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

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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

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

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 2013-2015 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

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

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 76.4. The Southern Cone averages 75.4, Central America 74.7, and the Caribbean 72.2 years. Figure 2 Life expectancy at birth 80 78 76 74 72 70 68 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

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 79.3 69.3-12.6 Andean sub region 76.4 66.2-13.4 Southern Cone 75.4 66.0-12.5 Central America 74.7 65.7-12.0 Caribbean 72.2 60.8-15.8 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 45 40 35 30 25 20 7

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 2050. This is to say, this age group will increase from 14.1 total population, as a 2013, to over 25 Americas by the year 2050. 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

age-related disabilities or chronic degenerative diseases brought on by unhealthy lifestyles or age. Figure 4 Life expectancy at 60 Caribbean North America 25 24 23 22 21 20 19 18 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

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, (%) 90 80 70 60 50 40 30 20 10 0 84.7 North america 81.2 Caribbean 75.9 75.5 Southern Cone Central America 70.7 17.1 13.0 12.7 6.3 9.0 8.310.5 11.1 11.8 12.3 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

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, 2010-1999 Increase within North America, 2010-1999 Increase within Central America, 2010-1999 Increase within the Caribbean, 2010-1999 Increase within the Andean sub region, 2010-1999 Increase within the Southern Cone, 2010-1999 1.68% 7.77% -4.77% 1.69% -14.42% 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% -14.84% -6.43% -21.66% 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

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) 3500 3000 2500 2000 1500 1000 500 0 5 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

(Prevalence rate deaths in 2013) Age group CISS North America Central America Caribbean Andean sub region Southern Cone 5 to 14 1.76 0.6 1.4 3.7 2.8 1.1 years 15 to 49 25.1 21.6 1920 34.5 20.1 19.9 years 50 to 69 309.7 225.2 250.0 433.6 201.5 283.2 years 70 and over 2,371.5 2,182.1 2,154.7 3,165.8 1,686.0 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) 1400 1200 1000 800 600 400 200 0 5 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 4.7 2.8 4.9 4.5 4.9 4.4 13

15 to 49 years 24.3 25.4 22.9 27.2 21.9 28.5 50 to 69 years 239.0 316.7 208.2 271.9 226.0 344.0 70 and over 954.0 1,189.8 841.3 1,184.0 1,027.8 1,143.6 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) 1000 900 800 700 600 500 400 300 200 100 0 5 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 1.8 0.8 1.9 3.4 1.9 1.1 15 to 49 years 12.8 7.5 16.3 14.1 8.7 5.5 50 to 69 years 150.2 61.2 208.1 133.2 104.2 74.3 70 and over 747.6 432.1 920.4 597.6 603.2 499.2 14

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

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) 4 65.5 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 $21,263.60 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, 2012 49.1 (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 919,084 458,331 460,754 30.7% 27.8% 34.3% 2.Neoplasms 512,109 264,336 247,772 17.1% 16.0% 18.4% 3.Diabetes 352,003 165,704 186,299 11.7% 10.0% 13.9% 4. Diarrhea/LRI/Other 226,336 116,573 109,763 7.6% 7.1% 8.2% 5. Chronic respiratory diseases 6. Self-harm & intersonal violence 7. Neurological disorders 176,383 98,775 77,608 5.9% 6.0% 5.8% 172,294 150,296 21,998 5.8% 9.1% 1.6% 135,868 67,753 68,115 4.5% 4.1% 5.1% 8. Transport injuries 120,319 93,940 26,379 4.0% 5.7% 2.0% 9. Cirrhosis 109,712 77,381 32,331 3.7% 4.7% 2.4% 10. Unintentional injuries 109,120 70,655 38,465 3.6% 4.3% 2.9% 11. Digestive diseases 83,642 41,877 41,765 2.8% 2.5% 3.1% 12. Neonatal disorders 79,001 45,884 33,118 2.6% 2.8% 2.5% TOTAL 2,995,871 1,651,504 1,344,367 100.0% 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 2015. 3 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 126,051,162 128,170,130 1.68% Years lived with disability (YLD) 18,548,188 28,668,156 54.56% Years of life lost (YLL) 107,502,977 99,501,869-7.44% 4571853 5,193,800 13.60% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 76,384,405 75,744,521-0.84% Years lived with disability (YLD) 10,529,572 15,411,753 46.37% Years of life lost (YLL) 65,854,837 60,332,663-8.39% 2,499,185 2,731,515 9.30% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 49,666,757 52,425,609 5.55% Years lived with disability (YLD) 8,018,616 13,256,403 65.32% Years of life lost (YLL) 41,648,140 39,169,206-5.95% 2,072,668 2,462,285 18.80% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 128,170,130 100% 28,668,156 100% 99,501,869 100% 5,193,800 100% 75,744,521 59.10% 15,411,753 53.76% 60,332,663 60.63% 2,731,515 52.59% 52,425,609 40.90% 13,256,403 46.24% 39,169,206 39.37% 2,462,285 47.41% 17

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 71.6 1. Neonatal disorders 159.7 37.8 2. Unsafe water, sanitation and handwashing 25.2 2. Diarrheal/LRI/other 87.7 20.8 3. Air pollution 8.4 3. Other non-communicable 82.1 19.4 4. Unsafe sex 6.7 4. Unintentional injuries 24.9 5.9 5. Smoking 2.3 5. Nutritional deficiencies 16.1 3.8 6. Low glomerular filtration rate 1.7 6. Diabetes 8.4 2.0 7. Alcohol and drug use 1.5 7. Communicable, maternal, neonatal, and nutritional diseases 8.3 2.0 Others 8.4 Children under 5 years 1. Child and maternal malnutrition 79.1 1. Neonatal disorders 181.5 38.9 2. Unsafe water, sanitation and handwashing 28.2 2. Diarrheal/LRI/other 96.7 20.7 3. Air pollution 9.2 3. Other non-communicable 88.4 18.9 4. Unsafe sex 6.6 4. Unintentional injuries 26.6 5.7 5. Smoking 2.4 5. Nutritional deficiencies 17.3 3.7 6. Low glomerular filtration rate 1.8 6. Diabetes 9.2 2.0 7. Alcohol and drug use 1.7 7. Communicable, maternal, neonatal, and nutritional diseases 8.3 1.8 Others 8.3 Children under 5 years 1. Child and maternal malnutrition 63.8 1. Neonatal disorders 137.0 36.4 2. Unsafe water, sanitation and handwashing 22.1 2. Diarrheal/LRI/other 78.3 20.8 3. Air pollution 7.5 3. Other non-communicable 75.6 20.1 4. Unsafe sex 6.9 4. Unintentional injuries 23.1 6.2 5. Smoking 2.1 5. Nutritional deficiencies 15.0 4.0 6. Low glomerular filtration rate 1.5 6. Communicable, maternal, neonatal, and nutritional diseases 8.2 2.2 7. Alcohol and drug use 1.3 7. Diabetes 7.5 2.0 18

Total population Others 8.4 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.1 1. Transport injuries 2. Alcohol and drug use 1.0 2. Diarrheal/LRI/other 5.5 16.0 3. Low glomerular filtration rate 0.6 3. Unintentional injuries 5.4 15.7 4. Air pollution 0.3 4. Neoplasms 4.7 13.6 5. High fasting plasma glucose 0.3 5. Self-harm & intersonal violence 2.8 8.1 5.5 16.1 6. Unsafe sex 0.3 6. Other non-communicable 2.2 6.3 7. Child and maternal malnutrition 0.2 7. Diabetes 1.8 5.4 Others 18.8 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.2 1. Unintentional injuries 2. Alcohol and drug use 1.3 2. Transport injuries 7.0 17.7 3. Low glomerular filtration rate 0.6 3. Diarrheal/LRI/other 5.9 15.0 4. Air pollution 0.4 4. Neoplasms 5.3 13.4 5. Unsafe sex 0.2 5. Self-harm & intersonal violence 3.6 9.1 7.0 17.7 6. High fasting plasma glucose 0.2 6. Other non-communicable 2.3 5.7 7. Child and maternal malnutrition 0.2 7. Diabetes 1.9 4.7 Others 16.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.9 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.7 2. Transport injuries 4.0 13.9 3. Low glomerular filtration rate 0.6 3. Neoplasms 4.0 13.9 4. Air pollution 0.3 4. Unintentional injuries 3.7 12.9 5. High fasting plasma glucose 0.3 5. Other non-communicable 2.0 7.1 5.0 17.5 6. Unsafe sex 0.3 6. Self-harm & intersonal violence 1.9 6.8 7. Child and maternal malnutrition 0.2 7. Diabetes 1.9 6.5 Others 21.5 19

Total population 15 to 49 years of age 1. Alcohol and drug use 36.8 1. Self-harm & intersonal violence 46.4 23.9 2. Dietary risks 22.2 2. Cardiovascular diseases 25.1 12.9 3. High body-mass index 17.9 3. Transport injuries 24.4 12.6 4. High systolic blood pressure 15.6 4. Neoplasms 24.3 12.5 5. High fasting plasma glucose 10.6 5. Diabetes 12.8 6.6 6. Unsafe sex 10.1 6. Unintentional injuries 12.0 6.2 7. Smoking 9.8 7. HIV/AIDS 10.3 5.3 Others 20.1 15 to 49 years of age 1. Alcohol and drug use 63.4 1. Self-harm & intersonal violence 83.9 30.3 2. Dietary risks 27.8 2. Transport injuries 41.5 15.0 3. High systolic blood pressure 19.9 3. Cardiovascular diseases 30.8 11.1 4. High body-mass index 19.7 4. Neoplasms 21.3 7.7 5. Smoking 13.3 5. Unintentional injuries 20.4 7.4 6. High fasting plasma glucose 12.8 6. Cirrhosis 15.9 5.7 7. High total cholesterol 11.8 7. Diabetes 14.4 5.2 Others 17.6 15 to 49 years of age 1. Dietary risks 16.7 1. Neoplasms 27.3 24.0 2. High body-mass index 16.1 2. Cardiovascular diseases 19.4 17.1 3. High systolic blood pressure 11.4 3. Diabetes 11.3 10.0 4. Alcohol and drug use 10.8 4. Self-harm & intersonal violence 9.9 8.7 5. Unsafe sex 9.9 5. Transport injuries 7.7 6.8 6. High fasting plasma glucose 8.4 6. HIV/AIDS 6.3 5.6 7. Smoking 6.3 7. Diarrheal/LRI/other 5.9 5.2 Others 22.6 20

Total population 50 to 69 years of age 1. Dietary risks 285.2 1. Cardiovascular diseases 309.7 30.3 2. High systolic blood pressure 231.6 2. Neoplasms 239.0 23.4 3. High body-mass index 216.7 3. Diabetes 150.2 14.7 4. High fasting plasma glucose 161.6 4. Cirrhosis 59.5 5.8 5. Smoking 137.7 5. Chronic respiratory diseases 44.9 4.4 6. Alcohol and drug use 91.8 6. Diarrheal/LRI/other 41.3 4.1 7. Low glomerular filtration rate 87.3 7. Transport injuries 29.7 2.9 Others 14.3 50 to 69 years of age 1. Dietary risks 359.0 1. Cardiovascular diseases 388.3 30.5 2. High systolic blood pressure 289.2 2. Neoplasms 259.8 20.4 3. High body-mass index 221.7 3. Diabetes 161.4 12.7 4. Smoking 200.9 4. Cirrhosis 92.1 7.2 5. High fasting plasma glucose 184.0 5. Chronic respiratory diseases 57.8 4.6 6. Alcohol and drug use 145.9 6. Diarrheal/LRI/other 51.4 4.0 7. High total cholesterol 109.7 7. Self-harm & intersonal violence 49.1 3.9 Others 16.6 50 to 69 years of age 1. Dietary risks 219.3 1. Cardiovascular diseases 239.6 30.1 2. High body-mass index 212.1 2. Neoplasms 220.5 27.7 3. High systolic blood pressure 180.3 3. Diabetes 140.3 17.6 4. High fasting plasma glucose 141.7 4. Chronic respiratory diseases 33.3 4.2 5. Smoking 81.3 5. Diarrheal/LRI/other 32.4 4.1 6. Low glomerular filtration rate 76.1 6. Cirrhosis 30.4 3.8 7. High total cholesterol 62.3 7. Digestive diseases 23.2 2.9 Others 9.7 21

Total population 70 years of age and over 1. Dietary risks 1,403.8 1. Cardiovascular diseases 2,371.5 37.4 2. High systolic blood pressure 1,357.0 2. Neoplasms 954.0 15.1 3. High fasting plasma glucose 817.1 3. Diabetes 747.6 11.8 4. High body-mass index 703.0 4. Chronic respiratory diseases 516.4 8.2 5. Smoking 612.2 5. Diarrheal/LRI/other 485.2 7.7 6. Low glomerular filtration rate 535.3 6. Neurological disorders 467.9 7.4 7. High total cholesterol 375.0 7. Digestive diseases 193.7 3.1 Others 9.4 70 years of age and over 1. Dietary risks 1,522.9 1. Cardiovascular diseases 2,436.5 34.9 2. High systolic blood pressure 1,396.5 2. Neoplasms 1,198.3 17.2 3. Smoking 855.8 3. Diabetes 739.5 10.6 4. High fasting plasma glucose 824.9 4. Chronic respiratory diseases 652.5 9.4 5. High body-mass index 590.9 5. Neurological disorders 522.1 7.5 6. Low glomerular filtration rate 540.7 6. Diarrheal/LRI/other 509.0 7.3 7. Air pollution 392.0 7. Digestive diseases 195.9 2.8 Others 10.3 70 years of age and over 1. High systolic blood pressure 1,326.9 1. Cardiovascular diseases 2,321.9 39.7 2. Dietary risks 1,313.0 2. Neoplasms 767.9 13.1 3. High fasting plasma glucose 811.1 3. Diabetes 753.8 12.9 4. High body-mass index 788.4 4. Diarrheal/LRI/other 467.1 8.0 5. Low glomerular filtration rate 531.1 5. Neurological disorders 426.6 7.3 6. Smoking 426.6 6. Chronic respiratory diseases 412.7 7.1 7. High total cholesterol 388.6 7. Digestive diseases 192.1 3.3 Others 8.7 22

Total population 1. Dietary risks 116.6 1. Cardiovascular diseases 165.8 28.5 All age 2. High systolic blood pressure 103.1 2. Neoplasms 92.4 15.9 3. High body-mass index 73.0 3. Diabetes 63.5 10.9 4. High fasting plasma glucose 66.1 4. Diarrheal/LRI/other 40.8 7.0 5. Smoking 53.1 5. Chronic respiratory diseases 31.8 5.5 6. Alcohol and drug use 41.7 6. Self-harm & intersonal violence 31.1 5.4 7. Low glomerular filtration rate 40.8 7. Neurological disorders 24.5 4.2 Others 22.5 1. Dietary risks 125.4 1. Cardiovascular diseases 168.0 25.8 All age 2. High systolic blood pressure 106.4 2. Neoplasms 96.9 14.9 3. Smoking 69.4 3. Diabetes 60.7 9.3 4. High fasting plasma glucose 65.4 4. Self-harm & intersonal violence 55.1 8.4 5. High body-mass index 65.1 5. Diarrheal/LRI/other 42.7 6.6 6. Alcohol and drug use 64.6 6. Chronic respiratory diseases 36.2 5.6 7. Low glomerular filtration rate 40.1 7. Transport injuries 34.4 5.3 Others 24.3 1. Dietary risks 108.1 1. Cardiovascular diseases 163.7 32.0 All age 2. High systolic blood pressure 100.0 2. Neoplasms 88.0 17.2 3. High body-mass index 80.6 3. Diabetes 66.2 12.9 4. High fasting plasma glucose 66.8 4. Diarrheal/LRI/other 40.0 7.6 5. Low glomerular filtration rate 41.6 5. Chronic respiratory diseases 27.6 5.4 6. Smoking 37.3 6. Neurological disorders 24.2 4.7 7. Alcohol and drug use 31.8 7. Digestive diseases 14.8 2.9 Others 17.3 23

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) 7 69.3 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 $51,995.00 Per capita GDP-PPP outlay on healthcare $8,712.00 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, 2012 40.0 (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 953,646 460,278 493,368 33.5% 32.0% 35.0% 2.Neoplasms 713,530 380,482 333,048 25.1% 26.5% 23.6% 3. Neurological disorders 361,281 153,961 207,320 12.7% 10.7% 14.7% 4.Diabetes 209,604 104,097 105,507 7.4% 7.2% 7.5% 5. Chronic respiratory diseases 198,315 102,664 95,651 7.0% 7.1% 6.8% 6. Diarrhea/LRI/Other 107,719 50,411 57,308 3.8% 3.5% 4.1% 7. Unintentional injuries 79,631 42,735 36,896 2.8% 3.0% 2.6% 8. Self-harm & intersonal violence 63,707 49,953 13,754 2.2% 3.5% 1.0% 9. Cirrhosis 57,416 36,218 21,197 2.0% 2.5% 1.5% 10. Digestive diseases 53,082 22,377 30705 1.9% 1.6% 2.2% 11. Transport injuries 50,447 35,134 15312 1.8% 2.4% 1.1% TOTAL 2,848,378 1,438,310 1,410,066 100.0% 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 2015. 6 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 63,198,573 68,108,010 7.77% Years lived with disability (YLD) 9,995,816 15,732,482 57.39% Years of life lost (YLL) 53,202,759 52,375,515-1.55% 3,013,640 3,180,191 5.53% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 38,944,506 39,762,501 2.10% Years lived with disability (YLD) 5,647,016 8,294,647 46.89% Years of life lost (YLL) 33,297,492 31,467,841-5.49% 1,602,010 1,608,266 0.39% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 24,254,067 28,345,509 16.87% Years lived with disability (YLD) 4,348,800 7,437,835 71.03% Years of life lost (YLL) 19,905,267 20,907,674 5.04% 1,411,630 1,571,925 11.36% Years of healthy life lost, centage growth by sex CONCEPT Total DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % 68,108,010 100% 15,732,482 100% 52,375,515 100% 3,180,191 100% 39,762,501 58.38% 8,294,647 52.72% 31,467,841 60.08% 1,608,266 50.57% 28,346,509 41.62% 7,437,835 47.28% 20,907,674 39.92% 1,571,925 49.43% 25

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 1.5 1. Neonatal disorders 55.1 42.0 2. Alcohol and drug use 0.7 2. Other non-communicable 41.9 31.9 3. Low glomerular filtration rate 0.3 3. Unintentional injuries 10.1 7.7 4. Unsafe sex 0.3 4. Diarrheal/LRI/other 5.5 4.2 5. High fasting plasma glucose 0.2 5. Transport injuries 3.7 2.8 6. Air pollution 0.2 6. Diabetes 3.3 2.5 7. Unsafe water, sanitation and handwashing 0.2 7. Neoplasms 3.2 2.4 Others 6.7 Children under 5 years 1. Child and maternal malnutrition 1.7 1. Neonatal disorders 60.7 42.3 2. Alcohol and drug use 0.8 2. Other non-communicable 44.2 30.8 3. Low glomerular filtration rate 0.4 3. Unintentional injuries 12.0 8.3 4. Unsafe sex 0.3 4. Diarrheal/LRI/other 6.1 4.2 5. High fasting plasma glucose 0.2 5. Transport injuries 4.0 2.8 6. Air pollution 0.2 6. Diabetes 3.7 2.6 7. Unsafe water, sanitation and handwashing 0.2 7. Neoplasms 3.4 2.3 Others Others Children under 5 years 1. Child and maternal malnutrition 1.2 1. Neonatal disorders 49.1 41.5 2. Alcohol and drug use 0.6 2. Other non-communicable 39.4 33.2 3. Unsafe sex 0.3 3. Unintentional injuries 8.0 6.8 4. Low glomerular filtration rate 0.3 4. Diarrheal/LRI/other 4.8 4.1 5. High fasting plasma glucose 0.2 5. Transport injuries 3.3 2.8 6. Air pollution 0.2 6. Neoplasms 2.9 2.5 26

7. Unsafe water, sanitation and handwashing 0.2 7. Diabetes 2.9 2.5 Others 6.6 Total population 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Transport injuries 2.9 22.7 2. High fasting plasma glucose 0.1 2. Neoplasms 2.8 21.2 3. Low glomerular filtration rate 0.1 3. Unintentional injuries 2.0 15.7 4. Sexual abuse and violence 0.1 4. Self-harm & intersonal violence 1.1 8.5 5. Unsafe water, sanitation and handwashing 0.1 5. Other non-communicable 1.0 7.7 6. Air pollution 0.1 6. Diabetes 0.8 6.1 7. High systolic blood pressure 0.1 7. Diarrheal/LRI/other 0.6 4.7 Others 13.4 5 to 14 years of age 1. Alcohol and drug use 0.5 1. Transport injuries 3.4 23.1 2. High fasting plasma glucose 0.1 2. Neoplasms 3.0 20.0 3. Low glomerular filtration rate 0.1 3. Unintentional injuries 2.7 18.0 4. Sexual abuse and violence 0.1 4. Self-harm & intersonal violence 1.5 9.8 5. Air pollution 0.1 5. Other non-communicable 1.0 6.9 6. High systolic blood pressure 0.1 6. Diabetes 0.8 5.6 7. Unsafe water, sanitation and handwashing 0.1 7. Cardiovascular diseases 0.6 4.1 Others 12.5 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Neoplasms 2.5 23.0 2. High fasting plasma glucose 0.1 2. Transport injuries 2.4 22.2 3. Low glomerular filtration rate 0.1 3. Unintentional injuries 1.4 12.3 4. Unsafe water, sanitation and handwashing 0.1 4. Other non-communicable 1.0 8.8 5. Air pollution 0.1 5. Diabetes 0.8 6.8 6. Sexual abuse and violence 0.1 6. Self-harm & intersonal violence 0.7 6.6 7. High systolic blood pressure 0.1 7. Diarrheal/LRI/other 0.6 5.6 27

Others 14.7 Total population 15 to 49 years of age 1. Alcohol and drug use 33.3 1. Neoplasms 25.4 18.7 2. Dietary risks 18.4 2. Self-harm & intersonal violence 23.1 17.0 3. High body-mass index 17.8 3. Cardiovascular diseases 21.6 15.9 4. Smoking 13.0 4. Transport injuries 16.5 12.1 5. High systolic blood pressure 10.4 5. Mental & substance use disorders 13.6 10.0 6. High total cholesterol 9.1 6. Diabetes 7.5 5.5 7. High fasting plasma glucose 6.7 7. Unintentional injuries 6.1 4.5 Others 16.3 15 to 49 years of age 1. Alcohol and drug use 47.8 1. Self-harm & intersonal violence 36.6 20.6 2. Dietary risks 25.4 2. Cardiovascular diseases 29.6 16.7 3. High body-mass index 22.9 3. Transport injuries 24.1 13.6 4. Smoking 15.9 4. Neoplasms 23.9 13.5 5. High systolic blood pressure 15.0 5. Mental & substance use disorders 18.8 10.6 6. High total cholesterol 13.7 6. Unintentional injuries 9.3 5.3 7. High fasting plasma glucose 9.2 7. Diabetes 8.9 5.0 Others 14.8 15 to 49 years of age 1. Alcohol and drug use 18.7 1. Neoplasms 26.9 28.8 2. High body-mass index 12.6 2. Cardiovascular diseases 13.5 14.4 3. Dietary risks 11.4 3. Self-harm & intersonal violence 9.4 10.1 4. Smoking 10.1 4. Transport injuries 8.7 9.3 5. High systolic blood pressure 5.8 5. Mental & substance use disorders 8.4 8.9 6. Sexual abuse and violence 4.8 6. Diabetes 6.1 6.5 7. High total cholesterol 4.4 7. Cirrhosis 3.8 4.1 28

Others 18.0 Total population 50 to 69 years of age 1. Smoking 211.7 1. Neoplasms 316.7 38.3 2. Dietary risks 202.1 2. Cardiovascular diseases 225.2 27.3 3. High body-mass index 161.3 3. Diabetes 61.2 7.4 4. High systolic blood pressure 121.8 4. Chronic respiratory diseases 49.5 6.0 5. High fasting plasma glucose 78.0 5. Cirrhosis 35.3 4.3 6. Alcohol and drug use 75.9 6. Neurological disorders 24.2 2.9 7. High total cholesterol 70.1 7. Self-harm & intersonal violence 20.6 2.5 Others 11.3 50 to 69 years of age 1. Dietary risks 282.1 1. Neoplasms 358.4 34.9 2. Smoking 270.1 2. Cardiovascular diseases 309.5 30.2 3. High body-mass index 202.9 3. Diabetes 73.7 7.2 4. High systolic blood pressure 166.0 4. Chronic respiratory diseases 55.6 5.4 5. Alcohol and drug use 108.2 5. Cirrhosis 50.4 4.9 6. High fasting plasma glucose 105.4 6. Self-harm & intersonal violence 32.3 3.2 7. High total cholesterol 96.3 7. Neurological disorders 26.8 2.6 Others 11.6 50 to 69 years of age 1. Smoking 156.9 1. Neoplasms 277.4 43.5 2. Dietary risks 127.1 2. Cardiovascular diseases 146.1 22.9 3. High body-mass index 122.2 3. Diabetes 49.5 7.8 4. High systolic blood pressure 80.4 4. Chronic respiratory diseases 43.7 6.9 5. High fasting plasma glucose 52.3 5. Neurological disorders 21.8 3.4 6. Alcohol and drug use 45.5 6. Cirrhosis 21.1 3.3 7. High total cholesterol 45.5 7. Diarrheal/LRI/other 15.6 2.4 29

Others 9.9 Total population 70 years of age and over 1. Dietary risks 1,219.5 1. Cardiovascular diseases 2,182.1 36.4 2. High systolic blood pressure 1,008.1 2. Neoplasms 1,189.8 19.9 3. Smoking 866.8 3. Neurological disorders 1,016.5 17.0 4. High body-mass index 612.8 4. Chronic respiratory diseases 456.3 7.6 5. High fasting plasma glucose 570.7 5. Diabetes 432.1 7.2 6. High total cholesterol 364.5 6. Diarrheal/LRI/other 259.1 4.3 7. Low glomerular filtration rate 363.4 7. Unintentional injuries 157.5 2.6 Others 5.0 70 years of age and over 1. Dietary risks 1,332.0 1. Cardiovascular diseases 2,184.8 33.8 2. Smoking 1,081.9 2. Neoplasms 1,491.9 23.1 3. High systolic blood pressure 958.0 3. Neurological disorders 1,005.5 15.6 4. High body-mass index 647.7 4. Chronic respiratory diseases 551.8 8.6 5. High fasting plasma glucose 645.1 5. Diabetes 466.2 7.2 6. Low glomerular filtration rate 361.5 6. Diarrheal/LRI/other 271.3 4.2 7. Low physical activity 337.2 7. Unintentional injuries 167.4 2.6 Others 4.9 70 years of age and over 1. Dietary risks 1,137.4 1. Cardiovascular diseases 2,180.1 38.6 2. High systolic blood pressure 1,044.6 2. Neurological disorders 1,024.6 18.1 3. Smoking 709.9 3. Neoplasms 969.5 17.2 4. High body-mass index 587.3 4. Diabetes 407.2 7.2 5. High fasting plasma glucose 516.4 5. Chronic respiratory diseases 386.6 6.8 6. High total cholesterol 423.9 6. Diarrheal/LRI/other 250.2 4.4 7. Low glomerular filtration rate 364.7 7. Unintentional injuries 150.2 2.7 30

Others 5.0 Total population 1. Dietary risks 172.5 1. Cardiovascular diseases 269.8 32.2 All age 2. Smoking 139.4 2. Neoplasms 201.9 24.1 3. High systolic blood pressure 129.2 3. Neurological disorders 102.2 12.2 4. High body-mass index 105.5 4. Diabetes 59.3 7.1 5. High fasting plasma glucose 75.7 5. Chronic respiratory diseases 56.1 6.7 6. High total cholesterol 55.6 6. Diarrheal/LRI/other 30.5 3.6 7. Alcohol and drug use 49.0 7. Unintentional injuries 22.5 2.7 Others 11.3 1. Dietary risks 187.3 1. Cardiovascular diseases 264.4 30.7 All age 2. Smoking 159.8 2. Neoplasms 218.6 25.4 3. High systolic blood pressure 124.2 3. Neurological disorders 88.4 10.3 4. High body-mass index 112.1 4. Diabetes 59.8 6.9 5. High fasting plasma glucose 81.6 5. Chronic respiratory diseases 59.0 6.8 6. Alcohol and drug use 64.2 6. Diarrheal/LRI/other 29.0 3.4 7. High total cholesterol 52.6 7. Self-harm & intersonal violence 28.7 3.3 Others 13.3 1. Dietary risks 158.2 1. Cardiovascular diseases 275.1 33.8 All age 2. High systolic blood pressure 134.0 2. Neoplasms 185.7 22.8 3. Smoking 119.6 3. Neurological disorders 115.6 14.2 4. High body-mass index 99.0 4. Diabetes 58.8 7.2 5. High fasting plasma glucose 70.0 5. Chronic respiratory diseases 53.3 6.6 6. High total cholesterol 58.6 6. Diarrheal/LRI/other 32.0 3.9 7. Low physical activity 45.4 7. Unintentional injuries 20.6 2.5 31

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 166.922 million inhabitants Life expectancy at birth (LEB) 74.7 years Health life expectancy at birth (HLEB) 10 66.2 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 $14,184.00 Per capita GDP-PPP outlay on healthcare $931.40 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, 2012 48.5 (Optimal: below a 39.0), 2012 Communicable diseases 12.5% Non-communicable diseases 74.6% Injuries 12.8% of death by sex, 2013 1. Cardiovascular diseases total Percentage total Percentage Percentage female 321,374 163,915 157,459 26.9% 24.5% 29.9% 2. Neoplasms 185,604 91,839 93,765 15.5% 13.7% 17.8% 3.Diabetes 183,319 89,592 93,728 15.3% 13.4% 17.8% 4. Self-harm & intersonal violence 86,278 75,972 10,305 7.2% 11.4% 2.0% 5. Diarrhea/LRI/Other 75,922 40,225 35,696 6.4% 6.0% 6.8% 6. Chronic respiratory diseases 75,908 40,450 35,457 6.4% 6.0% 6.7% 7. Cirrhosis 57,095 40,238 16,857 4.8% 6.0% 3.2% 8. Neurological disorders 54,574 27,035 27,538 4.6% 4.0% 5.2% 9. Transport injuries 49,355 38,859 10,496 4.1% 5.8% 2.0% 10. Unintentional injuries 41,593 28,707 12,886 3.5% 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 2015. 9 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

11. Digestive diseases 36,671 17,931 18,741 3.1% 2.7% 3.6% 12. Other noncommunicable 27,513 14,477 13,036 2.3% 2.2% 2.5% TOTAL 1,195,206 669,240 525,964 100.0% 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 29,215,191 27,821,176-4.77% Years lived with disability (YLD) 3,829,470 6,201,969 61.95% Years of life lost (YLL) 25,385,722 21,618,911-14.84% 619,176 842,359 36.05% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 16,756,676 16,289,365-2.79% Years lived with disability (YLD) 2,169,774 3,169,461 46.07% Years of life lost (YLL) 14,586,903 13,119,608-10.06% 350,929 478,911 36.47% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 12,458,515 11,531,811-7.44% Years lived with disability (YLD) 1,659,696 3,032,508 82.71% Years of life lost (YLL) 10,798,819 8,499,303-21.29% 268,247 363,448 35.49% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 27,821,176 100% 6,201,969 100% 21,618,911 100% 842,359 100% 16,289,365 58.55% 3,169,461 51.10% 13,119,608 60.69% 478,911 56.85% 11,531,811 41.45% 3,032,508 48.90% 8,499,303 39.31% 363,448 43.15% 33

