blood pressure Cardiovascular diseases Unsafe sex Self-harm & intersonal violence Smoking HIV/AIDS High fasting plasma glucose Cirrhosis Others to 49 years of age 1. Alcohol and drug use Transport injuries Dietary risks Unintentional injuries High systolic blood pressure Cardiovascular diseases High body-mass index Self-harm & intersonal violence Smoking HIV/AIDS Unsafe sex Neoplasms High fasting plasma glucose Cirrhosis Others to 49 years of age 1. Alcohol and drug use Neoplasms High body-mass index Unintentional injuries Dietary risks Maternal disorders Unsafe sex Cardiovascular diseases High systolic blood pressure Transport injuries Smoking Neoplasms High fasting plasma glucose Cirrhosis Others

112 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Cirrhosis Alcohol and drug use Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose Transport injuries Low glomerular filtration rate Unintentional injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms Alcohol and drug use Cirrhosis Smoking Diabetes High body-mass index Diarrheal/LRI/other High fasting plasma glucose Transport injuries Low glomerular filtration rate Unintentional injuries Others to 69 years of age 1. High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms Dietary risks Diabetes High fasting plasma glucose Cirrhosis Low glomerular filtration rate Diarrheal/LRI/other Smoking Digestive diseases Alcohol and drug use Unintentional injuries Others

113 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks 1, Neoplasms 1, High body-mass index Diarrheal/LRI/other Smoking Diabetes Low glomerular filtration rate Chronic respiratory diseases High fasting plasma glucose Cirrhosis Air pollution Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks 1, Neoplasms 1, Smoking Diarrheal/LRI/other High fasting plasma glucose Diabetes Low glomerular filtration rate Chronic respiratory diseases High body-mass index Cirrhosis Air pollution Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Diabetes High fasting plasma glucose Chronic respiratory diseases Smoking Digestive diseases Air pollution Unintentional injuries Others

114 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diarrheal/LRI/other Smoking Unintentional injuries Alcohol and drug use Diabetes High fasting plasma glucose Neonatal disorders Low glomerular filtration rate Cirrhosis Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Alcohol and drug use Diarrheal/LRI/other Smoking Unintentional injuries High body-mass index Neonatal disorders High fasting plasma glucose Transport injuries Low glomerular filtration rate Diabetes Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diarrheal/LRI/other High fasting plasma glucose Unintentional injuries Low glomerular filtration rate Diabetes Smoking Neonatal disorders Air pollution Cirrhosis Others

115 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE BRAZIL 36 Demographic indicators, 2013 Total population 200,362 millions of inhabitants Life expectancy at birth (LEB) 75 years Health life expectancy at birth (HLEB) 37 69years (9 years less than life expectancy at Birth) Median age 30 years Life expectancy for over-60 year population 22 years Over-60 years population 11% (22,040 millions of inhabitants) Macroeconomic indicators, 2013 Per capita GDP $16, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 9.7% Public outlay on healthcare 4.7% Private outlay on healthcare 2.9% Others outlays on healthcare 2.1% Human development indicators, 2013 Human Development Index 0,744 (High Human development, 79 th 187) HDI Adjusted for inequality (HDI-I) 0,542 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 13.5% Non-communicable diseases 74.7% Injuries 11.8% of death by sex, 2013 Causa total Percentage total Percentage Percentage female 1.Cardiovascular diseases 402, , , % 30.65% 38.34% 2.Neoplasms 215, ,637 99, % 17.68% 18.90% 3.Diabetes 110,122 49,379 60, % 7.55% 11.53% 4.Diarrhea/LRI/Other 81,989 41,184 40, % 6.30% 7.74% 5.Chronic respiratory diseases 73,287 42,585 30, % 6.51% 5.83% 6. Self-harm & intersonal violence 7.Neurological disorders 66,968 59,167 7, % 9.05% 1.48% 56,204 28,345 27, % 4.33% 5.29% 8. Transport injuries 47,482 37,881 9, % 5.79% 1.82% 9. Unintentional injuries 37, , % 3.67% 2.54% 10.Cirrhosis 33,445 25,021 8, % 3.83% 1.60% 11. Digestive diseases 30,174 15,120 15, % 2.31% 2.86% 12.Neonatal disorders 26,352 15,343 11, % 2.35% 2.09% TOTAL 1,181, , , % 100.0% 100.0% 36 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 53

116 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,651 43, % Years lived with disability (YLD) 6,059 7, % Years of life lost (YLL) 50,592 35, % , % Concept Disability adjusted life years (DALY) Grow rate ,068 27, % Years lived with disability (YLD) 3,299 4, % Years of life lost (YLL) 31,769 23, % % Concept Disability adjusted life years (DALY) Grow rate ,583 16, % Years lived with disability (YLD) 2,760 3, % Years of life lost (YLL) 18,823 12, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 43, % 7, % 35, % 1, % 27, % 4, % 23, % % 16, % 3, % 12, % % 54

117 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Air pollution Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Transport injuries Others 6.2 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Transport injuries Others 6.0 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Air pollution Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Communicable, maternal, neonatal, and nutritional diseases Others

118 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Neoplasms High fasting plasma glucose Diarrheal/LRI/other Air pollution Self-harm & intersonal violence Unsafe sex Other non-communicable High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Alcohol and drug use Unintentional injuries Unsafe water, sanitation and handwashing Transport injuries 3. Low glomerular filtration rate Neoplasms Air pollution Diarrheal/LRI/other High fasting plasma glucose Self-harm & intersonal violence Unsafe sex Other non-communicable Child and maternal malnutrition Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Neoplasms Low glomerular filtration rate Unintentional injuries Air pollution Self-harm & intersonal violence Unsafe sex Other non-communicable High systolic blood pressure Diabetes Others

119 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High systolic blood pressure Cardiovascular diseases High body-mass index Neoplasms Smoking Unintentional injuries High total cholesterol Cirrhosis Unsafe sex HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High systolic blood pressure Cardiovascular diseases High body-mass index Neoplasms Smoking Unintentional injuries High total cholesterol Cirrhosis High fasting plasma glucose HIV/AIDS Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Self-harm & intersonal violence Alcohol and drug use Diabetes Smoking Transport injuries Unsafe sex Diarrheal/LRI/other High total cholesterol HIV/AIDS Others

120 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Cirrhosis High total cholesterol Diarrheal/LRI/other Alcohol and drug use Transport injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms Smoking Diabetes High body-mass index Cirrhosis Alcohol and drug use Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Transport injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Digestive diseases Low glomerular filtration rate Cirrhosis Others

121 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms High fasting plasma glucose Diabetes Smoking Chronic respiratory diseases High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Chronic respiratory diseases High fasting plasma glucose Diabetes High body-mass index Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Neurological disorders High total cholesterol Chronic respiratory diseases Low glomerular filtration rate Digestive diseases Others

122 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence High total cholesterol Neurological disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Alcohol and drug use Self-harm & intersonal violence Smoking Diabetes High body-mass index Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Transport injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Chronic respiratory diseases High total cholesterol Neurological disorders Low glomerular filtration rate Digestive diseases Others

123 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE CANADA 38 Demographic indicators, 2013 Total population 35,182 hundred inhabitants Life expectancy at birth (LEB) 82 years Health life expectancy at birth (HLEB) 39 72years (10 years less than life expectancy at Birth) Median age 40 years Life expectancy for over-60 year population 25 years Over-60 years population 21% (7,388 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $43, Per capita GDP-PPP outlay on healthcare $4, Total outlay on healthcare 10.8% Public outlay on healthcare 7.6% Private outlay on healthcare 1.6% Others outlays on healthcare 1.6% Human development indicators, 2013 Human Development Index 0,902 (High Human development, 8 th 187) HDI Adjusted for inequality (HDI-I) 0,833 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 6.2% Non-communicable diseases 85.5% Injuries 8.3% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1.Cardiovascular diseases 82,889 38,552 44, % 29.7% 33.4% 2.Neoplasms 78,983 42,005 36, % 32.4% 27.9% 3.Neurological disorders 34,236 15,392 18, % 11.9% 14.2% 4.Diabetes 17,723 8,574 9, % 6.6% 6.9% 5.Chronic respiratory diseases 15,540 8,351 7, % 6.4% 5.4% 6.Diarrheal/LRI/Other 9,939 4,421 5, % 3.4% 4.2% 7.Unintentional injuries 8,084 3,951 4, % 3.0% 3.1% 8.Digestive diseases 6,075 2,409 3, % 1.9% 2.8% 9. Self-harm & intersonal violence 4, , % 2.8% 0.9% 10.Cirrhosis 4,144 2, % 1.9% 1.2% TOTAL 262, , , % 100.0% 100.0% 38 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 61

124 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,059,696 5,574, % Years lived with disability (YLD) 971,018 1,555, % Years of life lost (YLL) 4,088,680 4,018, % , % Concept Disability adjusted life years (DALY) Grow rate ,267,990 3,302, % Years lived with disability (YLD) 571, , % Years of life lost (YLL) 2,696,656 2,466, % 134, , % Concept Disability adjusted life years (DALY) Grow rate ,791,706 2,272, % Years lived with disability (YLD) 399, , % Years of life lost (YLL) 1,392,024 1,552, % 100, , % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 5,574, % 1,555, % 4,018, % 269, % 3,302, % 835, % 2,466, % 141, % 2,272, % 720, % 1,552, % 128, % 62

125 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries High fasting plasma glucose Diarrheal/LRI/other Air pollution Diabetes Unsafe water, sanitation and handwashing Neoplasms 7. Unsafe sex Transport injuries Others 5.0 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries High fasting plasma glucose Diarrheal/LRI/other Air pollution Diabetes Unsafe water, sanitation and handwashing Neoplasms 7. Unsafe sex Transport injuries Others 5.1 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries Air pollution Diarrheal/LRI/other High fasting plasma glucose Neoplasms Unsafe water, sanitation and handwashing Diabetes 7. Unsafe sex Transport injuries Others

126 Total population 5 to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Unintentional injuries Sexual abuse and violence Other non-communicable Unsafe water, sanitation and handwashing Self-harm & intersonal violence 6. Air pollution Diabetes High systolic blood pressure Diarrheal/LRI/other Others to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Unintentional injuries Sexual abuse and violence Self-harm & intersonal violence Unsafe water, sanitation and handwashing Other non-communicable 6. Air polution Diabetes High systolic blood pressure Neurological disorders Others to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Unintentional injuries Sexual abuse and violence Other non-communicable Unsafe water, sanitation and handwashing Diabetes 6. Air pollution Self-harm & intersonal violence High systolic blood pressure Diarrheal/LRI/other Others

127 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence Smoking Cardiovascular diseases High body-mass index Transport injuries High total cholesterol Mental and substance use High systolic blood pressure Unintentional injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Neoplasms High body-mass index Cardiovascular diseases Smoking Transport injuries High total cholesterol Mental and substance use High systolic blood pressure Unintentional injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. Alcohol and drug use Neoplasms Smoking Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Transport injuries Sexual abuse and violence Mental and substance use High total cholesterol Diabetes High systolic blood pressure Unintentional injuries Others

128 Total population 50 to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases High total cholesterol Transport injuries Alcohol and drug use Cirrhosis High fasting plasma glucose Self-harm & intersonal violence Others to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Cirrhosis High total cholesterol Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence High fasting plasma glucose Neurological disorders Others to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases Alcohol and drug use Neurological disorders High total cholesterol Cirrhosis High fasting plasma glucose Digestive diseases Others

129 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 1, Smoking Neurological disorders 1, High systolic blood pressure Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 1, Smoking 1, Neoplasms 1, High systolic blood pressure Neurological disorders High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Neoplasms 1, Smoking Neurological disorders High body-mass index Diabetes High total cholesterol Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others

130 Total population 1. Dietary risks Cardiovascular diseases All age 2. Smoking Neoplasms High systolic blood pressure Neurological disorders High body-mass index Diabetes High total cholesterol Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Others Dietary risks Neoplasms All age 2. Smoking Cardiovascular diseases High systolic blood pressure Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. Smoking Neoplasms High systolic blood pressure Neurological disorders High body-mass index Diabetes High total cholesterol Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others

131 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE CHILE 40 Demographic indicators, 2013 Total population 17,620 hundred inhabitants Life expectancy at birth (LEB) 80 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 33 years Life expectancy for over-60 year population 24 years Over-60 years population 14% (2,467 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $21, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 7.6% Public outlay on healthcare 3.6% Private outlay on healthcare 2.4% Others outlays on healthcare 1.6% Human development indicators, 2013 Human Development Index 0,822 (High Human development, 41 th 187) HDI Adjusted for inequality (HDI-I) 0,661 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 8.1% Non-communicable diseases 82.7% Injuries 9.2% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1.Cardiovascular diseases 29,868 14,581 15, % 26.7% 30.1% 2.Neoplasms 26,777 13,898 12, % 25.5% 25.4% 3.Nerological disorders 10,042 3,806 6, % 7.0% 12.3% 4.Diabetes 8,475 4,009 4, % 7.3% 8.8% 5.Chronic respiratory diseases 6,434 3,395 3, % 6.2% 6.0% 6.Diarrheal/LRI/Other 5,994 2,903 3, % 5.3% 6.1% 7.Cirrhosis 4,736 3,329 1, % 6.1% 2.8% 8. Self-harm & intersonal violence 9. Unintentional injuries 3,094 2, % 4.8% 1.0% 3, , % 3.6% 2.1% 10. Digestive diseases 2,827 1, % 2.4% 3.0% 11.Transport injuries 2,682 2, % 3.9% 1.1% 12. Other noncommunicable 1, % 1.2% 1.4% TOTAL 105,289 54,557 50, % 100.0% 100.0% 40 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 69

132 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,026,966 2,313, % Years lived with disability (YLD) 372, , % Years of life lost (YLL) 1,654,808 1,719, % , % Concept Disability adjusted life years (DALY) Grow rate ,314,708 1,470, % Years lived with disability (YLD) 235, , % Years of life lost (YLL) 1,079,164 1,124, % 43,966 52, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 136, , % Years of life lost (YLL) 575, , % 32,610 39, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 2,313, % 594, % 1,719, % 91, % 1,470, % 345, % 1,124, % 52, % 843, % 248, % 594, % 39, % 70

133 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Alcohol and drug use Neoplasms Smoking Diabetes Low glomerular filtration rate Transport injuries Others 5.0 Children under 5 years 1. Child and maternal malnutrition Other non-communicable Air pollution Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 4. Unsafe sex Unintentional injuries Alcohol and drug use Neoplasms Smoking Diabetes Low glomerular filtration rate Transport injuries Others 4.7 Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Alcohol and drug use Neoplasms Smoking Diabetes Low glomerular filtration rate Transport injuries Others

134 Total population 5 to 14 years of age 1. Alcohol and drug use Neoplasms Unsafe water, sanitation and handwashing Transport injuries 3. Low glomerular filtration rate Unintentional injuries High systolic blood pressure Other non-communicable Air pollution Self-harm & intersonal violence Sexual abuse and violence Diarrheal/LRI/other Unsafe sex Diabetes Others to 14 years of age 1. Alcohol and drug use Neoplasms Unsafe water, sanitation and handwashing Transport injuries 3. Low glomerular filtration rate Unintentional injuries High fasting plasma glucose Self-harm & intersonal violence Air pollution Other non-communicable Sexual abuse and violence Diarrheal/LRI/other Unsafe sex Diabetes Others to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Unsafe water, sanitation and handwashing Other non-communicable 4. High fasting plasma glucose Unintentional injuries Air pollution Diarrheal/LRI/other Sexual abuse and violence Self-harm & intersonal violence High systolic blood pressure Diabetes Others

135 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence High body-mass index Cardiovascular diseases High systolic blood pressure Transport injuries Smoking Unintentional injuries High total cholesterol Cirrhosis Sexual abuse and violence Diabetes Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High systolic blood pressure Neoplasms High body-mass index Cardiovascular diseases Smoking Unintentional injuries High total cholesterol Cirrhosis High fasting plasma glucose Mental and substance use Others to 49 years of age 1. High body-mass index Neoplasms Alcohol and drug use Cardiovascular diseases Dietary risks Self-harm & intersonal violence High systolic blood pressure Transport injuries Smoking Diabetes Unsafe sex Cirrhosis Sexual abuse and violence Unintentional injuries Others

136 Total population 50 to 69 years of age 1. High systolic blood pressure Neoplasms Dietary risks Cardiovascular diseases High body-mass index Cirrhosis Smoking Diabetes Alcohol and drug use Chronic respiratory diseases High fasting plasma glucose Transport injuries High total cholesterol Diarrheal/LRI/other Others to 69 years of age 1. Dietary risks Neoplasms High systolic blood pressure Cardiovascular diseases Smoking Cirrhosis Alcohol and drug use Diabetes High body-mass index Chronic respiratory diseases High fasting plasma glucose Transport injuries High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. High body-mass index Neoplasms High systolic blood pressure Cardiovascular diseases Dietary risks Diabetes Smoking Cirrhosis Alcohol and drug use Chronic respiratory diseases High fasting plasma glucose Neurological disorders Low glomerular filtration rate Digestive diseases Others

137 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks Neoplasms 1, High body-mass index Neurological disorders Smoking Diabetes High fasting plasma glucose Chronic respiratory diseases Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks 1, Neoplasms 1, Smoking Neurological disorders High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Cirrhosis Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks Neoplasms 1, High body-mass index Neurological disorders High fasting plasma glucose Diabetes Smoking Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Digestive diseases Others

138 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Neurological disorders Smoking Diabetes Alcohol and drug use Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Cirrhosis Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms Smoking Diabetes Alcohol and drug use Neurological disorders High body-mass index Chronic respiratory diseases High fasting plasma glucose Cirrhosis High total cholesterol Diarrheal/LRI/other Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Neurological disorders Smoking Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Digestive diseases Others

139 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE COLOMBIA 42 Demographic indicators, 2013 Total population 48,321 hundred inhabitants Life expectancy at birth (LEB) 78 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 28 years Life expectancy for over-60 year population 24 years Over-60 years population 10% (4,832 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $12, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.8% Public outlay on healthcare 5.2% Private outlay on healthcare 0.9% Others outlays on healthcare 0.7% Human development indicators, 2013 Human Development Index 0,711 (High Human development, 97 th 187) HDI Adjusted for inequality (HDI-I) 0,521 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 10.8% Non-communicable diseases 74.7% Injuries 14.5% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 72,710 36,305 36, % 28.19% 36.31% 2. Neoplasms 44,294 22,168 22, % 17.21% 22.07% 3. Self-harm & intersonal violence 28,007 22,137 2, % 17.19% 2.86% 4.Diabetes 17,974 8,446 9, % 6.56% 9.50% 5. Chronic respiratory diseases 17,830 9,655 8, % 7.50% 8.15% 6. Diarrheal/LRI/Other 12,016 6,284 5, % 4.88% 5.72% 7. Neurological disorders 9,928 4,720 5, % 3.66% 5.19% 8. Transport injuries 9,529 7,533 1, % 5.85% 1.99% 9. Unintentional injuries 7, , % 4.26% 2.30% 10. Digestive diseases 6,554 3, % 2.53% 3.28% 11. Other noncommunicable 5,415 2, % 2.16% 2.62% TOTAL 232, , , % 100.0% 100.0% 42 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 77

140 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,937,474 6,647, % Years lived with disability (YLD) 929, , % Years of life lost (YLL) 6,007,544 5,706, % , % Concept Disability adjusted life years (DALY) Grow rate ,718,138 4,664, % Years lived with disability (YLD) 539, , % Years of life lost (YLL) 4,178,402 3,800, % 112, , % Concept Disability adjusted life years (DALY) Grow rate ,219,336 1,983, % Years lived with disability (YLD) 390,194 76, % Years of life lost (YLL) 1,829,142 1,906, % 66,533 99, % Years of healthy life lost, centage growth by sex DALY YLD YLL DEATHS CONCEPT 2010 % 2010 % 2010 % 2010 % Total 6,647, % 941, % 5,706, % 237, % 4,664, % 864, % 3,800, % 137, % 1,983, % 76, % 1,906, % 99, % 78

141 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Others 10.0 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Others 9.8 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries Others

142 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Transport injuries Air pollution Self-harm & intersonal violence High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Other non-communicable Unsafe sex Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Self-harm & intersonal violence Air pollution Neoplasms High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Other non-communicable Unsafe sex Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Transport injuries High fasting plasma glucose Self-harm & intersonal violence Air pollution Unintentional injuries High systolic blood pressure Other non-communicable Unsafe sex Cardiovascular diseases Others

143 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Neoplasms High body-mass index Transport injuries High systolic blood pressure Cardiovascular diseases Unsafe sex Unintentional injuries High total cholesterol HVI/AIDS Smoking Diabetes Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms Unsafe sex Unintentional injuries High total cholesterol HVI/AIDS Smoking Diabetes Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Self-harm & intersonal violence Unsafe sex Cardiovascular diseases High systolic blood pressure Transport injuries Alcohol and drug use Diabetes High total cholesterol Maternal disorders High fasting plasma glucose Diarrheal/LRI/other Others

144 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Self-harm & intersonal violence High total cholesterol Transport injuries Air pollution Digestive diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Self-harm & intersonal violence High total cholesterol Transport injuries Air pollution Cirrhosis Others to 69 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Chronic respiratory diseases Smoking Digestive diseases High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Cirrhosis Others

145 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Chronic respiratory diseases High body-mass index Diabetes High fasting plasma glucose Neurological disorders Air pollution Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking 1, Chronic respiratory diseases High body-mass index Diabetes High fasting plasma glucose Neurological disorders Air pollution Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms High body-mass index Chronic respiratory diseases Smoking Diabetes High fasting plasma glucose Neurological disorders Air pollution Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others

146 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Self-harm & intersonal violence Smoking Diabetes High fasting plasma glucose Chronic respiratory diseases Air pollution Diarrheal/LRI/other High total cholesterol Neurological disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Self-harm & intersonal violence High body-mass index Chronic respiratory diseases Alcohol and drug use Diabetes High fasting plasma glucose Transport injuries Air pollution Diarrheal/LRI/other Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Air pollution Neurological disorders High total cholesterol Digestive diseases Others

147 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE COSTA RICA 44 Demographic indicators, 2013 Total population 4,872 hundred inhabitants Life expectancy at birth (LEB) 79 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 30 years Life expectancy for over-60 year population 23 years Over-60 years population 11% (536 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $13, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 9.9% Public outlay on healthcare 7.4% Private outlay on healthcare 2.3% Others outlays on healthcare 0.2% Human development indicators, 2013 Human Development Index 0,763 (High Human development, 97 th 187) HDI Adjusted for inequality (HDI-I) 0,611 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 6.6% Non-communicable diseases 83.6% Injuries 9.8% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 6,208 3,229 2, % 28.3% 32.8% 2. Neoplasms 4,920 2,651 2, % 23.2% 24.9% 3. Diabetes 1, % 7.9% 9.8% 4. Chronic respiratory diseases 1, % 6.6% 7.4% 5. Neurological disorders 1, % 6.0% 7.2% 6. Transport injuries % 5.6% 0.0% 7.Cirrhosis % 4.4% 3.2% 8. Diarrheal/LRI/Other % 3.6% 4.1% 9. Unintentional injuries % 4.1% 3.3% 10. Self-harm & intersonal violence % 5.4% 1.1% 11. Digestive diseases % 3.0% 4.0% 12. Other noncommunicable % 1.9% 2.2% TOTAL 20,665 11,403 9, % 100.0% 100.0% 44 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 85

148 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate , , % Years lived with disability (YLD) 75, , % Years of life lost (YLL) 237, , % , % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 49,496 84, % Years of life lost (YLL) 152, , % 5,890 10, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 26,201 60, % Years of life lost (YLL) 84, , % 1,093 1, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 513, % 144, % % 12, % 328, % 84, % 244, % 10, % 184, % 60, % 124, % 1, % 86

149 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders Unsafe sex Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Neoplasms Smoking Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes Others 7.1 Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders Unsafe sex Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Neoplasms Smoking Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes Others 7.0 Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders Unsafe sex Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Neoplasms Smoking Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes Others

150 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Unintentional injuries Unsafe sex Diarrheal/LRI/other High fasting plasma glucose Other non-communicable Sexual abuse and violence Self-harm & intersonal violence High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Transport injuries Unsafe sex Diarrheal/LRI/other Sexual abuse and violence Other non-communicable High systolic blood pressure Self-harm & intersonal violence High fasting plasma glucose Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Diarrheal/LRI/other Unsafe sex Unintentional injuries High fasting plasma glucose Other non-communicable Sexual abuse and violence Diabetes High systolic blood pressure Self-harm & intersonal violence Others

151 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence High body-mass index Transport injuries High systolic blood pressure Cardiovascular diseases Unsafe sex Unintentional injuries High total cholesterol Diabetes High fasting plasma glucose Cirrhosis Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High systolic blood pressure Neoplasms High body-mass index Cardiovascular diseases High total cholesterol Unintentional injuries Unsafe sex Cirrhosis Low glomerular filtration rate Diabetes Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases Alcohol and drug use Diabetes Unsafe sex Self-harm & intersonal violence High fasting plasma glucose Transport injuries Low glomerular filtration rate Cirrhosis High systolic blood pressure Unintentional injuries Others

152 Total population 50 to 69 years of age 1. Dietary risks Neoplasms High systolic blood pressure Cardiovascular diseases High body-mass index Diabetes High fasting plasma glucose Cirrhosis Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Transport injuries Smoking Digestive diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking Transport injuries Alcohol and drug use Chronic respiratory diseases High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Cirrhosis Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Digestive diseases Alcohol and drug use Neurological disorders Others

153 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks 1, Neoplasms 1, High fasting plasma glucose Chronic respiratory diseases High body-mass index Neurological disorders Low glomerular filtration rate Diabetes Smoking Diarrheal/LRI/other High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, High fasting plasma glucose Chronic respiratory diseases Smoking Neurological disorders Low glomerular filtration rate Diabetes High body-mass index Diarrheal/LRI/other High total cholesterol Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks Neoplasms High body-mass index Neurological disorders High fasting plasma glucose Diabetes Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Digestive diseases Smoking Diarrheal/LRI/other Others

154 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Smoking Transport injuries High total cholesterol Cirrhosis Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Smoking Neurological disorders Low glomerular filtration rate Transport injuries Alcohol and drug use Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Low glomerular filtration rate Neurological disorders High total cholesterol Diarrheal/LRI/other Smoking Digestive diseases Others

155 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE CUBA 46 Demographic indicators, 2013 Total population 11,266 hundred inhabitants Life expectancy at birth (LEB) 78 years Health life expectancy at birth (HLEB) years (12 years less than life expectancy at Birth) Median age 40 years Life expectancy for over-60 year population 22 years Over-60 years population 19% (2,141 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $20, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 8.8% Public outlay on healthcare 8.2% Private outlay on healthcare 0.6% Others outlays on healthcare 0.0% Human development indicators, 2013 Human Development Index 0,818 (High Human development, 44 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d(optimal: below 39.0), 2012 Communicable diseases 6.6% Non-communicable diseases 83.6% Injuries 9.8% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 39,084 19,359 19, % 38.94% 44.16% 2. Neoplasms 23,163 13,206 9, % 26.56% 22.30% 3. Diarrheal/LRI/Other 6,596 3,359 3, % 6.76% 7.25% 4. Neurological disorders 5,586 2,658 2, % 5.35% 6.56% 5. Diabetes 4,716 2,030 2, % 4.08% 6.02% 6. Chronic respiratory diseases 4,148 2,461 1, % 4.95% 3.78% 7. Unintentional injuries 3,839 1,774 2, % 3.57% 4.62% 8. Self-harm & intersonal violence 2,272 1, % 3.56% 1.13% 9. Digestive diseases 2, , % 2.13% 2.30% 10. Cirrhosis 1, % 2.05% 1.03% 11. Transport injuries 1,407 1, % 2.06% 0.86% TOTAL 94,379 49,720 44, % 100.0% 100.0% 46 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 93

156 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,068,971 2,477, % Years lived with disability (YLD) 421, , % Years of life lost (YLL) 1,647,636 1,865, % , % Concept Disability adjusted life years (DALY) Grow rate ,206,696 1,390, % Years lived with disability (YLD) 225, , % Years of life lost (YLL) 980,765 1,077, % 45,214 58, % Concept Disability adjusted life years (DALY) Grow rate ,275 1,086, % Years lived with disability (YLD) 195, , % Years of life lost (YLL) 666, , % 36,485 54, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 2,477, % 611, % 1,865, % 112, % 1,390, % 312, % 1,077, % 58, % 1,086, % 298, % 787, % 54, % 94

157 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Smoking Diarrheal/LRI/other Air pollution Unintentional injuries Low glomerular filtration rate Neoplasms Alcohol and drug use Diabetes Unsafe sex Neurological disorders Others 5.3 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Smoking Diarrheal/LRI/other Air pollution Unintentional injuries Low glomerular filtration rate Neoplasms Alcohol and drug use Diabetes Unsafe sex Neurological disorders Others 5.2 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Smoking Diarrheal/LRI/other Air pollution Unintentional injuries Alcohol and drug use Neoplasms Low glomerular filtration rate Diabetes Unsafe sex Neurological disorders Others

158 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Transport injuries High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Other non-communicable Air pollution Self-harm & intersonal violence Sexual abuse and violence Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Diarrheal/LRI/other Air pollution Other non-communicable High systolic blood pressure Self-harm & intersonal violence Sexual abuse and violence Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Other non-communicable High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Unintentional injuries Sexual abuse and violence Diabetes Air pollution Self-harm & intersonal violence Others

159 Total population 15 to 49 years of age 1. Dietary risks Neoplasms Smoking Cardiovascular diseases High systolic blood pressure Self-harm & intersonal violence High body-mass index Transport injuries Alcohol and drug use Unintentional injuries High total cholesterol Diabetes High fasting plasma glucose Cirrhosis Others to 49 years of age 1. Dietary risks Self-harm & intersonal violence Alcohol and drug use Transport injuries High systolic blood pressure Neoplasms Smoking Self-harm & intersonal violence High body-mass index Unintentional injuries High total cholesterol Diabetes High fasting plasma glucose Cirrhosis Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Smoking Self-harm & intersonal violence High systolic blood pressure Diabetes Unsafe sex Transport injuries High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Chronic respiratory diseases Others

160 Total population 50 to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms Smoking Diabetes High body-mass index Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Cirrhosis Low physical activity Self-harm & intersonal violence Others to 69 years of age 1. Smoking Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High body-mass index Self-harm & intersonal violence High fasting plasma glucose Chronic respiratory diseases High total cholesterol Cirrhosis Alcohol and drug use Diarrheal/LRI/other Others to 69 years of age 1. High systolic blood pressure Neoplasms High body-mass index Cardiovascular diseases Dietary risks Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Digestive diseases Low glomerular filtration rate Neurological disorders Others

161 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, Smoking Diarrheal/LRI/other High body-mass index Neurological disorders High fasting plasma glucose Chronic respiratory diseases Low glomerular filtration rate Diabetes Low physical activity Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, Smoking 1, Diarrheal/LRI/other High fasting plasma glucose Neurological disorders High body-mass index Chronic respiratory diseases Low physical activity Diabetes Low glomerular filtration rate Unintentional injuries Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms High body-mass index Diarrheal/LRI/other Smoking Neurological disorders High fasting plasma glucose Unintentional injuries Low glomerular filtration rate Diabetes Low physical activity Chronic respiratory diseases Others

162 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms Smoking Diarrheal/LRI/other High body-mass index Neurological disorders High fasting plasma glucose Diabetes Low glomerular filtration rate Chronic respiratory diseases Low physical activity Unintentional injuries Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms Smoking Diarrheal/LRI/other High body-mass index Neurological disorders High fasting plasma glucose Chronic respiratory diseases Low physical activity Diabetes Low glomerular filtration rate Unintentional injuries Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diarrheal/LRI/other Smoking Neurological disorders High fasting plasma glucose Diabetes Low glomerular filtration rate Unintentional injuries Low physical activity Chronic respiratory diseases Others

163 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE CURAZAO 48 Demographic indicators, 2013 Total population 148,406 inhabitants Life expectancy at birth (LEB) 78.2 years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 36.1 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) Over 65 year population 14.2% (14,268 inhabitants) General mortality rate 796 Macroeconomic indicators, 2013 Per capita GDP 15,000 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 21. Ischemic heart disease 15, % 22. Stroke 9, % 23. Diabetes 4, % 24. Lower respiratory infection 3, % 25. HIV/AIDS 3, % 26. Hytensive health disease 2, % 27. Road injuries 2, % 28. Prostate cancer 2, % 29. Preterm birth complications 1, % 30. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 11. Physiological risks 72% 12. Dietary risks 15% High body-mass index 146% 13. Alcohol and drug use 10% High blood glucose levels 113% 14. Physical inactivity 7% Low bone mineral density 95% 15. Smoking 6% 4. Alcohol and drug use 86% 8. Malnutrition 5% Drug use 146% 11. Injuries 4% Alcohol use 67% 12. Other risks 11% 5. Injuries 33% Total 100% 6. Dietary risks 29% 48 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 101