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 65.2 1. Neonatal disorders 121.9 33.5 2. Unsafe water, sanitation and handwashing 22.8 2. Other non-communicable 83.2 22.8 3. Air pollution 8.1 3. Diarrheal/LRI/other 80.1 22.0 4. Unsafe sex 3.8 4. Unintentional injuries 19.4 5.3 5. Smoking 2.2 5. Nutritional deficiencies 12.9 3.5 6. Low glomerular filtration rate 1.9 6. Diabetes 7.5 2.1 7. Alcohol and drug use 1.2 7. Neoplasms 7.4 2.0 Others 8.7 Children under 5 years 1. Child and maternal malnutrition 71.6 1. Neonatal disorders 139.4 34.9 2. Unsafe water, sanitation and handwashing 24.9 2. Other non-communicable 88.8 22.2 3. Air pollution 8.9 3. Diarrheal/LRI/other 88.2 22.0 4. Unsafe sex 3.7 4. Unintentional injuries 20.0 5.0 5. Smoking 2.4 5. Nutritional deficiencies 13.3 3.3 6. Low glomerular filtration rate 2.0 6. Diabetes 8.3 2.1 7. Alcohol and drug use 1.4 7. Neoplasms 8.0 2.0 Others 8.5 Children under 5 years 1. Child and maternal malnutrition 58.6 1. Neonatal disorders 103.5 31.7 2. Unsafe water, sanitation and handwashing 20.6 2. Other non-communicable 77.3 23.7 3. Air pollution 7.2 3. Diarrheal/LRI/other 71.6 21.9 4. Unsafe sex 3.9 4. Unintentional injuries 18.7 5.7 5. Smoking 2.1 5. Nutritional deficiencies 12.4 3.8 34

6. Low glomerular filtration rate 1.7 6. Neoplasms 6.8 2.1 7. Alcohol and drug use 1.1 7. Diabetes 6.7 2.1 Others 9.1 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.2 1. Diarrheal/LRI/other 5.0 15.6 2. Alcohol and drug use 0.8 2. Neoplasms 4.9 15.2 3. Low glomerular filtration rate 0.8 3. Transport injuries 4.8 14.9 4. Air pollution 0.3 4. Unintentional injuries 4.6 14.2 5. High fasting plasma glucose 0.3 5. Self-harm & intersonal violence 3.2 10.0 6. High systolic blood pressure 0.2 6. Other non-communicable 2.4 7.3 7. Unsafe sex 0.2 7. Diabetes 1.9 5.8 Others 17.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.4 1. Transport injuries 6.2 16.7 2. Alcohol and drug use 1.1 2. Unintentional injuries 5.9 15.8 3. Low glomerular filtration rate 0.8 3. Neoplasms 5.6 15.0 4. Air pollution 0.3 4. Diarrheal/LRI/other 5.3 14.2 5. High fasting plasma glucose 0.2 5. Self-harm & intersonal violence 4.1 11.1 6. High systolic blood pressure 0.2 6. Other non-communicable 2.4 6.6 7. Child and maternal malnutrition 0.2 7. Diabetes 1.9 5.0 Others 15.5 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.0 1. Diarrheal/LRI/other 4.7 17.4 2. Low glomerular filtration rate 0.8 2. Neoplasms 4.2 15.4 3. Alcohol and drug use 0.6 3. Transport injuries 3.4 12.4 4. Air pollution 0.3 4. Unintentional injuries 3.2 11.9 5. High fasting plasma glucose 0.3 5. Other non-communicable 2.3 8.4 6. High systolic blood pressure 0.2 6. Self-harm & intersonal violence 2.3 8.4 35

7. Unsafe sex 0.2 7. Diabetes 1.9 6.9 Others 19.3 Total population 15 to 49 years of age 1. Alcohol and drug use 35.4 1. Self-harm & intersonal violence 53.8 27.8 2. Dietary risks 20.1 2. Transport injuries 23.0 11.9 3. High body-mass index 17.6 3. Neoplasms 22.9 11.8 4. High fasting plasma glucose 13.4 4. Cardiovascular diseases 19.8 10.2 5. High systolic blood pressure 12.2 5. Diabetes 16.3 8.4 6. Low glomerular filtration rate 9.2 6. Unintentional injuries 11.8 6.1 7. Unsafe sex 7.9 7. Cirrhosis 11.4 5.9 Others 18.0 15 to 49 years of age 1. Alcohol and drug use 62.1 1. Self-harm & intersonal violence 99.1 34.5 2. Dietary risks 26.3 2. Transport injuries 39.9 13.9 3. High body-mass index 20.3 3. Cardiovascular diseases 25.7 9.0 4. High fasting plasma glucose 16.5 4. Unintentional injuries 20.8 7.3 5. High systolic blood pressure 15.8 5. Neoplasms 19.6 6.8 6. High total cholesterol 11.0 6. Cirrhosis 19.3 6.7 7. Low glomerular filtration rate 11.0 7. Diabetes 19.0 6.6 Others 15.2 15 to 49 years of age 1. High body-mass index 15.0 1. Neoplasms 25.9 24.7 2. Dietary risks 14.1 2. Cardiovascular diseases 14.2 13.6 3. High fasting plasma glucose 10.5 3. Diabetes 13.7 13.1 4. Alcohol and drug use 10.0 4. Self-harm & intersonal violence 10.7 10.2 5. High systolic blood pressure 8.8 5. Transport injuries 6.9 6.6 6. Unsafe sex 7.7 6. Diarrheal/LRI/other 5.3 5.0 36

7. Low glomerular filtration rate 7.5 7. Maternal disorders 4.4 4.2 Others 22.8 Total population 50 to 69 years of age 1. Dietary risks 266.9 1. Cardiovascular diseases 250.0 25.4 2. High body-mass index 233.5 2. Neoplasms 208.2 21.1 3. High fasting plasma glucose 214.5 3. Diabetes 208.1 21.1 4. High systolic blood pressure 198.4 4. Cirrhosis 75.6 7.7 5. Low glomerular filtration rate 117.3 5. Chronic respiratory diseases 42.9 4.4 6. Smoking 90.6 6. Diarrheal/LRI/other 32.4 3.3 7. Alcohol and drug use 89.0 7. Self-harm & intersonal violence 30.2 3.1 Others 14.0. 50 to 69 years of age 1. Dietary risks 342.7 1. Cardiovascular diseases 323.0 26.3 2. High systolic blood pressure 252.7 2. Diabetes 228.7 18.7 3. High fasting plasma glucose 248.0 3. Neoplasms 213.4 17.4 4. High body-mass index 245.0 4. Cirrhosis 116.4 9.5 5. Smoking 142.0 5. Self-harm & intersonal violence 55.8 4.6 6. Alcohol and drug use 135.7 6. Chronic respiratory diseases 53.4 4.4 7. Low glomerular filtration rate 133.8 7. Transport injuries 45.3 3.7 Others 15.6 50 to 69 years of age 1. High body-mass index 223.5 1. Neoplasms 203.6 26.3 2. Dietary risks 200.9 2. Diabetes 190.2 24.6 3. High fasting plasma glucose 185.4 3. Cardiovascular diseases 186.4 24.1 4. High systolic blood pressure 151.2 4. Cirrhosis 40.2 5.2 5. Low glomerular filtration rate 102.9 5. Chronic respiratory diseases 33.7 4.3 6. Child and maternal malnutrition 48.4 6. Diarrheal/LRI/other 26.2 3.4 37

7. High total cholesterol 46.2 7. Digestive diseases 25.0 3.2 Others 9.0 Total population 70 years of age and over 1. Dietary risks 1,361.9 1. Cardiovascular diseases 2,154.7 34.8 2. High systolic blood pressure 1,248.0 2. Diabetes 920.4 14.9 3. High fasting plasma glucose 980.0 3. Neoplasms 841.3 13.6 4. High body-mass index 715.5 4. Chronic respiratory diseases 576.3 9.3 5. Low glomerular filtration rate 602.7 5. Neurological disorders 466.8 7.5 6. Smoking 501.0 6. Diarrheal/LRI/other 351.9 5.7 7. Air pollution 371.4 7. Digestive diseases 219.9 3.6 Others 10.6 70 years of age and over 1. Dietary risks 1,538.5 1. Cardiovascular diseases 2,271.1 33.0 2. High systolic blood pressure 1,339.1 2. Neoplasms 1,032.8 15.0 3. High fasting plasma glucose 1,056.9 3. Diabetes 953.6 13.9 4. Smoking 721.3 4. Chronic respiratory diseases 688.3 10.0 5. High body-mass index 654.0 5. Neurological disorders 512.5 7.5 6. Low glomerular filtration rate 636.2 6. Digestive diseases 385.7 5.6 7. Air pollution 395.2 7. Cirrhosis 228.9 3.3 Others 11.7 70 years of age and over 1. Dietary risks 1,225.9 1. Cardiovascular diseases 2,065.0 36.5 2. High systolic blood pressure 1,178.0 2. Diabetes 894.8 15.8 3. High fasting plasma glucose 920.8 3. Neoplasms 693.9 12.3 4. High body-mass index 760.8 4. Chronic respiratory diseases 490.1 8.7 5. Low glomerular filtration rate 576.9 5. Neurological disorders 431.7 7.6 6. Air pollution 353.1 6. Diarrheal/LRI/other 325.9 5.8 38

7. Smoking 331.5 7. Digestive diseases 219.0 3.9 Others 9.5 Total population 1. Dietary risks 100.9 1. Cardiovascular diseases 130.7 24.9 All age 2. High systolic blood pressure 83.1 2. Neoplasms 75.5 14.4 3. High fasting plasma glucose 75.3 3. Diabetes 74.6 14.2 4. High body-mass index 69.5 4. Self-harm & intersonal violence 35.1 6.7 5. Low glomerular filtration rate 45.1 5. Diarrheal/LRI/other 30.9 5.9 6. Alcohol and drug use 38.9 6. Chronic respiratory diseases 30.9 5.9 7. Smoking 35.9 7. Cirrhosis 23.2 4.4 Others 23.5 1. Dietary risks 112.4 1. Cardiovascular diseases 136.2 22.6 All age 2. High systolic blood pressure 88.3 2. Neoplasms 76.3 12.7 3. High fasting plasma glucose 78.2 3. Diabetes 74.4 12.4 4. High body-mass index 65.4 4. Self-harm & intersonal violence 63.1 10.5 5. Alcohol and drug use 59.8 5. Chronic respiratory diseases 33.6 5.6 6. Smoking 49.3 6. Cirrhosis 33.4 5.6 7. Low glomerular filtration rate 45.9 7. Diarrheal/LRI/other 33.4 5.6 Others 25.1 1. Dietary risks 89.9 1. Cardiovascular diseases 125.5 27.9 All age 2. High systolic blood pressure 78.0 2. Neoplasms 74.7 16.6 3. High body-mass index 73.3 3. Diabetes 74.7 16.6 4. High fasting plasma glucose 72.5 4. Diarrheal/LRI/other 28.4 6.3 5. Low glomerular filtration rate 44.3 5. Chronic respiratory diseases 28.3 6.3 6. Air pollution 23.7 6. Neurological disorders 21.9 4.9 39

7. Smoking 23.0 7. Digestive diseases 14.9 3.3 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) 13 60.8 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 $12,651.20 Per capita GDP-PPP outlay on healthcare $933.30 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, 2012 53.2 (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 65,006 37.5% 34.2% 40.8% 2.Neoplasms 57,803 31,386 26,417 17.6% 18.4% 16.6% 3.Diabetes 29,403 12,790 16,613 8.9% 7.5% 10.4% 4.Diarrhea/LRI/Other 28,438 14,738 13,700 8.6% 8.6% 8.6% 5.Neonatal disorders 15,472 7,749 7,723 4.7% 4.5% 4.8% 6.HIV/AIDS 13,527 7,604 6,924 4.1% 4.5% 4.3% 7. Unintentional injuries 13,081 7,292 5,788 4.0% 4.3% 3.6% 8. Chronic respiratory diseases 9. Neonatal disorders 11,712 7,073 4,639 3.6% 4.1% 2.9% 10,728 6,050 4,678 3.3% 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 2015. 12 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

10. Self-harm & intersonal violence 11. Transport injuries 12. Digestive diseases 9,328 7,373 1,955 2.8% 4.3% 1.2% 8,859 6,335 2,523 2.7% 3.7% 1.6% 7,410 3,944 3,466 2.3% 2.3% 2.2% TOTAL 329,198 170,765 159,432 100.0% 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 7,978,351 8,113,459 1.69% Years lived with disability (YLD) 1,056,329 1,636,693 54.94% Years of life lost (YLL) 6,922,022 6,476,777-6.43% 211,189 293,514 38.98% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 4,474,030 4,441,342-0.73% Years lived with disability (YLD) 561,960 829,702 47.64% Years of life lost (YLL) 3,912,070 3,611,651-7.68% 113,308 151,024 33.29% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 3,504,321 3,672,117 4.79% Years lived with disability (YLD) 494,369 806,991 63.24% Years of life lost (YLL) 3,009,952 2,865,126-4.81% 97,881 142,490 45.57% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 8,113,459 100% 1,636,693 100% 6,476,777 100% 293,514 100% 4,441,342 54.74% 829,702 50.69% 3,611,651 55.76% 151,024 51.45% 3,672,117 45.26% 806,991 49.31% 2,865,126 44.24% 142,490 48.55% 41

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 211.1 1. Neonatal disorders 282.2 36.0 2. Unsafe water, sanitation and handwashing 81.2 2. Diarrheal/LRI/other 199.1 25.4 3. Unsafe sex 26.2 3. Other non-communicable 88.2 11.2 4. Air pollution 24.1 4. Nutritional deficiencies 72.7 9.3 5. Alcohol and drug use 2.8 5. Unintentional injuries 31.0 4.0 6. Smoking 2.6 6. Communicable, maternal, neonatal, and nutritional diseases 30.9 3.9 7. Low glomerular filtration rate 2.2 7. Cardiovascular diseases 20.2 2.6 Others 7.6 Children under 5 years 1. Child and maternal malnutrition 234.0 1. Neonatal disorders 311.6 36.3 2. Unsafe water, sanitation and handwashing 94.8 2. Diarrheal/LRI/other 221.1 25.7 3. Unsafe sex 25.8 3. Other non-communicable 97.7 11.4 4. Air pollution 25.7 4. Nutritional deficiencies 78.6 9.1 5. Alcohol and drug use 3.3 5. Unintentional injuries 34.6 4.0 6. Smoking 2.6 6. Communicable, maternal, neonatal, and nutritional diseases 31.4 3.7 7. Low glomerular filtration rate 2.5 7. Cardiovascular diseases 20.5 2.4 Others Others Children under 5 years 1. Child and maternal malnutrition 187.1 1. Neonatal disorders 251.5 35.7 2. Unsafe water, sanitation and handwashing 67.0 2. Diarrheal/LRI/other 176.1 25.0 3. Unsafe sex 26.6 3. Other non-communicable 78.3 11.1 42

4. Air pollution 22.4 4. Nutritional deficiencies 66.5 9.5 5. Smoking 2.7 5. Communicable, maternal, neonatal, and nutritional diseases 30.4 4.3 6. Alcohol and drug use 2.4 6. Unintentional injuries 27.2 3.9 7. Low glomerular filtration rate 1.9 7. Cardiovascular diseases 19.8 2.8 Others 7.7 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 3.6 1. Diarrheal/LRI/other 10.2 18.4 2. Alcohol and drug use 1.0 2. Unintentional injuries 7.0 12.7 3. Unsafe sex 1.0 3. Transport injuries 6.2 11.2 4. Air pollution 0.9 4. HIV/AIDS 5.3 9.6 5. Low glomerular filtration rate 0.7 5. Neoplasms 4.5 8.1 6. Child and maternal malnutrition 0.7 6. Cardiovascular diseases 3.7 6.6 7. High fasting plasma glucose 0.5 7. Other non-communicable 3.5 6.3 Others 27.0 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 4.1 1. Diarrheal/LRI/other 11.6 18.6 2. Alcohol and drug use 1.3 2. Unintentional injuries 9.1 14.6 3. Unsafe sex 0.9 3. Transport injuries 7.9 12.5 4. Air pollution 0.9 4. HIV/AIDS 5.5 8.8 5. Low glomerular filtration rate 0.8 5. Neoplasms 5.1 8.2 6. Child and maternal malnutrition 0.6 6. Other non-communicable 3.9 6.2 7. High fasting plasma glucose 0.4 7. Cardiovascular diseases 3.8 6.0 Others 25.2 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 3.1 1. Diarrheal/LRI/other 8.6 18.2 2. Unsafe sex 1.0 2. HIV/AIDS 5.1 10.7 3. Air pollution 0.9 3. Unintentional injuries 4.8 10.2 43

4. Child and maternal malnutrition 0.7 4. Transport injuries 4.4 9.4 5. Alcohol and drug use 0.7 5. Neoplasms 3.8 8.1 6. Low glomerular filtration rate 0.6 6. Cardiovascular diseases 3.5 7.4 7. High fasting plasma glucose 0.5 7. Diabetes 3.3 6.9 Others 29.1 Total population 15 to 49 years of age 1. Unsafe sex 34.2 1. HIV/AIDS 39.2 17.8 2. Alcohol and drug use 26.2 2. Cardiovascular diseases 34.5 15.6 3. Dietary risks 26.0 3. Neoplasms 27.2 12.3 4. High systolic blood pressure 21.2 4. Self-harm & intersonal violence 26.1 11.8 5. High body-mass index 20.9 5. Transport injuries 19.0 8.6 6. Smoking 13.1 6. Unintentional injuries 14.1 6.4 7. High fasting plasma glucose 11.7 7. Diabetes 14.1 6.4 Others 21.1 15 to 49 years of age 1. Alcohol and drug use 41.3 1. Self-harm & intersonal violence 42.5 16.1 2. Unsafe sex 33.1 2. HIV/AIDS 42.1 16.0 3. Dietary risks 30.6 3. Cardiovascular diseases 39.7 15.0 4. High systolic blood pressure 25.9 4. Transport injuries 30.1 11.4 5. High body-mass index 20.8 5. Neoplasms 23.4 8.8 6. Smoking 17.9 6. Unintentional injuries 22.4 8.5 7. High fasting plasma glucose 13.0 7. Diabetes 14.8 5.6 Others 18.7 15 to 49 years of age 1. Unsafe sex 35.3 1. HIV/AIDS 36.3 20.5 2. Dietary risks 21.4 2. Neoplasms 31.0 17.5 3. High body-mass index 21.0 3. Cardiovascular diseases 29.3 16.5 44

4. High systolic blood pressure 16.5 4. Diabetes 13.4 7.6 5. Alcohol and drug use 11.2 5. Neonatal disorders 10.5 5.9 6. High fasting plasma glucose 10.3 6. Diarrheal/LRI/other 10.4 5.9 7. Smoking 8.3 7. Self-harm & intersonal violence 9.8 5.5 Others 20.6 Total population 50 to 69 years of age 1. Dietary risks 326.5 1. Cardiovascular diseases 433.6 37.0 2. High systolic blood pressure 318.0 2. Neoplasms 271.9 23.2 3. High body-mass index 242.8 3. Diabetes 133.2 11.4 4. Smoking 192.1 4. Diarrheal/LRI/other 48.9 4.2 5. High fasting plasma glucose 157.4 5. HIV/AIDS 39.5 3.4 6. Air pollution 89.2 6. Cirrhosis 38.4 3.3 7. Low physical activity 87.5 7. Chronic respiratory diseases 36.7 3.1 Others 14.4 50 to 69 years of age 1. Dietary risks 378.8 1. Cardiovascular diseases 500.6 36.7 2. High systolic blood pressure 361.3 2. Neoplasms 296.0 21.7 3. Smoking 269.6 3. Diabetes 130.5 9.6 4. High body-mass index 218.7 4. Diarrheal/LRI/other 56.9 4.2 5. High fasting plasma glucose 163.4 5. Cirrhosis 52.8 3.9 6. Alcohol and drug use 106.8 6. HIV/AIDS 51.2 3.8 7. Low physical activity 103.1 7. Chronic respiratory diseases 46.8 3.4 Others 16.8 50 to 69 years of age 1. High systolic blood pressure 277.2 1. Cardiovascular diseases 370.4 37.5 2. Dietary risks 277.0 2. Neoplasms 249.1 25.2 3. High body-mass index 265.5 3. Diabetes 135.7 13.7 45

4. High fasting plasma glucose 151.7 4. Diarrheal/LRI/other 41.4 4.2 5. Smoking 118.9 5. HIV/AIDS 28.6 2.9 6. Air pollution 80.8 6. Chronic respiratory diseases 27.3 2.8 7. Low physical activity 72.9 7. Cirrhosis 24.8 2.5 Others 11.2 Total population 70 years of age and over 1. High systolic blood pressure 1,843.0 1. Cardiovascular diseases 3,165.8 45.0 2. Dietary risks 1,545.3 2. Neoplasms 1,184.0 16.8 3. High body-mass index 818.6 3. Diabetes 597.6 8.5 4. Smoking 786.6 4. Diarrheal/LRI/other 522.2 7.4 5. High fasting plasma glucose 783.8 5. Neurological disorders 512.6 7.3 6. Low glomerular filtration rate 554.9 6. Chronic respiratory diseases 308.1 4.4 7. Low physical activity 516.3 7. Unintentional injuries 226.2 3.2 Others 7.4 70 years of age and over 1. High systolic blood pressure 1,731.5 1. Cardiovascular diseases 3,069.1 41.1 2. Dietary risks 1,575.1 2. Neoplasms 1,535.8 20.6 3. Smoking 1,085.0 3. Neurological disorders 565.6 7.6 4. High fasting plasma glucose 706.8 4. Diarrheal/LRI/other 544.2 7.3 5. High body-mass index 558.3 5. Diabetes 520.9 7.0 6. Low glomerular filtration rate 512.9 6. Chronic respiratory diseases 422.8 5.7 7. Low physical activity 504.8 7. Unintentional injuries 193.1 2.6 Others 8.2 70 years of age and over 1. High systolic blood pressure 1,931.7 1. Cardiovascular diseases 3,242.8 48.4 2. Dietary risks 1,521.6 2. Neoplasms 904.2 13.5 3. High body-mass index 1,025.7 3. Diabetes 658.6 9.8 46

4. High fasting plasma glucose 845.0 4. Diarrheal/LRI/other 504.6 7.5 5. Low glomerular filtration rate 588.3 5. Neurological disorders 470.5 7.0 6. Smoking 549.3 6. Unintentional injuries 252.6 3.8 7. Low physical activity 525.3 7. Chronic respiratory diseases 216.8 3.2 Others 6.6 Total population 1. High systolic blood pressure 171.8 1. Cardiovascular diseases 277.8 34.8 All age 2. Dietary risks 158.1 2. Neoplasms 130.1 16.3 3. High body-mass index 99.0 3. Diabetes 66.2 8.3 4. Smoking 85.0 4. Diarrheal/LRI/other 64.0 8.0 5. High fasting plasma glucose 78.3 5. Neurological disorders 34.8 4.4 6. Low glomerular filtration rate 48.8 6. HIV/AIDS 30.4 3.8 7. Low physical activity 48.0 7. Unintentional injuries 29.4 3.7 Others 20.6 1. High systolic blood pressure 162.9 1. Cardiovascular diseases 265.0 31.7 All age 2. Dietary risks 159.8 2. Neoplasms 142.4 17.0 3. Smoking 110.1 3. Diarrheal/LRI/other 66.9 8.0 4. High body-mass index 75.4 4. Diabetes 58.0 6.9 5. High fasting plasma glucose 70.4 5. Neurological disorders 35.2 4.2 6. Alcohol and drug use 51.5 6. HIV/AIDS 34.5 4.1 7. Low physical activity 47.0 7. Self-harm & intersonal violence 33.4 4.0 Others 24.0 All age 1. High systolic blood pressure 180.7 1. Cardiovascular diseases 290.3 38.3 2. Dietary risks 156.5 2. Neoplasms 118.0 15.5 3. High body-mass index 122.2 3. Diabetes 74.2 9.8 47

4. High fasting plasma glucose 85.9 4. Diarrheal/LRI/other 61.2 8.1 5. Smoking 60.2 5. Neurological disorders 34.5 4.6 6. Low glomerular filtration rate 52.7 6. HIV/AIDS 26.5 3.5 7. Low physical activity 49.0 7. Unintentional injuries 25.9 3.4 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) 16 65.9 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 $11,377.00 Per capita GDP-PPP outlay on healthcare $ 723.00 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, 2012 52.6 (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 30,588 23.0% 21.2% 25.0% 2.Neoplasms 47,599 22,422 25,177 18.2% 16.1% 20.6% 3. Diarrhea/LRI/Other 37,488 19,088 18,400 14.3% 13.7% 15.0% 4. Diabetes 25,056 12,068 12,989 9.6% 8.7% 10.6% 5. Unintentional injuries 6. Chronic respiratory diseases 15,965 9,904 6,061 6.1% 7.1% 5.0% 14,289 7,869 6,421 5.5% 5.6% 5.2% 7. Transport injuries 13,024 9,567 3,458 5.0% 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 2015. 15 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

8. Cirrhosis 11,958 7,518 4,440 4.6% 5.4% 3.6% 9. Neonatal disorders 11,174 6,471 4,703 4.3% 4.6% 3.8% 10. Digestive diseases 8,489 4,407 4081 3.2% 3.2% 3.3% 11. Neurological disorders 12. Self-harm & intersonal violence 8,292 3,898 4393 3.2% 2.8% 3.6% 8,272 6,574 1698 3.2% 4.7% 1.4% TOTAL 261,803 139,396 122,408 100.0% 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 15,820,403 13,538,321-14.42% Years lived with disability (YLD) 2,113,955 2,800,656 32.48% Years of life lost (YLL) 13,706,448 10,737,859-21.66% 351183 430,179 22.49% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 9,763,748 8,619,295-11.72% Years lived with disability (YLD) 1,215,772 1,850,567 52.21% Years of life lost (YLL) 8,547,976 6,768,922-20.81% 206,177 241,258 17.01% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 6,056,655 4,919,026-18.78% Years lived with disability (YLD) 898,183 950,089 5.78% Years of life lost (YLL) 5,158,472 3,968,937-23.06% 145,006 188,921 30.28% CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 13,538,321 100% 2,800,656 100% 10,737,859 100% 430,179 100% 8,619,295 63.67% 1,850,567 66.08% 6,768,922 63.04% 241,258 56.08% 49

4,919,026 36.33% 950,089 33.92% 3,968,937 36.96% 188,921 43.92% 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 96.4 1. Neonatal disorders 190.9 32.9 2. Unsafe water, sanitation and handwashing 28.2 2. Diarrheal/LRI/other 140.6 24.2 3. Air pollution 12.8 3. Other non-communicable 84.9 14.6 4. Unsafe sex 10.5 4.Unintentional injuries 69.6 12.0 5. Smoking 3.6 5. Transport injuries 17.3 3.0 6. Low glomerular filtration rate 3.2 6. Nutritional deficiencies 15.9 2.7 7. Alcohol and drug use 2.4 7. Diabetes 13.8 2.4 Others 8.3 Children under 5 years 1. Child and maternal malnutrition 101.7 1. Neonatal disorders 216.3 34.5 2. Unsafe water, sanitation and handwashing 30.3 2. Diarrheal/LRI/other 147.9 23.5 3. Air pollution 13.5 3. Other non-communicable 88.7 14.1 4. Unsafe sex 10.3 4.Unintentional injuries 72.7 11.6 5. Smoking 3.9 5. Transport injuries 19.4 3.1 6. Low glomerular filtration rate 3.4 6. Nutritional deficiencies 16.8 2.7 7. Alcohol and drug use 2.6 7. Diabetes 14.7 2.3 Others 8.2 Children under 5 50

1. Child and maternal malnutrition 90.9 1. Neonatal disorders 164.4 30.9 2. Unsafe water, sanitation and handwashing 26.0 2. Diarrheal/LRI/other 133.0 25.0 3. Air pollution 12.0 3. Other non-communicable 81.0 15.2 4. Unsafe sex 10.7 4.Unintentional injuries 66.3 12.5 5. Smoking 3.4 5. Transport injuries 15.2 2.9 6. Low glomerular filtration rate 3.0 6. Nutritional deficiencies 15.1 2.8 7. Alcohol and drug use 2.1 7. Diabetes 12.9 2.4 Others 8.4 Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.0 1. Unintentional injuries 8.8 19.8 2. Alcohol and drug use 1.2 2. Transport injuries 8.4 19.0 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 7.9 17.9 4. Air pollution 0.6 4. Neoplasms 4.9 11.0 5. Unsafe sex 0.4 5. Cardiovascular diseases 2.8 6.3 6. Child and maternal malnutrition 0.3 6. Other non-communicable 2.0 4.5 7. High systolic blood pressure 0.2 7. Diabetes 1.9 4.4 Others 17.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.3 1. Transport injuries 10.4 20.7 2. Alcohol and drug use 1.4 2. Unintentional injuries 10.3 20.6 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 8.7 17.3 4. Air pollution 0.7 4. Neoplasms 5.6 11.1 5. Unsafe sex 0.4 5. Cardiovascular diseases 3.1 6.2 6. Child and maternal malnutrition 0.3 6. Other non-communicable 2.1 4.2 7. High systolic blood pressure 0.2 7. Self-harm & intersonal violence 2.1 4.1 Others 15.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.8 1. Unintentional injuries 7.1 18.8 51

2. Alcohol and drug use 0.9 2. Diarrheal/LRI/other 7.1 18.7 3. Low glomerular filtration rate 0.7 3. Transport injuries 6.3 16.6 4. Air pollution 0.5 4. Neoplasms 4.1 10.9 5. Unsafe sex 0.5 5. Cardiovascular diseases 2.5 6.5 6. Child and maternal malnutrition 0.3 6. Diabetes 1.9 5.0 7. High fasting plasma glucose 0.2 7. Other non-communicable 1.9 5.0 Others 18.6 Total population 15 to 49 years of age 1. Alcohol and drug use 25.8 1. Transport injuries 22.5 14.2 2. Dietary risks 15.6 2. Neoplasms 21.9 13.8 3. High body-mass index 11.5 3. Cardiovascular diseases 20.1 12.7 4. High systolic blood pressure 10.0 4. Self-harm & intersonal violence 20.1 12.7 5. Unsafe sex 7.8 5. Unintentional injuries 17.3 10.9 6. High fasting plasma glucose 6.7 6. HIV/AIDS 9.8 6.2 7. High total cholesterol 6.5 7. Diarrheal/LRI/other 9.6 6.1 Others 23.6 15 to 49 years of age 1. Alcohol and drug use 42.6 1. Transport injuries 36.2 17.7 2. Dietary risks 19.3 2. Self-harm & intersonal violence 32.8 16.0 3. High systolic blood pressure 13.1 3. Unintentional injuries 25.8 12.6 4. High body-mass index 11.5 4. Cardiovascular diseases 24.4 11.9 5. Smoking 8.9 5. Neoplasms 17.3 8.4 6. High total cholesterol 8.7 6. HIV/AIDS 14.2 6.9 7. High fasting plasma glucose 8.1 7. Diarrheal/LRI/other 11.9 5.8 Others 20.7 15 to 49 years of age 1. Dietary risks 11.8 1. Neoplasms 26.6 26.7 52

2. High body-mass index 11.5 2. Cardiovascular diseases 15.8 14.1 3. Alcohol and drug use 8.9 3. Transport injuries 8.7 7.7 4. Unsafe sex 8.1 4. Unintentional injuries 8.6 7.6 5. High systolic blood pressure 6.9 5. Diabetes 8.0 7.2 6. High fasting plasma glucose 5.4 6. Neonatal disorders 7.8 7.0 7. Low glomerular filtration rate 5.1 7. Diarrheal/LRI/other 7.3 6.5 Others 23.3 Total population 50 to 69 years of age 1. Dietary risks 178.3 1. Neoplasms 226.0 25.3 2. High systolic blood pressure 138.3 2. Cardiovascular diseases 201.5 22.5 3. High body-mass index 137.9 3. Diabetes 104.2 11.7 4. Alcohol and drug use 101.3 4. Cirrhosis 72.6 8.1 5. High fasting plasma glucose 99.5 5. Diarrheal/LRI/other 69.4 7.8 6. Smoking 81.5 6. Transport injuries 35.9 4.0 7. Low glomerular filtration rate 69.5 7. Chronic respiratory diseases 34.9 3.9 Others 16.8 50 to 69 years of age 1. Dietary risks 216.2 1. Cardiovascular diseases 235.5 22.8 2. High systolic blood pressure 162.3 2. Neoplasms 207.0 20.0 3. Alcohol and drug use 159.0 3. Diabetes 110.3 10.7 4. High body-mass index 124.0 4. Cirrhosis 99.1 9.6 5. Smoking 116.0 5. Diarrheal/LRI/other 82.2 7.9 6. High fasting plasma glucose 109.3 6. Transport injuries 52.9 5.1 7. Low glomerular filtration rate 75.2 7. Chronic respiratory diseases 43.6 4.2 Others 19.7 50 to 69 years of age 1. High body-mass index 151.1 1. Neoplasms 244.0 32.0 53

2. Dietary risks 142.4 2. Cardiovascular diseases 169.3 22.2 3. High systolic blood pressure 115.4 3. Diabetes 98.5 12.9 4. High fasting plasma glucose 90.3 4. Diarrheal/LRI/other 57.3 7.5 5. Low glomerular filtration rate 64.0 5. Cirrhosis 47.4 6.2 6. Smoking 48.8 6. Digestive disease 26.7 3.5 7. Alcohol and drug use 46.5 7. Chronic respiratory diseases 26.6 3.5 Others 12.1 Total population 70 years of age and over 1. Dietary risks 986.5 1. Cardiovascular diseases 1,686.0 28.6 2. High systolic blood pressure 945.9 2. Neoplasms 1,027.8 17.5 3. High fasting plasma glucose 521.7 3. Diarrheal/LRI/other 896.1 15.2 4. High body-mass index 513.2 4. Diabetes 603.2 10.2 5. Low glomerular filtration rate 512.3 5. Chronic respiratory diseases 453.7 7.7 6. Smoking 465.8 6. Neurological disorders 299.0 5.1 7. Air pollution 393.2 7. Digestive disease 204.2 3.5 Others 12.2 70 years of age and over 1. Dietary risks 1,050.7 1. Cardiovascular diseases 1,663.7 26.7 2. High systolic blood pressure 913.6 2. Neoplasms 1,160.4 18.6 3. Smoking 635.1 3. Diarrheal/LRI/other 926.3 14.9 4. High fasting plasma glucose 505.8 4. Diabetes 601.9 9.7 5. Low glomerular filtration rate 497.8 5. Chronic respiratory diseases 541.4 8.7 6. Air pollution 391.6 6. Neurological disorders 298.7 4.8 7. High body-mass index 381.6 7. Cirrhosis 231.6 3.7 Others 12.9 70 years of age and over 1. High systolic blood pressure 972.1 1. Cardiovascular diseases 1,704.1 30.4 54

2. Dietary risks 934.4 2. Neoplasms 920.4 16.4 3. High body-mass index 619.8 3. Diarrheal/LRI/other 871.7 15.5 4. High fasting plasma glucose 534.6 4. Diabetes 604.3 10.8 5. Low glomerular filtration rate 524.0 5. Chronic respiratory diseases 382.7 6.8 6. Air pollution 394.4 6. Neurological disorders 299.2 5.3 7. Smoking 328.6 7. Digestive disease 199.6 3.6 Others 11.2 Total population 1. Dietary risks 70.8 1. Cardiovascular diseases 105.9 21.0 All age 2. High systolic blood pressure 61.3 2. Neoplasms 83.8 16.6 3. High body-mass index 44.5 3. Diarrheal/LRI/other 66.0 13.1 4. High fasting plasma glucose 37.5 4. Diabetes 44.1 8.8 5. Alcohol and drug use 35.7 5. Unintentional injuries 28.1 5.6 6. Low glomerular filtration rate 33.0 6. Chronic respiratory diseases 25.2 5.0 7. Smoking 33.0 7. Transport injuries 22.9 4.6 Others 25.4 1. Dietary risks 75.1 1. Cardiovascular diseases 104.1 19.3 All age 2. High systolic blood pressure 60.3 2. Neoplasms 78.8 14.6 3. Alcohol and drug use 52.8 3. Diarrheal/LRI/other 67.1 12.5 4. Smoking 42.5 4. Diabetes 42.4 7.9 5. High fasting plasma glucose 36.4 5. Unintentional injuries 34.8 6.5 6. High body-mass index 35.4 6. Transport injuries 33.6 6.3 7. Low glomerular filtration rate 31.2 7. Chronic respiratory diseases 27.7 5.1 Others 27.8 All age 1. Dietary risks 66.6 1. Cardiovascular diseases 107.8 22.9 55

2. High systolic blood pressure 62.2 2. Neoplasms 88.7 18.9 3. High body-mass index 53.6 3. Diarrheal/LRI/other 64.8 13.8 4. High fasting plasma glucose 38.7 4. Diabetes 45.8 9.7 5. Low glomerular filtration rate 34.9 5. Chronic respiratory diseases 22.6 4.8 6. Air pollution 27.0 6. Unintentional injuries 21.4 4.6 7. Smoking 23.5 7. Neonatal disorders 16.6 3.5 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) 19 65.5 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 $16,109.00 Per capita GDP-PPP outlay on healthcare $1,492.00 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, 2012 51.2 (Optimal: below a 39.0), 2012 Communicable diseases 10.8% Non-communicable diseases 79.2% Injuries 10.0% of death by sex, 2013 1.Cardiovascular diseases total Percentage total Percentage Percentage female 143,974 67,177 76,797 31.3% 28.3% 34.6% 2.Neoplasms 106,488 57,279 49,209 23.2% 24.1% 22.2% 3. Chronic respiratory diseases 4. Diarrhea/LRI/Other 43,333 24,705 18,628 9.4% 10.4% 8.4% 35,125 16,508 18,617 7.6% 7.0% 8.4% 5.Diabetes 33,663 16,676 16,986 7.3% 7.0% 7.6% 6. Neurological disorders 30,806 12,476 18,329 6.7% 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 2015. 18 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

7. Unintentional injuries 15,011 8,912 6,100 3.3% 3.8% 2.7% 8.Cirrhosis 12,171 8,609 3,562 2.6% 3.6% 1.6% 9. Digestive diseases 10. Transport injuries 11. Self-harm & intersonal violence 12. Other noncommunicable 11,109 5,209 5,899 2.4% 2.2% 2.7% 10,813 8,028 2785 2.4% 3.4% 1.3% 10,157 8,359 1,797 2.2% 3.5% 0.8% 6,680 3,255 3,425 1.5% 1.4% 1.5% TOTAL 459,330 237,193 222,136 100.0% 100.0% 100.0% Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 9,838,644 10,589,164 7.63% Years lived with disability (YLD) 1,552,618 2,296,356 47.90% Years of life lost (YLL) 8,286,026 8,292,807 0.08% 376665 447,557 18.82% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 6,445,445 6,632,018 2.89% Years lived with disability (YLD) 935,050 1,267,376 35.54% Years of life lost (YLL) 5,510,396 5,364,641-2.65% 226,761 252,056 11.15% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 3,393,199 3,957,146 16.62% Years lived with disability (YLD) 617,568 1,028,980 66.62% Years of life lost (YLL) 2,775,630 2,928,166 5.50% 149,904 195,501 30.42% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % 57

Total 10,589,164 100% 2,296,356 100% 8,292,807 100% 447,557 100% 6,632,018 62.63% 1,267,376 55.19% 5,364,641 64.69% 252,056 56.32% 3,957,146 37.37% 1,028,980 44.81% 2,928,166 35.31% 195,501 43.68% Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 16.7 1. Neonatal disorders 95.6 38.3 2. Unsafe water, sanitation and handwashing 3.0 2. Other non-communicable 3. Unsafe sex 1.5 3. Diarrheal/LRI/other 25.6 10.7 4. Smoking 1.1 4. Unintentional injuries 18.8 7.6 5. Air pollution 1.1 5. Diabetes 5.7 2.3 78.3 31.4 6. Alcohol and drug use 1.0 6. Neoplasms 4.5 1.8 7. Low glomerular filtration rate 0.8 7. Transport injuries 3.9 1.6 Others 6.4 Children under 5 years 1. Child and maternal malnutrition 18.3 1. Neonatal disorders 107.8 39.1 2. Unsafe water, sanitation and handwashing 3.3 2. Other non-communicable 3. Unsafe sex 1.5 3. Diarrheal/LRI/other 29.2 10.7 4. Air pollution 1.2 4. Unintentional injuries 21.4 7.8 5. Alcohol and drug use 1.2 5. Diabetes 6.4 2.3 83.4 30.4 6. Smoking 1.2 6. Neoplasms 5.1 1.9 7. Low glomerular filtration rate 0.9 7. Transport injuries 4.5 1.7 Others 6.2 Chil dre 58

1. Child and maternal malnutrition 15.0 1. Neonatal disorders 83.0 37.1 2. Unsafe water, sanitation and handwashing 2.8 2. Other non-communicable 73.1 32.8 3. Unsafe sex 1.5 3. Diarrheal/LRI/other 23.9 10.7 4. Smoking 1.1 4. Unintentional injuries 16.0 7.2 5. Air pollution 1.0 5. Diabetes 5.0 2.3 6. Alcohol and drug use 0.9 6. Neoplasms 3.8 1.7 7. Low glomerular filtration rate 0.7 7. Cardiovascular diseases 3.4 1.6 Others 6.6 Total population 5 to 14 years of age 1. Alcohol and drug use 0.7 1. Neoplasms 4.4 19.9 2. Low glomerular filtration rate 0.3 2. Transport injuries 4.2 18.7 3. Unsafe water, sanitation and handwashing 0.2 3. Unintentional injuries 4. High fasting plasma glucose 0.1 4. Diarrheal/LRI/other 2.0 8.8 5. Unsafe sex 0.1 5. Other non-communicable 1.9 8.5 3.6 16.1 6. Air pollution 0.7 6. Self-harm & intersonal violence 1.6 7.3 7. High systolic blood pressure 0.1 7. Diabetes 1.1 5.1 Others 15.6 5 to 14 years of age 1. Alcohol and drug use 0.9 1. Transport injuries 5.2 20.2 2. Low glomerular filtration rate 0.3 2. Neoplasms 5.0 19.6 3. Unsafe water, sanitation and 3. Unintentional injuries handwashing 0.2 4.8 18.7 4. High fasting plasma glucose 4. Self-harm & intersonal 0.1 violence 2.1 8.1 5. Air pollution 0.1 5. Diarrheal/LRI/other 2.0 7.9 6. Unsafe sex 0.1 6. Other non-communicable 1.9 7.3 7. Sexual abuse and violence 0.1 7. Diabetes 1.2 4.5 Others 13.6 59

5 to 14 years of age 1. Alcohol and drug use 0.5 1. Neoplasms 3.8 20.3 2. Low glomerular filtration rate 0.3 2. Transport injuries 3.1 16.6 3. Unsafe water, sanitation and handwashing 0.2 3. Unintentional injuries 4. High fasting plasma glucose 0.1 4. Diarrheal/LRI/other 1.9 10.2 5. Unsafe sex 0.1 5. Other non-communicable 1.9 10.1 6. Air pollution 0.1 2.3 6. Self-harm & intersonal violence 1.2 7. High systolic blood pressure 0.1 7. Diabetes 1.1 5.9 12.3 6.2 Others 18.3 Total population 15 to 49 years of age 1. Alcohol and drug use 26.0 1. Neoplasms 28.5 21.0 2. Dietary risks 15.5 2. Self-harm & intersonal violence 20.4 15.1 3. High body-mass index 13.8 3. Cardiovascular diseases 19.9 14.7 4. Smoking 13.6 4. Transport injuries 16.8 12.4 5. High systolic blood pressure 10.7 5. Unintentional injuries 10.5 7.8 6. Unsafe sex 6.9 6. Cirrhosis 5.5 4.1 7. High total cholesterol 6.0 7. HIV/AIDS 5.5 4.0 Others 21.0 15 to 49 years of age 1. Alcohol and drug use 43.4 1. Self-harm & intersonal violence 34.1 18.6 2. Dietary risks 20.7 2. Transport injuries 27.2 14.8 3. Smoking 18.7 3. Cardiovascular diseases 26.4 14.4 4. High body-mass index 17.1 4. Neoplasms 25.9 14.2 5. High systolic blood pressure 15.3 5. Unintentional injuries 17.2 9.5 6. High total cholesterol 9.0 6. Mental and substance use disorders 17.3 4.9 7. Unsafe sex 6.9 7. HIV/AIDS 9.0 4.9 Others 18.7 15 to 60

1. High body-mass index 10.5 1. Neoplasms 31.2 35.6 2. Dietary risks 10.3 2. Cardiovascular diseases 13.3 15.2 3. Smoking 8.5 3. Self-harm & intersonal violence 6.6 7.6 4. Alcohol and drug use 8.5 4. Transport injuries 6.4 7.3 5. Unsafe sex 6.8 5. Diabetes 5.0 5.7 6. High systolic blood pressure 6.1 6. Diarrheal/LRI/other 3.8 4.4 7. High fasting plasma glucose 3.5 7. Unintentional injuries 3.6 4.1 Others 20.2 Total population 50 to 69 years of age 1. Smoking 223.2 1. Neoplasms 344.0 34.2 2. Dietary risks 222.3 2. Cardiovascular diseases 283.2 28.2 3. High body-mass index 186.7 3. Diabetes 74.3 7.4 4. High systolic blood pressure 180.3 4. Chronic respiratory diseases 65.6 6.5 5. Alcohol and drug use 99.2 5. Cirrhosis 52.6 5.2 6. High fasting plasma glucose 85.7 6. Diarrheal/LRI/other 44.4 4.4 7. High total cholesterol 61.8 7. Unintentional injuries 25.8 2.6 Others 11.5 50 to 69 years of age 1. Smoking 355.1 1. Neoplasms 414.8 30.6 2. Dietary risks 326.3 2. Cardiovascular diseases 400.4 29.5 3. High systolic blood pressure 259.8 3. Chronic respiratory diseases 95.8 7.1 4. High body-mass index 238.1 4. Diabetes 91.6 6.8 5. Alcohol and drug use 153.9 5. Cirrhosis 85.1 6.3 6. High fasting plasma glucose 115.0 6. Diarrheal/LRI/other 60.4 4.5 7. High total cholesterol 91.0 7. Unintentional injuries 41.2 3.0 Others 12.3 61

50 to 69 years of age 1. High body-mass index 140.3 1. Neoplasms 279.8 40.6 2. Dietary risks 128.3 2. Cardiovascular diseases 177.2 25.7 3. High systolic blood pressure 108.4 3. Diabetes 58.5 8.5 4. Smoking 103.9 4. Chronic respiratory diseases 38.2 5.5 5. High fasting plasma glucose 59.2 5. Diarrheal/LRI/other 29.9 4.3 6. Alcohol and drug use 49.7 6. Cirrhosis 23.2 3.4 7. High total cholesterol 35.5 7. Digestive diseases 17.1 2.5 Others 9.4 Total population 70 years of age and over 1. High systolic blood pressure 1,217.8 1. Cardiovascular diseases 2,273.5 34.4 2. Dietary risks 1,144.5 2. Neoplasms 1,243.6 18.8 3. Smoking 794.2 3. Chronic respiratory diseases 747.3 11.3 4. High body-mass index 689.3 4. Neurological disorders 610.9 9.3 5. High fasting plasma glucose 502.8 5. Diarrheal/LRI/other 582.6 8.8 6. Low glomerular filtration rate 359.8 6. Diabetes 499.2 7.6 7. High total cholesterol 288.9 7. Digestive diseases 167.7 2.5 Others 7.3 70 years of age and over 1. Smoking 1,357.6 1. Cardiovascular diseases 2,301.0 30.0 2. Dietary risks 1,314.7 2. Neoplasms 1,694.2 22.1 3. High systolic blood pressure 1,276.8 3. Chronic respiratory diseases 1,048.9 13.7 4. High body-mass index 739.5 4. Diarrheal/LRI/other 636.1 8.3 5. High fasting plasma glucose 567.4 5. Neurological disorders 616.5 8.0 6. Alcohol and drug use 399.9 6. Diabetes 590.4 7.7 7. Low glomerular filtration rate 388.2 7. Digestive diseases 179.1 2.3 Others 8.0 62

70 years of age and over 1. High systolic blood pressure 1,180.6 1. Cardiovascular diseases 2,256.3 38.0 2. Dietary risks 1,037.4 2. Neoplasms 959.8 16.2 3. High body-mass index 657.6 3. Neurological disorders 607.4 10.2 4. High fasting plasma glucose 462.1 4. Chronic respiratory diseases 557.3 9.4 5. Smoking 439.4 5. Diarrheal/LRI/other 548.9 9.3 6. Low glomerular filtration rate 341.8 6. Diabetes 441.7 7.4 7. High total cholesterol 320.7 7. Digestive diseases 160.5 2.7 Others 6.8 Total population 1. Dietary risks 133.2 1. Cardiovascular diseases 230.4 30.1 All age 2. High systolic blood pressure 128.5 2. Neoplasms 170.4 22.3 3. Smoking 106.6 3. Chronic respiratory diseases 69.4 9.1 4. High body-mass index 92.2 4. Diarrheal/LRI/other 56.2 7.4 5. High fasting plasma glucose 55.2 5. Diabetes 53.9 7.1 6. Alcohol and drug use 50.7 6. Neurological disorders 49.3 6.5 7. Low glomerular filtration rate 35.9 7. Unintentional injuries 24.0 3.1 Others 14.5 1. Smoking 151.8 1. Cardiovascular diseases 219.2 27.1 All age 2. Dietary risks 145.1 2. Neoplasms 186.9 23.1 3. High systolic blood pressure 128.4 3. Chronic respiratory diseases 80.6 10.0 4. High body-mass index 94.2 4. Diabetes 54.4 6.7 5. Alcohol and drug use 73.5 5. Diarrheal/LRI/other 53.9 6.7 6. High fasting plasma glucose 56.5 6. Neurological disorders 40.7 5.0 7. High total cholesterol 34.7 7. Unintentional injuries 29.1 3.6 Others 17.9 63

1. High systolic blood pressure 128.6 1. Cardiovascular diseases 241.2 33.5 All age 2. Dietary risks 121.6 2. Neoplasms 154.6 21.4 3. High body-mass index 90.2 3. Chronic respiratory diseases 58.5 8.1 4. Smoking 63.0 4. Diarrheal/LRI/other 58.5 8.1 5. High fasting plasma glucose 54.1 5. Neurological disorders 57.6 8.0 6. Low glomerular filtration rate 37.8 6. Diabetes 53.4 7.4 7. High total cholesterol 36.8 7. Unintentional injuries 19.2 2.7 Others 10.9 64

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) 21 69.9 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 15,532 32.8% 2. Stroke 9,648 20.3% 3. Diabetes 4,962 10.5% 4. Lower respiratory infection 3,257 6.9% 5. HIV/AIDS 3,004 6.3% 6. Hytensive health disease 2,797 5.9% 7. Road injuries 2,615 5.5% 8. Prostate cancer 2,267 4.8% 9. Preterm birth complications 1,702 3.6% 10. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 1. 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 2015. 21 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

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) 23 64 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 $21,027.00 Per capita GDP-PPP outlay on healthcare $1,021.00 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 198 92 106 36.7% 33.0% 40.3% 2.Neoplasms 92 49 43 17.0% 17.5% 16.3% 3.Diabetes 85 39 47 15.7% 14.0% 17.7% 4. Diarrhea/LRI/Other 31 15 16 5.7% 5.4% 6.1% 5. Neurological disorders 28 14 14 5.2% 5.0% 5.3% 6. Unintentional injuries 17 11 6 3.1% 3.9% 2.3% 7. Chronic respiratory diseases 8. Self-harm & intersonal violence 16 11 5 3.0% 3.9% 1.9% 16 13 3 3.0% 4.7% 1.1% 9.HVI/AIDS 12 9 3 2.2% 3.2% 1.3% 10. Digestive diseases 12 7 6 2.2% 2.3% 2.3% 11. Transport injuries 12 9 3 2.2% 3.2% 1.1% 12.Others noncommunicable 10 4 6 1.9% 1.6% 2.3% 13. Neonatal disorders 11 6 5 2.0% 2.3% 1.9% TOTAL 540 279 263 100.0% 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 2015. 23 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 9,729 14,768 51.79% Years lived with disability (YLD) 2,339 4,266 82.39% Years of life lost (YLL) 7,388 10,501 42.14% 351 567 61.54% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 5,709 8,333 45.96% Years lived with disability (YLD) 1,288 2,209 71.51% Years of life lost (YLL) 4,419 6,123 38.56% 195 300 53.85% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 4,020 6,435 60.07% Years lived with disability (YLD) 1,051 2,057 95.72% Years of life lost (YLL) 2,969 4,378 47.46% 156 267 71.15% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 14,768 100% 4,266 100% 10,501 100% 567 100% 8,333 56.43% 2,209 51.78% 6,123 58.31% 300 52.91% 6,435 43.57% 2,057 48.22% 4,378 41.69% 267 47.09% 4

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 42.4 1. Neonatal disorders 151.6 48.6 2. Unsafe water, sanitation and handwashing 14.7 2. Other non-communicable 3. Air pollution 3.0 3. Diarrheal/LRI/other 47.7 15.5 4. Smoking 1.8 4. Unintentional injuries 15.4 5.0 5. Low glomerular filtration rate 1.5 5. Nutritional deficiencies 11.5 3.7 54.5 17.7 6. High fasting plasma glucose 0.7 6. Diabetes 7.0 2.3 7. Alcohol and drug use 0.6 7. Cardiovascular diseases 5.2 1.7 Others 5.4 Children under 5 years 1. Child and maternal malnutrition 47.5 1. Neonatal disorders 172.7 49.9 2. Unsafe water, sanitation and handwashing 16.8 2. Other non-communicable 3. Air pollution 3.2 3. Diarrheal/LRI/other 53.0 15.6 4. Smoking 1.9 4. Unintentional injuries 17.3 5.1 5. Low glomerular filtration rate 1.7 5. Nutritional deficiencies 13.2 3.9 56.2 16.4 6. High fasting plasma glucose 0.7 6. Diabetes 7.3 2.2 7. Alcohol and drug use 0.7 7. Cardiovascular diseases 5.3 1.6 Others 5.6 Children under 5 years 1. Child and maternal malnutrition 37.2 1. Neonatal disorders 129.9 47.0 2. Unsafe water, sanitation and handwashing 12.6 2. Other non-communicable 3. Air pollution 2.7 3. Diarrheal/LRI/other 42.2 15.5 4. Smoking 1.8 4. Unintentional injuries 13.5 5.0 5. Low glomerular filtration rate 1.4 5. Nutritional deficiencies 9.7 3.5 52.9 19.4 6. High fasting plasma glucose 0.7 6. Diabetes 6.6 2.4 7. Alcohol and drug use 0.5 7. Cardiovascular diseases 5.1 1.9 Others 5.3 5

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Unintentional injuries 2. Low glomerular filtration rate 0.6 2. Transport injuries 4.2 14.5 3. Alcohol and drug use 0.5 3. Diarrheal/LRI/other 4.0 13.9 4. High fasting plasma glucose 0.3 4. Neoplasms 3.4 11.6 5. Child and maternal malnutrition 0.3 5. Other non-communicable 2.6 8.9 4.8 16.6 6. Air pollution 0.2 6. Cardiovascular diseases 2.1 7.3 7. High systolic blood pressure 0.2 7. Diabetes 2.0 6.9 Others 20.4 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Unintentional injuries 2. Alcohol and drug use 0.7 2. Transport injuries 5.6 16.3 3. Low glomerular filtration rate 0.6 3. Diarrheal/LRI/other 4.5 13.1 4. Child and maternal malnutrition 0.2 4. Neoplasms 3.9 11.4 5. High fasting plasma glucose 0.2 5. Other non-communicable 2.6 7.7 6.5 19.2 6. Air pollution 0.2 6. Self-harm & intersonal violence 2.3 6.8 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.2 6.5 Others 19.0 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.2 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.6 2. Unintentional injuries 3.1 12.8 3. Alcohol and drug use 0.3 3. Neoplasms 2.9 11.9 4. High fasting plasma glucose 0.3 4. Transport injuries 2.8 11.8 5. Child and maternal malnutrition 0.3 5. Other non-communicable 2.6 10.7 3.6 14.9 6. Air pollution 0.2 6. Cardiovascular diseases 2.0 8.3 7. High systolic blood pressure 0.2 7. Diabetes 2.0 8.2 Others 21.3 6

Total population 15 to 49 years of age 1. Dietary risks 25.8 1. Cardiovascular diseases 31.1 17.9 2. High body-mass index 21.9 2. Neoplasms 25.6 17.8 3. High systolic blood pressure 21.8 3. Self-harm & intersonal violence 23.4 13.4 4. Unsafe sex 17.0 4. Diabetes 18.7 10.8 5. Alcohol and drug use 16.1 5. HIV/AIDS 16.8 9.8 6 High fasting plasma glucose 14.8 6. Transport injuries 12.9 7.4 7. High total cholesterol 9.3 7. Unintentional injuries 12.3 7.0 Others 15.8 15 to 49 years of age 1. Dietary risks 34.3 1. Cardiovascular diseases 41.2 17.3 2. High systolic blood pressure 30.1 2. Self-harm & intersonal violence 41.0 17.2 3. Alcohol and drug use 27.4 3. HIV/AIDS 24.9 10.7 4. High body-mass index 24.1 4. Transport injuries 22.4 9.4 5. Unsafe sex 20.6 5. Neoplasms 22.2 9.3 6. High fasting plasma glucose 18.1 6. Unintentional injuries 21.5 9.0 7. High total cholesterol 13.8 7. Diabetes 21.4 8.9 Others 18.2 15 to 49 years of age 1. High body-mass index 20.0 1. Neoplasms 28.7 24.7 2. Dietary risks 18.2 2. Cardiovascular diseases 22.1 19.0 3. High systolic blood pressure 14.4 3. Diabetes 16.4 14.1 4. Unsafe sex 13.8 4. HIV/AIDS 9.6 8.6 5. High fasting plasma glucose 11.9 5. Self-harm & intersonal violence 7.6 6.5 6. Low glomerular filtration rate 6.2 6. Transport injuries 4.3 3.7 7. Alcohol and drug use 6.0 7. Diarrheal/LRI/other 4.2 3.6 Others 19.8 7

Total population 15 to 49 years of age 1. Dietary risks 25.8 1. Cardiovascular diseases 31.1 17.9 2. High body-mass index 21.9 2. Neoplasms 25.6 17.8 3. High systolic blood pressure 21.8 3. Self-harm & intersonal violence 23.4 13.4 4. Unsafe sex 17.0 4. Diabetes 18.7 10.8 5. Alcohol and drug use 16.1 5. HIV/AIDS 16.8 9.8 6 High fasting plasma glucose 14.8 6. Transport injuries 12.9 7.4 7. High total cholesterol 9.3 7. Unintentional injuries 12.3 7.0 Others 15.8 15 to 49 years of age 1. Dietary risks 34.3 1. Cardiovascular diseases 41.2 17.3 2. High systolic blood pressure 30.1 2. Self-harm & intersonal violence 41.0 17.2 3. Alcohol and drug use 27.4 3. HIV/AIDS 24.9 10.7 4. High body-mass index 24.1 4. Transport injuries 22.4 9.4 5. Unsafe sex 20.6 5. Neoplasms 22.2 9.3 6. High fasting plasma glucose 18.1 6. Unintentional injuries 21.5 9.0 7. High total cholesterol 13.8 7. Diabetes 21.4 8.9 Others 18.2 115 to 49 years of age 1. High body-mass index 20.0 1. Neoplasms 28.7 24.7 2. Dietary risks 18.2 2. Cardiovascular diseases 22.1 19.0 3. High systolic blood pressure 14.4 3. Diabetes 16.4 14.1 4. Unsafe sex 13.8 4. HIV/AIDS 9.6 8.6 5. High fasting plasma glucose 11.9 5. Self-harm & intersonal violence 7.6 6.5 6. Low glomerular filtration rate 6.2 6. Transport injuries 4.3 3.7 7. Alcohol and drug use 6.0 7. Diarrheal/LRI/other 4.2 3.6 Others 19.8 8

Total population 70 years of age and over 1. High systolic blood pressure 1,808.6 1. Cardiovascular diseases 2,950.6 42.3 2. Dietary risks 1,482.1 2. Diabetes 1,089.6 15.6 3. High fasting plasma glucose 1,167.8 3. Neoplasms 1,085.6 15.6 4. High body-mass index 881.9 4. Neurological disorders 532.7 7.7 5. Low glomerular filtration rate 555.7 5. Diarrheal/LRI/other 440.1 6.3 6. Low physical activity 523.8 6. Chronic respiratory diseases 226.5 3.3 7. High total cholesterol 311.9 7. Digestive diseases 143.6 2.1 Others 7.2 70 years of age and over 1. High systolic blood pressure 1,769.7 1. Cardiovascular diseases 2,851.4 37.1 2. Dietary risks 1,545.9 2. Neoplasms 1,514.8 19.7 3. High fasting plasma glucose 1,110.0 3. Diabetes 1,087.2 14.2 4. High body-mass index 644.2 4. Neurological disorders 643.2 8.4 5. Low glomerular filtration rate 561.8 5. Diarrheal/LRI/other 460.2 6.0 6. Low physical activity 521.8 6. Chronic respiratory diseases 379.0 4.9 7. Smoking 383.9 7. Digestive diseases 154.7 2.0 Others 7.6 70 years of age and over 1. High systolic blood pressure 1,834.9 1. Cardiovascular diseases 3,017.8 46.5 2. Dietary risks 1,438.7 2. Diabetes 1,091.2 16.8 3. High fasting plasma glucose 1,207.1 3. Neoplasms 794.5 12.2 4. High body-mass index 1,043.0 4. Neurological disorders 457.7 7.1 5. Low glomerular filtration rate 551.5 5. Diarrheal/LRI/other 426.4 6.6 6. Low physical activity 525.1 6. Digestive diseases 136.1 2.1 7. High total cholesterol 355.7 7. Unintentional injuries 128.8 2.0 Others 6.7 9