164 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE DOMINICA 50 Demographic indicators, 2013 Total population 72 hundred inhabitants Life expectancy at birth (LEB) 75 years Health life expectancy at birth (HLEB) years (12 years less than life expectancy at Birth) Median age 26 years Life expectancy for over-60 year population 21 years Over-60 years population 13% (9 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $10, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.0% Public outlay on healthcare 4.2% Private outlay on healthcare 1.6% Others outlays on healthcare 0.2% Human development indicators, 2013 Human Development Index 0,717 (High Human development, 44 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d(optimal: below 39.0), 2012 Communicable diseases 6.6% Non-communicable diseases 84.4% Injuries 9.0% of death by sex, 2013 Cause total male female Percentag e total Percentag e male Percentag e female 1. Cardiovascular diseases % 31.65% 40.89% 2.Neoplasms % 19.78% 16.26% 3.Diabetes % 14.39% 18.23% 4.Diarrheal/LRI/Other % 5.76% 5.91% 5. Neurological disorders 6. Chronic respiratory diseases % 5.40% 5.42% % 4.68% 1.97% 7. Unintentional injuries % 4.32% 2.46% 8. Self-harm & intersonal violence % 4.32% 0.88% 9.Neonatal disorders % 2.52% 2.46% 10. Transport injuries % 3.24% 1.07% 11. Non-communicable diseases % 1.78% 2.46% 12. Digestive diseases % 2.35% 1.97% TOTAL % 100.0% 100.0% 50 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 103

165 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,852 12, % Years lived with disability (YLD) 2,733 3, % Years of life lost (YLL) 9,120 9, % % Concept Disability adjusted life years (DALY) Grow rate ,297 7, % Years lived with disability (YLD) 1,385 1, % Years of life lost (YLL) 4,913 5, % % Concept Disability adjusted life years (DALY) Grow rate ,555 5, % Years lived with disability (YLD) 1,348 1, % Years of life lost (YLL) 4,207 3, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 12, % 3, % 9, % % 7, % 1, % 5, % % 5, % 1, % 3, % % 104

166 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others 5.5 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others 5.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others

167 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable Air pollution Cardiovascular diseases High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Air pollution Neoplasms Child and maternal malnutrition Other non-communicable High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Unintentional injuries Alcohol and drug use Transport injuries High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable Air pollution Diabetes High systolic blood pressure Cardiovascular diseases Others

168 Total population 15 to 49 years of age 1. Alcohol and drug use Cardiovascular diseases Dietary risks Self-harm & intersonal violence High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Unintentional injuries Unsafe sex Transport injuries Smoking HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High systolic blood pressure Unintentional injuries High body-mass index Transport injuries High fasting plasma glucose Diabetes Unsafe sex Neoplasms Smoking HIV/AIDS Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose HIV/AIDS Unsafe sex Self-harm & intersonal violence Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Others

169 Total population 50 to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Cirrhosis Smoking Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Cirrhosis High total cholesterol Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others

170 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Air pollution Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Smoking Diarrheal/LRI/other Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, High fasting plasma glucose 1, Diabetes 1, High body-mass index 1, Neoplasms Dietary risks 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Chronic respiratory diseases High total cholesterol Digestive diseases Others

171 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Smoking Neurological disorders Low physical activity Chronic respiratory diseases Air pollution Unintentional injuries Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Smoking Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. High body-mass index Diabetes High fasting plasma glucose Neoplasms Dietary risks Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Other non-communicable High total cholesterol Neonatal disorders Others

172 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE ECUADOR 52 Demographic indicators, 2013 Total population 15,738 hundred inhabitants Life expectancy at birth (LEB) 76 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 26 years Life expectancy for over-60 year population 22 years Over-60 years population 10% (1,574 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $10, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 7.5% Public outlay on healthcare 3.9% Private outlay on healthcare 3.4% Others outlays on healthcare 0.2% Human development indicators, 2013 Human Development Index 0,711 (High Human development, 44 th 187) HDI Adjusted for inequality (HDI-I) 0,549 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 16.4% Non-communicable diseases 69.4% Injuries 14.2% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 20,748 10,870 9, % 23.39% 28.63% 2. Neoplasms 14,042 7,098 6, % 15.27% 20.13% 3. Diabetes 9,377 4,678 4, % 10.07% 13.62% 4. Diarrheal/LRI/Other 8,563 4,568 3, % 9.83% 11.58% 5. Transport injuries 5,094 3,970 1, % 8.54% 3.26% 6. Self-harm & intersonal violence 4,759 3, % 8.61% 2.20% 7. Unintentional injuries 3,864 2, % 6.04% 3.07% 8. Chronic respiratory diseases 3,590 2,231 1, % 4.80% 3.94% 9.Cirrhosis 3, , % 4.38% 3.07% 10. Neurological disorders 2,738 1, % 2.91% 4.01% 11. Digestive diseases 2,613 1, % 3.09% 3.41% 12. Neonatal disorders 2,486 1, % 3.07% 3.07% TOTAL 80,969 46,469 34, % 100.0% 100.0% 52 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 111

173 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,842,482 2,002, % Years lived with disability (YLD) 319, , % Years of life lost (YLL) 1,522,557 1,483, % , % Concept Disability adjusted life years (DALY) Grow rate ,102,377 1,245, % Years lived with disability (YLD) 186, , % Years of life lost (YLL) 916, , % 23,244 36, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 133, , % Years of life lost (YLL) 606, , % 16,612 23, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 20,002,007 10% 518, % 1,483, % 59, % 1,248, % 279, % 966, % 36, % 756, % 239, % 516, % 23, % 112

174 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Other non-communicable Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Transport injuries Unsafe sex Diabetes Others 6.7 Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Other non-communicable Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Transport injuries Unsafe sex Diabetes Others 6.5 Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Other non-communicable Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Unsafe sex Transport injuries Alcohol and drug use Diabetes Others

175 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Neoplasms Child and maternal malnutrition Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases High fasting plasma glucose Other non-communicable Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Diarrheal/LRI/other Air pollution Neoplasms Child and maternal malnutrition Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases High fasting plasma glucose Other non-communicable Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Neoplasms Child and maternal malnutrition Self-harm & intersonal violence High fasting plasma glucose Cardiovascular diseases High systolic blood pressure Other non-communicable Others

176 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms High fasting plasma glucose Unintentional injuries Unsafe sex Diabetes High total cholesterol HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High systolic blood pressure Unintentional injuries High body-mass index Cardiovascular diseases High fasting plasma glucose Neoplasms High total cholesterol HIV/AIDS Unsafe sex Diabetes Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Self-harm & intersonal violence High fasting plasma glucose Diabetes Alcohol and drug use Transport injuries Unsafe sex Diarrheal/LRI/other Low glomerular filtration rate Maternal disorders Others

177 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes Alcohol and drug use Cirrhosis High body-mass index Transport injuries Low glomerular filtration rate Self-harm & intersonal violence Smoking Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High fasting plasma glucose Diabetes High systolic blood pressure Cirrhosis Low glomerular filtration rate Diarrheal/LRI/other High total cholesterol Digestive diseases Alcohol and drug use Transport injuries Others

178 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks 1, Neoplasms 1, High fasting plasma glucose Diabetes Smoking Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases High body-mass index Neurological disorders High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, High fasting plasma glucose Diabetes Smoking Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases High body-mass index Neurological disorders Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 1, Dietary risks 1, Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders High total cholesterol Chronic respiratory diseases Low physical activity Digestive diseases Others

179 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Transport injuries Alcohol and drug use Self-harm & intersonal violence Smoking Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Alcohol and drug use Diabetes High fasting plasma glucose Diarrheal/LRI/other High body-mass index Self-harm & intersonal violence Low glomerular filtration rate Transport injuries Smoking Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders High total cholesterol Chronic respiratory diseases Low physical activity Digestive diseases Others

180 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE EL SALVADOR 54 Demographic indicators, 2013 Total population 6,340 hundred inhabitants Life expectancy at birth (LEB) 73 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 24 years Life expectancy for over-60 year population 22 years Over-60 years population 10% (634 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $7, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.9% Public outlay on healthcare 4.6% Private outlay on healthcare 2.0% Others outlays on healthcare 0.3% Human development indicators, 2013 Human Development Index 0,662 (High Human development, 115 th 187) HDI Adjusted for inequality (HDI-I) 0,485 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 13.2% Non-communicable diseases 65.2% Injuries 21.6% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 9,350 4,262 5, % 20.30% 31.07% 2.Diabetes 4,975 2,664 2, % 12.69% 14.11% 3. Self-harm & intersonal violence 4,852 4, % 19.94% 4.07% 4.Neoplasms 4,807 2,016 2, % 9.60% 17.04% 5. Diarrheal/LRI/Other 3,124 1,589 1, % 7.57% 9.37% 6. Chronic respiratory diseases 2, , % 4.72% 7.34% 7. Transport injuries 2,114 1, % 7.70% 3.04% 8. Neurological disorders 1, % 3.82% 5.44% 9.Cirrhosis 1, % 3.84% 2.93% 10. Unintentional injuries 11.Mental & substance use disorders 1, % 3.26% 2.15% % 4.52% 0.28% 12. Digestive diseases % 2.03% 3.15% TOTAL 37,366 20,990 16, % 100.0% 100.0% 54 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 119

181 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,146,070 1,130, % Years lived with disability (YLD) 147, , % Years of life lost (YLL) 998, , % , % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 89, , % Years of life lost (YLL) 654, , % 16,019 20, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 58,444 98, % Years of life lost (YLL) 343, , % 10,852 16, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,130, % 215, % 915, % 37, % 722, % 117, % 604, % 20, % 408, % 98, % 310, % 16, % 120

182 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Smoking Diabetes High systolic blood pressure Self-harm & intersonal violence Others 7.0 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Unsafe sex Nutritional deficiencies Smoking Diabetes High systolic blood pressure Self-harm & intersonal violence Others 7.0 Children under 5 years 1. Child and maternal malnutrition Other non-communicable Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Diarrheal/LRI/other Unsafe sex Nutritional deficiencies Low glomerular filtration rate Unintentional injuries Smoking Self-harm & intersonal violence High systolic blood pressure Diabetes Others

183 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Low glomerular filtration rate Self-harm & intersonal violence Alcohol and drug use Diarrheal/LRI/other High systolic blood pressure Unintentional injuries Air pollution Neoplasms Child and maternal malnutrition Other non-communicable High fasting plasma glucose Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Self-harm & intersonal violence Low glomerular filtration rate Diarrheal/LRI/other Air pollution Unintentional injuries High systolic blood pressure Neoplasms Child and maternal malnutrition Other non-communicable High fasting plasma glucose Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Self-harm & intersonal violence 2. Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Diarrheal/LRI/other High systolic blood pressure Neoplasms Air pollution Unintentional injuries Child and maternal malnutrition Other non-communicable High fasting plasma glucose Cardiovascular diseases Others

184 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Neoplasms Low glomerular filtration rate Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Mental and substance use disorders Unsafe sex Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries Low glomerular filtration rate Mental and substance use disorders High systolic blood pressure Cardiovascular diseases High fasting plasma glucose Diabetes High body-mass index Unintentional injuries Smoking Cirrhosis Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Self-harm & intersonal violence Unsafe sex Cardiovascular diseases Alcohol and drug use Diabetes Low glomerular filtration rate Transport injuries High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Maternal disorders Others

185 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Neoplasms High fasting plasma glucose Cirrhosis Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Self-harm & intersonal violence High total cholesterol Transport injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Neoplasms Low glomerular filtration rate Self-harm & intersonal violence Alcohol and drug use Mental and substance use disorders High body-mass index Transport injuries Smoking Cirrhosis Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Diabetes High fasting plasma glucose Neoplasms High systolic blood pressure Self-harm & intersonal violence Low glomerular filtration rate Mental and substance use disorders High total cholesterol Transport injuries Air pollution Cirrhosis Others

186 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Diabetes High fasting plasma glucose Neoplasms High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders Smoking Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Diabetes High fasting plasma glucose Neoplasms Low glomerular filtration rate Diarrheal/LRI/other Air pollution Chronic respiratory diseases High body-mass index Neurological disorders Smoking Transport injuries Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders High total cholesterol Digestive diseases Others

187 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Diabetes High fasting plasma glucose Self-harm & intersonal violence High body-mass index Neoplasms Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Chronic respiratory diseases Air pollution Transport injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Self-harm & intersonal violence Alcohol and drug use Diabetes High fasting plasma glucose Neoplasms Low glomerular filtration rate Transport injuries High body-mass index Diarrheal/LRI/other Smoking Chronic respiratory diseases Others Dietary risks Cardiovascular diseases All age 2. High body-mass index Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders High total cholesterol Self-harm & intersonal violence Others

188 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE UNITE STATES 56 Demographic indicators, 2013 Total population 320,051 million of inhabitants Life expectancy at birth (LEB) 79 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 37 years Life expectancy for over-60 year population 23 years Over-60 years population 20% (64,010 million of inhabitants) Macroeconomic indicators, 2013 Per capita GDP $52, Per capita GDP-PPP outlay on healthcare $9, Total outlay on healthcare 17.1% Public outlay on healthcare 8.1% Private outlay on healthcare 2.0% Others outlays on healthcare 7.0% Human development indicators, 2013 Human Development Index 0,914 (High Human development, 5 th 187) HDI Adjusted for inequality (HDI-I) 0,755 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 6.4% Non-communicable diseases 84.6% Injuries 9.0% of death by sex, 2013 Cause total male female Percentag e total Percentag e male Percentag e female 1. Cardiovascular diseases 870, , , % 32.28% 35.18% 2.Neoplasms 634, , , % 25.91% 23.20% 3. Neurological disorders 327, , , % 10.61% 14.77% 4.Diabetes 191,851 95,509 96, % 7.31% 7.55% 5. Chronic respiratory diseases 182,748 94,300 88, % 7.22% 6.93% 6. Diarrheal/LRI/Other 97,765 45,984 51, % 3.52% 4.06% 7. Unintentional injuries 8. Self-harm & intersonal violence 71,536 38,778 32, % 2.97% 2.57% 58,897 46,340 12, % 3.55% 0.98% 9.Cirrhosis 53, , % 2.58% 1.53% 10. Transport injuries 47,199 32,931 14, % 2.52% 1.12% 11. Digestive diseases 47,000 19,965 27, % 1.53% 2.12% TOTAL 2,582,323 1,306,160 1,276, % 100.0% 100.0% 56 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 127

189 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,138,877 62,533, % Years lived with disability (YLD) 9,024,798 14,177, % Years of life lost (YLL) 49,114,079 48,356, % ,910, % Concept Disability adjusted life years (DALY) Grow rate ,676,516 36,460, % Years lived with disability (YLD) 5,075,680 7,459, % Years of life lost (YLL) 30,600,836 29,001, % 1,467,282 1,467, % Concept Disability adjusted life years (DALY) Grow rate ,462,361 26,073, % Years lived with disability (YLD) 3,949,118 6,717, % Years of life lost (YLL) 18,513,243 19,355, % 1,311,176 1,443, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 62,533, % 14,177, % 48,356, % 2,910, % 36,460, % 7,459, % 29,001, % 1,467, % 26,073, % 6,717, % 19,355, % 1,443, % 128

190 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries Unsafe sex Diarrheal/LRI/other High fasting plasma glucose Transport injuries Air pollution Diabetes Unsafe water, sanitation and handwashing Neoplasms Others 6.8 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Low glomerular filtration rate Unintentional injuries Unsafe sex Diarrheal/LRI/other High fasting plasma glucose Transport injuries Air pollution Diabetes Unsafe water, sanitation and handwashing Neoplasms Others 6.8 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Alcohol and drug use Other non-communicable Unsafe sex Unintentional injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Transport injuries Air pollution Neoplasms Unsafe water, sanitation and handwashing Diabetes Others

191 Total population 5 to 14 years of age 1. Alcohol and drug use Transport injuries High fasting plasma glucose Neoplasms Low glomerular filtration rate Unintentional injuries Sexual abuse and violence Self-harm & intersonal violence Unsafe water, sanitation and handwashing Other non-communicable 6. Air pollution Diabetes High systolic blood pressure Diarrheal/LRI/other Others to 14 years of age 1. Alcohol and drug use Transport injuries High fasting plasma glucose Neoplasms Low glomerular filtration rate Unintentional injuries Sexual abuse and violence Self-harm & intersonal violence Air pollution Other non-communicable High systolic blood pressure Diabetes Unsafe water, sanitation and handwashing Cardiovascular diseases Others to 14 years of age 1. Alcohol and drug use Neoplasms High fasting plasma glucose Transport injuries Low glomerular filtration rate Unintentional injuries Unsafe water, sanitation and handwashing Other non-communicable 5. Air pollution Diabetes High systolic blood pressure Self-harm & intersonal violence Sexual abuse and violence Diarrheal/LRI/other Others