Total population 1. High systolic blood pressure 144.3 1. Cardiovascular diseases 220.0 35.1 All age 2. Dietary risks 134.0 2. Neoplasms 102.5 16.3 3. High fasting plasma glucose 98.1 3. Diabetes 95.0 15.1 4. High body-mass index 93.0 4. Diarrheal/LRI/other 34.4 5.5 5. Low glomerular filtration rate 42.6 5. Neurological disorders 31.0 5.0 6. Low physical activity 42.3 6. Unintentional injuries 18.7 3.0 7. High total cholesterol 32.3 7. Chronic respiratory diseases 17.8 2.8 Others 17.2 1. High systolic blood pressure 145.1 1. Cardiovascular diseases 214.3 31.3 All age 2. Dietary risks 141.8 2. Neoplasms 114.4 16.7 3. High fasting plasma glucose 91.9 3. Diabetes 90.1 13.2 4. High body-mass index 76.1 4. Diarrheal/LRI/other 35.7 5.2 5. Low physical activity 42.4 5. Neurological disorders 33.0 4.8 6. Low glomerular filtration rate 42.0 6. Self-harm & intersonal violence 30.2 4.4 7. Smoking 40.4 7. Chronic respiratory diseases 25.6 3.7 Others 20.6 1. High systolic blood pressure 143.6 1. Cardiovascular diseases 225.2 39.1 All age 2. Dietary risks 126.9 2. Diabetes 99.4 17.2 3. High body-mass index 108.5 3. Neoplasms 91.6 15.8 4. High fasting plasma glucose 103.8 4. Diarrheal/LRI/other 33.2 5.8 5. Low glomerular filtration rate 43.2 5. Neurological disorders 29.2 5.1 6. Low physical activity 42.3 6. Unintentional injuries 12.7 2.2 7. High total cholesterol 31.6 7. Other non-communicable 12.0 2.1 Others 12.6 10

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) 25 67 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 $15,009.00 Per capita GDP-PPP outlay on healthcare $1,725.00 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, 2012 44.5 (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 55,588 32.20% 28.80% 35.83% 2.Neoplasms 71,024 38,480 32,543 22.11% 23.17% 20.98% 3. Chronic respiratory diseases 34,669 19,903 14,766 10.79% 11.99% 9.52% 4. Diarrhea/LRI/Other 27,351 12,816 14,534 8.52% 7.72% 9.37% 5. Diabetes 23,305 11,756 11,548 7.26% 7.08% 7.44% 6. Neurological disorders 7. Unintentional injuries 17,236 7,307 9,928 5.37% 4.40% 6.40% 11,076 6,454 4,622 3.45% 3.89% 2.98% 8. Transport injuries 7,529 5,477 2,052 2.34% 3.30% 1.32% 9. Digestive diseases 7,397 3,530 3,867 2.30% 2.13% 2.49% 10. Cirrhosis 6,898 4,908 1,989 2.15% 2.96% 1.28% 11. Self-harm & intersonal violence 12. Others noncommunicable 6,381 5,198 1,183 1.99% 3.13% 0.76% 4,916 2,404 2,512 1.53% 1.45% 1.62% TOTAL 321,195 166,057 155,132 100.0% 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 2015. 25 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 7,005,513 7,491,014 6.93% Years lived with disability (YLD) 1,060,535 1,546,702 45.84% Years of life lost (YLL) 5,944,977 5,944,312-0.01% 266627 318,943 19.62% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 4,606,950 4,670,555 1.38% Years lived with disability (YLD) 630,049 839,017 33.17% Years of life lost (YLL) 3,976,901 3,831,538-3.66% 162,724 178,612 9.76% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 2,398,563 2,820,459 17.59% Years lived with disability (YLD) 430,486 707,685 64.39% Years of life lost (YLL) 1,968,076 2,112,774 7.35% 103,903 140,331 35.06% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 7,491,014 100% 1,546,702 100% 5,944,312 100% 318,943 100% 4,670,555 62.35% 839,017 54.25% 3,831,538 64.46% 178,612 56.00% 2,820,459 37.65% 707,685 45.75% 2,112,774 35.54% 140,331 44.00% 12

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 19.6 1. Neonatal disorders 114.8 39.9 2. Unsafe water, sanitation and handwashing 3.7 2. Other non-communicable 3. Unsafe sex 1.7 3. Diarrheal/LRI/other 30.3 10.6 4. Smoking 1.4 4. Unintentional injuries 22.9 8.0 5. Alcohol and drug use 1.3 5. Diabetes 6.8 2.4 83.4 29.1 6. Air pollution 1.1 6. Neoplasms 4.8 1.7 7. Low glomerular filtration rate 1.0 7. Cardiovascular diseases 4.7 1.6 Others 6.7 Children under 5 years 1. Child and maternal malnutrition 21.5 1. Neonatal disorders 129.7 40.8 2. Unsafe water, sanitation and handwashing 3.9 2. Other non-communicable 3. Unsafe sex 1.7 3. Diarrheal/LRI/other 33.2 10.5 4. Alcohol and drug use 1.5 4. Unintentional injuries 26.0 8.2 5. Smoking 1.4 5. Diabetes 7.6 2.4 89.2 28.1 6. Air pollution 1.3 6. Neoplasms 5.5 1.7 7. Low glomerular filtration rate 1.1 7. Transport injuries 5.3 1.7 Others 6.5 Children under 5 years 1. Child and maternal malnutrition 17.7 1. Neonatal disorders 99.4 38.8 2. Unsafe water, sanitation and handwashing 3.4 2. Other non-communicable 3. Unsafe sex 1.8 3. Diarrheal/LRI/other 27.3 10.7 4. Smoking 1.3 4. Unintentional injuries 19.7 7.7 5. Alcohol and drug use 1.0 5. Diabetes 6.0 2.4 77.4 30.3 6. Air pollution 1.0 6. Cardiovascular diseases 4.5 1.8 7. Low glomerular filtration rate 0.9 7. Neoplasms 4.1 1.6 Others 6.7 13

Total population 5 to 14 years of age 1. Alcohol and drug use 0.8 1. Neoplasms 4.7 19.1 2. Low glomerular filtration rate 0.3 2. Transport injuries 4.6 18.6 3. Unsafe water, sanitation and handwashing 0.2 3. Unintentional injuries 4. High fasting plasma glucose 0.2 4. Diarrheal/LRI/other 2.3 9.1 5. Unsafe sex 0.1 5. Other non-communicable 2.0 8.0 4.1 16.6 6. Air pollution 0.1 6. Self-harm & intersonal violence 1.7 7.0 7. High systolic blood pressure 0.1 7. Cardiovascular diseases 1.3 5.3 Others 16.3 5 to 14 years of age 1. Alcohol and drug use 1.0 1. Transport injuries 5.8 20.3 2. Low glomerular filtration rate 0.3 2. Unintentional injuries 5.5 19.3 3. Unsafe water, sanitation and handwashing 0.2 3. Neoplasms 4. High fasting plasma glucose 0.2 4. Diarrheal/LRI/other 2.3 8.1 5. Air pollution 0.1 5. Self-harm & intersonal violence 2.2 7.8 5.3 18.6 6. Unsafe sex 0.1 6. Other non-communicable 2.0 7.0 7. Sexual abuse and violence 0.1 7. Cardiovascular diseases 1.4 4.8 Others 14.1 5 to 14 years of age 1. Alcohol and drug use 0.6 1. Neoplasms 4.1 19.7 2. Low glomerular filtration rate 0.3 2. Transport injuries 3.4 16.3 3. High fasting plasma glucose 0.2 3. Unintentional injuries 2.7 12.7 4. Unsafe water, sanitation and handwashing 0.2 4. Diarrheal/LRI/other 5. Unsafe sex 0.1 5. Other non-communicable 2.0 9.4 2.2 10.5 6. Air pollution 0.1 6. Diabetes 1.3 6.1 7. High systolic blood pressure 0.1 7. Cardiovascular diseases 1.3 6.1 Others 19.2 14

Total population 15 to 49 years of age 1. Alcohol and drug use 26.7 1. Neoplasms 30.1 20.9 2. Dietary risks 17.5 2. Cardiovascular diseases 22.3 15.5 3. Smoking 15.8 3. Self-harm & intersonal violence 19.6 13.6 4. High body-mass index 15.3 4. Transport injuries 17.7 12.3 5. High systolic blood pressure 11.2 5. Unintentional injuries 11.0 7.6 6. Unsafe sex 8.0 6. HIV/AIDS 6.5 4.5 7. High total cholesterol 6.5 7. Diarrheal/LRI/other 6.2 4.3 Others 21.3 15 to 49 years of age 1. Alcohol and drug use 44.5 1. Self-harm & intersonal violence 32.5 16.9 2. Dietary risks 23.2 2. Cardiovascular diseases 29.5 15.3 3. Smoking 21.8 3. Transport injuries 28.3 14.7 4. High body-mass index 19.1 4. Neoplasms 27.4 14.2 5. High systolic blood pressure 16.0 5. Unintentional injuries 17.9 9.3 6. High total cholesterol 9.5 6. HIV/AIDS 10.7 5.5 7. Sexual abuse and violence 8.5 7. Mental and substances disorders 10.5 5.5 Others 18.5 15 to 49 years of age 1. Dietary risks 11.7 1. Neoplasms 32.8 34.4 2. High body-mass index 11.5 2. Cardiovascular diseases 15.0 15.8 3. Smoking 9.8 3. Transport injuries 7.0 7.3 4. Alcohol and drug use 8.7 4. Self-harm & intersonal violence 6.6 6.9 5. Unsafe sex 7.6 5. Diabetes 5.5 5.7 6. High systolic blood pressure 6.4 6. Diarrheal/LRI/other 4.7 5.0 7. High fasting plasma glucose 4.0 7. Unintentional injuries 4.0 4.2 Others 20.7 15

Total population 50 to 69 years of age 1. Smoking 266.8 1. Neoplasms 369.0 33.2 2. Dietary risks 256.9 2. Cardiovascular diseases 326.0 29.3 3. High body-mass index 207.7 3. Chronic respiratory diseases 82.9 7.5 4. High systolic blood pressure 192.7 4. Diabetes 82.8 7.5 5. High fasting plasma glucose 96.5 5. Diarrheal/LRI/other 56.9 5.1 6. Low glomerular filtration rate 95.7 6. Cirrhosis 45.7 4.1 7. High total cholesterol 68.4 7. Unintentional injuries 28.8 2.6 Others 10.7 50 to 69 years of age 1. Smoking 430.1 1. Cardiovascular diseases 468.0 30.7 2. Dietary risks 383.5 2. Neoplasms 456.6 29.9 3. High systolic blood pressure 283.4 3. Chronic respiratory diseases 124.2 8.1 4. High body-mass index 274.5 4. Diabetes 105.6 6.9 5. Alcohol and drug use 150.1 5. Diarrheal/LRI/other 77.6 5.1 6. High fasting plasma glucose 131.3 6. Cirrhosis 76.2 5.0 7. High total cholesterol 102.1 7. Unintentional injuries 45.8 3.0 Others 11.3 50 to 69 years of age 1. High body-mass index 148.3 1. Neoplasms 290.9 39.2 2. Dietary risks 144.1 2. Cardiovascular diseases 199.5 26.9 3. Smoking 121.3 3. Diabetes 62.5 8.4 4. High systolic blood pressure 111.8 4. Chronic respiratory diseases 46.1 6.2 5. High fasting plasma glucose 65.4 5. Diarrheal/LRI/other 38.5 5.2 6. Alcohol and drug use 47.3 6. Cirrhosis 18.6 2.5 7. High total cholesterol 38.4 7. Digestive diseases 17.3 2.3 Others 9.1 16

Total population 70 years of age and over 1. Dietary risks 1,225.7 1. Cardiovascular diseases 2,406.8 35.2 2. High systolic blood pressure 1,204.4 2. Neoplasms 1,204.3 17.6 3. Smoking 879.9 3. Chronic respiratory diseases 885.7 13.0 4. High body-mass index 708.1 4. Diarrheal/LRI/other 666.6 9.8 5. High fasting plasma glucose 523.2 5. Neurological disorders 506.9 7.4 6. Low glomerular filtration rate 370.6 6. Diabetes 505.4 7.4 7. High total cholesterol 304.9 7. Unintentional injuries 180.7 2.6 Others 7.1 70 years of age and over 1. Smoking 1,541.1 1. Cardiovascular diseases 2,424.3 30.0 2. Dietary risks 1,401.6 2. Neoplasms 1,671.2 20.7 3. High systolic blood pressure 1,238.2 3. Chronic respiratory diseases 1,271.9 15.7 4. High body-mass index 773.7 4. Diarrheal/LRI/other 737.4 9.1 5. High fasting plasma glucose 582.7 5. Diabetes 617.4 7.6 6. Low glomerular filtration rate 402.6 6. Neurological disorders 548.1 6.8 7. Alcohol and drug use 386.4 7. Unintentional injuries 200.2 2.5 Others 7.6 70 years of age and over 1. High systolic blood pressure 1,183.8 1. Cardiovascular diseases 2,396.2 39.4 2. Dietary risks 1,118.3 2. Neoplasms 919.1 15.1 3. High body-mass index 668.0 3. Chronic respiratory diseases 649.8 10.7 4. High fasting plasma glucose 486.8 4. Diarrheal/LRI/other 623.4 10.3 5. Smoking 476.2 5. Neurological disorders 481.7 7.9 6. Low glomerular filtration rate 351.1 6. Diabetes 437.0 7.2 7. High total cholesterol 344.7 7. Unintentional injuries 168.9 2.8 Others 6.6 17

Total population 1. Dietary risks 145.8 1. Cardiovascular diseases 249.5 30.9 All age 2. High systolic blood pressure 129.8 2. Neoplasms 171.3 21.2 3. Smoking 120.9 3. Chronic respiratory diseases 83.6 10.4 4. High body-mass index 97.2 4. Diarrheal/LRI/other 66.0 8.2 5. High fasting plasma glucose 58.8 5. Diabetes 56.2 7.0 6. Alcohol and drug use 48.9 6. Neurological disorders 41.6 5.1 7. High total cholesterol 38.2 7. Unintentional injuries 26.7 3.3 Others 14.0 1. Smoking 173.5 1. Cardiovascular diseases 235.7 27.4 All age 2. Dietary risks 158.2 2. Neoplasms 189.7 22.1 3. High systolic blood pressure 128.1 3. Chronic respiratory diseases 98.1 11.4 4. High body-mass index 101.2 4. Diarrheal/LRI/other 63.2 7.4 5. Alcohol and drug use 71.3 5. Diabetes 58.0 6.7 6. High fasting plasma glucose 59.3 6. Neurological disorders 36.0 4.2 7. High total cholesterol 36.1 7. Unintentional injuries 31.8 3.7 Others 17.1 1. Dietary risks 133.9 1. Cardiovascular diseases 262.6 34.6 All age 2. High systolic blood pressure 131.4 2. Neoplasms 153.7 20.3 3. High body-mass index 93.5 3. Chronic respiratory diseases 69.8 9.2 4. Smoking 70.4 4. Diarrheal/LRI/other 68.7 9.0 5. High fasting plasma glucose 58.3 5. Diabetes 54.6 7.2 6. High total cholesterol 40.1 6. Neurological disorders 46.9 6.2 7. Low glomerular filtration rate 39.6 7. Unintentional injuries 21.8 2.9 Others 10.7 18

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) 27 65.2 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 15,532 32.8% 12. Stroke 9,648 20.3% 13. Diabetes 4,962 10.5% 14. Lower respiratory infection 3,257 6.9% 15. HIV/AIDS 3,004 6.3% 16. Hytensive health disease 2,797 5.9% 17. Road injuries 2,615 5.5% 18. Prostate cancer 2,267 4.8% 19. Preterm birth complications 1,702 3.6% 20. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 2. 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 2015. 27 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

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) 29 64 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 $23,264.00 Per capita GDP-PPP outlay on healthcare $1,688.00 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 1,016 479 537 36.82% 33.40% 40.59% 2.Neoplasms 512 262 250 18.56% 18.27% 18.90% 3.Diabetes 394 174 220 14.28% 12.13% 16.63% 4. Diarrhea/LRI/Other 128 64 64 4.64% 4.46% 4.84% 5. Neurological disorders 115 56 59 4.17% 3.91% 4.46% 6.HVI/AIDS 102 78 23 3.70% 5.44% 1.77% 7. Self-harm & intersonal violence 99 82 17 3.59% 5.72% 1.30% 8. Unintentional injuries 83 55 28 3.01% 3.84% 2.12% 9. Chronic respiratory diseases 76 49 27 2.75% 3.42% 2.04% 10. Transport injuries 65 50 15 2.36% 3.49% 1.11% 11. Digestive diseases 62 33 29 2.25% 2.29% 2.19% 12. Others noncommunicable 48 21 27 1.74% 1.44% 2.04% 13. Neonatal disorders 59 32 27 2.14% 2.23% 2.04% TOTAL 2,759 1,434 1,323 100.0% 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 2015. 29 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 50,298 55,535 10.41% Years lived with disability (YLD) 9,448 16,063 70.01% Years of life lost (YLL) 40,851 39,473-3.37% 1476 1,523 3.18% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 31,808 35,274 10.90% Years lived with disability (YLD) 5,085 8,404 65.27% Years of life lost (YLL) 26,724 26,871 0.55% 871 963 10.56% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 18,490 20,261 9.58% Years lived with disability (YLD) 4,363 7,659 75.54% Years of life lost (YLL) 14,127 12,602-10.79% 605 560-7.44% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 55,535 100% 16,063 100% 39,473 100% 1,523 100% 35,274 63.52% 8,404 52.32% 26,871 68.07% 963 63.23% 20,261 36.48% 7,659 47.68% 12,602 31.93% 560 36.77% 22

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 19.1 1. Neonatal disorders 211.8 61.8 2. Unsafe water, sanitation and handwashing 8.6 2. Other non-communicable 3. Air pollution 2.1 3. Diarrheal/LRI/other 31.5 9.3 4. Unsafe sex 1.5 4. Unintentional injuries 11.5 3.4 5. Low glomerular filtration rate 1.1 5. Nutritional deficiencies 6.4 1.9 54.0 15.9 6. Smoking 1.0 6. Diabetes 5.9 1.7 7. High fasting plasma glucose 0.7 7. Cardiovascular diseases 4.2 1.3 Others 4.7 Children under 5 years 1. Child and maternal malnutrition 24.2 1. Neonatal disorders 224.9 59.7 2. Unsafe water, sanitation and handwashing 10.7 2. Other non-communicable 3. Air pollution 2.5 3. Diarrheal/LRI/other 37.9 10.2 4. Unsafe sex 1.5 4. Unintentional injuries 14.4 3.9 5. Low glomerular filtration rate 1.3 5. Nutritional deficiencies 8.3 2.2 58.5 15.7 6. Smoking 1.2 6. Diabetes 6.9 1.8 7. High fasting plasma glucose 0.8 7. Cardiovascular diseases 4.4 1.2 Others 5.3 Children under 5 years 1. Child and maternal malnutrition 13.8 1. Neonatal disorders 198.0 64.5 2. Unsafe water, sanitation and handwashing 6.5 2. Other non-communicable 3. Air pollution 1.7 3. Diarrheal/LRI/other 24.8 8.2 4. Unsafe sex 1.5 4. Unintentional injuries 8.5 2.8 5. Low glomerular filtration rate 0.8 5. Diabetes 4.9 1.6 49.3 16.2 6. Smoking 0.8 6. Nutritional deficiencies 4.4 1.5 7. High fasting plasma glucose 0.7 7. Cardiovascular diseases 4.0 1.3 Others 4.0 23

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Unintentional injuries 2. Low glomerular filtration rate 0.7 2. Transport injuries 4.7 14.3 3. Alcohol and drug use 0.7 3. Diarrheal/LRI/other 4.3 13.0 4. High fasting plasma glucose 0.3 4. Neoplasms 4.1 12.5 5. Child and maternal malnutrition 0.3 5. Other non-communicable 3.2 9.6 5.1 15.7 6. Air pollution 0.2 6. Diabetes 2.5 7.5 7. High systolic blood pressure 0.2 7. Self-harm & intersonal violence 2.3 7.1 Others 20.4 5 to 14 years of age 1. 1. Unsafe water, sanitation and handwashing 1.4 1. Unintentional injuries 2. Alcohol and drug use 0.9 2. Transport injuries 6.1 16.2 3. Low glomerular filtration rate 0.7 3. Neoplasms 4.6 12.3 4. High fasting plasma glucose 0.3 4. Diarrheal/LRI/other 4.6 12.2 5. Child and maternal malnutrition 0.3 5. Other non-communicable 3.2 8.6 6.7 18.0 6. Air pollution 0.2 6. Self-harm & intersonal violence 2.9 7.7 7. High systolic blood pressure 0.2 7. Diabetes 2.4 6.5 Others 15.5 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.2 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.7 2. Neoplasms 3.5 12.7 3. Alcohol and drug use 0.5 3. Unintentional injuries 3.5 12.5 4. High fasting plasma glucose 0.3 4. Transport injuries 3.2 11.6 5. Child and maternal malnutrition 0.3 5. Other non-communicable 3.1 11.0 3.9 14.1 6. High systolic blood pressure 0.2 6. Diabetes 2.5 8.9 7. Air pollution 0.2 7. Cardiovascular diseases 2.3 8.2 Others 21.1 24

Total population 15 to 49 years of age 1. High body-mass index 32.7 1. Cardiovascular diseases 36.4 15.7 2. Unsafe sex 30.9 2. Self-harm & intersonal violence 34.7 14.9 3. Dietary risks 28.1 3. Neoplasms 32.5 14.0 4. High systolic blood pressure 27.1 4. HIV/AIDS 32.1 14.0 5. Alcohol and drug use 26.4 5. Diabetes 21.4 9.2 6. High fasting plasma glucose 15.2 6. Transport injuries 17.4 7.5 7. Smoking 14.3 7. Unintentional injuries 15.7 6.7 Others 17.9 15 to 49 years of age 1. Alcohol and drug use 43.6 1. Self-harm & intersonal violence 59.3 18.6 2. Unsafe sex 42.0 2. HIV/AIDS 48.3 15.5 3. High body-mass index 39.8 3. Cardiovascular diseases 48.7 15.2 4. High systolic blood pressure 37.2 4. Transport injuries 29.7 9.3 5. Dietary risks 37.1 5. Neoplasms 28.8 9.0 6. Smoking 23.1 6. Unintentional injuries 26.5 8.3 7. High total cholesterol 18.7 7. Diabetes 23.9 7.5 Others 16.7 15 to 49 years of age 1. High body-mass index 25.7 1. Neoplasms 36.1 24.7 2. Unsafe sex 19.9 2. Cardiovascular diseases 24.2 16.5 3. Dietary risks 19.2 3. Diabetes 19.0 13.0 4. High systolic blood pressure 17.1 4. HVI/AIDS 16.0 11.3 5. High fasting plasma glucose 12.0 5. Self-harm & intersonal violence 10.4 7.1 6. Alcohol and drug use 9.4 6. Unintentional injuries 5.4 3.7 7. Low glomerular filtration rate 7.9 7. Diarrheal/LRI/other 5.0 3.4 Others 20.4 25

Total population 50 to 69 years of age 1. High body-mass index 399.1 1. Cardiovascular diseases 477.2 36.6 2. High systolic blood pressure 379.5 2. Neoplasms 299.5 23.0 3. Dietary risks 366.7 3. Diabetes 209.3 16.1 4. High fasting plasma glucose 225.1 4. Cirrhosis 42.3 3.2 5. Smoking 154.6 5. HVI/AIDS 41.2 3.2 6. High total cholesterol 121.6 6. Diarrheal/LRI/other 35.5 2.7 7. Low physical activity 100.4 7. Chronic respiratory diseases 34.3 2.6 Others 12.6 50 to 69 years of age 1. High systolic blood pressure 484.0 1. Cardiovascular diseases 617.0 37.4 2. Dietary risks 466.8 2. Neoplasms 326.7 19.8 3. High body-mass index 443.3 3. Diabetes 228.2 13.8 4. Smoking 265.9 4. HVI/AIDS 72.3 4.5 5. High fasting plasma glucose 259.1 5. Cirrhosis 65.5 4.0 6. High total cholesterol 163.9 6. Chronic respiratory diseases 51.6 3.1 7. Low physical activity 127.5 7. Diarrheal/LRI/other 48.3 2.9 Others 14.5 50 to 69 years of age 1. High body-mass index 360.5 1. Cardiovascular diseases 355.0 35.5 2. High systolic blood pressure 288.1 2. Neoplasms 275.7 27.5 3. Dietary risks 279.2 3. Diabetes 192.8 19.3 4. High fasting plasma glucose 195.3 4. Diarrheal/LRI/other 24.2 2.4 5. High total cholesterol 84.7 5. Cirrhosis 22.0 2.2 6. Low physical activity 76.8 6. Digestive diseases 21.3 2.1 7. Low glomerular filtration rate 76.4 7. Chronic respiratory diseases 19.3 1.9 Others 9.1 26

Total population 70 years of age and over 1. High systolic blood pressure 2,196.4 1. Cardiovascular diseases 3,297.6 43.9 2. Dietary risks 1,581.9 2. Neoplasms 1,262.0 16.8 3. High body-mass index 1,570.9 3. Diabetes 1,092.8 14.6 4. High fasting plasma glucose 1,166.8 4. Neurological disorders 497.6 6.6 5. Low glomerular filtration rate 622.6 5. Diarrheal/LRI/other 414.5 5.5 6. Smoking 547.6 6. Chronic respiratory diseases 231.7 3.1 7. High total cholesterol 466.0 7. Digestive diseases 162.4 2.2 Others 7.4 70 years of age and over 1. High systolic blood pressure 2,099.0 1. Cardiovascular diseases 3,140.2 39.2 2. Dietary risks 1,664.8 2. Neoplasms 1,714.0 21.4 3. High body-mass index 1,318.0 3. Diabetes 1,019.1 12.7 4. High fasting plasma glucose 1,072.1 4. Neurological disorders 569.3 7.1 5. Smoking 782.9 5. Diarrheal/LRI/other 418.4 5.2 6. Low glomerular filtration rate 594.2 6. Chronic respiratory diseases 359.5 4.5 7. Low physical activity 536.0 7. Digestive diseases 167.3 2.1 Others 7.7 70 years of age and over 1. High systolic blood pressure 2,259.4 1. Cardiovascular diseases 3,399.5 47.3 2. High body-mass index 1,734.7 2. Diabetes 1,140.6 15.9 3. Dietary risks 1,528.3 3. Neoplasms 969.5 13.5 4. High fasting plasma glucose 1,228.1 4. Neurological disorders 451.1 6.3 5. Low glomerular filtration rate 641.1 5. Diarrheal/LRI/other 412.0 5.7 6. Low physical activity 555.1 6. Digestive diseases 159.2 2.2 7. High total cholesterol 450.8 7. Chronic respiratory diseases 149.0 2.1 Others 7.1 27

Total population 1. High systolic blood pressure 145.8 1. Cardiovascular diseases 249.5 30.9 All age 2. High body-mass index 129.8 2. Neoplasms 171.3 21.2 3. Dietary risks 120.9 3. Diabetes 83.6 10.4 4. High fasting plasma glucose 97.2 4. Diarrheal/LRI/other 66.0 8.2 5. Smoking 58.8 5. Neurological disorders 56.2 7.0 6. Low glomerular filtration rate 48.9 6. HVI/AIDS 41.6 5.1 7. High total cholesterol 38.2 7. Self-harm & intersonal violence 26.7 3.3 Others 14.0 1. High systolic blood pressure 173.5 1. Cardiovascular diseases 235.7 27.4 All age 2. Dietary risks 158.2 2. Neoplasms 189.7 22.1 3. High body-mass index 128.1 3. Diabetes 98.1 11.4 4. High fasting plasma glucose 101.2 4. Self-harm & intersonal violence 63.2 7.4 5. Smoking 71.3 5. HVI/AIDS 58.0 6.7 6. High total cholesterol 59.3 6. Diarrheal/LRI/other 36.0 4.2 7. Alcohol and drug use 36.1 7. Neurological disorders 31.8 3.7 Others 17.1 1. High systolic blood pressure 133.9 1. Cardiovascular diseases 262.6 34.6 All age 2. High body-mass index 131.4 2. Neoplasms 153.7 20.3 3. Dietary risks 93.5 3. Chronic respiratory diseases 69.8 9.2 4. High fasting plasma glucose 70.4 4. Diarrheal/LRI/other 68.7 9.0 5. Low glomerular filtration rate 58.3 5. Diabetes 54.6 7.2 6. Low physical activity 40.1 6. Neurological disorders 46.9 6.2 7. High total cholesterol 39.6 7. Unintentional injuries 21.8 2.9 Others 10.7 28

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) 31 66 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 $13,293.00 Per capita GDP-PPP outlay on healthcare $1,060.00 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 784 333 451 34.04% 30.47% 37.30% 2.Neoplasms 445 223 220 19.32% 20.40% 18.20% 3.Diabetes 406 167 240 17.63% 15.28% 19.85% 4. Diarrhea/LRI/Other 149 66 83 6.47% 6.04% 6.87% 5. Neurological disorders 132 64 68 5.73% 5.86% 5.62% 6. Chronic respiratory diseases 67 43 24 2.91% 3.93% 1.99% 7. Unintentional injuries 59 36 24 2.56% 3.29% 1.99% 8. Digestive diseases 53 25 27 2.30% 2.33% 2.23% 9. Self-harm & intersonal violence 10. Others noncommunicable 49 39 10 2.13% 3.57% 0.81% 46 17 29 2.00% 1.56% 2.40% 11. HVI/AIDS 35 27 8 1.52% 2.47% 0.66% 12. Transport injuries 38 27 11 1.65% 2.47% 0.90% 13.Cirrhosis 40 26 14 1.74% 2.37% 1.16% TOTAL 2,303 1,093 1,209 100.0% 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 2015. 31 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 51,744 57,323 10.78% Years lived with disability (YLD) 10,648 15,307 43.75% Years of life lost (YLL) 41,097 42,015 2.23% 2277 2,445 7.38% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 27,339 28,442 4.03% Years lived with disability (YLD) 5,214 7,509 44.02% Years of life lost (YLL) 22,126 20,932-5.40% 1,025 947-7.61% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 24,405 28,881 18.34% Years lived with disability (YLD) 5,434 7,798 43.50% Years of life lost (YLL) 18,971 21,083 11.13% 1,252 1,498 19.65% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 57,323 100% 15,307 100% 42,015 100% 2,445 100% 28,442 49.62% 7,509 49.06% 20,932 49.82% 947 38.73% 28,881 50.38% 7,798 50.94% 21,083 50.18% 1,498 61.27% 30

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 36.6 1. Neonatal disorders 173.6 51.8 2. Unsafe water, sanitation and handwashing 12.5 2. Other non-communicable 3. Air pollution 2.7 3. Diarrheal/LRI/other 43.2 13.1 4. Low glomerular filtration rate 1.5 4. Unintentional injuries 14.1 4.3 5. Smoking 1.2 5. Nutritional deficiencies 10.4 3.1 64.7 19.5 6. Unsafe sex 0.9 6. Diabetes 7.0 2.1 7. High fasting plasma glucose 0.7 7. Cardiovascular diseases 5.0 1.5 Others 4.6 Children under 5 years 1. Child and maternal malnutrition 40.9 1. Neonatal disorders 194.5 52.3 2. Unsafe water, sanitation and handwashing 14.3 2. Other non-communicable 3. Air pollution 2.9 3. Diarrheal/LRI/other 47.9 13.1 4. Low glomerular filtration rate 1.6 4. Unintentional injuries 15.4 4.2 5. Smoking 1.4 5. Nutritional deficiencies 11.8 3.2 70.8 19.3 6. Unsafe sex 0.9 6. Diabetes 7.3 2.0 7. Alcohol and drug use 0.8 7. Cardiovascular diseases 4.9 1.3 Others 4.6 Children under 5 years 1. Child and maternal malnutrition 32.2 1. Neonatal disorders 152.0 51.1 2. Unsafe water, sanitation and handwashing 10.7 2. Other non-communicable 3. Air pollution 2.4 3. Diarrheal/LRI/other 38.3 13.0 4. Low glomerular filtration rate 1.4 4. Unintentional injuries 12.7 4.4 5. Smoking 1.0 5. Nutritional deficiencies 9.0 3.0 58.5 19.8 6. Unsafe sex 0.9 6. Diabetes 6.6 2.2 7. High fasting plasma glucose 0.6 7. Cardiovascular diseases 5.1 1.7 Others 4.6 31

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Unintentional injuries 2. Alcohol and drug use 0.7 2. Transport injuries 4.1 13.7 3. Low glomerular filtration rate 0.6 3. Diarrheal/LRI/other 4.1 13.6 4. High fasting plasma glucose 0.3 4. Neoplasms 3.8 12.8 5. Child and maternal malnutrition 0.2 5. Other non-communicable 3.0 9.9 4.7 15.9 6. High systolic blood pressure 0.2 6. Diabetes 2.2 7.3 7. Air pollution 0.2 7. Cardiovascular diseases 2.1 7.1 Others 19.6 5 to 14 years of age 1. 1. Unsafe water, sanitation and handwashing 1.4 1. Unintentional injuries 2. Alcohol and drug use 0.9 2. Transport injuries 5.2 15.3 3. Low glomerular filtration rate 0.6 3. Diarrheal/LRI/other 4.4 12.9 4. High fasting plasma glucose 0.2 4. Neoplasms 4.3 12.7 5. Child and maternal malnutrition 0.2 5. Other non-communicable 3.0 8.9 6.3 18.4 6. High systolic blood pressure 0.2 6. Self-harm & intersonal violence 2.3 6.7 7. Air pollution 0.2 7. Diabetes 2.2 6.4 Others 18.7 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.1 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.6 2. Neoplasms 3.3 13.0 3. Alcohol and drug use 0.5 3. Unintentional injuries 3.2 12.5 4. High fasting plasma glucose 0.3 4. Transport injuries 2.9 11.4 5. Child and maternal malnutrition 0.3 5. Other non-communicable 2.9 11.4 3.7 14.6 6. High systolic blood pressure 0.2 6. Diabetes 2.2 8.6 7. Air pollution 0.2 7. Cardiovascular diseases 2.1 8.3 Others 18.7 32

Total population 15 to 49 years of age 1. High body-mass index 25.0 1. Cardiovascular diseases 27.5 16.9 2. Dietary risks 24.0 2. Neoplasms 26.4 16.2 3. Alcohol and drug use 19.9 3. Self-harm & intersonal violence 21.6 13.2 4. High systolic blood pressure 19.2 4. Diabetes 18.2 11.2 5. Unsafe sex 14.9 5. HIV/AIDS 14.3 8.8 6. High fasting plasma glucose 14.7 6. Transport injuries 11.6 7.1 7. High total cholesterol 8.8 7. Unintentional injuries 11.5 7.0 Others 19.5 15 to 49 years of age 1. Alcohol and drug use 30.7 1. Self-harm & intersonal violence 34.9 17.2 2. Dietary risks 28.5 2. Cardiovascular diseases 33.4 16.4 3. High body-mass index 25.7 3. HIV/AIDS 21.1 10.5 4. High systolic blood pressure 23.4 4. Neoplasms 20.7 10.2 5. Unsafe sex 17.9 5. Diabetes 18.6 9.1 6. High fasting plasma glucose 16.3 6. Unintentional injuries 18.5 9.1 7. Smoking 12.1 7. Transport injuries 18.1 8.9 Others 18.6 15 to 49 years of age 1. High body-mass index 24.3 1. Neoplasms 32.6 27.0 2. Dietary risks 19.3 2. Cardiovascular diseases 21.2 17.6 3. High systolic blood pressure 14.8 3. Diabetes 17.9 14.8 4. High fasting plasma glucose 13.0 4. Self-harm & intersonal violence 7.4 6.2 5. Unsafe sex 11.8 5. HVI/AIDS 7.0 5.9 6. Alcohol and drug use 8.4 6. Transport injuries 4.6 3.8 7. Low glomerular filtration rate 6.7 7. Diarrheal/LRI/other 4.4 3.7 Others 20.9 33

Total population 50 to 69 years of age 1. Dietary risks 291.1 1. Cardiovascular diseases 321.4 32.4 2. High body-mass index 275.8 2. Neoplasms 242.6 24.4 3. High systolic blood pressure 251.1 3. Diabetes 198.8 20.0 4. High fasting plasma glucose 216.3 4. Cirrhosis 30.5 3.1 5. Low physical activity 78.0 5. Chronic respiratory diseases 29.8 3.0 6. High total cholesterol 75.0 6. Diarrheal/LRI/other 27.8 2.8 7. Low glomerular filtration rate 66.9 7. Unintentional injuries 23.1 2.3 Others 12.0 50 to 69 years of age 1. Dietary risks 337.8 1. Cardiovascular diseases 383.4 33.5 2. High systolic blood pressure 288.8 2. Neoplasms 242.8 21.3 3. High body-mass index 254.7 3. Diabetes 198.8 17.4 4. High fasting plasma glucose 225.7 4. Cirrhosis 43.1 3.8 5. Smoking 101.7 5. Chronic respiratory diseases 39.1 3.4 6. Low physical activity 90.2 6. Diarrheal/LRI/other 38.1 3.3 7. High total cholesterol 90.0 7. Unintentional injuries 30.4 2.7 Others 14.6 50 to 69 years of age 1. High body-mass index 295.6 1. Cardiovascular diseases 263.3 30.9 2. Dietary risks 247.3 2. Neoplasms 242.4 28.4 3. High systolic blood pressure 215.9 3. Diabetes 198.8 23.3 4. High fasting plasma glucose 207.5 4. Diarrheal/LRI/other 22.1 2.6 5. Low physical activity 66.6 5. Cirrhosis 18.6 2.2 6. Low glomerular filtration rate 61.9 6. Digestive diseases 18.3 2.1 7. High total cholesterol 60.9 7. Chronic respiratory diseases 17.2 2.0 Others 8.4 34

Total population 70 years of age and over 1. High systolic blood pressure 1,640.9 1. Cardiovascular diseases 2,632.9 37.3 2. Dietary risks 1,455.9 2. Diabetes 1,223.1 17.3 3. High fasting plasma glucose 1,330.0 3. Neoplasms 1,198.0 17.0 4. High body-mass index 1,078.9 4. Neurological disorders 567.9 8.1 5. Low physical activity 514.6 5. Diarrheal/LRI/other 551.3 7.8 6. Low glomerular filtration rate 506.0 6. Chronic respiratory diseases 211.9 3.0 7. High total cholesterol 287.3 7. Digestive diseases 154.9 2.2 Others 7.3 70 years of age and over 1. Dietary risks 1,398.0 1. Cardiovascular diseases 2,316.4 31.9 2. High systolic blood pressure 1,395.7 2. Neoplasms 1,614.9 22.2 3. High fasting plasma glucose 1,147.3 3. Diabetes 1,108.2 15.3 4. High body-mass index 808.8 4. Neurological disorders 668.5 9.2 5. Smoking 566.4 5. Diarrheal/LRI/other 537.0 7.4 6. Low physical activity 472.1 6. Chronic respiratory diseases 336.7 4.6 7. Low glomerular filtration rate 467.1 7. Digestive diseases 153.6 2.1 Others 7.2 70 years of age and over 1. High systolic blood pressure 1,800.7 1. Cardiovascular diseases 2,839.1 41.0 2. Dietary risks 1,493.6 2. Diabetes 1,298.0 18.8 3. High fasting plasma glucose 1,448.9 3. Neoplasms 926.4 13.4 4. High body-mass index 1,254.8 4. Diarrheal/LRI/other 560.6 8.1 5. Low physical activity 542.3 5. Neurological disorders 502.5 7.3 6. Low glomerular filtration rate 531.3 6. Other non-communicable 164.2 2.4 7. High total cholesterol 330.8 7. Digestive diseases 155.8 2.3 Others 6.8 35

Total population 1. High systolic blood pressure 184.5 1. Cardiovascular diseases 275.6 32.9 All age 2. Dietary risks 183.2 2. Neoplasms 155.6 18.6 3. High body-mass index 153.6 3. Diabetes 142.9 17.0 4. High fasting plasma glucose 152.1 4. Diarrheal/LRI/other 52.2 6.2 5. Low physical activity 57.4 5. Neurological disorders 46.5 5.6 6. Low glomerular filtration rate 55.3 6. Chronic respiratory diseases 23.4 2.8 7. High total cholesterol 42.3 7. Unintentional injuries 20.8 2.5 Others 14.4 1. Dietary risks 169.9 1. Cardiovascular diseases 234.6 29.3 All age 2. High systolic blood pressure 155.9 2. Neoplasms 157.0 19.6 3. High fasting plasma glucose 124.0 3. Diabetes 117.6 14.7 4. High body-mass index 116.6 4. Diarrheal/LRI/other 46.4 5.8 5. Smoking 61.2 5. Neurological disorders 45.1 5.7 6. Low physical activity 50.3 6. Chronic respiratory diseases 30.1 3.8 7. Low glomerular filtration rate 46.8 7. Self-harm & intersonal violence 27.7 3.5 Others 17.7 1. High systolic blood pressure 212.9 1. Cardiovascular diseases 316.4 36.1 All age 2. Dietary risks 196.5 2. Diabetes 168.1 19.2 3. High body-mass index 190.3 3. Neoplasms 154.1 17.6 4. High fasting plasma glucose 180.1 4. Diarrheal/LRI/other 58.1 6.7 5. Low physical activity 64.5 5. Neurological disorders 47.8 5.5 6. Low glomerular filtration rate 63.7 6. Other non-communicable 20.3 2.3 7. High total cholesterol 45.7 7. Digestive diseases 19.2 2.2 Others 10.5 36

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) 33 64 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 $8,487.00 Per capita GDP-PPP outlay on healthcare $458.00 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, 2012 53.1 (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 566 274 292 31.9% 27.8% 36.5% 2.Neoplasms 289 153 136 16.3% 15.5% 17.0% 3.Diabetes 268 124 144 15.1% 12.6% 18.0% 4.Diarrhea/LRI/Other 110 59 51 6.2% 6.0% 6.4% 5.Self-harm & intersonal violence 104 85 19 5.9% 8.6% 2.4% 6.Unintentional injuries 73 51 21 4.1% 5.2% 2.6% 7.Neonatal disorders 70 40 30 3.9% 4.1% 3.8% 8.Neurological disorders 68 40 30 3.8% 4.0% 3.8% 9.Transport injuries 64 50 14 3.6% 5.1% 1.8% 10. Chronic respiratory diseases 61 43 18 3.4% 4.4% 2.3% 11.HVI/AIDS 58 44 22 3.3% 4.5% 2.8% 12.Others noncommunicable 46 24 22 2.6% 2.4% 2.8% TOTAL 1,777 986 799 100.0% 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 2015. 33 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 26,995 47,460 75.81% Years lived with disability (YLD) 6,093 12,670 107.94% Years of life lost (YLL) 20,899 34,793 66.48% 737 1,398 89.69% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 16,017 27,277 70.30% Years lived with disability (YLD) 3,368 6,591 95.69% Years of life lost (YLL) 12,646 20,689 63.60% 418 756 80.86% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 10,978 20,183 83.85% Years lived with disability (YLD) 2,725 6,079 123.08% Years of life lost (YLL) 8,253 14,104 70.90% 319 642 101.25% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 57,323 100% 15,307 100% 42,015 100% 2,445 100% 28,442 49.62% 7,509 49.06% 20,932 49.82% 947 38.73% 28,881 50.38% 7,798 50.94% 21,083 50.18% 1,498 61.27% 38

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 45.8 1. Neonatal disorders 186.0 48.3 2. Unsafe water, sanitation and handwashing 18.3 2. Other non-communicable 3. Smoking 3.2 3. Diarrheal/LRI/other 53.4 13.9 4. Unsafe sex 2.4 4. Unintentional injuries 19.6 5.1 5. Air pollution 1.9 5. Nutritional deficiencies 12.7 3.3 6. Low glomerular filtration rate 1.8 6. Diabetes 8.9 2.3 72.2 18.8 7. High fasting plasma glucose 1.2 7. Cardiovascular diseases 6.6 1.7 Others 6.6 Children under 5 years 1. Child and maternal malnutrition 51.9 1. Neonatal disorders 209.9 49.0 2. Unsafe water, sanitation and handwashing 20.6 2. Other non-communicable 3. Smoking 3.6 3. Diarrheal/LRI/other 60.6 14.2 4. Unsafe sex 2.4 4. Unintentional injuries 22.0 5.1 5. Air pollution 2.1 5. Nutritional deficiencies 14.2 3.3 77.5 18.1 6. Low glomerular filtration rate 1.9 6. Diabetes 9.3 2.2 7. Alcohol and drug use 1.3 7. Cardiovascular diseases 6.4 1.5 Others 6.6 Children under 5 years 1. Child and maternal malnutrition 39.6 1. Neonatal disorders 161.5 47.4 2. Unsafe water, sanitation and handwashing 15.9 2. Other non-communicable 3. Smoking 2.8 3. Diarrheal/LRI/other 46.1 13.5 4. Unsafe sex 2.5 4. Unintentional injuries 17.1 5.0 5. Low glomerular filtration rate 1.7 5. Nutritional deficiencies 11.2 3.3 66.9 19.7 6. Air pollution 1.6 6. Diabetes 8.4 2.5 7. Alcohol and drug use 1.1 7. Cardiovascular diseases 6.7 2.0 Others 6.6 39

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Unintentional injuries 2. Alcohol and drug use 1.1 2. Transport injuries 5.5 14.5 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 4.9 12.7 4. Child and maternal malnutrition 0.3 4. Neoplasms 4.6 12.0 5. High fasting plasma glucose 0.3 5. Other non-communicable 3.4 9.0 6.2 16.4 6. High systolic blood pressure 0.2 6. Self-harm & intersonal violence 2.8 7.4 7. Air pollution 0.1 7. Cardiovascular diseases 2.7 7.0 Others 20.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.7 1. Unintentional injuries 2. Alcohol and drug use 1.4 2. Transport injuries 7.0 16.2 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 5.2 12.0 4. Child and maternal malnutrition 0.3 4. Neoplasms 5.1 11.8 5. High fasting plasma glucose 0.3 5. Other non-communicable 3.4 7.9 8.3 19.2 6. High systolic blood pressure 0.2 6. Self-harm & intersonal violence 3.3 7.8 7. Air pollution 0.1 7. Cardiovascular diseases 2.6 6.1 Others 19.0 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.8 2. Unintentional injuries 4.2 12.7 3. Low glomerular filtration rate 0.8 3. Neoplasms 4.0 12.2 4. High fasting plasma glucose 0.4 4. Transport injuries 4.0 12.1 5. Child and maternal malnutrition 0.4 5. Other non-communicable 3.4 10.5 4.5 13.7 6. High systolic blood pressure 0.2 6. Cardiovascular diseases 2.7 8.3 7. Air pollution 0.1 7. Diabetes 2.7 8.3 Others 22.2 40

Total population 15 to 49 years of age 1. Alcohol and drug use 39.7 1. Self-harm & intersonal violence 46.9 18.1 2. High body-mass index 33.8 2. Cardiovascular diseases 36.3 14.0 3. Dietary risks 29.6 3. Neoplasms 33.3 12.8 4. High fasting plasma glucose 25.7 4. Diabetes 25.5 9.8 5. High systolic blood pressure 20.0 5. HIV/AIDS 25.1 9.7 6. High fasting plasma glucose 17.3 6. Transport injuries 23.6 9.1 7. Smoking 14.7 7. Unintentional injuries 19.2 7.4 Others 19.1 15 to 49 years of age 1. Alcohol and drug use 64.1 1. Self-harm & intersonal violence 77.7 22.8 2. Dietary risks 33.7 2. Cardiovascular diseases 41.5 12.2 3. High body-mass index 33.3 3. Transport injuries 38.9 11.4 4. High systolic blood pressure 31.7 4. HIV/AIDS 37.2 11.1 5. Unsafe sex 25.3 5. Unintentional injuries 31.9 9.4 6. High fasting plasma glucose 23.0 6. Neoplasms 27.4 8.0 7. Smoking 17.2 7. Diabetes 25.9 7.6 Others 17.6 15 to 49 years of age 1. High body-mass index 33.9 1. Neoplasms 39.3 21.9 2. Dietary risks 26.0 2. Cardiovascular diseases 31.0 17.3 3. Unsafe sex 19.8 3. Diabetes 25.1 14.0 4. High fasting plasma glucose 17.5 4. Self-harm & intersonal violence 16.2 9.1 5. Alcohol and drug use 15.4 5. HVI/AIDS 12.9 7.4 6. High systolic blood pressure 14.7 6. Transport injuries 8.3 4.6 7. Low glomerular filtration rate 9.7 7. Diarrheal/LRI/other 6.9 3.9 Others 21.8 41

Total population 50 to 69 years of age 1. High body-mass index 479.4 1. Cardiovascular diseases 533.5 33.3 2. Dietary risks 435.1 2. Neoplasms 337.9 21.1 3. High systolic blood pressure 353.1 3. Diabetes 321.3 20.1 4. High fasting plasma glucose 324.8 4. Cirrhosis 61.1 3.8 5. Smoking 212.8 5. Chronic respiratory diseases 49.8 3.1 6. Low physical activity 131.1 6. Diarrheal/LRI/other 46.8 2.9 7. Alcohol and drug use 115.1 7. Self-harm & intersonal violence 41.3 2.6 Others 13.1 50 to 69 years of age 1. Dietary risks 485.2 1. Cardiovascular diseases 618.6 32.4 2. High body-mass index 444.6 2. Neoplasms 371.0 19.4 3. High systolic blood pressure 418.1 3. Diabetes 319.9 16.8 4. Smoking 361.6 4. Cirrhosis 91.5 4.8 5. High fasting plasma glucose 310.5 5. Chronic respiratory diseases 74.8 3.9 6. Alcohol and drug use 178.4 6. Self-harm & intersonal violence 69.1 3.6 7. Low physical activity 150.5 7. Diarrheal/LRI/other 61.6 3.2 Others 15.9 50 to 69 years of age 1. High body-mass index 513.1 1. Cardiovascular diseases 451.4 34.6 2. Dietary risks 386.6 2. Diabetes 322.7 24.8 3. High fasting plasma glucose 338.7 3. Neoplasms 305.8 23.5 4. High systolic blood pressure 290.3 4. Diarrheal/LRI/other 32.5 2.5 5. Low physical activity 112.4 5. Cirrhosis 31.7 2.4 6. Low glomerular filtration rate 96.8 6. Digestive diseases 28.3 2.2 7. High total cholesterol 91.4 7. Chronic respiratory diseases 25.7 2.0 Others 8.1 42

Total population 70 years of age and over 1. High systolic blood pressure 2,050.1 1. Cardiovascular diseases 3,820.3 42.2 2. Dietary risks 1,825.1 2. Neoplasms 1,379.3 15.3 3. High fasting plasma glucose 1,387.6 3. Diabetes 1,354.9 15.0 4. High body-mass index 1,267.8 4. Diarrheal/LRI/other 625.7 6.9 5. Low glomerular filtration rate 736.8 5. Neurological disorders 599.1 6.6 6. Low physical activity 688.8 6. Chronic respiratory diseases 393.7 4.4 7. Smoking 678.8 7. Digestive diseases 198.6 2.2 Others 7.4 70 years of age and over 1. High systolic blood pressure 2,034.3 1. Cardiovascular diseases 3,629.1 37.5 2. Dietary risks 1,797.6 2. Neoplasms 1,781.1 18.4 3. High fasting plasma glucose 1,187.0 3. Diabetes 1,275.4 13.2 4. Smoking 1,126.9 4. Neurological disorders 721.9 7.5 5. High body-mass index 987.2 5. Diarrheal/LRI/other 650.0 6.7 6. Low glomerular filtration rate 714.8 6. Chronic respiratory diseases 629.6 6.5 7. Low physical activity 665.0 7. Digestive diseases 206.6 2.1 Others 8.2 70 years of age and over 1. High systolic blood pressure 2,062.9 1. Cardiovascular diseases 3,975.3 46.7 2. Dietary risks 1,847.4 2. Diabetes 1,419.3 16.7 3. High fasting plasma glucose 1,550.4 3. Neoplasms 1,053.3 12.4 4. High body-mass index 1,495.5 4. Diarrheal/LRI/other 605.9 7.1 5. Low glomerular filtration rate 754.6 5. Neurological disorders 499.4 5.9 6. Low physical activity 708.1 6. Chronic respiratory diseases 202.4 2.4 7. High total cholesterol 478.7 7. Digestive diseases 192.2 2.3 Others 6.7 43

Total population 1. Dietary risks 104.4 1. Cardiovascular diseases 171.2 29.6 All age 2. High systolic blood pressure 97.7 2. Neoplasms 87.3 15.1 3. High body-mass index 96.0 3. Diabetes 80.8 14.0 4. High fasting plasma glucose 76.2 4. Diarrheal/LRI/other 33.2 5.7 5. Smoking 45.9 5. Self-harm & intersonal violence 31.5 5.4 6. Alcohol and drug use 39.0 6. Unintentional injuries 22.0 3.8 7. Low glomerular filtration rate 35.4 7. Neonatal disorders 21.0 3.6 Others 22.9 1. Dietary risks 104.6 1. Cardiovascular diseases 165.9 25.7 All age 2. High systolic blood pressure 100.0 2. Neoplasms 92.5 14.3 3. High fasting plasma glucose 82.0 3. Diabetes 74.9 11.6 4. Smoking 72.4 4. Self-harm & intersonal violence 51.3 7.9 5. High fasting plasma glucose 65.7 5. Diarrheal/LRI/other 35.8 5.5 6. Alcohol and drug use 59.4 6. Unintentional injuries 31.0 4.8 7. Low glomerular filtration rate 34.0 7. Transport injuries 30.4 4.7 Others 25.5 1. High body-mass index 110.0 1. Cardiovascular diseases 176.4 34.4 All age 2. Dietary risks 104.2 2. Diabetes 86.8 16.9 3. High systolic blood pressure 95.4 3. Neoplasms 82.1 16.0 4. High fasting plasma glucose 86.6 4. Diarrheal/LRI/other 30.6 6.0 5. Low glomerular filtration rate 36.7 5. Neurological disorders 18.1 3.6 6. Low physical activity 34.6 6. Neonatal disorders 18.0 3.5 7. High total cholesterol 26.3 7. Other non-communicable 13.4 2.6 Others 17.0 44

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 $6,131.00 Per capita GDP-PPP outlay on healthcare $372.00 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, 2012 56.3 (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 6,246 22.29% 19.51% 25.16% 2. Neoplasms 7,662 3,347 4,315 15.18% 13.06% 17.38% 3. Diarrhea/LRI/Other 6,440 3,197 3,242 12.76% 12.47% 13.06% 4. Unintentional injuries 5,662 3,107 2,555 11.22% 12.12% 10.29% 5.Diabetes 4,233 2,013 2,220 8.39% 7.85% 8.94% 6. Transport injuries 3,804 2,241 1,563 7.54% 8.74% 6.30% 7.Cirrhosis 3,027 1,745 1,282 6.00% 6.81% 5.16% 8. Transport injuries 3,019 2,064 955 5.98% 8.05% 3.85% 9. Chronic respiratory diseases 2,286 1,242 1,044 4.53% 4.85% 4.21% 10.Digestive diseases 1,737 820 917 3.44% 3.20% 3.69% 11.HIV/AIDS 1,343 856 487 2.66% 3.34% 1.96% TOTAL 50,459 25,632 24,826 100.0% 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 2015. 35 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 2,254,404 1,777,256-21.17% Years lived with disability (YLD) 231,158 373,755 61.69% Years of life lost (YLL) 2,023,245 1,403,502-30.63% 42192 44,020 4.33% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,236,290 943,950-23.65% Years lived with disability (YLD) 124,861 190,386 52.48% Years of life lost (YLL) 1,111,428 753,565-32.20% 21,909 21,422-2.22% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,018,114 833,306-18.15% Years lived with disability (YLD) 106,297 183,369 72.51% Years of life lost (YLL) 911,817 649,937-28.72% 20,283 22,598 11.41% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,777,256 100% 373,755 100% 1,403,502 100% 44,020 100% 943,950 53.11% 190,386 50.94% 753,565 53.69% 21,422 48.66% 833,306 46.89% 183,369 49.06% 649,937 46.31% 22,598 51.34% 46

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 130.0 1. Neonatal disorders 292.6 33.3 2. Unsafe water, sanitation and handwashing 55.4 2. Diarrheal/LRI/other 3. Unsafe sex 22.8 3. Unintentional injuries 159.7 18.1 4. Air pollution 15.5 4. Other non-communicable 87.6 10.0 5. High fasting plasma glucose 3.9 5. Transport injuries 33.5 3.8 6. Alcohol and drug use 3.6 6. Communicable, maternal, neonatal, and nutritional diseases 186.4 21.2 26.6 3.0 7. Low glomerular filtration rate 3.0 7. Cardiovascular diseases 25.3 2.9 Others 7.8 Children under 5 years 1. Child and maternal malnutrition 133.3 1. Neonatal disorders 337.6 35.7 2. Unsafe water, sanitation and handwashing 58.4 2. Diarrheal/LRI/other 3. Unsafe sex 22.7 3. Unintentional injuries 165.0 17.4 4. Air pollution 15.7 4. Other non-communicable 91.6 9.7 5. High fasting plasma glucose 4.5 5. Transport injuries 37.3 3.9 6. Alcohol and drug use 4.1 6. Cardiovascular diseases 27.4 2.9 7. Low glomerular filtration rate 2.9 190.0 7. Communicable, maternal, neonatal, and nutritional diseases 26.8 20.0 2.8 Others 7.7 Children under 5 years 1. Child and maternal malnutrition 126.6 1. Neonatal disorders 245.6 30.4 2. Unsafe water, sanitation and handwashing 52.2 2. Diarrheal/LRI/other 3. Unsafe sex 22.9 3. Unintentional injuries 154.1 19.1 4. Air pollution 15.2 4. Other non-communicable 83.5 10.3 5. High fasting plasma glucose 3.3 5. Transport injuries 29.5 3.6 6. Low glomerular filtration rate 3.1 182.7 6. Communicable, maternal, neonatal, and nutritional diseases 26.4 7. Alcohol and drug use 3.0 7. Cardiovascular diseases 23.1 2.9 22.6 3.3 Others 8.0 47

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.9 1. Unintentional injuries 2. Alcohol and drug use 1.5 2. Transport injuries 12.1 20.6 3. Unsafe sex 0.9 3. Diarrheal/LRI/other 8.5 14.6 4. Low glomerular filtration rate 0.5 4. Neoplasms 3.4 5.8 5. Air pollution 0.5 5. Cardiovascular diseases 3.3 5.7 18.1 30.9 6. Child and maternal malnutrition 0.4 6. Diabetes 2.5 4.2 7. High fasting plasma glucose 0.4 7. Other non-communicable 2.2 3.8 Others 14.3 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 3.4 1. Unintentional injuries 2. Alcohol and drug use 1.8 2. Transport injuries 15.0 22.6 3. Unsafe sex 0.9 3. Diarrheal/LRI/other 9.5 14.4 4. Air pollution 0.6 4. Neoplasms 4.0 6.0 5. Low glomerular filtration rate 0.5 5. Cardiovascular diseases 3.7 5.6 20.3 30.7 6. High fasting plasma glucose 0.3 6. Diabetes 2.6 3.9 7. Child and maternal malnutrition 0.3 7. Other non-communicable 2.4 3.6 Others 13.3 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.5 1. Unintentional injuries 2. Alcohol and drug use 1.1 2. Transport injuries 9.1 18.0 3. Unsafe sex 1.0 3. Diarrheal/LRI/other 7.6 15.0 4. Low glomerular filtration rate 0.6 4. Cardiovascular diseases 3.0 5.9 5. Child and maternal malnutrition 0.4 5. Neoplasms 2.8 5.5 15.7 31.2 6. Air pollution 0.4 6. Diabetes 2.3 4.6 7. High fasting plasma glucose 0.4 7. Other non-communicable 2.1 4.1 Others 15.8 48

Total population 15 to 49 years of age 1. Alcohol and drug use 27.6 1. Unintentional injuries 31.2 17.2 2. Dietary risks 15.1 2. Transport injuries 27.0 14.9 3. High body-mass index 12.3 3. Neoplasms 20.1 11.1 4. High systolic blood pressure 11.7 4. Cardiovascular diseases 20.1 11.1 5. Unsafe sex 11.3 5. Self-harm & intersonal violence 12.6 7.0 6. Smoking 8.5 6. HIV/AIDS 11.9 6.2 7. High fasting plasma glucose 6.7 7. Cirrhosis 11.0 6.1 Others 26.5 15 to 49 years of age 1. Alcohol and drug use 42.1 1. Transport injuries 40.9 19.3 2. Dietary risks 17.3 2. Unintentional injuries 37.7 17.8 3. High systolic blood pressure 13.7 3. Cardiovascular diseases 22.3 10.5 4. High body-mass index 11.6 4. Self-harm & intersonal violence 18.5 8.7 5. Smoking 11.4 5 HIV/AIDS. 16.5 7.4 6. Unsafe sex 11.5 6. Neoplasms 15.1 7.1 7. High fasting plasma glucose 8.0 7. Cirrhosis 14.5 6.8 Others 22.3 15 to 49 years of age 1. Alcohol and drug use 13.1 1. Neoplasms 25.2 16.7 2. High body-mass index 13.0 2. Unintentional injuries 24.6 16.3 3. Dietary risks 13.0 3. Maternal disorders 18.3 12.5 4. Unsafe sex 11.1 4. Cardiovascular diseases 17.9 11.9 5. High systolic blood pressure 9.7 5. Transport injuries 13.0 8.6 6. Smoking 5.6 6. Neoplasms 8.0 5.3 7. High fasting plasma glucose 5.4 7. Cirrhosis 7.5 5.0 Others 23.8 49