192 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence High body-mass index Cardiovascular diseases Smoking Transport injuries High systolic blood pressure Mental and substance use disorders High total cholesterol Diabetes High fasting plasma glucose Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Transport injuries Smoking Neoplasms High systolic blood pressure Mental and substance use disorders High total cholesterol Unintentional injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. Alcohol and drug use Neoplasms High body-mass index Cardiovascular diseases Dietary risks Self-harm & intersonal violence Smoking Transport injuries High systolic blood pressure Mental and substance use disorders Sexual abuse and violence Diabetes High total cholesterol Cirrhosis Others

193 Total population 50 to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases High fasting plasma glucose Cirrhosis Alcohol and drug use Neurological disorders High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Neoplasms Smoking Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases Alcohol and drug use Cirrhosis High fasting plasma glucose Self-harm & intersonal violence High total cholesterol Neurological disorders Others to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Chronic respiratory diseases High fasting plasma glucose Neurological disorders High total cholesterol Cirrhosis Alcohol and drug use Diarrheal/LRI/other Others

194 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Neurological disorders 1, High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Low glomerular filtration rate Diarrheal/LRI/other High total cholesterol Unintentional injuries Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, Smoking 1, Neoplasms 1, High systolic blood pressure Neurological disorders 1, High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Unintentional injuries Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neurological disorders 1, Smoking Neoplasms High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Others

195 Total population 1. Dietary risks Cardiovascular diseases All age 2. Smoking Neoplasms High systolic blood pressure Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Others Dietary risks Cardiovascular diseases All age 2. Smoking Neoplasms High systolic blood pressure Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence High total cholesterol Diarrheal/LRI/other Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Neurological disorders High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases High total cholesterol Diarrheal/LRI/other Low physical activity Unintentional injuries Others

196 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE GRENADA 58 Demographic indicators, 2013 Total population 106 hundred inhabitants Life expectancy at birth (LEB) 73 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 26 years Life expectancy for over-60 year population 19 years Over-60 years population 10% (11 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $11, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.3% Public outlay on healthcare 3.0% Private outlay on healthcare 3.2% Others outlays on healthcare 0.1% Human development indicators, 2013 Human Development Index 0,744 (High Human development, 79 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d (Optimal: below 39.0), 2012 Communicable diseases n.d Non-communicable diseases n.d Injuries n.d Cause 1. Cardiovascular diseases total of death by sex, 2013 male female Percentage total Percentage male Percentage female % 31.50% 40.82% 2. Neoplasms % 18.41% 16.43% 3.Diabetes % 12.94% 18.36% 4. Diarrheal/LRI/Other % 5.47% 6.52% 5. Neurological disorders % 4.48% 4.59% 6. Unintentional injuries % 4.73% 2.42% 7. Chronic respiratory diseases 8. Self-harm & intersonal violence % 4.23% 1.93% % 5.22% 0.96% 9. Transport injuries % 3.73% 1.14% 10.HIV/AIDS % 3.48% 1.27% 11. Digestive diseases % 2.30% 2.17% 12.Non-communicable diseases % 1.70% 2.17% 13.Neonatal disorders % 1.83% 1.21% TOTAL % 100.0% 100.0% 58 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 135

197 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,100 22, % Years lived with disability (YLD) 3,602 4, % Years of life lost (YLL) 17,502 17, % % Concept Disability adjusted life years (DALY) Grow rate ,931 12, % Years lived with disability (YLD) 1,864 2, % Years of life lost (YLL) 9,071 9, % % Concept Disability adjusted life years (DALY) Grow rate ,169 9, % Years lived with disability (YLD) 1,738 2, % Years of life lost (YLL) 8,431 7, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 22, % 4, % 17, % % 12, % 2, % 9, % % 9, % 2, % 7, % % 136

198 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Cardiovascular diseases Others 6.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Air pollution Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Cardiovascular diseases Others 6.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable 3. Unsafe sex Diarrheal/LRI/other Air pollution Unintentional injuries High fasting plasma glucose Nutritional deficiencies Low glomerular filtration rate Diabetes Alcohol and drug use Cardiovascular diseases Others

199 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Child and maternal malnutrition Neoplasms Air pollution Other non-communicable High fasting plasma glucose Diabetes High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Child and maternal malnutrition Neoplasms Air pollution Other non-communicable High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Unintentional injuries Low glomerular filtration rate Neoplasms High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable Air pollution Diabetes High systolic blood pressure Cardiovascular diseases Others

200 Total population 15 to 49 years of age 1. Alcohol and drug use Cardiovascular diseases Dietary risks Self-harm & intersonal violence High body-mass index Neoplasms High systolic blood pressure Diabetes Unsafe sex HVI/AIDS High fasting plasma glucose Unintentional injuries Smoking Transport injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High systolic blood pressure Unintentional injuries High body-mass index Transport injuries Unsafe sex HVI/AIDS Smoking Neoplasms High fasting plasma glucose Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Diabetes High systolic blood pressure HVI/AIDS Alcohol and drug use Self-harm & intersonal violence High fasting plasma glucose Transport injuries Low glomerular filtration rate Unintentional injuries Others

201 Total population 50 to 69 years of age 1. Alcohol and drug use Cardiovascular diseases Dietary risks Self-harm & intersonal violence High body-mass index Neoplasms High systolic blood pressure Diabetes Unsafe sex HVI/AIDS High fasting plasma glucose Unintentional injuries Smoking Transport injuries Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking Chronic respiratory diseases Alcohol and drug use Unintentional injuries High total cholesterol Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Cirrhosis High total cholesterol Digestive diseases Low glomerular filtration rate Chronic respiratory diseases Others

202 Total population 70 years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index 1, Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Smoking Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, Smoking Neurological disorders High body-mass index Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Low glomerular filtration rate Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms 1, High body-mass index 1, Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Digestive diseases High total cholesterol Unintentional injuries Others

203 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Smoking Neurological disorders Low physical activity Unintentional injuries Alcohol and drug use Chronic respiratory diseases Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes Smoking Diarrheal/LRI/other High body-mass index Self-harm & intersonal violence Alcohol and drug use Unintentional injuries Low physical activity Neurological disorders Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High fasting plasma glucose Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Unintentional injuries High total cholesterol Digestive diseases Others

204 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE GUADELOUPE 60 Demographic indicators, 2013 Total population 403,314 inhabitants Life expectancy at birth (LEB) 83.4years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 36.1 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) General mortality rate Macroeconomic indicators, 2013 Per capita GDP 17,812 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 31. Ischemic heart disease 15, % 32. Stroke 9, % 33. Diabetes 4, % 34. Lower respiratory infection 3, % 35. HIV/AIDS 3, % 36. Hytensive health disease 2, % 37. Road injuries 2, % 38. Prostate cancer 2, % 39. Preterm birth complications 1, % 40. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 16. Physiological risks 72% 17. Dietary risks 15% High body-mass index 146% 18. Alcohol and drug use 10% High blood glucose levels 113% 19. Physical inactivity 7% Low bone mineral density 95% 20. Smoking 6% 5. Alcohol and drug use 86% 9. Malnutrition 5% Drug use 146% 13. Injuries 4% Alcohol use 67% 14. Other risks 11% 6. Injuries 33% Total 100% 7. Dietary risks 29% 60 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 143

205 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE GUATEMALA 62 Demographic indicators, 2013 Total population 15,468 hundred inhabitants Life expectancy at birth (LEB) 72 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 19 years Life expectancy for over-60 year population 21 years Over-60 years population 7% (1,083 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $7, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 6.4% Public outlay on healthcare 2.4% Private outlay on healthcare 3.3% Others outlays on healthcare 0.7% Human development indicators, 2013 Human Development Index 0,628(High Human development, 125 th 187) HDI Adjusted for inequality (HDI-I) 0,422 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 29.1 Non-communicable diseases 55.8 Injuries 15.1 of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Diarrheal/LRI/Other 14,385 7,540 6, % 18.2% 20.7% 2. Cardiovascular diseases 11,595 5,480 6, % 13.2% 18.5% 3. Neoplasms 8,495 3,780 4, % 9.1% 14.2% 4. Self-harm & intersonal violence 7,751 6,567 1, % 15.8% 3.6% 5. Diabetes 7,661 3,476 4, % 8.4% 12.6% 6. Nutritional deficiencies 4,571 2,187 2, % 5.3% 7.2% 7. Neonatal disorders 3,749 2,166 1, % 5.2% 4.8% 8.Cirrhosis 3,415 2,284 1, % 5.5% 3.4% 9. Chronic respiratory diseases 2, , % 3.7% 4.1% 10. Unintentional injuries 2,800 1, % 4.6% 2.7% 11. Neurological disorders 2,720 1, % 3.4% 3.9% 12. Digestive diseases 2,434 1, % 2.9% 3.7% 11.Mental and substance use disorders 2,142 1, % 4.6% 0.7% TOTAL 74,613 41,477 33, % 100.0% 100.0% 62 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 145

206 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,143,388 2,877, % Years lived with disability (YLD) 260, , % Years of life lost (YLL) 2,883,232 2,432, % , % Concept Disability adjusted life years (DALY) Grow rate ,875,169 1,868, % Years lived with disability (YLD) 169, , % Years of life lost (YLL) 1,705,956 1,601, % 29,969 39, % Concept Disability adjusted life years (DALY) Grow rate ,268,219 1,009, % Years lived with disability (YLD) 90, , % Years of life lost (YLL) 1,177, , % 21,613 26, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 2,877, % 445, % 2,432, % 65, % 1,868, % 266, % 1,601, % 39, % 1,009, % 178, % 830, % 26, % 146

207 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Other non-communicable Smoking Nutritional deficiencies Low glomerular filtration rate Unintentional injuries Unsafe sex Diabetes High fasting plasma glucose Self-harm & intersonal violence Others 7.4 Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Other non-communicable Smoking Nutritional deficiencies Low glomerular filtration rate Unintentional injuries Unsafe sex Diabetes High fasting plasma glucose Self-harm & intersonal violence Others 7.3 Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Other non-communicable Smoking Nutritional deficiencies Unsafe sex Unintentional injuries Low glomerular filtration rate Diabetes High fasting plasma glucose Self-harm & intersonal violence Others

208 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Air pollution Self-harm & intersonal violence Low glomerular filtration rate Unintentional injuries Alcohol and drug use Neoplasms Child and maternal malnutrition Nutritional deficiencies High fasting plasma glucose Transport injuries High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Air pollution Self-harm & intersonal violence Low glomerular filtration rate Unintentional injuries Alcohol and drug use Neoplasms Child and maternal malnutrition Transport injuries High fasting plasma glucose Nutritional deficiencies High systolic blood pressure Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Air pollution Self-harm & intersonal violence Low glomerular filtration rate Neoplasms Child and maternal malnutrition Unintentional injuries High fasting plasma glucose Nutritional deficiencies Alcohol and drug use Diabetes Unsafe sex Transport injuries Others

209 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Diarrheal/LRI/other High body-mass index Neoplasms High fasting plasma glucose Cardiovascular diseases Unsafe sex Mental and substance use disorders Air pollution Cirrhosis High systolic blood pressure Diabetes Others to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Self-harm & intersonal violence High body-mass index Diarrheal/LRI/other High fasting plasma glucose Cardiovascular diseases High systolic blood pressure Diabetes Air pollution Maternal disorders Unsafe sex Cirrhosis Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Self-harm & intersonal violence High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Cardiovascular diseases Unsafe sex Diabetes Air pollution Maternal disorders Low glomerular filtration rate Cirrhosis Others

210 Total population 50 to 69 years of age 1. Dietary risks Neoplasms High fasting plasma glucose Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Diarrheal/LRI/other Alcohol and drug use Cirrhosis Air pollution Self-harm & intersonal violence Low glomerular filtration rate Digestive diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases Alcohol and drug use Diabetes High fasting plasma glucose Neoplasms High systolic blood pressure Diarrheal/LRI/other High body-mass index Cirrhosis Air pollution Self-harm & intersonal violence Low glomerular filtration rate Mental and substance use disorders Others to 69 years of age 1. High fasting plasma glucose Neoplasms Dietary risks Diabetes High body-mass index Cardiovascular diseases High systolic blood pressure Diarrheal/LRI/other Air pollution Cirrhosis Low glomerular filtration rate Digestive diseases Alcohol and drug use Nutritional deficiencies Others

211 Total population 70 years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Diarrheal/LRI/other 1, High fasting plasma glucose Neoplasms Air pollution Diabetes Low glomerular filtration rate Nutritional deficiencies High body-mass index Neurological disorders Smoking Chronic respiratory diseases Others years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Diarrheal/LRI/other 1, High fasting plasma glucose Neoplasms Air pollution Diabetes Low glomerular filtration rate Nutritional deficiencies Smoking Neurological disorders Alcohol and drug use Chronic respiratory diseases Others years of age and over 1. Dietary risks Cardiovascular diseases 1, High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Diabetes Air pollution Neoplasms Low glomerular filtration rate Nutritional deficiencies High body-mass index Neurological disorders High total cholesterol Chronic respiratory diseases Others

212 Total population 1. Dietary risks Diarrheal/LRI/other All age 2. High fasting plasma glucose Cardiovascular diseases High systolic blood pressure Neoplasms Alcohol and drug use Self-harm & intersonal violence Air pollution Diabetes Child and maternal malnutrition Nutritional deficiencies High body-mass index Neonatal disorders Others Alcohol and drug use Diarrheal/LRI/other All age 2. Dietary risks Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases High fasting plasma glucose Neoplasms Child and maternal malnutrition Diabetes Air pollution Cirrhosis Unsafe water, sanitation and handwashing Nutritional deficiencies Others Dietary risks Diarrheal/LRI/other All age 2. High fasting plasma glucose Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Air pollution Nutritional deficiencies Air pollution Neonatal disorders Low glomerular filtration rate Chronic respiratory diseases Others

213 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE HAITÍ 64 Demographic indicators, 2013 Total population 10,317 hundred inhabitants Life expectancy at birth (LEB) 63 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 22 years Life expectancy for over-60 year population 17 years Over-60 years population 7% (722 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $1, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 9.4% Public outlay on healthcare 0.7% Private outlay on healthcare 2.8% Others outlays on healthcare 5.9% Human development indicators, 2013 Human Development Index 0,471(High Human development, 168 th 187) HDI Adjusted for inequality (HDI-I) 0,285 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 33.2 Non-communicable diseases 59.5 Injuries 7.3 of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 20,277 8,555 11, % 23.73% 31.97% 2. Diarrheal/LRI/Other 11,389 6,133 5, % 17.01% 14.33% 3. HIV/AIDS 9,068 4,669 4, % 12.95% 12.00% 4. Neoplasms 6,994 3,397 3, % 9.42% 9.81% 5. Diabetes 5,946 2,397 3, % 6.65% 9.68% 6. Neonatal disorders 5,261 2,936 2, % 8.14% 6.34% 7. Nutritional deficiencies 4,100 2,058 2, % 5.71% 5.57% 8. Unintentional injuries 3,643 2,154 1, % 5.98% 4.06% 9. Transport injuries 2, % 3.73% 2.53% 10. Digestive diseases 2,104 1, % 3.27% 2.53% 11. Self-harm & intersonal violence 1,661 1, % 3.40% 1.19% TOTAL 72,712 36,047 36, % 100.0% 100.0% 64 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 153

214 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,030,956 3,184, % Years lived with disability (YLD) 328, , % Years of life lost (YLL) 3,702,362 2,683, % , % Concept Disability adjusted life years (DALY) Grow rate ,189,511 1,620, % Years lived with disability (YLD) 173, , % Years of life lost (YLL) 2,015,879 1,363, % 38,681 39, % Concept Disability adjusted life years (DALY) Grow rate ,841,445 1,564, % Years lived with disability (YLD) 154, , % Years of life lost (YLL) 1,686,483 1,319, % 38,573 45, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 3,184, % 501, % 2,683, % 85, % 1,620, % 256, % 1,363, % 39, % 1,564, % 245, % 1,319, % 45, % 154

215 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Unsafe sex Nutritional deficiencies Air pollution Other non-communicable Alcohol and drug use Communicable, maternal, neonatal, and nutritional diseases Smoking Unintentional injuries Low glomerular filtration rate Cardiovascular diseases Others 6.8 Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Unsafe sex Nutritional deficiencies Air pollution Other non-communicable Alcohol and drug use Smoking Communicable, maternal, neonatal, and nutritional diseases 6. Unintentional injuries High fasting plasma glucose Cardiovascular diseases Others 6.6 Children under 5 years 1. Child and maternal malnutrition Diarrheal/LRI/other Unsafe water, sanitation and handwashing Neonatal disorders 3. Unsafe sex Nutritional deficiencies Air pollution Other non-communicable Alcohol and drug use Communicable, maternal, neonatal, and nutritional diseases Smoking Unintentional injuries High fasting plasma glucose Cardiovascular diseases Others