Total population 50 to 69 years of age 1. Dietary risks 225.8 1. Cardiovascular diseases 284.5 24.7 2. High systolic blood pressure 215.4 2. Neoplasms 255.8 22.2 3. High body-mass index 190.3 3. Cirrhosis 123.9 10.8 4. Alcohol and drug use 138.1 4. Diabetes 119.3 10.4 5. Smoking 133.8 5. Diarrheal/LRI/other 66.9 5.8 6. High fasting plasma glucose 117.2 6. Transport injuries 46.3 4.0 7. Low glomerular filtration rate 98.8 7. Unintentional injuries 46.0 4.0 Others 18.2 50 to 69 years of age 1. Dietary risks 249.7 1. Cardiovascular diseases 288.2 22.9 2. High systolic blood pressure 218.9 2. Neoplasms 232.2 18.4 3. Alcohol and drug use 204.1 3. Cirrhosis 154.1 12.2 4. Smoking 177.3 4. Diabetes 122.6 9.7 5. High body-mass index 155.9 5. Diarrheal/LRI/other 74.9 5.9 6. High fasting plasma glucose 124.9 6. Transport injuries 62.8 5.0 7. Low glomerular filtration rate 99.6 7. Unintentional injuries 58.4 4.6 Others 21.1 50 to 69 years of age 1. High body-mass index 221.4 1. Cardiovascular diseases 281.0 26.6 2. High systolic blood pressure 212.3 2. Neoplasms 277.1 26.2 3. Dietary risks 204.2 3. Diabetes 116.2 11.0 4. High fasting plasma glucose 110.2 4. Cirrhosis 96.6 9.2 5. Low glomerular filtration rate 98.1 5. Diarrheal/LRI/other 59.6 5.6 6. Smoking 94.5 6. Digestive diseases 42.3 4.0 7. Alcohol and drug use 78.5 7. Unintentional injuries 35.4 3.4 Others 14.0 50

Total population 70 years of age and over 1. High systolic blood pressure 1,236.5 1. Cardiovascular diseases 1,981.2 30.2 2. Dietary risks 1,081.3 2. Neoplasms 1,030.5 15.7 3. High body-mass index 655.5 3. Diarrheal/LRI/other 793.1 12.1 4. Smoking 624.2 4. Diabetes 625.3 9.5 5. Low glomerular filtration rate 619.3 5. Chronic respiratory diseases 473.6 7.2 6. High fasting plasma glucose 612.4 6. Cirrhosis 289.7 4.4 7. Air pollution 431.1 7. Unintentional injuries 280.6 4.3 Others 16.6 70 years of age and over 1. High systolic blood pressure 1,133.1 1. Cardiovascular diseases 1,831.4 27.6 2. Dietary risks 1,089.1 2. Neoplasms 1,082.9 16.3 3. Smoking 844.2 3. Diarrheal/LRI/other 800.0 12.0 4. High fasting plasma glucose 586.6 4. Diabetes 639.5 9.6 5. Low glomerular filtration rate 582.9 5. Chronic respiratory diseases 562.6 8.5 6. High body-mass index 487.0 6. Cirrhosis 337.6 5.1 7. Air pollution 408.0 7. Unintentional injuries 289.4 4.4 Others 16.6 70 years of age and over 1. High systolic blood pressure 1,315.0 1. Cardiovascular diseases 2,094.8 32.2 2. Dietary risks 1,075.3 2. Neoplasms 990.8 15.2 3. High body-mass index 783.3 3. Diarrheal/LRI/other 787.9 12.1 4. Low glomerular filtration rate 646.9 4. Diabetes 614.6 9.5 5. High fasting plasma glucose 632.0 5. Chronic respiratory diseases 406.2 6.3 6. Smoking 457.3 6. Digestive diseases 290.9 4.5 7. Air pollution 448.7 7. Unintentional injuries 273.9 4.2 Others 16.1 51

Total population 1. High systolic blood pressure 67.2 1. Cardiovascular diseases 105.2 19.5 All age 2. Dietary risks 65.3 2. Neoplasms 71.7 13.3 3. High body-mass index 47.2 3. Diarrheal/LRI/other 60.3 11.2 4. Smoking 38.3 4. Unintentional injuries 53.0 9.9 5. Alcohol and drug use 38.0 5. Diabetes 39.6 7.4 6. High fasting plasma glucose 35.4 6. Neonatal disorders 35.6 6.7 7. Low glomerular filtration rate 32.9 7. Cirrhosis 28.3 5.3 Others 26.9 1. Dietary risks 63.5 1. Cardiovascular diseases 93.7 17.1 All age 2. High systolic blood pressure 59.7 2. Neoplasms 62.7 11.4 3. Alcohol and drug use 52.5 3. Diarrheal/LRI/other 59.9 11.0 4. Smoking 46.8 4. Unintentional injuries 58.2 10.6 5. High body-mass index 35.1 5. Neonatal disorders 42.0 7.7 6. High fasting plasma glucose 33.2 6. Transport injuries 38.7 7.0 7. Low glomerular filtration rate 29.3 7. Diabetes 37.7 6.9 Others 28.2 1. High systolic blood pressure 74.7 1. Cardiovascular diseases 116.8 22.0 All age 2. Dietary risks 67.1 2. Neoplasms 80.7 15.2 3. High body-mass index 59.2 3. Diarrheal/LRI/other 60.6 11.5 4. High fasting plasma glucose 37.7 4. Unintentional injuries 47.8 9.1 5. Low glomerular filtration rate 36.6 5. Diabetes 41.5 7.8 6. Smoking 29.8 6. Neonatal disorders 29.2 5.6 7. Air pollution 27.0 7. Cirrhosis 24.0 4.5 Others 24.3 52

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 $16,032.00 Per capita GDP-PPP outlay on healthcare $1,454.00 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, 2012 54.7(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 402,521 200,452 202,068 34.08% 30.65% 38.34% 2.Neoplasms 215,260 115,637 99,622 18.22% 17.68% 18.90% 3.Diabetes 110,122 49,379 60,743 9.32% 7.55% 11.53% 4.Diarrhea/LRI/Other 81,989 41,184 40,805 6.94% 6.30% 7.74% 5.Chronic respiratory diseases 73,287 42,585 30,701 6.20% 6.51% 5.83% 6. Self-harm & intersonal violence 7.Neurological disorders 66,968 59,167 7,800 5.67% 9.05% 1.48% 56,204 28,345 27,859 4.76% 4.33% 5.29% 8. Transport injuries 47,482 37,881 9,600 4.02% 5.79% 1.82% 9. Unintentional injuries 37,352 23983 13,369 3.16% 3.67% 2.54% 10.Cirrhosis 33,445 25,021 8,425 2.83% 3.83% 1.60% 11. Digestive diseases 30,174 15,120 15,054 2.55% 2.31% 2.86% 12.Neonatal disorders 26,352 15,343 11,009 2.23% 2.35% 2.09% TOTAL 1,181,156 654,097 527,054 100.0% 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 2015. 37 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 56,651 43,423-23.35% Years lived with disability (YLD) 6,059 7,955 31.29% Years of life lost (YLL) 50,592 35,468-29.89% 1426 1,393-2.31% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 35,068 27,258-22.27% Years lived with disability (YLD) 3,299 4,121 24.92% Years of life lost (YLL) 31,769 23,137-27.17% 845 803-4.97% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 21,583 16,165-25.10% Years lived with disability (YLD) 2,760 3,834 38.91% Years of life lost (YLL) 18,823 12,331-34.49% 581 590 1.55% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 43,423 100% 7,955 100% 35,468 100% 1,393 100% 27,258 62.77% 4,121 51.80% 23,137 65.23% 803 57.65% 16,165 37.23% 3,834 48.20% 12,331 34.77% 590 42.35% 54

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 37.9 1. Neonatal disorders 176.4 48.7 2. Unsafe water, sanitation and handwashing 13.9 2. Other non-communicable 3. Unsafe sex 3.5 3. Diarrheal/LRI/other 51.8 14.3 4. Air pollution 3.3 4. Unintentional injuries 15.2 4.2 5. Smoking 1.7 5. Nutritional deficiencies 7.2 2.0 6. Alcohol and drug use 1.2 6. Diabetes 6.2 1.7 77.7 21.5 7. High fasting plasma glucose 0.7 7. Transport injuries 5.1 1.4 Others 6.2 Children under 5 years 1. Child and maternal malnutrition 44.2 1. Neonatal disorders 201.0 49.1 2. Unsafe water, sanitation and handwashing 16.1 2. Other non-communicable 3. Air pollution 3.8 3. Diarrheal/LRI/other 59.8 14.6 4. Unsafe sex 3.4 4. Unintentional injuries 17.5 4.3 5. Smoking 1.9 5. Nutritional deficiencies 8.4 2.0 58.1 20.8 6. Alcohol and drug use 1.4 6. Diabetes 7.1 1.7 7. High fasting plasma glucose 0.8 7. Transport injuries 6.1 1.5 Others 6.0 Children under 5 years 1. Child and maternal malnutrition 31.3 1. Neonatal disorders 150.7 48.2 2. Unsafe water, sanitation and handwashing 11.7 2. Other non-communicable 3. Unsafe sex 3.6 3. Diarrheal/LRI/other 43.6 14.0 4. Air pollution 2.7 4. Unintentional injuries 12.8 4.1 5. Smoking 1.5 5. Nutritional deficiencies 6.1 1.9 6. Alcohol and drug use 1.0 6. Diabetes 5.3 1.7 7. High fasting plasma glucose 0.6 70.0 7. Communicable, maternal, neonatal, and nutritional diseases 4.5 22.4 1.5 Others 6.2 55

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Transport injuries 2. Alcohol and drug use 1.2 2. Unintentional injuries 5.1 17.4 3. Low glomerular filtration rate 0.3 3. Neoplasms 4.3 14.7 4. High fasting plasma glucose 0.2 4. Diarrheal/LRI/other 4.2 14.5 5. Air pollution 0.2 5. Self-harm & intersonal violence 2.6 9.1 5.5 18.7 6. Unsafe sex 0.1 6. Other non-communicable 1.6 5.4 7. High systolic blood pressure 0.1 7. Cardiovascular diseases 1.5 5.2 Others 15.0 5 to 14 years of age 1. Alcohol and drug use 1.5 1. Unintentional injuries 7.1 20.5 2. Unsafe water, sanitation and handwashing 1.5 2. Transport injuries 3. Low glomerular filtration rate 0.3 3. Neoplasms 4.9 14.1 4. Air pollution 0.2 4. Diarrheal/LRI/other 4.6 13.2 5. High fasting plasma glucose 0.2 5. Self-harm & intersonal violence 3.6 10.4 6.8 19.8 6. Unsafe sex 0.1 6. Other non-communicable 1.6 4.7 7. Child and maternal malnutrition 0.1 7. Cardiovascular diseases 1.6 4.6 Others 12.7 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Transport injuries 2. Alcohol and drug use 0.9 2. Diarrheal/LRI/other 3.9 16.4 3. High fasting plasma glucose 0.3 3. Neoplasms 3.7 15.7 4. Low glomerular filtration rate 0.3 4. Unintentional injuries 3.0 12.6 5. Air pollution 0.2 5. Self-harm & intersonal violence 1.7 7.1 4.0 17.2 6. Unsafe sex 0.1 6. Other non-communicable 1.5 6.5 7. High systolic blood pressure 0.1 7. Diabetes 1.5 6.3 Others 18.2 56

Total population 15 to 49 years of age 1. Alcohol and drug use 43.7 1. Self-harm & intersonal violence 49.4 24.8 2. Dietary risks 25.7 2. Transport injuries 30.7 15.4 3. High systolic blood pressure 19.9 3. Cardiovascular diseases 27.5 13.8 4. High body-mass index 19.4 4. Neoplasms 26.2 13.1 5. Smoking 13.9 5. Unintentional injuries 10.3 5.2 6. High total cholesterol 10.3 6. Cirrhosis 9.6 4.8 7. Unsafe sex 8.4 7. HIV/AIDS 9.1 4.6 Others 18.4 15 to 49 years of age 1. Alcohol and drug use 75.7 1. Self-harm & intersonal violence 89.8 31.0 2. Dietary risks 31.2 2. Transport injuries 46.9 16.2 3. High systolic blood pressure 25.3 3. Cardiovascular diseases 36.8 12.7 4. High body-mass index 21.0 4. Neoplasms 24.0 8.3 5. Smoking 17.4 5 Unintentional injuries 18.1 6.3 6. High total cholesterol 13.7 6. Cirrhosis 15.3 5.3 7. High fasting plasma glucose 9.7 7. HIV/AIDS 12.5 4.3 Others 15.9 15 to 49 years of age 1. Dietary risks 20.3 1. Neoplasms 28.3 25.5 2. High body-mass index 17.8 2. Cardiovascular diseases 24.6 22.2 3. High systolic blood pressure 14.7 3. Self-harm & intersonal violence 9.6 8.6 4. Alcohol and drug use 12.3 4. Diabetes 9.0 8.1 5. Smoking 10.4 5. Transport injuries 8.3 7.5 6. Unsafe sex 7.8 6. Diarrheal/LRI/other 5.4 4.8 7. High total cholesterol 7.0 7. HIV/AIDS 4.2 3.8 Others 19.5 57

Total population 50 to 69 years of age 1. Dietary risks 315.9 1. Cardiovascular diseases 363.8 34.7 2. High systolic blood pressure 265.0 2. Neoplasms 264.7 25.3 3. High body-mass index 208.7 3. Diabetes 105.4 10.1 4. Smoking 184.3 4. Chronic respiratory diseases 51.2 4.9 5. High fasting plasma glucose 122.0 5. Cirrhosis 45.5 4.3 6. High total cholesterol 106.6 6. Diarrheal/LRI/other 42.3 4.0 7. Alcohol and drug use 97.0 7. Transport injuries 30.1 2.9 Others 13.8 50 to 69 years of age 1. Dietary risks 401.1 1. Cardiovascular diseases 459.7 34.2 2. High systolic blood pressure 336.4 2. Neoplasms 309.0 23.0 3. Smoking 260.7 3. Diabetes 112.9 8.4 4. High body-mass index 219.1 4. Cirrhosis 76.1 5.7 5. Alcohol and drug use 161.8 5. Chronic respiratory diseases 68.3 5.1 6. High fasting plasma glucose 141.2 6. Diarrheal/LRI/other 54.7 4.1 7. High total cholesterol 134.9 7. Transport injuries 49.2 3.7 Others 16.1 50 to 69 years of age 1. Dietary risks 240.2 1. Cardiovascular diseases 278.7 35.6 2. High systolic blood pressure 201.6 2. Neoplasms 225.4 28.8 3. High body-mass index 199.6 3. Diabetes 98.7 12.6 4. Smoking 116.5 4. Chronic respiratory diseases 36.1 4.6 5. High fasting plasma glucose 104.9 5. Diarrheal/LRI/other 31.3 4.0 6. High total cholesterol 81.5 6. Digestive diseases 20.9 2.7 7. Low glomerular filtration rate 53.1 7. Cirrhosis 18.3 2.3 Others 9.4 58

Total population 70 years of age and over 1. Dietary risks 1,492.5 1. Cardiovascular diseases 2,518.3 39.5 2. High systolic blood pressure 1,421.2 2. Neoplasms 984.7 15.4 3. High fasting plasma glucose 725.6 3. Diabetes 644.6 10.1 4. Smoking 704.5 4. Chronic respiratory diseases 531.0 8.3 5. High body-mass index 691.4 5. Diarrheal/LRI/other 512.0 8.0 6. Low glomerular filtration rate 465.5 6. Neurological disorders 469.2 7.8 7. High total cholesterol 439.8 7. Digestive diseases 175.5 2.8 Others 8.1 70 years of age and over 1. Dietary risks 1,598.1 1. Cardiovascular diseases 2,604.5 36.7 2. High systolic blood pressure 1,472.1 2. Neoplasms 1,280.4 18.0 3. Smoking 975.0 3. Chronic respiratory diseases 711.7 10.0 4. High fasting plasma glucose 694.4 4. Diabetes 612.5 8.6 5. High body-mass index 576.8 5. Neurological disorders 574.1 8.1 6. Low glomerular filtration rate 458.7 6. Diarrheal/LRI/other 522.5 7.4 7. High total cholesterol 390.1 7. Digestive diseases 176.4 2.5 Others 8.7 70 years of age and over 1. Dietary risks 1,415.1 1. Cardiovascular diseases 2,455.2 42.0 2. High systolic blood pressure 1,384.0 2. Neoplasms 768.0 13.1 3. High body-mass index 775.3 3. Diabetes 668.2 11.4 4. High fasting plasma glucose 748.4 4. Diarrheal/LRI/other 504.2 8.6 5. Smoking 506.3 5. Neurological disorders 439.1 7.5 6. High total cholesterol 476.2 6. Chronic respiratory diseases 398.6 6.8 7. Low glomerular filtration rate 470.4 7. Digestive diseases 174.8 3.0 Others 7.6 59

Total population 1. Dietary risks 139.4 1. Cardiovascular diseases 200.8 32.1 All age 2. High systolic blood pressure 124.3 2. Neoplasms 107.4 17.2 3. High body-mass index 79.0 3. Diabetes 54.9 8.8 4. Smoking 72.7 4. Diarrheal/LRI/other 40.9 6.5 5. High fasting plasma glucose 60.2 5. Chronic respiratory diseases 36.6 5.8 6. Alcohol and drug use 48.4 6. Self-harm & intersonal violence 33.4 5.3 7. High total cholesterol 44.8 7. Neurological disorders 28.0 4.5 Others 19.8 1. Dietary risks 148.0 1. Cardiovascular diseases 203.3 28.7 All age 2. High systolic blood pressure 129.2 2. Neoplasms 117.3 16.6 3. Alcohol and drug use 92.1 3. Self-harm & intersonal violence 60.0 8.5 4. Smoking 77.1 4. Diabetes 50.1 7.1 5. High body-mass index 70.5 5. Chronic respiratory diseases 43.2 6.1 6. High fasting plasma glucose 57.0 6. Diarrheal/LRI/other 41.8 5.9 7. Low glomerular filtration rate 45.3 7. Transport injuries 38.4 5.4 Others 21.8 1. Dietary risks 131.0 1. Cardiovascular diseases 198.3 36.3 All age 2. High systolic blood pressure 119.7 2. Neoplasms 97.8 17.9 3. High body-mass index 87.2 3. Diabetes 59.6 10.9 4. High fasting plasma glucose 63.2 4. Diarrheal/LRI/other 40.1 7.3 5. Smoking 54.0 5. Chronic respiratory diseases 30.1 5.5 6. High total cholesterol 44.3 6. Neurological disorders 27.3 5.0 7. Low glomerular filtration rate 37.9 7. Digestive diseases 14.8 2.7 Others 14.3 60

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 $43,033.00 Per capita GDP-PPP outlay on healthcare $4,759.00 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, 2012 32.6(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 44,338 31.6% 29.7% 33.4% 2.Neoplasms 78,983 42,005 36,978 30.1% 32.4% 27.9% 3.Neurological disorders 34,236 15,392 18,844 13.0% 11.9% 14.2% 4.Diabetes 17,723 8,574 9,150 6.8% 6.6% 6.9% 5.Chronic respiratory diseases 15,540 8,351 7,189 5.9% 6.4% 5.4% 6.Diarrheal/LRI/Other 9,939 4,421 5,518 3.8% 3.4% 4.2% 7.Unintentional injuries 8,084 3,951 4,132 3.1% 3.0% 3.1% 8.Digestive diseases 6,075 2,409 3,666 2.3% 1.9% 2.8% 9. Self-harm & intersonal violence 4,798 3603 1,195 1.8% 2.8% 0.9% 10.Cirrhosis 4,144 2,494 1650 1.6% 1.9% 1.2% TOTAL 262,411 129,752 132,660 100.00% 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 2015. 39 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 5,059,696 5,574,289 10.17% Years lived with disability (YLD) 971,018 1,555,478 60.19% Years of life lost (YLL) 4,088,680 4,018,813-1.71% 235182 269,771 14.71% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 3,267,990 3,302,180 1.05% Years lived with disability (YLD) 571,336 835,453 46.23% Years of life lost (YLL) 2,696,656 2,466,729-8.53% 134,728 141,085 4.72% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,791,706 2,272,109 26.81% Years lived with disability (YLD) 399,682 720,025 80.15% Years of life lost (YLL) 1,392,024 1,552,084 11.50% 100,454 128,686 28.10% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 5,574,289 100% 1,555,478 100% 4,018,813 100% 269,771 100% 3,302,180 59.24% 835,453 53.71% 2,466,729 61.38% 141,085 52.30% 2,272,109 40.76% 720,025 46.29% 1,552,084 38.62% 128,686 47.70% 62

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 1.1 1. Neonatal disorders 49.0 44.0 2. Alcohol and drug use 0.5 2. Other non-communicable 36.1 32.4 3. Low glomerular filtration rate 0.2 3. Unintentional injuries 6.5 5.8 4. High fasting plasma glucose 0.2 4. Diarrheal/LRI/other 4.7 4.3 5. Air pollution 0.2 5. Diabetes 3.5 3.2 6. Unsafe water, sanitation and handwashing 0.2 6. Neoplasms 7. Unsafe sex 0.1 7. Transport injuries 2.6 2.3 3.4 3.1 Others 5.0 Children under 5 years 1. Child and maternal malnutrition 1.3 1. Neonatal disorders 53.2 44.0 2. Alcohol and drug use 0.5 2. Other non-communicable 38.6 31.8 3. Low glomerular filtration rate 0.3 3. Unintentional injuries 7.6 6.2 4. High fasting plasma glucose 0.2 4. Diarrheal/LRI/other 5.3 4.3 5. Air pollution 0.2 5. Diabetes 4.1 3.4 6. Unsafe water, sanitation and handwashing 0.2 6. Neoplasms 7. Unsafe sex 0.1 7. Transport injuries 2.7 2.2 3.7 3.0 Others 5.1 Children under 5 years 1. Child and maternal malnutrition 1.0 1. Neonatal disorders 44.5 44.1 2. Alcohol and drug use 0.4 2. Other non-communicable 33.5 33.2 3. Low glomerular filtration rate 0.2 3. Unintentional injuries 5.3 5.3 4. Air pollution 0.2 4. Diarrheal/LRI/other 4.2 4.2 5. High fasting plasma glucose 0.2 5. Neoplasms 3.1 3.1 6. Unsafe water, sanitation and handwashing 0.2 6. Diabetes 7. Unsafe sex 0.1 7. Transport injuries 2.4 2.4 2.9 2.9 Others 4.9 63

Total population 5 to 14 years of age 1. Alcohol and drug use 0.3 1. Neoplasms 2.7 25.3 2. Low glomerular filtration rate 0.1 2. Transport injuries 2.2 20.5 3. High fasting plasma glucose 0.1 3. Unintentional injuries 1.6 15.5 4. Sexual abuse and violence 0.0 4. Other non-communicable 1.0 9.0 5. Unsafe water, sanitation and handwashing 0.0 5. Self-harm & intersonal violence 6. Air pollution 0.0 6. Diabetes 0.7 6.8 0.8 7.3 7. High systolic blood pressure 0.0 7. Diarrheal/LRI/other 0.5 4.4 Others 11.3 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Neoplasms 3.0 25.0 2. Low glomerular filtration rate 0.0 2. Transport injuries 2.5 20.8 3. High fasting plasma glucose 0.0 3. Unintentional injuries 2.2 17.8 4. Sexual abuse and violence 0.0 4. Self-harm & intersonal violence 1.0 8.2 5. Unsafe water, sanitation and handwashing 0.0 5. Other non-communicable 6. Air polution 0.0 6. Diabetes 0.8 6.3 1.0 8.1 7. High systolic blood pressure 0.0 7. Neurological disorders 0.5 4.0 Others 10.0 5 to 14 years of age 1. Alcohol and drug use 0.3 1. Neoplasms 2.3 25.8 2. Low glomerular filtration rate 0.1 2. Transport injuries 1.8 20.0 3. High fasting plasma glucose 0.1 3. Unintentional injuries 1.1 12.2 4. Sexual abuse and violence 0.0 4. Other non-communicable 0.9 10.2 5. Unsafe water, sanitation and handwashing 0.0 5. Diabetes 6. Air pollution 0.0 6. Self-harm & intersonal violence 0.5 6.0 0.7 7.4 7. High systolic blood pressure 0.0 7. Diarrheal/LRI/other 0.5 5.4 Others 13.0 64

Total population 15 to 49 years of age 1. Alcohol and drug use 18.3 1. Neoplasms 23.7 27.7 2. Dietary risks 9.9 2. Self-harm & intersonal violence 16.1 18.8 3. Smoking 8.3 3. Cardiovascular diseases 10.8 12.6 4. High body-mass index 7.7 4. Transport injuries 9.9 11.5 5. High total cholesterol 5.6 5. Mental and substance use 5.7 6.6 6. High systolic blood pressure 4.8 6. Unintentional injuries 4.5 5.2 7. High fasting plasma glucose 3.1 7. Diabetes 3.6 4.2 Others 13.5 15 to 49 years of age 1. Alcohol and drug use 26.1 1. Self-harm & intersonal violence 24.2 22.7 2. Dietary risks 13.8 2. Neoplasms 21.2 19.9 3. High body-mass index 10.0 3. Cardiovascular diseases 15.0 14.0 4. Smoking 9.4 4. Transport injuries 14.1 13.3 5. High total cholesterol 8.8 5 Mental and substance use 8.0 7.5 6. High systolic blood pressure 7.2 6. Unintentional injuries 6.9 6.4 7. High fasting plasma glucose 4.3 7. Diabetes 4.2 3.9 Others 12.3 15 to 49 years of age 1. Alcohol and drug use 10.3 1. Neoplasms 26.3 49.9 2. Smoking 7.1 2. Self-harm & intersonal violence 7.7 12.0 3. Dietary risks 5.9 3. Cardiovascular diseases 6.5 10.1 4. High body-mass index 5.3 4. Transport injuries 5.5 8.6 5. Sexual abuse and violence 3.8 5. Mental and substance use 3.4 5.2 6. High total cholesterol 2.4 6. Diabetes 2.9 4.5 7. High systolic blood pressure 2.3 7. Unintentional injuries 2.0 3.1 Others 6.5 65

Total population 50 to 69 years of age 1. Smoking 164.6 1. Neoplasms 307.1 48.7 2. Dietary risks 133.6 2. Cardiovascular diseases 144.5 22.9 3. High body-mass index 94.2 3. Diabetes 35.7 5.7 4. High systolic blood pressure 75.4 4. Chronic respiratory diseases 25.4 4.0 5. High total cholesterol 57.8 5. Transport injuries 21.3 3.4 6. Alcohol and drug use 52.5 6. Cirrhosis 21.2 3.4 7. High fasting plasma glucose 46.1 7. Self-harm & intersonal violence 16.2 2.6 Others 9.5 50 to 69 years of age 1. Smoking 202.8 1. Neoplasms 336.2 44.2 2. Dietary risks 189.6 2. Cardiovascular diseases 200.8 26.4 3. High body-mass index 119.0 3. Diabetes 43.8 5.8 4. High systolic blood pressure 105.2 4. Cirrhosis 29.2 3.8 5. High total cholesterol 83.9 5. Chronic respiratory diseases 28.5 3.7 6. Alcohol and drug use 71.3 6. Self-harm & intersonal violence 24.0 3.2 7. High fasting plasma glucose 63.2 7. Neurological disorders 23.5 3.1 Others 9.8 50 to 69 years of age 1. Smoking 127.5 1. Neoplasms 278.9 55.1 2. Dietary risks 79.1 2. Cardiovascular diseases 89.6 17.7 3. High body-mass index 70.1 3. Diabetes 27.8 5.5 4. High systolic blood pressure 46.5 4. Chronic respiratory diseases 22.4 4.4 5. Alcohol and drug use 34.2 5. Neurological disorders 19.2 3.8 6. High total cholesterol 32.4 6. Cirrhosis 13.3 2.6 7. High fasting plasma glucose 29.4 7. Digestive diseases 9.4 1.9 Others 8.9 66

Total population 70 years of age and over 1. Dietary risks 1,025.9 1. Cardiovascular diseases 1,886.8 34.2 2. Smoking 796.3 2. Neurological disorders 1,294.4 23.5 3. High systolic blood pressure 777.3 3. Neurological disorders 887.2 16.1 4. High body-mass index 496.9 4. Diabetes 382.7 6.9 5. High fasting plasma glucose 459.0 5. Chronic respiratory diseases 362.7 6.6 6. High total cholesterol 449.7 6. Diarrheal/LRI/other 239.6 4.3 7. Low glomerular filtration rate 327.8 7. Unintentional injuries 168.5 3.1 Others 5.3 70 years of age and over 1. Dietary risks 1,127.4 1. Cardiovascular diseases 1,815.0 31.0 2. Smoking 1,021.6 2. Neoplasms 1,600.7 27.3 3. High systolic blood pressure 752.3 3. Neurological disorders 908.7 15.5 4. High body-mass index 505.8 4. Chronic respiratory diseases 449.7 7.7 5. High fasting plasma glucose 492.9 5. Diabetes 398.0 6.8 6. High total cholesterol 402.4 6. Diarrheal/LRI/other 236.4 4.0 7. Low glomerular filtration rate 303.3 7. Unintentional injuries 161.4 2.8 Others 5.0 70 years of age and over 1. Dietary risks 948.7 1. Cardiovascular diseases 1,941.3 37.0 2. High systolic blood pressure 796.3 2. Neoplasms 1,061.7 20.2 3. Smoking 625.1 3. Neurological disorders 870.9 16.6 4. High body-mass index 490.2 4. Diabetes 371.1 7.1 5. High total cholesterol 485.7 5. Chronic respiratory diseases 296.6 5.7 6. High fasting plasma glucose 433.2 6. Diarrheal/LRI/other 242.0 4.6 7. Low glomerular filtration rate 346.4 7. Unintentional injuries 174.0 3.3 Others 5.6 67

Total population 1. Dietary risks 143.5 1. Cardiovascular diseases 234.0 30.3 All age 2. Smoking 127.5 2. Neoplasms 223.0 28.9 3. High systolic blood pressure 100.7 3. Neurological disorders 96.7 12.5 4. High body-mass index 78.6 4. Diabetes 50.0 6.5 5. High total cholesterol 63.3 5. Chronic respiratory diseases 43.9 5.7 6. High fasting plasma glucose 60.0 6. Diarrheal/LRI/other 28.1 3.6 7. Alcohol and drug use 39.2 7. Unintentional injuries 22.8 3.0 Others 9.5 1. Dietary risks 155.1 1. Neoplasms 238.9 30.9 All age 2. Smoking 147.1 2. Cardiovascular diseases 219.3 28.4 3. High systolic blood pressure 97.0 3. Neurological disorders 87.5 11.3 4. High body-mass index 80.3 4. Diabetes 48.8 6.3 5. High fasting plasma glucose 61.9 5. Chronic respiratory diseases 47.5 6.1 6. High total cholesterol 61.5 6. Diarrheal/LRI/other 25.1 3.3 7. Alcohol and drug use 48.3 7. Unintentional injuries 22.5 2.9 Others 10.8 1. Dietary risks 132.0 1. Cardiovascular diseases 248.6 32.3 All age 2. Smoking 108.3 2. Neoplasms 207.3 26.9 3. High systolic blood pressure 104.3 3. Neurological disorders 105.6 13.7 4. High body-mass index 76.9 4. Diabetes 51.3 6.7 5. High total cholesterol 65.1 5. Chronic respiratory diseases 40.3 5.2 6. High fasting plasma glucose 58.2 6. Diarrheal/LRI/other 30.9 4.0 7. Low glomerular filtration rate 42.8 7. Unintentional injuries 23.2 3.0 Others 8.1 68