216 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Unsafe sex HIV/AIDS Air pollution Unintentional injuries Child and maternal malnutrition Nutritional deficiencies Alcohol and drug use Cardiovascular diseases High fasting plasma glucose Transport injuries Low glomerular filtration rate Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Unsafe sex HIV/AIDS Air pollution Unintentional injuries Child and maternal malnutrition Transport injuries Alcohol and drug use Nutritional deficiencies Low glomerular filtration rate Cardiovascular diseases High fasting plasma glucose Other non-communicable Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Unsafe sex HIV/AIDS Air pollution Nutritional deficiencies Child and maternal malnutrition Unintentional injuries High fasting plasma glucose Cardiovascular diseases Alcohol and drug use Transport injuries Low glomerular filtration rate Diabetes Others

217 Total population 15 to 49 years of age 1. Unsafe sex HIV/AIDS Alcohol and drug use Cardiovascular diseases Dietary risks Diarrheal/LRI/other High systolic blood pressure Self-harm & intersonal violence Air pollution Neoplasms High body-mass index Unintentional injuries High fasting plasma glucose Transport injuries Others to 49 years of age 1. Unsafe sex HIV/AIDS Alcohol and drug use Cardiovascular diseases Dietary risks Diarrheal/LRI/other High systolic blood pressure Self-harm & intersonal violence Air pollution Unintentional injuries High fasting plasma glucose Transport injuries High body-mass index Neoplasms Others to 49 years of age 1. Unsafe sex HIV/AIDS Dietary risks Cardiovascular diseases High body-mass index Maternal disorders High systolic blood pressure Diarrheal/LRI/other Air pollution Neoplasms Alcohol and drug use Diabetes High fasting plasma glucose Transport injuries Others

218 Total population 50 to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High body-mass index Diabetes Air pollution HIV/AIDS High fasting plasma glucose Diarrheal/LRI/other Smoking Unintentional injuries Unsafe sex Digestive diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms Air pollution HIV/AIDS Smoking Diabetes High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Unintentional injuries High body-mass index Digestive diseases Others to 69 years of age 1. High systolic blood pressure Cardiovascular diseases Dietary risks Neoplasms High body-mass index Diabetes Air pollution HIV/AIDS High fasting plasma glucose Diarrheal/LRI/other Unsafe sex Unintentional injuries Smoking Digestive diseases Others

219 Total population 70 years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, Air pollution 1, Diabetes High fasting plasma glucose Diarrheal/LRI/other High body-mass index Neurological disorders Low glomerular filtration rate Unintentional injuries Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, Air pollution 1, Diarrheal/LRI/other High fasting plasma glucose Diabetes Smoking Neurological disorders Low physical activity Chronic respiratory diseases Low glomerular filtration rate Unintentional injuries Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, Air pollution 1, Neoplasms High fasting plasma glucose 1, Diarrheal/LRI/other High body-mass index Neurological disorders Low glomerular filtration rate Unintentional injuries Low physical activity Digestive diseases Others

220 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diarrheal/LRI/other Air pollution HIV/AIDS Unsafe sex Neoplasms Child and maternal malnutrition Diabetes High fasting plasma glucose Neonatal disorders High body-mass index Nutritional deficiencies Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Diarrheal/LRI/other Child and maternal malnutrition HIV/AIDS Air pollution Neoplasms Unsafe sex Neonatal disorders Alcohol and drug use Diabetes High fasting plasma glucose Unintentional injuries Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diarrheal/LRI/other High body-mass index HIV/AIDS Air pollution Neoplasms Unsafe sex Diabetes High fasting plasma glucose Neonatal disorders Child and maternal malnutrition Nutritional deficiencies Others

221 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE HONDURAS 66 Demographic indicators, 2013 Total population 8,098 hundred inhabitants Life expectancy at birth (LEB) 74 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 22 years Life expectancy for over-60 year population 22years Over-60 years population 7% (567 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $4, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 8.7% Public outlay on healthcare 4.3% Private outlay on healthcare 3.9% Others outlays on healthcare 0.5% Human development indicators, 2013 Human Development Index 0,617(High Human development, 129 th 187) HDI Adjusted for inequality (HDI-I) 0,418 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 18.4% Non-communicable diseases 68.9% Injuries 12.7% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 13,013 6,500 6, % 32.76% 35.93% 2. Neoplasms 4,482 2,026 2, % 10.21% 13.55% 3.Chronic respiratory diseases 3,800 1,804 1, % 9.09% 11.01% 4. Diarrheal/LRI/Other 3,591 1,876 1, % 9.45% 9.46% 5. Self-harm & intersonal violence 2,976 2, % 11.98% 3.31% 6.Diabetes 2,555 1,260 1, % 6.35% 7.14% 7. Neurological disorders 1, % 4.34% 4.88% 8. Digestive diseases 1, % 4.55% 4.30% 9. Neonatal disorders 1, % 4.69% 3.63% 10. HIV/AIDS 1, % 3.53% 3.63% 11. Other noncommunicable diseases 1, % 3.06% 3.15% TOTAL 37,967 19,844 18, % 100.0% 100.0% 66 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 161

222 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,094,989 1,322, % Years lived with disability (YLD) 126, , % Years of life lost (YLL) 968,874 1,095, % , % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 74, , % Years of life lost (YLL) 384, , % 13,477 21, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 51, , % Years of life lost (YLL) 584, , % 10,396 20, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,322, % 226, % 1,095, % 41, % 587, % 122, % 465, % 21, % 734, % 104, % 629, % 20, % 162

223 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Unsafe sex Chronic respiratory diseases Smoking Cardiovascular diseases High systolic blood pressure Diabetes Alcohol and drug use Unintentional injuries Others 10.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Air pollution Other non-communicable diseases Unsafe sex Chronic respiratory diseases Smoking Cardiovascular diseases High systolic blood pressure Alcohol and drug use Diabetes 7. Communicable, maternal, neonatal, and nutritional diseases Others 9.9 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Unsafe sex Diarrheal/LRI/other Air pollution Chronic respiratory diseases Smoking Cardiovascular diseases High systolic blood pressure Unintentional injuries Alcohol and drug use Diabetes Others

224 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Self-harm & intersonal violence Child and maternal malnutrition Unintentional injuries Unsafe sex Cardiovascular diseases Air pollution Neoplasms High systolic blood pressure Other non-communicable diseases Low glomerular filtration rate Transport injuries Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Self-harm & intersonal violence Child and maternal malnutrition Unintentional injuries Air pollution Neoplasms Unsafe sex Cardiovascular diseases High systolic blood pressure Transport injuries Low glomerular filtration rate Other non-communicable diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Child and maternal malnutrition Self-harm & intersonal violence Unsafe sex Cardiovascular diseases Alcohol and drug use Unintentional injuries Air pollution Other non-communicable diseases High systolic blood pressure Neoplasms Low glomerular filtration rate Diabetes Others

225 Total population 15 to 49 years of age 1. Dietary risks Self-harm & intersonal violence Alcohol and drug use Cardiovascular diseases Unsafe sex Neoplasms High body-mass index HIV/AIDS High systolic blood pressure Transport injuries High total cholesterol Unintentional injuries Air pollution Diarrheal/LRI/other Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High systolic blood pressure Unintentional injuries Unsafe sex Transport injuries High total cholesterol HIV/AIDS Smoking Neoplasms High body-mass index Diarrheal/LRI/other Others to 49 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms Unsafe sex Self-harm & intersonal violence High systolic blood pressure HIV/AIDS Air pollution Diabetes High total cholesterol Diarrheal/LRI/other Alcohol and drug use Maternal disorders Others

226 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Chronic respiratory diseases Air pollution Diabetes Smoking Diarrheal/LRI/other High total cholesterol Cirrhosis High fasting plasma glucose Digestive diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms Smoking Chronic respiratory diseases Air pollution Diabetes High body-mass index Cirrhosis High total cholesterol Self-harm & intersonal violence High fasting plasma glucose Diarrheal/LRI/other Others to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Chronic respiratory diseases Air pollution Diabetes High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Digestive diseases Smoking Cirrhosis Others

227 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 3, High systolic blood pressure 1, Chronic respiratory diseases 1, Air pollution Neoplasms High body-mass index Diarrheal/LRI/other High fasting plasma glucose Neurological disorders High total cholesterol Diabetes Smoking Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 3, High systolic blood pressure 1, Chronic respiratory diseases 1, Air pollution Neoplasms Smoking Diarrheal/LRI/other High fasting plasma glucose Neurological disorders Low physical activity Diabetes Low glomerular filtration rate Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Chronic respiratory diseases 1, Air pollution 1, Neoplasms High body-mass index Diarrheal/LRI/other High fasting plasma glucose Neurological disorders High total cholesterol Diabetes Low glomerular filtration rate Digestive diseases Others

228 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Air pollution Chronic respiratory diseases High body-mass index Diarrheal/LRI/other High fasting plasma glucose Self-harm & intersonal violence High total cholesterol Diabetes Smoking Neurological disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Self-harm & intersonal violence Air pollution Neoplasms Smoking Diarrheal/LRI/other High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes High total cholesterol Neonatal disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Chronic respiratory diseases Air pollution Diarrheal/LRI/other High fasting plasma glucose Diabetes High total cholesterol Neurological disorders Low physical activity Digestive diseases Others

229 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE TURKS AND CAICOS 68 Demographic indicators, 2013 Total population 50,280 inhabitants Life expectancy at birth (LEB) 79.7 years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 32.4 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) Over 65 year population 4.3% (2,149 inhabitants) General mortality rate 170 Macroeconomic indicators, 2013 Per capita GDP 42,300 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 41. Ischemic heart disease 15, % 42. Stroke 9, % 43. Diabetes 4, % 44. Lower respiratory infection 3, % 45. HIV/AIDS 3, % 46. Hytensive health disease 2, % 47. Road injuries 2, % 48. Prostate cancer 2, % 49. Preterm birth complications 1, % 50. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 21. Physiological risks 72% 22. Dietary risks 15% High body-mass index 146% 23. Alcohol and drug use 10% High blood glucose levels 113% 24. Physical inactivity 7% Low bone mineral density 95% 25. Smoking 6% 6. Alcohol and drug use 86% 10. Malnutrition 5% Drug use 146% 15. Injuries 4% Alcohol use 67% 16. Other risks 11% 7. Injuries 33% Total 100% 8. Dietary risks 29% 68 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 169

230 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE BRITISH VIRGIN ISLANDS 70 Demographic indicators, 2013 Total population 33,454 inhabitants Life expectancy at birth (LEB) 78.5 years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 35.9 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) Over 65 year population 8.2% (2,758inhabitants) General mortality rate 310 Macroeconomic indicators, 2013 Per capita GDP 42,300 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 51. Ischemic heart disease 15, % 52. Stroke 9, % 53. Diabetes 4, % 54. Lower respiratory infection 3, % 55. HIV/AIDS 3, % 56. Hytensive health disease 2, % 57. Road injuries 2, % 58. Prostate cancer 2, % 59. Preterm birth complications 1, % 60. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 26. Physiological risks 72% 27. Dietary risks 15% High body-mass index 146% 28. Alcohol and drug use 10% High blood glucose levels 113% 29. Physical inactivity 7% Low bone mineral density 95% 30. Smoking 6% 7. Alcohol and drug use 86% 11. Malnutrition 5% Drug use 146% 17. Injuries 4% Alcohol use 67% 18. Other risks 11% 8. Injuries 33% Total 100% 9. Dietary risks 29% 70 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 171

231 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE MÉXICO 72 Demographic indicators, 2013 Total population 12.3 million inhabitants Life expectancy at birth (LEB) 75 years Health life expectancy at birth (HLEB) years (8 years less than life expectancy at Birth) Median age 27 years Life expectancy for over-60 year population 21years Over-60 years population 10% (12.2 million inhabitants) Macroeconomic indicators, 2013 Per capita GDP $16, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 6.2% Public outlay on healthcare 3.2% Private outlay on healthcare 2.7% Others outlays on healthcare 0.3% Human development indicators, 2013 Human Development Index 0,756(High Human development, 71 th 187) HDI Adjusted for inequality (HDI-I) 0,583 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 9.8% Non-communicable diseases 79.5% Injuries 10.7% Cause of death by sex, 2013 total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 147,475 7,762 7, % 11.9% 16.3% 2.Diabetes 127,192 9,044 9, % 13.9% 18.5% 3.Neoplasms 85,339 4,379 5, % 6.7% 10.4% 4.Cirrhosis 41,204 4,655 1, % 7.2% 3.8% 5. Chronic respiratory diseases 38,727 2,411 2, % 3.7% 4.8% 6. Diarrheal/LRI/Other 31,710 2,527 2, % 3.9% 4.4% 7. Neurological disorders 29,158 1,599 1, % 2.5% 3.4% 8. Self-harm & intersonal violence 28,664 3,247 3, % 5.0% 6.9% 9.Trandport injuries 24,627 2,300 5, % 3.5% 11.1% 10.Unintentionals Injuries 21,744 1,702 6, % 2.6% 14.2% 11. Digestive diseases 20,332 9,721 1, % 14.9% 2.8% 12. Other non-communicable diseases 14,492 7, % 11.7% 1.8% 13. Neonatal disorders 13,619 8, % 12.4% 1.7% TOTAL 624,283 65,043 48, % 100.0% 100.0% 72 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 173

232 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,502,355 19,813, % Years lived with disability (YLD) 2,929,174 4,700, % Years of life lost (YLL) 17,573,181 15,113, % , % Concept Disability adjusted life years (DALY) Grow rate ,199,673 11,820, % Years lived with disability (YLD) 1,659,176 2,384, % Years of life lost (YLL) 10,540,497 9,435, % 263, , % Concept Disability adjusted life years (DALY) Grow rate ,302,682 7,993, % Years lived with disability (YLD) 1,269,998 2,315, % Years of life lost (YLL) 7,032,684 5,677, % 192, , % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 19,813, % 4,700, % 15,113, % 630, % 11,820, % 2,384, % 9,435, % 365, % 7,993, % 2,315, % 5,677, % 265, % 174

233 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Neoplasms Alcohol and drug use Diabetes Others 7.2 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Diabetes 7. Alcohol and drug use Neoplasms Others 7.1 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Neoplasms Alcohol and drug use Diabetes Others

234 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Unintentional injuries High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Other non-communicable diseases Air pollution Diabetes Child and maternal malnutrition Self-harm & intersonal violence Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Neoplasms Low glomerular filtration rate Unintentional injuries High fasting plasma glucose Diarrheal/LRI/other High systolic blood pressure Other non-communicable diseases Child and maternal malnutrition Self-harm & intersonal violence Air pollution Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Transport injuries High fasting plasma glucose Unintentional injuries High systolic blood pressure Other non-communicable diseases Air pollution Diabetes Child and maternal malnutrition Self-harm & intersonal violence Others

235 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence High body-mass index Transport injuries Dietary risks Diabetes High fasting plasma glucose Neoplasms Low glomerular filtration rate Cardiovascular diseases High systolic blood pressure Cirrhosis High total cholesterol Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Diabetes High fasting plasma glucose Neoplasms Low glomerular filtration rate Cardiovascular diseases High systolic blood pressure Cirrhosis High total cholesterol Unintentional injuries Others to 49 years of age 1. High body-mass index Neoplasms High fasting plasma glucose Diabetes Dietary risks Cardiovascular diseases Alcohol and drug use Transport injuries Low glomerular filtration rate Self-harm & intersonal violence High systolic blood pressure Cirrhosis Unsafe sex Diarrheal/LRI/other Others

236 Total population 50 to 69 years of age 1. High fasting plasma glucose Diabetes High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Digestive diseases High total cholesterol Diarrheal/LRI/other Others to 69 years of age 1. High fasting plasma glucose Diabetes Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases High total cholesterol Self-harm & intersonal violence Smoking Transport injuries Others to 69 years of age 1. High body-mass index Diabetes High fasting plasma glucose Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Digestive diseases Low physical activity Diarrheal/LRI/other Others

237 Total population 70 years of age and over 1. High fasting plasma glucose 1, Cardiovascular diseases 1, Dietary risks 1, Diabetes 1, High systolic blood pressure 1, Neoplasms High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Smoking Diarrheal/LRI/other High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High fasting plasma glucose 1, Diabetes 1, High systolic blood pressure 1, Neoplasms High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Smoking Diarrheal/LRI/other High total cholesterol Cirrhosis Others years of age and over 1. High fasting plasma glucose 1, Cardiovascular diseases 1, Dietary risks 1, Diabetes 1, High systolic blood pressure 1, Neoplasms High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Smoking Diarrheal/LRI/other Low physical activity Digestive diseases Others

238 Total population 1. High fasting plasma glucose Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other Smoking Neurological disorders Others Dietary risks Cardiovascular diseases All age 2. High fasting plasma glucose Diabetes High systolic blood pressure Neoplasms High body-mass index Cirrhosis Alcohol and drug use Self-harm & intersonal violence Low glomerular filtration rate Chronic respiratory diseases Smoking Transport injuries Others High fasting plasma glucose Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High systolic blood pressure Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Alcohol and drug use Diarrheal/LRI/other Low physical activity Cirrhosis Others

239 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE NICARAGUA 74 Demographic indicators, 2013 Total population 6,080 hundred inhabitants Life expectancy at birth (LEB) 74 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 23 years Life expectancy for over-60 year population 21years Over-60 years population 7% (426 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $4, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 8.4% Public outlay on healthcare 4.5% Private outlay on healthcare 3.4% Others outlays on healthcare 0.5% Human development indicators, 2013 Human Development Index 0,614(High Human development, 132 th 187) HDI Adjusted for inequality (HDI-I) 0,452 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 10.9% Non-communicable diseases 79.8% Injuries 9.3% of death by sex, 2013 Cause 1. Cardiovascular diseases total male female Percentage total Percentage male Percentage female 6,560 3,184 3, % 24.62% 32.63% 2. Diabetes 3,642 2,018 1, % 15.60% 15.70% 3. Neoplasms 3,099 1,497 1, % 11.58% 15.49% 4. Diarrheal/LRI/Other 1, % 7.65% 7.36% 5. Chronic respiratory diseases 1, % 5.64% 6.12% 6. Neonatal disorders 1, % 5.23% 4.66% 7. Neurological disorders 1, % 4.45% 5.29% 8. Cirrhosis 1, % 5.92% 2.93% 9. Self-harm & intersonal violence 10. Other noncommunicable diseases 1, % 6.52% 1.82% % 3.67% 3.93% 11. Transport injuries % 4.60% 1.34% 12. Unintentional Injuries % 4.53% 2.74% TOTAL 23,277 12,933 10, % 100.0% 100.0% 74 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 181

240 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate , , % Years lived with disability (YLD) 59,226 95, % Years of life lost (YLL) 701, , % , % Concept Disability adjusted life years (DALY) Grow rate ,221 17, % Years lived with disability (YLD) 3,234 3, % Years of life lost (YLL) 37,987 14, % % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 55,992 91, % Years of life lost (YLL) 663, , % 11,240 10, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 385, % 95, % 290, % 11, % 17, % 3, % 14, % % 368, % 91, % 276, % 10, % 182

241 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Air pollution Other non-communicable diseases Unsafe sex Nutritional deficiencies Smoking Unintentional injuries Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes Others 5.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other Air pollution Other non-communicable diseases Unsafe sex Nutritional deficiencies Smoking Unintentional injuries Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes Others 5.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases Air pollution Diarrheal/LRI/other Unsafe sex Nutritional deficiencies Smoking Unintentional injuries Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Neoplasms Others

242 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Neoplasms 2. Low glomerular filtration rate Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Unsafe sex Transport injuries Air pollution Diabetes High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Other non-communicable diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Low glomerular filtration rate Neoplasms Alcohol and drug use Transport injuries Air pollution Diarrheal/LRI/other Unsafe sex Self-harm & intersonal violence High fasting plasma glucose Diabetes High systolic blood pressure Other non-communicable diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Neoplasms Alcohol and drug use Unintentional injuries Unsafe sex Transport injuries High fasting plasma glucose Diabetes Air pollution Self-harm & intersonal violence Child and maternal malnutrition Other non-communicable diseases Others

243 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Low glomerular filtration rate Neoplasms Dietary risks Diabetes High body-mass index Cardiovascular diseases High systolic blood pressure Transport injuries High fasting plasma glucose Cirrhosis Unsafe sex Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Low glomerular filtration rate Diabetes High systolic blood pressure Transport injuries Dietary risks Unintentional injuries High body-mass index Cirrhosis High fasting plasma glucose Cardiovascular diseases Unsafe sex Neoplasms Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Diabetes High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Maternal disorders Low glomerular filtration rate Cirrhosis Alcohol and drug use Diarrheal/LRI/other Others

244 Total population 50 to 69 years of age 1. Dietary risks Diabetes High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms High fasting plasma glucose Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other Smoking Transport injuries Others to 69 years of age 1. High systolic blood pressure Diabetes Dietary risks Cardiovascular diseases High fasting plasma glucose Neoplasms Low glomerular filtration rate Cirrhosis High body-mass index Mental and substance use disorders Alcohol and drug use Chronic respiratory diseases Smoking Transport injuries Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High fasting plasma glucose Diabetes High systolic blood pressure Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Air pollution Diarrheal/LRI/other Unsafe sex Digestive diseases Others

245 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes High fasting plasma glucose Neoplasms High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Air pollution Diarrheal/LRI/other Smoking Cirrhosis Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes High fasting plasma glucose Neoplasms Low glomerular filtration rate Chronic respiratory diseases High body-mass index Neurological disorders Air pollution Diarrheal/LRI/other Smoking Cirrhosis Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes High body-mass index Neoplasms High fasting plasma glucose Chronic respiratory diseases Low glomerular filtration rate Neurological disorders Air pollution Diarrheal/LRI/other Low physical activity Digestive diseases Others

246 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes High fasting plasma glucose Neoplasms High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Neonatal disorders Air pollution Neurological disorders Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes Low glomerular filtration rate Neoplasms High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Self-harm & intersonal violence High body-mass index Cirrhosis Air pollution Chronic respiratory diseases Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Air pollution Neurological disorders Low physical activity Neonatal disorders Others

247 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE PANAMA 76 Demographic indicators, 2013 Total population 3,864 hundred inhabitants Life expectancy at birth (LEB) 77 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 28 years Life expectancy for over-60 year population 24years Over-60 years population 10% (386 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $19, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 7.2% Public outlay on healthcare 4.9% Private outlay on healthcare 1.8% Others outlays on healthcare 0.5% Human development indicators, 2013 Human Development Index 0,765 (High Human development, 65 th 187) HDI Adjusted for inequality (HDI-I) 0,596 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 16.4% Non-communicable diseases 70.9% Injuries 12.7% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 5,550 2,991 2, % 29.1% 34.5% 2.Neoplasms 3,358 1,849 1, % 18.0% 20.3% 3.Diabetes 2,034 1,028 1, % 10.0% 13.5% 4. Diarrheal/LRI/Other 1, % 6.8% 7.6% 5. Neurological disorders 1, % 5.5% 6.8% 6. Chronic respiratory diseases 1, % 5.5% 6.2% 7. Self-harm & intersonal violence % 7.8% 1.5% 8. Transport injuries % 5.8% 1.9% 9. Unintentional Injuries % 4.9% 2.8% 10.HIV/AIDS % 4.2% 1.8% 11. Other noncommunicable diseases % 2.5% 3.1% TOTAL 17,710 10,289 7, % 100.0% 100.0% 76 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 189

248 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,254,404 1,777, % Years lived with disability (YLD) 231, , % Years of life lost (YLL) 2,023,245 1,403, % , % Concept Disability adjusted life years (DALY) Grow rate ,236, , % Years lived with disability (YLD) 124, , % Years of life lost (YLL) 1,111, , % 21,909 21, % Concept Disability adjusted life years (DALY) Grow rate ,018, , % Years lived with disability (YLD) 106, , % Years of life lost (YLL) 911, , % 20,283 22, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,777, % 373, % 1,403, % 44, % 943, % 190, % 753, % 21, % 833, % 183, % 649, % 22, % 190

249 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Unsafe sex Nutritional deficiencies Smoking Chronic respiratory diseases Alcohol and drug use Neoplasms Others 8.2 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Smoking Nutritional deficiencies Unsafe sex Chronic respiratory diseases 7. Alcohol and drug use Diabetes Others 8.1 Children under 5 years 1. Child and maternal malnutrition Other non-communicable diseases Unsafe water, sanitation and handwashing Neonatal disorders 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Nutritional deficiencies Unsafe sex Unintentional injuries Alcohol and drug use Chronic respiratory diseases Smoking Neoplasms Others

250 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Neoplasms High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Self-harm & intersonal violence Air pollution Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Transport injuries High fasting plasma glucose Neoplasms High systolic blood pressure Other non-communicable diseases Air pollution Self-harm & intersonal violence Child and maternal malnutrition Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Neoplasms Alcohol and drug use Unintentional injuries High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable diseases Unsafe sex Diabetes Air pollution Self-harm & intersonal violence Others

251 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Neoplasms Unsafe sex Transport injuries High body-mass index Cardiovascular diseases High systolic blood pressure HIV/AIDS High fasting plasma glucose Unintentional injuries Low glomerular filtration rate Diabetes Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries Unsafe sex HIV/AIDS High systolic blood pressure Cardiovascular diseases High body-mass index Unintentional injuries High fasting plasma glucose Neoplasms Low glomerular filtration rate Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Unsafe sex Cardiovascular diseases Dietary risks Diabetes Alcohol and drug use Self-harm & intersonal violence High systolic blood pressure HIV/AIDS High fasting plasma glucose Transport injuries Low glomerular filtration rate Diarrheal/LRI/other Others

252 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking HIV/AIDS Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Diarrheal/LRI/other Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose HIV/AIDS Smoking Cirrhosis Alcohol and drug use Transport injuries Low glomerular filtration rate Chronic respiratory diseases Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Chronic respiratory diseases Low glomerular filtration rate Cirrhosis Alcohol and drug use Diarrheal/LRI/other High total cholesterol Digestive diseases Others

253 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms High fasting plasma glucose Diabetes Smoking Neurological disorders High body-mass index Chronic respiratory diseases Low glomerular filtration rate Diarrheal/LRI/other High total cholesterol Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking Diabetes High fasting plasma glucose Neurological disorders Low glomerular filtration rate Chronic respiratory diseases High body-mass index Diarrheal/LRI/other Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms High fasting plasma glucose Diabetes High body-mass index Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Smoking Diarrheal/LRI/other High total cholesterol Digestive diseases Others

254 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes High body-mass index Diarrheal/LRI/other Smoking Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Alcohol and drug use Self-harm & intersonal violence Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes Smoking Self-harm & intersonal violence Alcohol and drug use Diarrheal/LRI/other High body-mass index Transport injuries Low glomerular filtration rate Chronic respiratory diseases Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Smoking Chronic respiratory diseases High total cholesterol Other non-communicable diseases Others

255 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE PARAGUAY 78 Demographic indicators, 2013 Total population 6,802 hundred inhabitants Life expectancy at birth (LEB) 75 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 24 years Life expectancy for over-60 year population 21 years Over-60 years population 8% (544 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $8, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 9.0% Public outlay on healthcare 3.5% Private outlay on healthcare 5.1% Others outlays on healthcare 0.4% Human development indicators, 2013 Human Development Index 0,676(High Human development, 111 th 187) HDI Adjusted for inequality (HDI-I) 0,513 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 12.2% Non-communicable diseases 77.0% Injuries 10.8% of death by sex, 2013 Cause 1. Cardiovascular diseases total male female Percentage total Percentage male Percentage female 11,556 5,923 5, % 31.60% 37.46% 2. Neoplasms 5,843 3,053 2, % 16.29% 18.55% 3. Diabetes 4,102 1,875 2, % 10.00% 14.81% 4. Diarrheal/LRI/Other 2,498 1,337 1, % 7.13% 7.72% 5. Transport injuries 1,600 1, % 6.92% 2.02% 6. Self-harm & intersonal violence 1,449 1, % 6.45% 1.60% 7. Neonatal disorders 1, % 4.50% 3.64% 8. Neurological disorders 1, % 3.87% 4.00% 9. Chronic respiratory diseases 1, % 4.26% 2.59% 10. Unintentional Injuries 1, % 4.10% 2.39% 11. Digestive diseases % 2.53% 2.81% 12. Other noncommunicable diseases TOTAL % 2.35% 2.39% 33,781 18,744 15, % 100.0% 100.0% 78 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 197

256 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,489 37, % Years lived with disability (YLD) 5,659 6, % Years of life lost (YLL) 30,830 31, % 933 1, % Concept Disability adjusted life years (DALY) Grow rate ,712 22, % Years lived with disability (YLD) 3,252 3, % Years of life lost (YLL) 17,460 19, % % Concept Disability adjusted life years (DALY) Grow rate ,777 14, % Years lived with disability (YLD) 2,407 2, % Years of life lost (YLL) 13,370 11, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 37, % 6, % 31, % 1, % 22, % 3, % 19, % % 14, % 2, % 11, % % 198

257 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe sex Other non-communicable diseases Unsafe water, sanitation and handwashing Air pollution Diarrheal/LRI/other Communicable, maternal, neonatal, and nutritional diseases Smoking Unintentional injuries Alcohol and drug use Nutritional deficiencies Low glomerular filtration rate Diabetes Others 6.1 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe sex Unsafe water, sanitation and handwashing Air pollution Other non-communicable diseases 3. Diarrheal/LRI/other 4. Communicable, maternal, neonatal, and nutritional diseases Smoking Unintentional injuries Alcohol and drug use Nutritional deficiencies 7. Low glomerular filtration rate Diabetes Others 6.1 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe sex Other non-communicable diseases Unsafe water, sanitation and handwashing Air pollution Diarrheal/LRI/other 4. Communicable, maternal, neonatal, and nutritional diseases Smoking Unintentional injuries Alcohol and drug use Nutritional deficiencies Low glomerular filtration rate Diabetes Others

258 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Unsafe sex Transport injuries Alcohol and drug use Unintentional injuries Low glomerular filtration rate Neoplasms Air pollution Other non-communicable diseases High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Communicable, maternal, neonatal, and nutritional diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Diarrheal/LRI/other Unsafe sex Unintentional injuries Air pollution Neoplasms Low glomerular filtration rate Other non-communicable diseases High fasting plasma glucose Self-harm & intersonal violence Child and maternal malnutrition Communicable, maternal, neonatal, and nutritional diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Unsafe sex Neoplasms Alcohol and drug use Transport injuries Low glomerular filtration rate Unintentional injuries Child and maternal malnutrition Other non-communicable diseases High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Communicable, maternal, neonatal, and nutritional diseases Others

259 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms Smoking Unintentional injuries High fasting plasma glucose Diabetes Unsafe sex HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Transport injuries High body-mass index Cardiovascular diseases High systolic blood pressure Neoplasms Smoking Unintentional injuries High fasting plasma glucose HIV/AIDS Air pollution Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Self-harm & intersonal violence High systolic blood pressure Maternal disorders Alcohol and drug use Diabetes High fasting plasma glucose Transport injuries Air pollution Diarrheal/LRI/other Others

260 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Cirrhosis Air pollution Transport injuries Low glomerular filtration rate Chronic respiratory diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Cirrhosis High fasting plasma glucose Transport injuries Alcohol and drug use Diarrheal/LRI/other Air pollution Chronic respiratory diseases Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Air pollution Digestive diseases Low glomerular filtration rate Transport injuries Air pollution Cirrhosis Others

261 Total population 70 years of age and over 1. Dietary risks 1, Cardiovascular diseases 3, High systolic blood pressure 1, Neoplasms 1, High body-mass index 1, Diabetes High fasting plasma glucose 1, Diarrheal/LRI/other Smoking Neurological disorders Air pollution Chronic respiratory diseases Low glomerular filtration rate Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 2, High systolic blood pressure 1, Neoplasms 1, Smoking 1, Diabetes High fasting plasma glucose Neurological disorders High body-mass index Diarrheal/LRI/other Air pollution Chronic respiratory diseases Low glomerular filtration rate Digestive diseases Others years of age and over 1. Dietary risks 1, Cardiovascular diseases 3, High systolic blood pressure 1, Diabetes 1, High body-mass index 1, Neoplasms High fasting plasma glucose 1, Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Air pollution Chronic respiratory diseases Smoking Digestive diseases Others

262 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Smoking Transport injuries Air pollution Self-harm & intersonal violence Low glomerular filtration rate Neonatal disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Diabetes High body-mass index Diarrheal/LRI/other High fasting plasma glucose Transport injuries Alcohol and drug use Self-harm & intersonal violence Air pollution Neonatal disorders Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Air pollution Neurological disorders Low glomerular filtration rate Neonatal disorders Smoking Digestive diseases Others

263 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE PERU 80 Demographic indicators, 2013 Total population 30,376 hundred inhabitants Life expectancy at birth (LEB) 77 years Health life expectancy at birth (HLEB) years (10 years less than life expectancy at Birth) Median age 27 years Life expectancy for over-60 year population 23 years Over-60 years population 9% (2,734 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $11, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 5.2% Public outlay on healthcare 3.1% Private outlay on healthcare 1.8% Others outlays on healthcare 0.3% Human development indicators, 2013 Human Development Index 0,737(High Human development, 111 th 187) HDI Adjusted for inequality (HDI-I) 0,562 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 22.7% Non-communicable diseases 65.3% Injuries 9.0% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 28,204 13,738 14, % 21.1% 23.3% 2.Neoplasms 25,896 11,977 13, % 18.4% 22.4% 3. Diarrheal/LRI/Other 22,486 11,323 11, % 17.4% 18.0% 4. Diabetes 11,447 5,378 6, % 8.3% 9.8% 5. Chronic respiratory diseases 8,414 4,396 4, % 6.8% 6.5% 6. Unintentional Injuries 6,439 3,992 2, % 6.1% 3.9% 7. Cirrhosis 5,836 3,738 2, % 5.7% 3.4% 8. Transport injuries 4,911 3,533 1, % 5.4% 2.2% 9. Neonatal disorders 4,885 2,805 2, % 4.3% 3.4% 10. Neurological disorders 4,486 2,054 2, % 3.2% 3.9% 11. Digestive diseases 4,138 2,151 1, % 3.3% 3.2% TOTAL 127,142 65,085 62, % 100.0% 100.0% 80 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 205