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) 41 70 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 $21,913.00 Per capita GDP-PPP outlay on healthcare $1,678.00 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, 2012 52.1(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 15,287 28.4% 26.7% 30.1% 2.Neoplasms 26,777 13,898 12,879 25.4% 25.5% 25.4% 3.Nerological disorders 10,042 3,806 6,237 9.5% 7.0% 12.3% 4.Diabetes 8,475 4,009 4,466 8.0% 7.3% 8.8% 5.Chronic respiratory diseases 6,434 3,395 3,039 6.1% 6.2% 6.0% 6.Diarrheal/LRI/Other 5,994 2,903 3,091 5.7% 5.3% 6.1% 7.Cirrhosis 4,736 3,329 1,407 4.5% 6.1% 2.8% 8. Self-harm & intersonal violence 9. Unintentional injuries 3,094 2,609 485 2.9% 4.8% 1.0% 3,013 1963 1,050 2.9% 3.6% 2.1% 10. Digestive diseases 2,827 1,293 1534 2.7% 2.4% 3.0% 11.Transport injuries 2,682 2,112 570 2.5% 3.9% 1.1% 12. Other noncommunicable 1,347 659 688 1.3% 1.2% 1.4% TOTAL 105,289 54,557 50,733 100.0% 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 2015. 41 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 2,026,966 2,313,538 14.14% Years lived with disability (YLD) 372,159 594,459 59.73% Years of life lost (YLL) 1,654,808 1,719,078 3.88% 76576 91,850 19.95% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,314,708 1,470,067 11.82% Years lived with disability (YLD) 235,545 345,621 46.73% Years of life lost (YLL) 1,079,164 1,124,445 4.20% 43,966 52,676 19.81% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 712,258 843,471 18.42% Years lived with disability (YLD) 136,614 248,838 82.15% Years of life lost (YLL) 575,644 594,633 3.30% 32,610 39,174 20.13% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 2,313,538 100% 594,459 100% 1,719,078 100% 91,850 100% 1,470,067 63.54% 345,621 58.14% 1,124,445 65.41% 52,676 57.35% 843,471 36.46% 248,838 41.86% 594,633 34.59% 39,174 42.65% 70

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 7.0 1. Other non-communicable 65.8 43.9 2. Unsafe water, sanitation and handwashing 1.2 2. Neonatal disorders 3. Air pollution 1.1 3. Diarrheal/LRI/other 15.3 10.2 4. Unsafe sex 0.8 4. Unintentional injuries 7.6 5.0 5. Alcohol and drug use 0.5 5. Neoplasms 3.5 2.3 6. Smoking 0.5 6. Diabetes 3.0 2.0 45.1 30.2 7. Low glomerular filtration rate 0.4 7. Transport injuries 2.3 1.5 Others 5.0 Children under 5 years 1. Child and maternal malnutrition 7.8 1. Other non-communicable 69.2 42.5 2. Air pollution 1.2 2. Neonatal disorders 50.1 30.8 3. Unsafe water, sanitation and handwashing 1.2 3. Diarrheal/LRI/other 4. Unsafe sex 0.8 4. Unintentional injuries 8.9 5.4 5. Alcohol and drug use 0.6 5. Neoplasms 4.0 2.4 16.9 10.4 6. Smoking 0.5 6. Diabetes 3.4 2.1 7. Low glomerular filtration rate 0.5 7. Transport injuries 2.6 1.6 Others 4.7 Children under 5 years 1. Child and maternal malnutrition 6.2 1. Other non-communicable 62.3 45.5 2. Unsafe water, sanitation and handwashing 1.1 2. Neonatal disorders 3. Air pollution 1.0 3. Diarrheal/LRI/other 13.6 9.9 4. Unsafe sex 0.8 4. Unintentional injuries 6.2 4.5 5. Alcohol and drug use 0.5 5. Neoplasms 2.9 2.2 40.0 29.3 6. Smoking 0.4 6. Diabetes 2.5 1.8 7. Low glomerular filtration rate 0.4 7. Transport injuries 2.0 1.5 Others 5.3 71

Total population 5 to 14 years of age 1. Alcohol and drug use 0.5 1. Neoplasms 3.8 23.4 2. Unsafe water, sanitation and handwashing 0.2 2. Transport injuries 3. Low glomerular filtration rate 0.2 3. Unintentional injuries 2.1 13.3 4. High systolic blood pressure 0.1 4. Other non-communicable 1.6 10.1 5. Air pollution 0.1 5. Self-harm & intersonal violence 1.4 8.8 3.0 19.0 6. Sexual abuse and violence 0.1 6. Diarrheal/LRI/other 1.3 8.0 7. Unsafe sex 0.1 7. Diabetes 0.7 4.6 Others 12.8 5 to 14 years of age 1. Alcohol and drug use 0.7 1. Neoplasms 4.4 23.7 2. Unsafe water, sanitation and handwashing 0.2 2. Transport injuries 3. Low glomerular filtration rate 0.2 3. Unintentional injuries 2.9 15.5 4. High fasting plasma glucose 0.1 4. Self-harm & intersonal violence 1.8 9.8 5. Air pollution 0.1 5. Other non-communicable 1.6 8.5 3.6 19.7 6. Sexual abuse and violence 0.1 6. Diarrheal/LRI/other 1.3 7.1 7. Unsafe sex 0.1 7. Diabetes 0.8 4.2 Others 11.6 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Neoplasms 3.1 23.0 2. Low glomerular filtration rate 0.2 2. Transport injuries 2.4 18.0 3. Unsafe water, sanitation and handwashing 0.2 3. Other non-communicable 4. High fasting plasma glucose 0.1 4. Unintentional injuries 1.4 10.3 5. Air pollution 0.1 5. Diarrheal/LRI/other 1.2 9.1 1.7 12.3 6. Sexual abuse and violence 0.1 6. Self-harm & intersonal violence 1.0 7.4 7. High systolic blood pressure 0.1 7. Diabetes 0.7 5.3 Others 14.6 72

Total population 15 to 49 years of age 1. Alcohol and drug use 25.2 1. Neoplasms 24.1 20.7 2. Dietary risks 11.2 2. Self-harm & intersonal violence 22.2 19.1 3. High body-mass index 10.5 3. Cardiovascular diseases 14.9 12.8 4. High systolic blood pressure 9.6 4. Transport injuries 14.9 12.8 5. Smoking 8.2 5. Unintentional injuries 9.2 7.9 6. High total cholesterol 5.1 6. Cirrhosis 8.2 7.0 7. Sexual abuse and violence 4.2 7. Diabetes 4.3 3.7 Others 15.9 15 to 49 years of age 1. Alcohol and drug use 41.9 1. Self-harm & intersonal violence 37.6 23.2 2. Dietary risks 15.2 2. Transport injuries 24.7 15.2 3. High systolic blood pressure 13.7 3. Neoplasms 21.3 13.1 4. High body-mass index 12.6 4. Cardiovascular diseases 20.2 12.5 5. Smoking 11.1 5 Unintentional injuries 15.9 9.8 6. High total cholesterol 8.0 6. Cirrhosis 13.3 8.2 7. High fasting plasma glucose 4.8 7. Mental and substance use 5.7 3.5 Others 14.5 15 to 49 years of age 1. High body-mass index 8.4 1. Neoplasms 26.9 38.5 2. Alcohol and drug use 8.2 2. Cardiovascular diseases 9.6 13.7 3. Dietary risks 7.1 3. Self-harm & intersonal violence 6.6 9.5 4. High systolic blood pressure 5.4 4. Transport injuries 5.0 7.1 5. Smoking 5.4 5. Diabetes 4.0 5.6 6. Unsafe sex 5.1 6. Cirrhosis 3.1 4.4 7. Sexual abuse and violence 2.8 7. Unintentional injuries 2.5 3.5 Others 6.5 73

Total population 50 to 69 years of age 1. High systolic blood pressure 149.7 1. Neoplasms 274.0 35.3 2. Dietary risks 149.7 2. Cardiovascular diseases 193.5 24.9 3. High body-mass index 143.2 3. Cirrhosis 70.6 9.1 4. Smoking 120.7 4. Diabetes 60.2 7.8 5. Alcohol and drug use 110.5 5. Chronic respiratory diseases 30.8 4.0 6. High fasting plasma glucose 68.2 6. Transport injuries 22.2 2.9 7. High total cholesterol 48.4 7. Diarrheal/LRI/other 20.8 2.7 Others 13.5 50 to 69 years of age 1. Dietary risks 207.9 1. Neoplasms 298.4 30.3 2. High systolic blood pressure 203.5 2. Cardiovascular diseases 260.2 26.4 3. Smoking 176.3 3. Cirrhosis 108.2 11.0 4. Alcohol and drug use 166.3 4. Diabetes 67.5 6.8 5. High body-mass index 163.6 5. Chronic respiratory diseases 38.7 3.9 6. High fasting plasma glucose 88.1 6. Transport injuries 37.0 3.8 7. High total cholesterol 68.2 7. Self-harm & intersonal violence 36.1 3.7 Others 14.2 50 to 69 years of age 1. High body-mass index 124.1 1. Neoplasms 251.0 43.2 2. High systolic blood pressure 99.2 2. Cardiovascular diseases 130.9 22.5 3. Dietary risks 95.1 3. Diabetes 53.4 9.2 4. Smoking 68.5 4. Cirrhosis 35.3 6.1 5. Alcohol and drug use 58.2 5. Chronic respiratory diseases 23.3 4.0 6. High fasting plasma glucose 49.5 6. Neurological disorders 17.4 3.0 7. Low glomerular filtration rate 30.7 7. Digestive diseases 16.3 2.8 Others 9.1 74

Total population 70 years of age and over 1. High systolic blood pressure 1,207.6 1. Cardiovascular diseases 1,863.9 31.6 2. Dietary risks 910.4 2. Neoplasms 1,274.2 21.6 3. High body-mass index 640.5 3. Neurological disorders 784.9 13.3 4. Smoking 571.3 4. Diabetes 508.1 8.6 5. High fasting plasma glucose 482.5 5. Chronic respiratory diseases 446.6 7.6 6. Low glomerular filtration rate 339.8 6. Diarrheal/LRI/other 409.2 6.9 7. Alcohol and drug use 309.0 7. Digestive diseases 168.0 2.9 Others 7.6 70 years of age and over 1. High systolic blood pressure 1,300.8 1. Cardiovascular diseases 1,928.6 29.6 2. Dietary risks 1,067.7 2. Neoplasms 1,625.3 25.0 3. Smoking 860.3 3. Neurological disorders 689.9 10.6 4. High body-mass index 658.1 4. Chronic respiratory diseases 554.2 8.5 5. High fasting plasma glucose 570.5 5. Diabetes 547.1 8.4 6. Alcohol and drug use 453.0 6. Diarrheal/LRI/other 438.1 6.7 7. Low glomerular filtration rate 357.2 7. Cirrhosis 183.8 2.8 Others 8.4 70 years of age and over 1. High systolic blood pressure 1,142.6 1. Cardiovascular diseases 1,818.8 33.2 2. Dietary risks 800.8 2. Neoplasms 1,029.3 18.8 3. High body-mass index 628.2 3. Neurological disorders 851.2 15.5 4. High fasting plasma glucose 421.2 4. Diabetes 480.9 8.8 5. Smoking 369.8 5. Diarrheal/LRI/other 389.0 7.1 6. Low glomerular filtration rate 327.7 6. Chronic respiratory diseases 371.5 6.8 7. High total cholesterol 264.7 7. Digestive diseases 167.9 3.1 Others 6.8 75

Total population 1. High systolic blood pressure 114.6 1. Cardiovascular diseases 169.5 27.4 All age 2. Dietary risks 95.8 2. Neoplasms 152.0 24.6 3. High body-mass index 76.3 3. Neurological disorders 57.0 9.2 4. Smoking 66.1 4. Diabetes 48.1 7.8 5. Alcohol and drug use 55.7 5. Chronic respiratory diseases 36.5 5.9 6. High fasting plasma glucose 47.3 6. Diarrheal/LRI/other 34.0 5.5 7. Low glomerular filtration rate 30.9 7. Cirrhosis 26.9 4.4 Others 15.2 1. High systolic blood pressure 118.3 1. Cardiovascular diseases 167.3 25.8 All age 2. Dietary risks 107.1 2. Neoplasms 159.5 24.5 3. Smoking 87.4 3. Diabetes 46.0 7.1 4. Alcohol and drug use 79.7 4. Neurological disorders 43.7 6.7 5. High body-mass index 74.6 5. Chronic respiratory diseases 39.0 6.0 6. High fasting plasma glucose 51.0 6. Cirrhosis 38.2 5.9 7. High total cholesterol 30.3 7. Diarrheal/LRI/other 33.3 5.1 Others 18.9 1. High systolic blood pressure 110.9 1. Cardiovascular diseases 171.7 29.3 All age 2. Dietary risks 84.6 2. Neoplasms 144.7 24.6 3. High body-mass index 77.9 3. Neurological disorders 70.0 11.9 4. Smoking 45.2 4. Diabetes 50.2 8.6 5. High fasting plasma glucose 43.7 5. Diarrheal/LRI/other 34.7 5.9 6. Low glomerular filtration rate 32.6 6. Chronic respiratory diseases 34.1 5.8 7. Alcohol and drug use 32.2 7. Digestive diseases 17.2 2.9 Others 10.9 76

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) 43 67 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 $12,454.00 Per capita GDP-PPP outlay on healthcare $843.00 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, 2012 55.9(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 36,406 31.33% 28.19% 36.31% 2. Neoplasms 44,294 22,168 22,126 19.09% 17.21% 22.07% 3. Self-harm & intersonal violence 28,007 22,137 2,869 12.07% 17.19% 2.86% 4.Diabetes 17,974 8,446 9,529 7.75% 6.56% 9.50% 5. Chronic respiratory diseases 17,830 9,655 8,175 7.68% 7.50% 8.15% 6. Diarrheal/LRI/Other 12,016 6,284 5,733 5.18% 4.88% 5.72% 7. Neurological disorders 9,928 4,720 5,208 4.28% 3.66% 5.19% 8. Transport injuries 9,529 7,533 1,996 4.11% 5.85% 1.99% 9. Unintentional injuries 7,803 5492 2,311 3.36% 4.26% 2.30% 10. Digestive diseases 6,554 3,263 3291 2.82% 2.53% 3.28% 11. Other noncommunicable 5,415 2,784 2631 2.33% 2.16% 2.62% TOTAL 232,060 128,787 100,275 100.0% 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 2015. 43 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 6,937,474 6,647,776-4.18% Years lived with disability (YLD) 929,929 941,027 1.19% Years of life lost (YLL) 6,007,544 5,706,941-5.00% 179089 237,411 32.57% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 4,718,138 4,664,013-1.15% Years lived with disability (YLD) 539,735 864,184 60.11% Years of life lost (YLL) 4,178,402 3,800,021-9.06% 112,556 137,552 22.21% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 2,219,336 1,983,763-10.61% Years lived with disability (YLD) 390,194 76,843-80.31% Years of life lost (YLL) 1,829,142 1,906,920 4.25% 66,533 99,859 50.09% Years of healthy life lost, centage growth by sex DALY YLD YLL DEATHS CONCEPT 2010 % 2010 % 2010 % 2010 % Total 6,647,776 100% 941,027 100% 5,706,941 100% 237,411 100% 4,664,013 70.20% 864,184 91.80% 3,800,021 66.60% 137,552 57.90% 1,983,763 29.80% 76,543 8.10% 1,906,920 33.40% 99,859 42.10% 78

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 54.0 1. Neonatal disorders 113.8 31.4 2. Unsafe water, sanitation and handwashing 18.3 2. Other non-communicable 3. Air pollution 5.8 3. Diarrheal/LRI/other 68.8 19.0 4. Unsafe sex 3.2 4. Unintentional injuries 28.2 7.8 5. Smoking 1.7 5. Nutritional deficiencies 15.5 4.3 6. Alcohol and drug use 1.5 6. Neoplasms 9.3 2.6 83.1 22.9 7. Low glomerular filtration rate 1.5 7. Transport injuries 7.7 2.1 Others 10.0 Children under 5 years 1. Child and maternal malnutrition 58.5 1. Neonatal disorders 128.2 32.3 2. Unsafe water, sanitation and handwashing 20.0 2. Other non-communicable 3. Air pollution 6.3 3. Diarrheal/LRI/other 75.2 19.0 4. Unsafe sex 3.1 4. Unintentional injuries 31.7 8.0 5. Smoking 1.7 5. Nutritional deficiencies 16.0 4.0 88.1 22.2 6. Alcohol and drug use 1.6 6. Neoplasms 10.1 2.5 7. Low glomerular filtration rate 1.6 7. Transport injuries 8.7 2.2 Others 9.8 Children under 5 years 1. Child and maternal malnutrition 49.3 1. Neonatal disorders 98.6 30.1 2. Unsafe water, sanitation and handwashing 16.6 2. Other non-communicable 3. Air pollution 5.2 3. Diarrheal/LRI/other 62.2 19.0 4. Unsafe sex 3.3 4. Unintentional injuries 24.6 7.6 5. Smoking 1.7 5. Nutritional deficiencies 14.9 4.6 77.8 23.8 6. Alcohol and drug use 1.4 6. Neoplasms 8.5 2.6 7. Low glomerular filtration rate 1.3 7. Transport injuries 6.8 2.1 Others 10.3 79

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Neoplasms 2. Alcohol and drug use 0.9 2. Unintentional injuries 5.6 16.0 3. Low glomerular filtration rate 0.5 3. Transport injuries 5.4 15.4 4. Air pollution 0.2 4. Self-harm & intersonal violence 5.2 14.8 5. High fasting plasma glucose 0.2 5. Diarrheal/LRI/other 4.3 12.2 5.6 16.0 6. High systolic blood pressure 0.2 6. Other non-communicable 1.9 5.4 7. Unsafe sex 0.1 7. Cardiovascular diseases 1.6 4.6 Others 15.7 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.6 1. Unintentional injuries 2. Alcohol and drug use 1.2 2. Transport injuries 6.9 16.9 3. Low glomerular filtration rate 0.4 3. Self-harm & intersonal violence 6.5 16.2 4. Air pollution 0.2 4. Neoplasms 6.4 15.7 5. High fasting plasma glucose 0.2 5. Diarrheal/LRI/other 4.5 11.1 7.4 18.2 6. High systolic blood pressure 0.1 6. Other non-communicable 1.8 4.5 7. Unsafe sex 0.1 7. Cardiovascular diseases 1.6 4.0 Others 13.4 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Neoplasms 2. Alcohol and drug use 0.7 2. Diarrheal/LRI/other 4.0 13.8 3. Low glomerular filtration rate 0.5 3. Transport injuries 3.8 13.1 4. High fasting plasma glucose 0.3 4. Self-harm & intersonal violence 3.7 12.9 5. Air pollution 0.2 5. Unintentional injuries 3.7 12.7 4.8 16.5 6. High systolic blood pressure 0.2 6. Other non-communicable 2.0 6.8 7. Unsafe sex 0.1 7. Cardiovascular diseases 1.6 5.3 Others 18.9 80

Total population 15 to 49 years of age 1. Alcohol and drug use 27.0 1. Self-harm & intersonal violence 81.3 41.9 2. Dietary risks 17.1 2. Neoplasms 24.8 12.8 3. High body-mass index 12.1 3. Transport injuries 21.8 11.3 4. High systolic blood pressure 10.0 4. Cardiovascular diseases 19.0 9.8 5. Unsafe sex 8.2 5. Unintentional injuries 10.6 5.4 6. High total cholesterol 6.4 6. HVI/AIDS 7.5 3.9 7. Smoking 6.0 7. Diabetes 6.6 3.4 Others 11.5 15 to 49 years of age 1. Alcohol and drug use 47.9 1. Self-harm & intersonal violence 148.5 50.4 2. Dietary risks 21.6 2. Transport injuries 37.6 12.8 3. High body-mass index 13.5 3. Cardiovascular diseases 23.4 7.9 4. High systolic blood pressure 13.3 4. Neoplasms 22.7 7.7 5. Unsafe sex 9.4 5 Unintentional injuries 18.6 6.3 6. High total cholesterol 8.9 6. HVI/AIDS 12.3 4.2 7. Smoking 8.7 7. Diabetes 7.0 2.4 Others 8.3 15 to 49 years of age 1. Dietary risks 12.7 1. Neoplasms 26.9 28.1 2. High body-mass index 10.7 2. Self-harm & intersonal violence 15.6 16.4 3. Unsafe sex 7.0 3. Cardiovascular diseases 14.7 15.4 4. High systolic blood pressure 6.8 4. Transport injuries 6.5 6.8 5. Alcohol and drug use 6.7 5. Diabetes 6.1 6.4 6. High total cholesterol 4.0 6. Maternal disorders 4.4 4.7 7. High fasting plasma glucose 3.8 7. Diarrheal/LRI/other 3.7 3.9 Others 18.5 81

Total population 50 to 69 years of age 1. Dietary risks 256.2 1. Cardiovascular diseases 271.2 32.7 2. High systolic blood pressure 185.7 2. Neoplasms 235.2 28.4 3. High body-mass index 159.0 3. Diabetes 79.2 9.6 4. Smoking 106.3 4. Chronic respiratory diseases 49.7 6.0 5. High fasting plasma glucose 81.0 5. Self-harm & intersonal violence 35.7 4.3 6. High total cholesterol 69.2 6. Transport injuries 25.7 3.1 7. Air pollution 60.2 7. Digestive diseases 24.4 2.9 Others 13.0 50 to 69 years of age 1. Dietary risks 334.9 1. Cardiovascular diseases 342.1 33.2 2. High systolic blood pressure 233.6 2. Neoplasms 248.1 24.1 3. High body-mass index 170.6 3. Diabetes 86.4 8.4 4. Smoking 157.9 4. Chronic respiratory diseases 65.5 6.3 5. High fasting plasma glucose 93.0 5. Self-harm & intersonal violence 65.4 6.3 6. High total cholesterol 88.8 6. Transport injuries 42.2 4.1 7. Air pollution 75.2 7. Cirrhosis 34.1 3.3 Others 14.3 50 to 69 years of age 1. Dietary risks 187.2 1. Neoplasms 223.9 34.4 2. High body-mass index 148.8 2. Cardiovascular diseases 208.9 32.1 3. High systolic blood pressure 143.7 3. Diabetes 72.8 11.2 4. High fasting plasma glucose 70.5 4. Chronic respiratory diseases 35.8 5.5 5. Smoking 61.0 5. Digestive diseases 19.8 3.0 6. High total cholesterol 51.9 6. Diarrheal/LRI/other 18.0 2.8 7. Low glomerular filtration rate 47.0 7. Cirrhosis 14.6 2.2 Others 8.8 82

Total population 70 years of age and over 1. Dietary risks 1,687.2 1. Cardiovascular diseases 2,572.0 40.5 2. High systolic blood pressure 1,466.7 2. Neoplasms 1,067.0 16.8 3. Smoking 765.9 3. Chronic respiratory diseases 719.0 11.3 4. High body-mass index 652.2 4. Diabetes 543.6 8.6 5. High fasting plasma glucose 536.9 5. Neurological disorders 448.2 7.1 6. Air pollution 473.1 6. Diarrheal/LRI/other 298.7 4.7 7. Low glomerular filtration rate 444.0 7. Digestive diseases 213.9 3.4 Others 7.6 70 years of age and over 1. Dietary risks 1,960.9 1. Cardiovascular diseases 2,739.4 38.4 2. High systolic blood pressure 1,567.6 2. Neoplasms 1,312.0 18.4 3. Smoking 1,034.7 3. Chronic respiratory diseases 883.0 12.4 4. High body-mass index 551.9 4. Diabetes 557.8 7.8 5. High fasting plasma glucose 548.2 5. Neurological disorders 481.3 6.8 6. Air pollution 506.3 6. Diarrheal/LRI/other 321.7 4.5 7. Low glomerular filtration rate 474.3 7. Digestive diseases 225.9 3.2 Others 8.5 70 years of age and over 1. Dietary risks 1,487.0 1. Cardiovascular diseases 2,449.5 42.5 2. High systolic blood pressure 1,392.8 2. Neoplasms 887.7 15.4 3. High body-mass index 725.5 3. Chronic respiratory diseases 598.9 10.4 4. Smoking 569.3 4. Diabetes 533.1 9.2 5. High fasting plasma glucose 528.6 5. Neurological disorders 424.0 7.4 6. Air pollution 448.9 6. Diarrheal/LRI/other 281.8 4.9 7. Low glomerular filtration rate 421.9 7. Digestive diseases 205.2 3.6 Others 6.8 83

Total population 1. Dietary risks 112.5 1. Cardiovascular diseases 150.4 29.4 All age 2. High systolic blood pressure 89.7 2. Neoplasms 91.6 17.9 3. High body-mass index 55.5 3. Self-harm & intersonal violence 51.7 10.1 4. Smoking 48.8 4. Diabetes 37.2 7.3 5. High fasting plasma glucose 35.5 5. Chronic respiratory diseases 36.9 7.2 6. Air pollution 30.3 6. Diarrheal/LRI/other 24.9 4.9 7. High total cholesterol 28.5 7. Neurological disorders 20.5 4.0 Others 19.3 1. Dietary risks 124.4 1. Cardiovascular diseases 152.8 26.0 All age 2. High systolic blood pressure 92.4 2. Neoplasms 93.3 15.9 3. Smoking 61.6 3. Self-harm & intersonal violence 93.1 15.8 4. High body-mass index 50.0 4. Chronic respiratory diseases 40.6 6.9 5. Alcohol and drug use 38.8 5. Diabetes 35.5 6.1 6. High fasting plasma glucose 34.6 6. Transport injuries 31.7 5.4 7. Air pollution 31.2 7. Diarrheal/LRI/other 26.4 4.5 Others 19.4 1. Dietary risks 101.1 1. Cardiovascular diseases 148.2 33.7 All age 2. High systolic blood pressure 87.0 2. Neoplasms 90.1 20.5 3. High body-mass index 60.9 3. Diabetes 38.8 8.8 4. Smoking 36.3 4. Chronic respiratory diseases 33.3 7.6 5. High fasting plasma glucose 36.3 5. Diarrheal/LRI/other 23.3 5.3 6. Air pollution 29.4 6. Neurological disorders 21.2 4.8 7. High total cholesterol 27.9 7. Digestive diseases 13.4 3.1 Others 16.2 84

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) 45 69 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 $13,872.00 Per capita GDP-PPP outlay on healthcare $1,369.00 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, 2012 50.7(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 2,979 30.0% 28.3% 32.8% 2. Neoplasms 4,920 2,651 2,269 23.8% 23.2% 24.9% 3. Diabetes 1,791 896 895 8.7% 7.9% 9.8% 4. Chronic respiratory diseases 1,422 747 675 6.9% 6.6% 7.4% 5. Neurological disorders 1,346 687 658 6.5% 6.0% 7.2% 6. Transport injuries 800 636 0 3.9% 5.6% 0.0% 7.Cirrhosis 796 502 293 3.9% 4.4% 3.2% 8. Diarrheal/LRI/Other 787 413 374 3.8% 3.6% 4.1% 9. Unintentional injuries 767 471 296 3.7% 4.1% 3.3% 10. Self-harm & intersonal violence 718 620 98.48 3.5% 5.4% 1.1% 11. Digestive diseases 696 336 360 3.4% 3.0% 4.0% 12. Other noncommunicable 414 215 199 2.0% 1.9% 2.2% TOTAL 20,665 11,403 9,096 100.0% 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 2015. 45 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 312,946 513,819 64.19% Years lived with disability (YLD) 75,697 144,843 91.35% Years of life lost (YLL) 237,248 368,676 55.40% 6983 12,367 77.10% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 202,040 328,988 62.83% Years lived with disability (YLD) 49,496 84,258 70.23% Years of life lost (YLL) 152,543 244,430 60.24% 5,890 10,668 81.12% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 110,906 184,831 66.66% Years lived with disability (YLD) 26,201 60,585 131.23% Years of life lost (YLL) 84,705 124,246 46.68% 1,093 1,699 55.44% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 513,819 100% 144,843 100% 368 100184% 12,367 100% 328,988 64.03% 84,258 58.17% 244,430 66421.20% 10,668 86.26% 184,831 35.97% 60,585 41.83% 124,246 33762.50% 1,699 13.74% 86

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 12.7 1. Other non-communicable 81.0 38.5 2. Unsafe water, sanitation and handwashing 7.0 2. Neonatal disorders 69.5 33.0 3. Unsafe sex 3.5 3. Diarrheal/LRI/other 23.3 11.1 4. Low glomerular filtration rate 1.2 4. Unintentional injuries 8.4 4.0 5. Air pollution 0.9 5. Neoplasms 5.1 2.4 6. Smoking 0.6 6. Communicable, maternal, neonatal, and nutritional diseases 4.4 2.1 7. Alcohol and drug use 0.4 7. Diabetes 3.9 1.9 Others 7.1 Children under 5 years 1. Child and maternal malnutrition 14.1 1. Other non-communicable 86.9 37.6 2. Unsafe water, sanitation and handwashing 7.6 2. Neonatal disorders 78.8 34.1 3. Unsafe sex 3.4 3. Diarrheal/LRI/other 25.4 11.0 4. Low glomerular filtration rate 1.2 4. Unintentional injuries 9.7 4.2 5. Air pollution 1.0 5. Neoplasms 5.3 2.3 6. Smoking 0.6 6. Communicable, maternal, neonatal, and nutritional diseases 4.5 2.0 7. Alcohol and drug use 0.5 7. Diabetes 4.3 1.9 Others 7.0 Children under 5 years 1. Child and maternal malnutrition 11.2 1. Other non-communicable 74.9 39.6 2. Unsafe water, sanitation and handwashing 6.5 2. Neonatal disorders 59.8 31.6 3. Unsafe sex 3.6 3. Diarrheal/LRI/other 21.1 11.2 4. Low glomerular filtration rate 1.1 4. Unintentional injuries 7.0 3.7 5. Air pollution 0.8 5. Neoplasms 4.8 2.6 6. Smoking 0.5 6. Communicable, maternal, neonatal, and nutritional diseases 4.3 2.3 7. Alcohol and drug use 0.4 7. Diabetes 3.5 1.9 Others 7.1 87

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Neoplasms 2. Low glomerular filtration rate 0.4 2. Transport injuries 3.2 16.2 3. Alcohol and drug use 0.4 3. Unintentional injuries 2.9 14.7 4. Unsafe sex 0.1 4. Diarrheal/LRI/other 2.6 13.0 5. High fasting plasma glucose 0.1 5. Other non-communicable 1.8 9.4 4.1 20.8 6. Sexual abuse and violence 0.1 6. Self-harm & intersonal violence 1.2 6.0 7. High systolic blood pressure 0.1 7. Diabetes 1.0 4.9 Others 15.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Neoplasms 2. Alcohol and drug use 0.5 2. Unintentional injuries 3.8 17.7 3. Low glomerular filtration rate 0.4 3. Transport injuries 3.8 17.6 4. Unsafe sex 0.1 4. Diarrheal/LRI/other 2.7 12.4 5. Sexual abuse and violence 0.1 5. Other non-communicable 1.8 8.2 4.4 20.5 6. High systolic blood pressure 0.1 6. Self-harm & intersonal violence 1.3 6.3 7. High fasting plasma glucose 0.1 7. Diabetes 0.9 4.0 Others 13.4 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.2 1. Neoplasms 2. Low glomerular filtration rate 0.4 2. Transport injuries 2.6 14.4 3. Alcohol and drug use 0.3 3. Diarrheal/LRI/other 2.5 13.9 4. Unsafe sex 0.1 4. Unintentional injuries 2.0 11.0 5. High fasting plasma glucose 0.1 5. Other non-communicable 1.9 10.9 3.8 21.1 6. Sexual abuse and violence 0.1 6. Diabetes 1.1 6.0 7. High systolic blood pressure 0.1 7. Self-harm & intersonal violence 1.0 5.6 Others 17.2 88