264 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,786,043 3,111, % Years lived with disability (YLD) 632, , % Years of life lost (YLL) 4,153,102 2,144, % , % Concept Disability adjusted life years (DALY) Grow rate ,706,943 1,765, % Years lived with disability (YLD) 365, , % Years of life lost (YLL) 2,341,853 1,248, % 48,468 46, % Concept Disability adjusted life years (DALY) Grow rate ,079,100 1,345, % Years lived with disability (YLD) 267, , % Years of life lost (YLL) 1,811, , % 41,578 42, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 3,111, % 967, % 2,144, % 89, % 1,765, % 516, % 1,248, % 46, % 1,345, % 450, % 895, % 42, % 206

265 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Air pollution Other non-communicable diseases Unsafe sex Unintentional injuries Low glomerular filtration rate Diabetes Alcohol and drug use Transport injuries High systolic blood pressure Communicable, maternal, neonatal, and nutritional diseases Others 8.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Unsafe sex Communicable, maternal, neonatal, and nutritional diseases Low glomerular filtration rate Unintentional injuries Alcohol and drug use Nutritional deficiencies 7. High systolic blood pressure Diabetes Others 8.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Diarrheal/LRI/other 3. Air pollution Other non-communicable diseases Unsafe sex Unintentional injuries Low glomerular filtration rate Communicable, maternal, neonatal, and nutritional diseases Alcohol and drug use Diabetes High systolic blood pressure Nutritional deficiencies Others

266 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Unintentional injuries Air pollution Transport injuries Low glomerular filtration rate Neoplasms Unsafe sex Cardiovascular diseases High systolic blood pressure Other non-communicable diseases Child and maternal malnutrition Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Transport injuries Air pollution Unintentional injuries Low glomerular filtration rate Neoplasms Unsafe sex Cardiovascular diseases High systolic blood pressure Other non-communicable diseases Child and maternal malnutrition Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Unintentional injuries Air pollution Transport injuries Low glomerular filtration rate Neoplasms Unsafe sex Cardiovascular diseases High systolic blood pressure Other non-communicable diseases Child and maternal malnutrition Diabetes Others

267 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Dietary risks Cardiovascular diseases High body-mass index Transport injuries High systolic blood pressure Unintentional injuries Smoking Diarrheal/LRI/other High total cholesterol Self-harm & intersonal violence Air pollution HIV/AIDS Others to 49 years of age 1. Alcohol and drug use Transport injuries Dietary risks Cardiovascular diseases High systolic blood pressure Unintentional injuries High body-mass index Neoplasms Smoking Self-harm & intersonal violence High fasting plasma glucose Diarrheal/LRI/other Air pollution HIV/AIDS Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases Alcohol and drug use Diarrheal/LRI/other Unsafe sex Diabetes Air pollution Transport injuries High systolic blood pressure Unintentional injuries Low glomerular filtration rate Maternal disorders Others

268 Total population 50 to 69 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Diarrheal/LRI/other Alcohol and drug use Diabetes Smoking Cirrhosis High fasting plasma glucose Chronic respiratory diseases Air pollution Digestive diseases Others to 69 years of age 1. Dietary risks Neoplasms Alcohol and drug use Cardiovascular diseases High systolic blood pressure Diarrheal/LRI/other Smoking Cirrhosis High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Air pollution Transport injuries Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Air pollution Cirrhosis Low glomerular filtration rate Chronic respiratory diseases Smoking Digestive diseases Others

269 Total population 70 years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Diarrheal/LRI/other 1, Air pollution Neoplasms 1, Smoking Diabetes High body-mass index Chronic respiratory diseases Low glomerular filtration rate Neurological disorders High fasting plasma glucose Digestive diseases Others years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Diarrheal/LRI/other 1, Smoking Neoplasms 1, Air pollution Chronic respiratory diseases Low glomerular filtration rate Diabetes High fasting plasma glucose Neurological disorders High body-mass index Cirrhosis Others years of age and over 1. Dietary risks Cardiovascular diseases 1, High systolic blood pressure Diarrheal/LRI/other 1, High body-mass index Neoplasms Air pollution Diabetes Low glomerular filtration rate Chronic respiratory diseases High fasting plasma glucose Neurological disorders Smoking Digestive diseases Others

270 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diarrheal/LRI/other Smoking Diabetes Alcohol and drug use Chronic respiratory diseases Air pollution Unintentional injuries Low glomerular filtration rate Cirrhosis Others Dietary risks Cardiovascular diseases All age 2. Alcohol and drug use Neoplasms High systolic blood pressure Diarrheal/LRI/other Smoking Diabetes High body-mass index Chronic respiratory diseases Air pollution Unintentional injuries Low glomerular filtration rate Cirrhosis Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High body-mass index Diarrheal/LRI/other Air pollution Diabetes Low glomerular filtration rate Chronic respiratory diseases High fasting plasma glucose Unintentional injuries Smoking Neurological disorders Others

271 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE REPUBLICA DOMINICANA 82 Demographic indicators, 2013 Total population 10,404 hundred inhabitants Life expectancy at birth (LEB) 74 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 26 years Life expectancy for over-60 year population 21 years Over-60 years population 9% (936 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $12, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 5.4% Public outlay on healthcare 2.8% Private outlay on healthcare 2.1% Others outlays on healthcare 0.5% Human development indicators, 2013 Human Development Index 0,700(High Human development, 102 th 187) HDI Adjusted for inequality (HDI-I) 0,524 Gini coefficient, (Optimal: below 39.0), 2012 Communicable diseases 14.3% Non-communicable diseases 73.5% Injuries 12.2% of death by sex, 2013 Cause 1. Cardiovascular diseases total male female Percentage total Percentage male Percentage female 23,966 12,612 11, % 36.7% 43.8% 2. Neoplasms 9,227 5,184 4, % 15.1% 15.6% 3. Diabetes 4,975 2,487 2, % 7.2% 9.6% 4. Diarrheal/LRI/Other 3,509 1,878 1, % 5.5% 6.3% 5. Neonatal disorders 3,010 1,707 1, % 5.0% 5.0% 6. Neurological disorders 2,877 1,632 1, % 4.7% 4.8% 7. Transport injuries 2,869 2, % 6.7% 2.2% 8. Chronic respiratory diseases 9. Self-harm & intersonal violence 10. Unintentional Injuries 11. Other noncommunicable diseases 2,493 1, % 4.4% 3.8% 2,231 1, % 5.4% 1.4% 1,986 1, % 3.9% 2.5% 1, % 2.2% 2.3% 12. Cirrhosis 1, % 3.2% 2.7% TOTAL 60,304 34,362 25, % 100.0% 100.0% 82 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 213

272 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,380,606 1,834, % Years lived with disability (YLD) 213, , % Years of life lost (YLL) 1,167,012 1,455, % 34,619 71, % Concept Disability adjusted life years (DALY) Grow rate ,049 1,070, % Years lived with disability (YLD) 113, , % Years of life lost (YLL) 688, , % 19,837 39, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 100, , % Years of life lost (YLL) 478, , % 14,782 31, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,834, % 379, % 1,455, % 71, % 1,070, % 185, % 884, % 39, % 763, % 193, % 570, % 31, % 214

273 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Alcohol and drug use Nutritional deficiencies Smoking Diabetes High fasting plasma glucose Cardiovascular diseases Others 6.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Alcohol and drug use Nutritional deficiencies Smoking Diabetes 7. High fasting plasma glucose Cardiovascular diseases Others 6.8 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Alcohol and drug use Diabetes Smoking Nutritional deficiencies High fasting plasma glucose Cardiovascular diseases Others

274 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries Alcohol and drug use Unintentional injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Air pollution Diabetes Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Alcohol and drug use Unsafe water, sanitation and handwashing Transport injuries 2. Unintentional injuries 3. Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Air pollution Diabetes Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Self-harm & intersonal violence Others to 14 years of age 1. Unsafe water, sanitation and handwashing Transport injuries 2. Alcohol and drug use Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries High fasting plasma glucose Neoplasms Air pollution Diabetes Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Cardiovascular diseases Others

275 Total population 15 to 49 years of age 1. Alcohol and drug use Cardiovascular diseases Dietary risks Transport injuries High systolic blood pressure Self-harm & intersonal violence High body-mass index Neoplasms High total cholesterol Unintentional injuries Unsafe sex HIV/AIDS Smoking Diabetes Others to 49 years of age 1. Alcohol and drug use Transport injuries Dietary risks Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases High body-mass index Unintentional injuries High total cholesterol HIV/AIDS Smoking Neoplasms Unsafe sex Diabetes Others to 49 years of age 1. Dietary risks Neoplasms High body-mass index Cardiovascular diseases High systolic blood pressure Diabetes Alcohol and drug use Transport injuries Unsafe sex HIV/AIDS High total cholesterol Self-harm & intersonal violence smoking Diarrheal/LRI/other Others

276 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Cirrhosis High fasting plasma glucose Transport injuries High total cholesterol Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Transport injuries High fasting plasma glucose Cirrhosis High total cholesterol Self-harm & intersonal violence Low physical activity Chronic respiratory diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes Smoking Transport injuries High fasting plasma glucose Cirrhosis High total cholesterol Self-harm & intersonal violence Low physical activity Chronic respiratory diseases Others

277 Total population 70 years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High body-mass index 1, Neurological disorders Smoking Diabetes Low glomerular filtration rate Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Low physical activity Cirrhosis Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, Smoking 1, Neurological disorders High body-mass index Diabetes Low glomerular filtration rate Chronic respiratory diseases Low physical activity Diarrheal/LRI/other High fasting plasma glucose Cirrhosis Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms High body-mass index 1, Diabetes High fasting plasma glucose Neurological disorders Smoking Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Low physical activity Cirrhosis Others

278 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose Neonatal disorders Low glomerular filtration rate Neurological disorders High total cholesterol Transport injuries Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms Smoking Diabetes High body-mass index Transport injuries Alcohol and drug use Diarrheal/LRI/other High fasting plasma glucose Self-harm & intersonal violence Low glomerular filtration rate Neonatal disorders Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes Smoking Diarrheal/LRI/other High fasting plasma glucose Neonatal disorders Low glomerular filtration rate Neurological disorders High total cholesterol Chronic respiratory diseases Others

279 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE ST. KITTS AND NEVIS 84 Demographic indicators, 2013 Total population 51,936 inhabitants Life expectancy at birth (LEB) 75.5 years Health life expectancy at birth (HLEB) years (11.4 years less than life expectancy at Birth, Average in the Caribbean) Median age 34 years Life expectancy for over-60 year population 19 years (Average in the Caribbean) Over 65 year population 8.1% (2,758inhabitants) General mortality rate 670 Macroeconomic indicators, 2013 Per capita GDP 21,100 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 61. Ischemic heart disease 15, % 62. Stroke 9, % 63. Diabetes 4, % 64. Lower respiratory infection 3, % 65. HIV/AIDS 3, % 66. Hytensive health disease 2, % 67. Road injuries 2, % 68. Prostate cancer 2, % 69. Preterm birth complications 1, % 70. Cirrhosis 1, % Total 10 main causes 47, % Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) Physiological risks 46% 31. Physiological risks 72% 32. Dietary risks 15% High body-mass index 146% 33. Alcohol and drug use 10% High blood glucose levels 113% 34. Physical inactivity 7% Low bone mineral density 95% 35. Smoking 6% 8. Alcohol and drug use 86% 12. Malnutrition 5% Drug use 146% 19. Injuries 4% Alcohol use 67% 20. Other risks 11% 9. Injuries 33% Total 100% 10. Dietary risks 29% 84 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 221

280 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SAINT VINCENT AND THE GRANADINES 86 Demographic indicators, 2013 Total population 109 hundred inhabitants Life expectancy at birth (LEB) 74 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 29 years Life expectancy for over-60 year population 21 years Over-60 years population 10% (11 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $10, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 5.2% Public outlay on healthcare 4.3% Private outlay on healthcare 0.9% Others outlays on healthcare 0.0% Human development indicators, 2013 Human Development Index 0,719(High Human development, 102 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d(optimal: below 39.0), 2012 Communicable diseases n.d Non-communicable diseases n.d Injuries n.d of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases % 32.1% 41.9% 2. Neoplasms % 17.7% 16.8% 3. Diabetes % 12.6% 16.8% 4. Diarrheal/LRI/Other % 5.1% 5.5% 5. Neurological disorders % 4.4% 4.0% 6. Unintentional Injuries % 4.6% 2.3% 7. Self-harm & intersonal violence % 5.4% 1.1% 8. HIV/AIDS % 4.1% 1.7% 9. Neonatal disorders % 3.0% 2.6% 10. Chronic respiratory diseases % 3.6% 1.7% 11. Transport injuries % 3.3% 1.2% 12. Other noncommunicable diseases % 1.9% 2.3% 13. Digestive diseases % 2.2% 2.0% TOTAL % 100.0% 100.0% 86 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 223

281 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,216 21, % Years lived with disability (YLD) 4,023 5, % Years of life lost (YLL) 17,193 15, % % Concept Disability adjusted life years (DALY) Grow rate ,384 11, % Years lived with disability (YLD) 2,144 2, % Years of life lost (YLL) 9,240 9, % % Concept Disability adjusted life years (DALY) Grow rate ,832 9, % Years lived with disability (YLD) 1,879 2, % Years of life lost (YLL) 7,953 6, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 21, % 5, % 15, % % 11, % 2, % 9, % % 9, % 2, % 6, % % 224

282 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others 5.8 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes 7. High fasting plasma glucose Cardiovascular diseases Others 5.9 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others

283 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable diseases Air pollution Diabetes High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Neoplasms Child and maternal malnutrition Diarrheal/LRI/other Air pollution Other non-communicable diseases High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Unintentional injuries Alcohol and drug use Neoplasms High fasting plasma glucose Transport injuries Child and maternal malnutrition Other non-communicable diseases Air pollution Diabetes High systolic blood pressure Cardiovascular diseases Others

284 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases Unsafe sex Neoplasms High body-mass index HIV/AIDS High systolic blood pressure Diabetes High fasting plasma glucose Unintentional injuries Smoking Transport injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases Unsafe sex HIV/AIDS High systolic blood pressure Unintentional injuries High body-mass index Neoplasms Smoking Transport injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Diabetes High systolic blood pressure HIV/AIDS High fasting plasma glucose Self-harm & intersonal violence Alcohol and drug use Transport injuries Low glomerular filtration rate Unintentional injuries Others

285 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking HIV/AIDS Low physical activity Diarrheal/LRI/other High total cholesterol Chronic respiratory diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Cirrhosis Smoking HIV/AIDS Alcohol and drug use Chronic respiratory diseases Low physical activity Unintentional injuries Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Cirrhosis Low glomerular filtration rate Digestive diseases High total cholesterol Chronic respiratory diseases Others

286 Total population 70 years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Air pollution Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes High body-mass index Neurological disorders Smoking Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 2, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, High body-mass index 1, Neoplasms High fasting plasma glucose 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Digestive diseases High total cholesterol Unintentional injuries Others

287 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Unintentional injuries Smoking Self-harm & intersonal violence Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Neoplasms High fasting plasma glucose Diabetes High body-mass index Self-harm & intersonal violence Smoking Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Low physical activity Neurological disorders Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Diarrheal/LRI/other Low glomerular filtration rate Neurological disorders Low physical activity Neonatal disorders High total cholesterol Unintentional injuries Others

288 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE SAINT LUCIA 88 Demographic indicators, 2013 Total population 182 hundred inhabitants Life expectancy at birth (LEB) 75 years Health life expectancy at birth (HLEB) years (12 years less than life expectancy at Birth) Median age 31years Life expectancy for over-60 year population 21 years Over-60 years population 12% (22 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $10, Per capita GDP-PPP outlay on healthcare $ Total outlay on healthcare 8.5% Public outlay on healthcare 4.7% Private outlay on healthcare 3.6% Others outlays on healthcare 0.2% Human development indicators, 2013 Human Development Index 0,714(High Human development, 97 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d(optimal: below 39.0), 2012 Communicable diseases n.d Non-communicable diseases n.d Injuries n.d of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases % 31.7% 40.8% 2. Neoplasms % 19.2% 16.0% 3. Diabetes % 13.5% 18.4% 4. Neurological disorders % 5.9% 5.4% 5. Diarrheal/LRI/Other % 5.5% 5.9% 6. Chronic respiratory diseases 7. Self-harm & intersonal violence % 5.2% 2.3% % 4.7% 1.1% 8. Unintentional Injuries % 3.4% 2.2% 9. Digestive diseases % 2.1% 2.0% 10. HIV/AIDS % 2.6% 1.2% 11. Transport injuries % 2.6% 1.0% 12. Other non-communicable diseases % 1.6% 2.0% 13. Neonatal disorders % 2.0% 1.7% TOTAL 1, % 100.0% 100.0% 88 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 231

289 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate ,391 32, % Years lived with disability (YLD) 5,519 8, % Years of life lost (YLL) 24,872 23, % , % Concept Disability adjusted life years (DALY) Grow rate ,970 18, % Years lived with disability (YLD) 2,911 4, % Years of life lost (YLL) 14,059 14, % % Concept Disability adjusted life years (DALY) Grow rate ,421 13, % Years lived with disability (YLD) 2,608 4, % Years of life lost (YLL) 10,813 9, % % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 32, % 8, % 23, % 1, % 18, % 4, % 14, % % 13, % 4, % 9, % % 232

290 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others 5.9 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes 7. High fasting plasma glucose Cardiovascular diseases Others 6.0 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Air pollution Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Nutritional deficiencies Alcohol and drug use Diabetes High fasting plasma glucose Cardiovascular diseases Others

291 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable diseases Air pollution Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Neoplasms Air pollution Diarrheal/LRI/other Child and maternal malnutrition Other non-communicable diseases High fasting plasma glucose Self-harm & intersonal violence High systolic blood pressure Cardiovascular diseases Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Alcohol and drug use Neoplasms Low glomerular filtration rate Unintentional injuries High fasting plasma glucose Other non-communicable diseases Child and maternal malnutrition Transport injuries Air pollution Diabetes High systolic blood pressure Cardiovascular diseases Others

292 Total population 15 to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Diabetes Unsafe sex HIV/AIDS High fasting plasma glucose Unintentional injuries Smoking Transport injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index HIV/AIDS Unsafe sex Unintentional injuries Smoking Transport injuries High fasting plasma glucose Diabetes Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Diabetes High systolic blood pressure HIV/AIDS High fasting plasma glucose Self-harm & intersonal violence Alcohol and drug use Transport injuries Sexual abuse and violence Diarrheal/LRI/other Others

293 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Cirrhosis Smoking Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Alcohol and drug use Self-harm & intersonal violence Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Neoplasms High body-mass index Diabetes High fasting plasma glucose Chronic respiratory diseases Smoking Cirrhosis Alcohol and drug use Self-harm & intersonal violence Low physical activity Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Neoplasms High systolic blood pressure Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Cirrhosis Low glomerular filtration rate Digestive diseases High total cholesterol Chronic respiratory diseases Others

294 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, High body-mass index 1, Neurological disorders Low glomerular filtration rate Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Smoking Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High fasting plasma glucose 1, Diabetes 1, Smoking Neurological disorders High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Low physical activity Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms Smoking 1, Neurological disorders High body-mass index Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Low physical activity Unintentional injuries Others

295 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Diabetes High fasting plasma glucose Neurological disorders Smoking Diarrheal/LRI/other Low physical activity Chronic respiratory diseases Low glomerular filtration rate Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High fasting plasma glucose Diabetes High body-mass index Neurological disorders Smoking Diarrheal/LRI/other Alcohol and drug use Chronic respiratory diseases Low physical activity Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Diabetes High body-mass index Neoplasms High fasting plasma glucose Diarrheal/LRI/other Low physical activity Neurological disorders Low glomerular filtration rate Chronic respiratory diseases Air pollution Unintentional injuries Others

296 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE TRINIDAD AND TOBAGO 90 Demographic indicators, 2013 Total population 1,341 hundred inhabitants Life expectancy at birth (LEB) 71 years Health life expectancy at birth (HLEB) years (11 years less than life expectancy at Birth) Median age 33 years Life expectancy for over-60 year population 18 years Over-60 years population 14% (188 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $30, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 5.4% Public outlay on healthcare 2.6% Private outlay on healthcare 2.3% Others outlays on healthcare 0.5% Human development indicators, 2013 Human Development Index 0,766 (High Human development, 74 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d(optimal: below 39.0), 2012 Communicable diseases 9.1% Non-communicable diseases 79.8% Injuries 11.1% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 4,274 2,341 1, % 34.30% 39.03% 2. Diabetes 2,371 1,270 1, % 18.61% 22.23% 3. Neoplasms 1,811 1, % 14.95% 15.97% 4. Diarrheal/LRI/Other % 4.01% 4.36% 5. Neurological disorders % 3.46% 4.46% 6. Self-harm & intersonal violence 7. Chronic respiratory diseases % 5.64% 1.34% % 3.47% 1.98% 8. Unintentional Injuries % 3.21% 2.08% 9. Digestive diseases % 2.50% 2.42% 10. Transport injuries % 3.36% 1.23% 11. HIV/AIDS % 3.16% 1.18% 12. Other non-communicable diseases % 1.36% 1.88% 13. Neonatal disorders % 1.96% 1.82% TOTAL 11, % 100.0% 100.0% 90 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 239

297 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate , , % Years lived with disability (YLD) 48,403 72, % Years of life lost (YLL) 226, , % , % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 25,939 38, % Years of life lost (YLL) 123, , % 5,591 8, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 22,464 34, % Years of life lost (YLL) 102, , % 4,165 5, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 352, % 72, % 280, % 14, % 209, % 38, % 171, % 8, % 143, % 34, % 108, % 5, % 240

298 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Smoking Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Diabetes Unsafe sex Nutritional deficiencies Alcohol and drug use Cardiovascular diseases Others 5.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Smoking Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Diabetes Unsafe sex Nutritional deficiencies 7. Alcohol and drug use Cardiovascular diseases Others 5.4 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Smoking Diarrheal/LRI/other Low glomerular filtration rate Unintentional injuries Air pollution Diabetes Unsafe sex Nutritional deficiencies Alcohol and drug use Cardiovascular diseases Others

299 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Self-harm & intersonal violence Air pollution Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Unintentional injuries 2. Alcohol and drug use Transport injuries Low glomerular filtration rate Diarrheal/LRI/other High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Self-harm & intersonal violence Air pollution Diabetes Others to 14 years of age 1. Unsafe water, sanitation and handwashing Diarrheal/LRI/other 2. Low glomerular filtration rate Transport injuries Alcohol and drug use Unintentional injuries High fasting plasma glucose Neoplasms Child and maternal malnutrition Other non-communicable diseases High systolic blood pressure Diabetes Air pollution Cardiovascular diseases Others

300 Total population 15 to 49 years of age 1. High body-mass index Self-harm & intersonal violence Dietary risks Cardiovascular diseases Alcohol and drug use Neoplasms Unsafe sex Diabetes High systolic blood pressure HIV/AIDS High fasting plasma glucose Transport injuries Smoking Unintentional injuries Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index HIV/AIDS High systolic blood pressure Transport injuries Unsafe sex Diabetes Smoking Unintentional injuries High fasting plasma glucose Neoplasms Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Unsafe sex Diabetes High fasting plasma glucose HIV/AIDS High systolic blood pressure Self-harm & intersonal violence Alcohol and drug use Transport injuries Sexual abuse and violence Diarrheal/LRI/other Others

301 Total population 50 to 69 years of age 1. Dietary risks Cardiovascular diseases High body-mass index Diabetes High systolic blood pressure Neoplasms High fasting plasma glucose Cirrhosis Smoking Diarrheal/LRI/other High total cholesterol Chronic respiratory diseases Low physical activity Digestive diseases Others to 69 years of age 1. Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes High body-mass index Neoplasms High fasting plasma glucose Cirrhosis Smoking Self-harm & intersonal violence High total cholesterol Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Cardiovascular diseases Dietary risks Diabetes High fasting plasma glucose Neoplasms High systolic blood pressure Digestive diseases Low physical activity Diarrheal/LRI/other High total cholesterol Chronic respiratory diseases Low glomerular filtration rate Cirrhosis Others

302 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 3, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms 1, High body-mass index 1, Neurological disorders Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Chronic respiratory diseases Smoking Digestive diseases Others years of age and over 1. Dietary risks 2, Cardiovascular diseases 3, High systolic blood pressure 2, Diabetes 1, High fasting plasma glucose 1, Neoplasms 1, High body-mass index 1, Neurological disorders Smoking 1, Chronic respiratory diseases Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Diabetes 1, High fasting plasma glucose 1, Neoplasms High body-mass index 1, Neurological disorders Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases High total cholesterol Chronic respiratory diseases Others

303 Total population 1. Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Diabetes High body-mass index Neoplasms High fasting plasma glucose Diarrheal/LRI/other Smoking Neurological disorders Low physical activity Self-harm & intersonal violence High total cholesterol Chronic respiratory diseases Others Dietary risks Cardiovascular diseases All age 2. High systolic blood pressure Diabetes High body-mass index Neoplasms High fasting plasma glucose Self-harm & intersonal violence Smoking Diarrheal/LRI/other Low physical activity Chronic respiratory diseases High total cholesterol Neurological disorders Others High body-mass index Cardiovascular diseases All age 2. Dietary risks Diabetes High systolic blood pressure Neoplasms High fasting plasma glucose Neurological disorders Low physical activity Diarrheal/LRI/other High total cholesterol Digestive diseases Low glomerular filtration rate Unintentional injuries Others

304 Inter-American Observatory of Social Protection 2016 RISK FACTORS PREVENTABLE BY SEX AND AGE URUGUAY 92 Demographic indicators, 2013 Total population 3,407 hundred inhabitants Life expectancy at birth (LEB) 77 years Health life expectancy at birth (HLEB) years (9 years less than life expectancy at Birth) Median age 34 years Life expectancy for over-60 year population 22 years Over-60 years population 19% (647 hundred inhabitants) Macroeconomic indicators, 2013 Per capita GDP $19, Per capita GDP-PPP outlay on healthcare $1, Total outlay on healthcare 8.8% Public outlay on healthcare 6.2% Private outlay on healthcare 1.5% Others outlays on healthcare 1.1% Human development indicators, 2013 Human Development Index 0,790 (High Human development, 50 th 187) HDI Adjusted for inequality (HDI-I) n.d Gini coefficient, 2012 n.d(optimal: below 39.0), 2012 Communicable diseases 8.4% Non-communicable diseases 81.7% Injuries 9.9% of death by sex, 2013 Cause total male female Percentage total Percentage male Percentage female 1. Cardiovascular diseases 10,683 4,767 5, % 28.8% 36.40% 2. Neoplasms 8,680 4,897 3, % 29.6% 23.28% 3. Neurological disorders 3,525 1,362 2, % 8.2% 13.31% 4. Chronic respiratory diseases 2,226 1, % 8.5% 5.06% 5. Diabetes 1, % 5.5% 5.97% 6. Diarrheal/LRI/Other 1, % 4.8% 6.10% 7. Unintentional Injuries % 3.0% 2.63% 8. Digestive diseases % 2.3% 3.06% 9. Self-harm & intersonal violence % 3.3% 0.80% 10. Transport injuries % 2.6% 1.00% 11. Other noncommunicable diseases % 1.2% 1.38% 12. Cirrhosis % 2.2% 1.02% TOTAL 32,813 16,560 16, % 100.0% 100.0% 92 Source: Inter-American Observatory of Social Protection, CISS, with information Database of World Bank, the Human Development Index, PNUD 2015; the Global Borden of Disease, Institute for Health Metrics and Evaluation; generating evidence, guide policy, WA, IHME,2015; World Health Statistic, OMS Health life expectancy at birth (HLEB) it represents the average number of years a son has the population expectation of living with Total Health, counting the years lived in full health less years with disease and/or injuries. 247

305 Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total Grow rate , , % Years lived with disability (YLD) 108, , % Years of life lost (YLL) 604, , % , % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 62,905 75, % Years of life lost (YLL) 405, , % 18,737 19, % Concept Disability adjusted life years (DALY) Grow rate , , % Years lived with disability (YLD) 45,301 65, % Years of life lost (YLL) 199, , % 12,366 14, % Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 703, % 141, % 562, % 34, % 441, % 75, % 365, % 19, % 262, % 65, % 196, % 14, % 248

306 Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Neoplasms Air pollution Nutritional deficiencies Alcohol and drug use Diabetes Others 5.6 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Neoplasms Air pollution Nutritional deficiencies 7. Alcohol and drug use Diabetes Others 5.5 Children under 5 years 1. Child and maternal malnutrition Neonatal disorders Unsafe water, sanitation and handwashing Other non-communicable diseases 3. Unsafe sex Diarrheal/LRI/other Smoking Unintentional injuries Low glomerular filtration rate Diabetes Air pollution Nutritional deficiencies Alcohol and drug use Neoplasms Others

307 Total population 5 to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Unintentional injuries Unsafe water, sanitation and handwashing Other non-communicable diseases 5. Unsafe sex Diarrheal/LRI/other Smoking Self-harm & intersonal violence High systolic blood pressure Diabetes Others to 14 years of age 1. Alcohol and drug use Unintentional injuries 2. Low glomerular filtration rate Transport injuries High fasting plasma glucose Neoplasms Unsafe water, sanitation and handwashing Other non-communicable diseases 5. Unsafe sex Diarrheal/LRI/other Sexual abuse and violence Self-harm & intersonal violence High systolic blood pressure Neurological disorders Others to 14 years of age 1. Alcohol and drug use Neoplasms Low glomerular filtration rate Transport injuries High fasting plasma glucose Unintentional injuries Unsafe water, sanitation and handwashing Other non-communicable diseases 5. Unsafe sex Diarrheal/LRI/other Smoking Self-harm & intersonal violence High systolic blood pressure Diabetes Others

308 Total population 15 to 49 years of age 1. Alcohol and drug use Neoplasms Smoking Self-harm & intersonal violence Dietary risks Cardiovascular diseases High body-mass index Transport injuries High systolic blood pressure Unintentional injuries Unsafe sex HIV/AIDS High total cholesterol Diabetes Others to 49 years of age 1. Alcohol and drug use Self-harm & intersonal violence Smoking Neoplasms High body-mass index Transport injuries High body-mass index Cardiovascular diseases High systolic blood pressure Unintentional injuries High total cholesterol HIV/AIDS Unsafe sex Mental and substance use disorders Others to 49 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases Smoking Self-harm & intersonal violence Unsafe sex Transport injuries Alcohol and drug use Unintentional injuries High systolic blood pressure Diabetes Sexual abuse and violence Diarrheal/LRI/other Others

309 Total population 50 to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Chronic respiratory diseases High body-mass index Diabetes Alcohol and drug use Cirrhosis High fasting plasma glucose Diarrheal/LRI/other High total cholesterol Self-harm & intersonal violence Others to 69 years of age 1. Smoking Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Chronic respiratory diseases High body-mass index Diabetes Alcohol and drug use Cirrhosis High total cholesterol Self-harm & intersonal violence High fasting plasma glucose Diarrheal/LRI/other Others to 69 years of age 1. High body-mass index Neoplasms Dietary risks Cardiovascular diseases High systolic blood pressure Diabetes Smoking Chronic respiratory diseases High fasting plasma glucose Diarrheal/LRI/other Alcohol and drug use Neurological diseases Low physical activity Digestive diseases Others

310 Total population 70 years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, Smoking Neurological disorders High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Smoking 1, Neoplasms 2, Dietary risks 1, Neurological disorders High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Low physical activity Diarrheal/LRI/other Low glomerular filtration rate Digestive diseases Others years of age and over 1. High systolic blood pressure 1, Cardiovascular diseases 2, Dietary risks 1, Neoplasms 1, High body-mass index Neurological disorders High fasting plasma glucose Diarrheal/LRI/other Smoking Diabetes Low physical activity Chronic respiratory diseases Low glomerular filtration rate Digestive diseases Others

311 Total population 1. High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms Smoking Neurological disorders High body-mass index Chronic respiratory diseases High fasting plasma glucose Diabetes Low physical activity Diarrheal/LRI/other Alcohol and drug use Unintentional injuries Others Smoking Neoplasms All age 2. Dietary risks Cardiovascular diseases High systolic blood pressure Chronic respiratory diseases High body-mass index Neurological disorders Alcohol and drug use Diabetes High fasting plasma glucose Diarrheal/LRI/other Low physical activity Self-harm & intersonal violence Others High systolic blood pressure Cardiovascular diseases All age 2. Dietary risks Neoplasms High body-mass index Neurological disorders Smoking Diarrheal/LRI/other High fasting plasma glucose Diabetes Low physical activity Chronic respiratory diseases High total cholesterol Digestive diseases Others

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