Total population 15 to 49 years of age 1. Alcohol and drug use 16.1 1. Neoplasms 21.5 19.8 2. Dietary risks 10.6 2. Self-harm & intersonal violence 19.9 18.3 3. High body-mass index 8.8 3. Transport injuries 16.4 15.1 4. High systolic blood pressure 6.9 4. Cardiovascular diseases 13.2 12.1 5. Unsafe sex 5.1 5. Unintentional injuries 8.0 7.4 6. High total cholesterol 4.6 6. Diabetes 6.2 5.7 7. High fasting plasma glucose 4.5 7. Cirrhosis 5.4 5.0 Others 16.7 15 to 49 years of age 1. Alcohol and drug use 26.4 1. Self-harm & intersonal violence 34.0 22.9 2. Dietary risks 13.8 2. Transport injuries 27.4 18.5 3. High systolic blood pressure 10.4 3. Neoplasms 19.3 13.0 4. High body-mass index 10.3 4. Cardiovascular diseases 16.9 11.4 5. High total cholesterol 6.5 5 Unintentional injuries 13.3 9.0 6. Unsafe sex 5.5 6. Cirrhosis 8.1 5.5 7. Low glomerular filtration rate 5.5 7. Diabetes 7.0 4.7 Others 14.9 15 to 49 years of age 1. Dietary risks 7.3 1. Neoplasms 23.9 35.3 2. High body-mass index 7.3 2. Cardiovascular diseases 9.2 13.6 3. Alcohol and drug use 5.3 3. Diabetes 5.3 7.8 4. Unsafe sex 4.7 4. Self-harm & intersonal violence 5.2 7.8 5. High fasting plasma glucose 3.6 5. Transport injuries 5.0 7.4 6. Low glomerular filtration rate 3.4 6. Cirrhosis 2.6 3.9 7. High systolic blood pressure 3.4 7. Unintentional injuries 2.4 3.6 Others 20.7 89

Total population 50 to 69 years of age 1. Dietary risks 156.9 1. Neoplasms 207.2 31.7 2. High systolic blood pressure 122.2 2. Cardiovascular diseases 183.0 28.0 3. High body-mass index 121.4 3. Diabetes 68.4 10.5 4. High fasting plasma glucose 76.0 4. Cirrhosis 45.9 7.0 5. Low glomerular filtration rate 58.7 5. Chronic respiratory diseases 25.7 3.9 6. High total cholesterol 54.7 6. Transport injuries 22.4 3.4 7. Smoking 53.0 7. Digestive diseases 19.4 3.0 Others 12.6 50 to 69 years of age 1. Dietary risks 202.7 1. Cardiovascular diseases 233.1 29.5 2. High systolic blood pressure 155.9 2. Neoplasms 218.7 27.6 3. High body-mass index 129.0 3. Diabetes 73.8 9.3 4. High fasting plasma glucose 84.2 4. Cirrhosis 62.5 7.9 5. Smoking 85.2 5. Transport injuries 36.5 4.6 6. Alcohol and drug use 71.5 6. Chronic respiratory diseases 29.9 3.8 7. High total cholesterol 70.7 7. Self-harm & intersonal violence 27.8 3.5 Others 13.8 50 to 69 years of age 1. High body-mass index 113.7 1. Neoplasms 195.6 38.0 2. Dietary risks 110.6 2. Cardiovascular diseases 132.3 25.7 3. High systolic blood pressure 88.1 3. Diabetes 63.0 12.2 4. High fasting plasma glucose 64.7 4. Cirrhosis 29.0 5.6 5. Low glomerular filtration rate 48.8 5. Chronic respiratory diseases 21.4 4.1 6. High total cholesterol 38.5 6. Digestive diseases 17.0 3.3 7. Alcohol and drug use 28.0 7. Neurological disorders 12.7 2.5 Others 8.6 90

Total population 70 years of age and over 1. High systolic blood pressure 1,093.5 1. Cardiovascular diseases 1,940.0 35.4 2. Dietary risks 1,081.1 2. Neoplasms 1,165.2 21.3 3. High fasting plasma glucose 532.8 3. Chronic respiratory diseases 513.9 9.4 4. High body-mass index 503.3 4. Neurological disorders 510.2 9.3 5. Low glomerular filtration rate 466.4 5. Diabetes 467.9 8.5 6. Smoking 388.1 6. Diarrheal/LRI/other 213.6 3.9 7. High total cholesterol 320.2 7. Digestive diseases 210.2 3.8 Others 8.3 70 years of age and over 1. Dietary risks 1,242.9 1. Cardiovascular diseases 2,002.8 33.5 2. High systolic blood pressure 1,086.8 2. Neoplasms 1,443.7 24.1 3. High fasting plasma glucose 548.2 3. Chronic respiratory diseases 582.6 9.7 4. Smoking 547.4 4. Neurological disorders 555.8 9.3 5. Low glomerular filtration rate 490.5 5. Diabetes 479.1 8.0 6. High body-mass index 461.1 6. Diarrheal/LRI/other 224.2 3.8 7. High total cholesterol 285.0 7. Digestive diseases 202.6 3.4 Others 8.2 70 years of age and over 1. High systolic blood pressure 1,099.0 1. Cardiovascular diseases 1,888.0 37.3 2. Dietary risks 946.9 2. Neoplasms 934.2 18.5 3. High body-mass index 538.2 3. Neurological disorders 472.4 9.3 4. High fasting plasma glucose 520.0 4. Diabetes 458.5 9.1 5. Low glomerular filtration rate 446.4 5. Chronic respiratory diseases 456.9 9.0 6. High total cholesterol 349.5 6. Digestive diseases 216.5 4.3 7. Smoking 255.9 7. Diarrheal/LRI/other 204.7 4.1 Others 8.5 91

Total population 1. Dietary risks 81.7 1. Cardiovascular diseases 127.4 29.0 All age 2. High systolic blood pressure 74.6 2. Neoplasms 101.0 22.9 3. High body-mass index 48.2 3. Diabetes 36.8 8.4 4. High fasting plasma glucose 39.7 4. Chronic respiratory diseases 29.2 6.6 5. Low glomerular filtration rate 33.9 5. Neurological disorders 27.6 6.3 6. Smoking 28.7 6. Transport injuries 16.4 3.7 7. High total cholesterol 26.4 7. Cirrhosis 16.3 3.7 Others 19.4 1. Dietary risks 92.1 1. Cardiovascular diseases 130.5 27.2 All age 2. High systolic blood pressure 76.1 2. Neoplasms 107.2 22.3 3. High body-mass index 45.9 3. Diabetes 36.2 7.6 4. High fasting plasma glucose 39.9 4. Chronic respiratory diseases 30.2 6.3 5. Smoking 39.5 5. Neurological disorders 27.8 5.8 6. Low glomerular filtration rate 34.7 6. Transport injuries 25.7 5.4 7. Alcohol and drug use 33.2 7. Self-harm & intersonal violence 25.1 5.2 Others 20.2 1. High systolic blood pressure 72.9 1. Cardiovascular diseases 124.2 31.1 All age 2. Dietary risks 71.0 2. Neoplasms 94.6 23.7 3. High body-mass index 50.6 3. Diabetes 37.3 9.3 4. High fasting plasma glucose 39.5 4. Chronic respiratory diseases 28.2 7.1 5. Low glomerular filtration rate 33.0 5. Neurological disorders 27.5 6.9 6. High total cholesterol 25.8 6. Diarrheal/LRI/other 15.6 3.9 7. Smoking 17.6 7. Digestive diseases 15.0 3.8 Others 14.3 92

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) 47 66 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 $20,788.30 Per capita GDP-PPP outlay on healthcare $1,828.00 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 19,724 41.41% 38.94% 44.16% 2. Neoplasms 23,163 13,206 9,957 24.54% 26.56% 22.30% 3. Diarrheal/LRI/Other 6,596 3,359 3,238 6.99% 6.76% 7.25% 4. Neurological disorders 5,586 2,658 2,928 5.92% 5.35% 6.56% 5. Diabetes 4,716 2,030 2,687 5.00% 4.08% 6.02% 6. Chronic respiratory diseases 4,148 2,461 1,688 4.40% 4.95% 3.78% 7. Unintentional injuries 3,839 1,774 2,064 4.07% 3.57% 4.62% 8. Self-harm & intersonal violence 2,272 1,769 503 2.41% 3.56% 1.13% 9. Digestive diseases 2,086 1059 1,027 2.21% 2.13% 2.30% 10. Cirrhosis 1,482 1021 461 1.57% 2.05% 1.03% 11. Transport injuries 1,407 1,024 383 1.49% 2.06% 0.86% TOTAL 94,379 49,720 44,660 100.0% 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 2015. 47 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 2,068,971 2,477,546 19.75% Years lived with disability (YLD) 421,334 611,874 45.22% Years of life lost (YLL) 1,647,636 1,865,673 13.23% 81699 112,698 37.94% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,206,696 1,390,719 15.25% Years lived with disability (YLD) 225,930 312,900 38.49% Years of life lost (YLL) 980,765 1,077,820 9.90% 45,214 58,204 28.73% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 862,275 1,086,827 26.04% Years lived with disability (YLD) 195,404 298,974 53.00% Years of life lost (YLL) 666,871 787,853 18.14% 36,485 54,494 49.36% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 2,477,546 100% 611,874 100% 1,865,673 100% 112,698 100% 1,390,719 56.13% 312,900 51.14% 1,077,820 57.77% 58,204 51.65% 1,086,827 43.87% 298,974 48.86% 787,853 42.23% 54,494 48.35% 94

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 8.0 1. Neonatal disorders 39.7 35.9 2. Unsafe water, sanitation and handwashing 3.7 2. Other non-communicable 3. Smoking 1.0 3. Diarrheal/LRI/other 17.0 15.4 4. Air pollution 0.5 4. Unintentional injuries 6.7 6.1 5. Low glomerular filtration rate 0.3 5. Neoplasms 3.9 3.5 6. Alcohol and drug use 0.3 6. Diabetes 3.2 2.9 32.9 29.8 7. Unsafe sex 0.1 7. Neurological disorders 1.3 1.2 Others 5.3 Children under 5 years 1. Child and maternal malnutrition 8.9 1. Neonatal disorders 45.4 37.4 2. Unsafe water, sanitation and handwashing 3.9 2. Other non-communicable 3. Smoking 1.1 3. Diarrheal/LRI/other 18.7 15.4 4. Air pollution 0.6 4. Unintentional injuries 7.8 6.4 5. Low glomerular filtration rate 0.3 5. Neoplasms 4.4 3.6 34.0 28.0 6. Alcohol and drug use 0.3 6. Diabetes 3.5 2.9 7. Unsafe sex 0.1 7. Neurological disorders 1.4 1.1 Others 5.2 Children under 5 years 1. Child and maternal malnutrition 7.1 1. Neonatal disorders 33.6 34.0 2. Unsafe water, sanitation and handwashing 3.5 2. Other non-communicable 3. Smoking 0.9 3. Diarrheal/LRI/other 15.1 15.3 4. Air pollution 0.4 4. Unintentional injuries 5.6 5.6 5. Alcohol and drug use 0.3 5. Neoplasms 3.3 3.4 31.8 32.1 6. Low glomerular filtration rate 0.3 6. Diabetes 2.9 2.9 7. Unsafe sex 0.1 7. Neurological disorders 1.2 1.2 Others 5.5 95

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 0.8 1. Neoplasms 2. Alcohol and drug use 0.4 2. Unintentional injuries 3.6 19.1 3. Low glomerular filtration rate 0.2 3. Transport injuries 2.7 14.5 4. High fasting plasma glucose 0.1 4. Diarrheal/LRI/other 2.1 11.1 5. High systolic blood pressure 0.1 5. Other non-communicable 2.1 10.9 4.1 21.5 6. Air pollution 0.1 6. Self-harm & intersonal violence 0.9 4.8 7. Sexual abuse and violence 0.1 7. Diabetes 0.8 4.3 Others 13.8 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 0.9 1. Unintentional injuries 2. Alcohol and drug use 0.4 2. Neoplasms 4.7 20.6 3. Low glomerular filtration rate 0.2 3. Transport injuries 3.4 14.8 4. High fasting plasma glucose 0.1 4. Diarrheal/LRI/other 2.3 10.1 5. Air pollution 0.1 5. Other non-communicable 2.1 9.4 5.4 23.8 6. High systolic blood pressure 0.1 6. Self-harm & intersonal violence 1.1 4.6 7. Sexual abuse and violence 0.1 7. Diabetes 0.9 3.8 Others 12.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 0.8 1. Neoplasms 2. Alcohol and drug use 0.3 2. Transport injuries 2.0 13.8 3. Low glomerular filtration rate 0.3 3. Other non-communicable 2.0 13.5 4. High fasting plasma glucose 0.1 4. Diarrheal/LRI/other 1.9 12.8 5. High systolic blood pressure 0.1 5. Unintentional injuries 1.7 11.5 3.4 22.9 6. Sexual abuse and violence 0.1 6. Diabetes 0.8 5.2 7. Air pollution 0.1 7. Self-harm & intersonal violence 0.7 5.1 Others 15.2 96

Total population 15 to 49 years of age 1. Dietary risks 19.5 1. Neoplasms 32.9 25.3 2. Smoking 17.3 2. Cardiovascular diseases 25.7 19.8 3. High systolic blood pressure 17.1 3. Self-harm & intersonal violence 18.6 14.3 4. High body-mass index 16.4 4. Transport injuries 11.1 8.6 5. Alcohol and drug use 15.5 5. Unintentional injuries 8.3 6.4 6. High total cholesterol 7.8 6. Diabetes 7.2 5.5 7. High fasting plasma glucose 7.4 7. Cirrhosis 4.4 3.4 Others 16.9 15 to 49 years of age 1. Dietary risks 25.3 1. Self-harm & intersonal violence 33.7 20.4 2. Alcohol and drug use 25.3 2. Transport injuries 29.2 17.7 3. High systolic blood pressure 23.2 3. Neoplasms 29.1 17.6 4. Smoking 22.1 4. Self-harm & intersonal violence 17.4 10.6 5. High body-mass index 18.7 5 Unintentional injuries 13.8 8.4 6. High total cholesterol 11.3 6. Diabetes 7.8 4.7 7. High fasting plasma glucose 9.3 7. Cirrhosis 7.2 4.4 Others 16.2 15 to 49 years of age 1. High body-mass index 14.0 1. Neoplasms 36.8 39.0 2. Dietary risks 13.4 2. Cardiovascular diseases 17.4 18.5 3. Smoking 12.2 3. Self-harm & intersonal violence 7.8 8.2 4. High systolic blood pressure 10.8 4. Diabetes 6.6 7.0 5. Unsafe sex 7.1 5. Transport injuries 4.6 4.9 6. High fasting plasma glucose 5.4 6. Diarrheal/LRI/other 3.1 3.3 7. Alcohol and drug use 5.2 7. Chronic respiratory diseases 2.8 3.0 Others 16.0 97

Total population 50 to 69 years of age 1. High systolic blood pressure 226.5 1. Cardiovascular diseases 315.4 35.6 2. Dietary risks 226.2 2. Neoplasms 311.4 35.1 3. Smoking 224.5 3. Diabetes 55.5 6.3 4. High body-mass index 170.1 4. Chronic respiratory diseases 35.7 4.0 5. High fasting plasma glucose 88.3 5. Diarrheal/LRI/other 29.1 3.3 6. High total cholesterol 65.8 6. Cirrhosis 26.1 2.9 7. Low physical activity 60.2 7. Self-harm & intersonal violence 26.0 2.9 Others 9.9 50 to 69 years of age 1. Smoking 307.2 1. Cardiovascular diseases 396.1 36.8 2. Dietary risks 283.1 2. Neoplasms 355.4 33.0 3. High systolic blood pressure 278.6 3. Diabetes 52.4 4.9 4. High body-mass index 169.6 4. Self-harm & intersonal violence 40.5 3.8 5. High fasting plasma glucose 101.2 5. Chronic respiratory diseases 39.5 3.7 6. High total cholesterol 81.4 6. Cirrhosis 39.2 3.6 7. Alcohol and drug use 79.1 7. Diarrheal/LRI/other 35.8 3.3 Others 11.0 50 to 69 years of age 1. High systolic blood pressure 175.2 1. Neoplasms 268.1 38.3 2. High body-mass index 170.5 2. Cardiovascular diseases 236.1 33.8 3. Dietary risks 170.2 3. Diabetes 58.6 8.4 4. Smoking 143.2 4. Chronic respiratory diseases 32.0 4.6 5. High fasting plasma glucose 75.6 5. Diarrheal/LRI/other 22.6 3.2 6. High total cholesterol 50.5 6. Digestive diseases 15.5 2.2 7. Low glomerular filtration rate 48.7 7. Neurological disorders 14.6 2.1 Others 7.5 98

Total population 70 years of age and over 1. High systolic blood pressure 1,567.3 1. Cardiovascular diseases 2,837.4 45.1 2. Dietary risks 1,325.4 2. Neoplasms 1,271.1 20.2 3. Smoking 952.0 3. Diarrheal/LRI/other 527.1 8.4 4. High body-mass index 649.2 4. Neurological disorders 482.1 7.7 5. High fasting plasma glucose 570.7 5. Chronic respiratory diseases 295.9 4.7 6. Low glomerular filtration rate 487.8 6. Diabetes 274.0 4.4 7. Low physical activity 445.4 7. Unintentional injuries 271.8 4.3 Others 5.3 70 years of age and over 1. High systolic blood pressure 1,519.0 1. Cardiovascular diseases 2,829.2 41.7 2. Dietary risks 1,386.6 2. Neoplasms 1,654.0 24.4 3. Smoking 1,260.8 3. Diarrheal/LRI/other 568.4 8.4 4. High fasting plasma glucose 567.9 4. Neurological disorders 494.4 7.3 5. High body-mass index 475.9 5. Chronic respiratory diseases 399.8 5.9 6. Low physical activity 443.0 6. Diabetes 237.6 3.5 7. Low glomerular filtration rate 442.2 7. Unintentional injuries 209.2 3.1 Others 5.8 70 years of age and over 1. High systolic blood pressure 1,607.2 1. Cardiovascular diseases 2,844.1 48.4 2. Dietary risks 1,274.7 2. Neoplasms 953.9 16.2 3. High body-mass index 792.9 3. Diarrheal/LRI/other 492.9 8.4 4. Smoking 696.1 4. Neurological disorders 471.9 8.0 5. High fasting plasma glucose 573.0 5. Unintentional injuries 323.7 5.5 6. Low glomerular filtration rate 525.6 6. Diabetes 304.2 5.2 7. Low physical activity 447.5 7. Chronic respiratory diseases 209.9 3.6 Others 4.8 99

Total population 1. High systolic blood pressure 204.6 1. Cardiovascular diseases 346.4 40.5 All age 2. Dietary risks 183.4 2. Neoplasms 205.3 24.0 3. Smoking 147.5 3. Diarrheal/LRI/other 58.5 6.8 4. High body-mass index 106.8 4. Neurological disorders 49.5 5.8 5. High fasting plasma glucose 76.4 5. Diabetes 41.8 4.9 6. Low glomerular filtration rate 60.2 6. Chronic respiratory diseases 36.8 4.3 7. Low physical activity 57.1 7. Unintentional injuries 34.0 4.0 Others 9.7 1. High systolic blood pressure 200.7 1. Cardiovascular diseases 341.4 38.0 All age 2. Dietary risks 191.8 2. Neoplasms 232.9 25.9 3. Smoking 185.0 3. Diarrheal/LRI/other 59.2 6.6 4. High body-mass index 87.2 4. Neurological disorders 46.9 5.2 5. High fasting plasma glucose 74.7 5. Chronic respiratory diseases 43.4 4.8 6. Low physical activity 56.5 6. Diabetes 35.8 4.0 7. Low glomerular filtration rate 53.7 7. Unintentional injuries 31.3 3.5 Others 12.1 1. High systolic blood pressure 208.6 1. Cardiovascular diseases 351.5 43.4 All age 2. Dietary risks 175.1 2. Neoplasms 177.4 21.9 3. High body-mass index 126.6 3. Diarrheal/LRI/other 57.7 7.1 4. Smoking 109.7 4. Neurological disorders 52.2 6.4 5. High fasting plasma glucose 78.2 5. Diabetes 47.9 5.9 6. Low glomerular filtration rate 66.8 6. Unintentional injuries 36.8 4.5 7. Low physical activity 57.8 7. Chronic respiratory diseases 30.1 3.7 Others 7.1 100

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) 49 66.8 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 15,532 32.8% 22. Stroke 9,648 20.3% 23. Diabetes 4,962 10.5% 24. Lower respiratory infection 3,257 6.9% 25. HIV/AIDS 3,004 6.3% 26. Hytensive health disease 2,797 5.9% 27. Road injuries 2,615 5.5% 28. Prostate cancer 2,267 4.8% 29. Preterm birth complications 1,702 3.6% 30. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 3. 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 2015. 49 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

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) 51 63 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 $10,343.00 Per capita GDP-PPP outlay on healthcare $597.00 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 171 88 83 35.63% 31.65% 40.89% 2.Neoplasms 88 55 33 18.33% 19.78% 16.26% 3.Diabetes 77 40 37 16.04% 14.39% 18.23% 4.Diarrheal/LRI/Other 27 16 12 5.63% 5.76% 5.91% 5. Neurological disorders 6. Chronic respiratory diseases 26 15 11 5.42% 5.40% 5.42% 17 13 4 3.54% 4.68% 1.97% 7. Unintentional injuries 16 12 5 3.33% 4.32% 2.46% 8. Self-harm & intersonal violence 14 12 2 2.92% 4.32% 0.88% 9.Neonatal disorders 12 7 5 2.50% 2.52% 2.46% 10. Transport injuries 11 9 2 2.29% 3.24% 1.07% 11. Non-communicable diseases 10 5 5 2.08% 1.78% 2.46% 12. Digestive diseases 11 7 4 2.29% 2.35% 1.97% TOTAL 480 278 203 100.0% 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 2015. 51 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 11,852 12,829 8.24% Years lived with disability (YLD) 2,733 3,735 36.66% Years of life lost (YLL) 9,120 9,096-0.26% 414 460 11.11% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 6,297 7,461 18.48% Years lived with disability (YLD) 1,385 1,809 30.61% Years of life lost (YLL) 4,913 5,654 15.08% 203 251 23.65% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 5,555 5,368-3.37% Years lived with disability (YLD) 1,348 1,926 42.88% Years of life lost (YLL) 4,207 3,442-18.18% 211 209-0.95% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 12,829 100% 3,735 100% 9,096 100% 460 100% 7,461 58.16% 1,809 48.43% 5,654 62.16% 251 54.57% 5,368 41.84% 1,926 51.57% 3,442 37.84% 209 45.43% 104

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 49.0 1. Neonatal disorders 218.7 49.3 2. Unsafe water, sanitation and handwashing 18.0 2. Other non-communicable 3. Air pollution 5.4 3. Diarrheal/LRI/other 63.7 14.2 4. Low glomerular filtration rate 2.7 4. Unintentional injuries 23.9 5.3 5. Smoking 1.7 5. Nutritional deficiencies 17.2 3.8 6. Alcohol and drug use 1.2 6. Diabetes 10.5 2.3 79.8 17.9 7. High fasting plasma glucose 1.1 7. Cardiovascular diseases 7.7 1.7 Others 5.5 Children under 5 years 1. Child and maternal malnutrition 55.0 1. Neonatal disorders 247.4 50.3 2. Unsafe water, sanitation and handwashing 21.0 2. Other non-communicable 3. Air pollution 5.9 3. Diarrheal/LRI/other 71.8 14.4 4. Low glomerular filtration rate 3.0 4. Unintentional injuries 27.1 5.5 5. Smoking 1.6 5. Nutritional deficiencies 19.4 3.9 82.5 16.7 6. Alcohol and drug use 1.3 6. Diabetes 11.1 2.2 7. High fasting plasma glucose 1.1 7. Cardiovascular diseases 7.7 1.5 Others 5.6 Children under 5 years 1. Child and maternal malnutrition 42.8 1. Neonatal disorders 188.7 48.1 2. Unsafe water, sanitation and handwashing 14.9 2. Other non-communicable 3. Air pollution 4.8 3. Diarrheal/LRI/other 55.2 13.8 4. Low glomerular filtration rate 2.4 4. Unintentional injuries 20.4 5.1 5. Smoking 1.7 5. Nutritional deficiencies 14.9 3.7 77.1 19.5 6. Alcohol and drug use 1.0 6. Diabetes 9.9 2.5 7. High fasting plasma glucose 1.0 7. Cardiovascular diseases 7.7 1.9 Others 5.3 105

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Unintentional injuries 2. Low glomerular filtration rate 0.9 2. Transport injuries 5.4 14.7 3. Alcohol and drug use 0.9 3. Diarrheal/LRI/other 4.9 13.2 4. High fasting plasma glucose 0.4 4. Neoplasms 4.2 11.3 5. Child and maternal malnutrition 0.3 5. Other non-communicable 3.3 9.0 6.5 17.7 6. Air pollution 0.3 6. Cardiovascular diseases 2.7 7.4 7. High systolic blood pressure 0.2 7. Diabetes 2.7 7.3 Others 19.5 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.6 1. Unintentional injuries 2. Alcohol and drug use 1.2 2. Transport injuries 7.2 16.4 3. Low glomerular filtration rate 1.0 3. Diarrheal/LRI/other 5.5 12.4 4. Air pollution 0.3 4. Neoplasms 4.8 10.9 5. Child and maternal malnutrition 0.3 5. Other non-communicable 3.6 8.2 9.0 20.4 6. High fasting plasma glucose 0.3 6. Self-harm & intersonal violence 2.9 6.6 7. High systolic blood pressure 0.3 7. Cardiovascular diseases 2.9 6.5 Others 18.7 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.8 2. Unintentional injuries 4.0 13.6 3. Alcohol and drug use 0.6 3. Transport injuries 3.6 12.2 4. High fasting plasma glucose 0.4 4. Neoplasms 3.5 11.9 5. Child and maternal malnutrition 0.4 5. Other non-communicable 3.0 10.3 4.3 14.4 6. Air pollution 0.3 6. Diabetes 2.6 8.9 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.6 8.7 Others 20.1 106

Total population 15 to 49 years of age 1. Alcohol and drug use 25.3 1. Cardiovascular diseases 29.7 16.5 2. Dietary risks 24.4 2. Self-harm & intersonal violence 27.7 15.4 3. High systolic blood pressure 23.3 3. Neoplasms 24.4 13.6 4. High body-mass index 22.9 4. Diabetes 19.9 11.1 5. High fasting plasma glucose 17.5 5. Unintentional injuries 15.8 8.8 6. Unsafe sex 11.7 6. Transport injuries 15.8 8.8 7. Smoking 9.2 7. HIV/AIDS 11.6 6.5 Others 19.4 15 to 49 years of age 1. Alcohol and drug use 43.6 1. Self-harm & intersonal violence 49.6 18.9 2. Dietary risks 34.1 2. Cardiovascular diseases 41.5 15.8 3. High systolic blood pressure 33.5 3. Unintentional injuries 28.0 10.7 4. High body-mass index 26.8 4. Transport injuries 27.5 10.5 5. High fasting plasma glucose 23.0 5 Diabetes 25.5 9.7 6. Unsafe sex 15.9 6. Neoplasms 24.3 9.3 7. Smoking 12.9 7. HIV/AIDS 16.5 6.4 Others 18.8 15 to 49 years of age 1. High body-mass index 19.0 1. Neoplasms 24.6 25.1 2. Dietary risks 14.8 2. Cardiovascular diseases 18.0 18.4 3. High systolic blood pressure 13.2 3. Diabetes 14.3 14.6 4. High fasting plasma glucose 12.1 4. HIV/AIDS 6.8 7.1 5. Unsafe sex 10.5 5. Self-harm & intersonal violence 6.0 6.1 6. Alcohol and drug use 7.1 6. Transport injuries 4.1 4.2 7. Low glomerular filtration rate 5.7 7. Diarrheal/LRI/other 3.8 3.8 Others 20.7 107

Total population 50 to 69 years of age 1. High systolic blood pressure 315.0 1. Cardiovascular diseases 372.6 34.2 2. Dietary risks 311.0 2. Neoplasms 243.6 22.4 3. High body-mass index 274.6 3. Diabetes 209.3 19.2 4. High fasting plasma glucose 251.8 4. Cirrhosis 36.7 3.4 5. Smoking 87.4 5. Chronic respiratory diseases 33.3 3.1 6. High total cholesterol 78.4 6. Diarrheal/LRI/other 31.8 2.9 7. Low glomerular filtration rate 78.2 7. Digestive diseases 26.4 2.4 Others 12.4 50 to 69 years of age 1. High systolic blood pressure 423.5 1. Cardiovascular diseases 508.5 34.5 2. Dietary risks 413.1 2. Neoplasms 300.0 20.3 3. High fasting plasma glucose 301.3 3. Diabetes 251.1 17.0 4. High body-mass index 285.6 4. Cirrhosis 59.8 4.1 5. Smoking 159.3 5. Chronic respiratory diseases 54.7 3.7 6. Alcohol and drug use 108.2 6. Diarrheal/LRI/other 47.1 3.2 7. Low glomerular filtration rate 105.4 7. Unintentional injuries 43.4 2.9 Others 14.3 50 to 69 years of age 1. High body-mass index 264.3 1. Cardiovascular diseases 244.1 33.8 2. Dietary risks 215.4 2. Neoplasms 190.2 26.3 3. High systolic blood pressure 212.5 3. Diabetes 169.8 23.5 4. High fasting plasma glucose 205.1 4. Cirrhosis 17.3 2.4 5. High total cholesterol 58.3 5. Chronic respiratory diseases 14.8 2.1 6. Low physical activity 53.5 6. Diarrheal/LRI/other 14.7 2.0 7. Low glomerular filtration rate 52.5 7. Unintentional injuries 13.2 1.8 Others 8.1 108

Total population 70 years of age and over 1. High systolic blood pressure 1,908.2 1. Cardiovascular diseases 2,792.0 40.1 2. Dietary risks 1,386.1 2. Neoplasms 1,203.4 17.3 3. High fasting plasma glucose 1,331.7 3. Diabetes 1,074.5 15.4 4. High body-mass index 1,050.1 4. Neurological disorders 549.0 7.9 5. Low glomerular filtration rate 553.4 5. Diarrheal/LRI/other 405.4 5.8 6. Low physical activity 439.1 6. Chronic respiratory diseases 287.6 4.1 7. Air pollution 354.1 7. Digestive diseases 139.0 2.0 Others 7.3 70 years of age and over 1. High systolic blood pressure 1,905.3 1. Cardiovascular diseases 2,768.8 34.1 2. Dietary risks 1,485.8 2. Neoplasms 1,802.6 22.2 3. High fasting plasma glucose 1,260.3 3. Diabetes 1,128.2 13.9 4. High body-mass index 705.2 4. Neurological disorders 677.7 8.4 5. Low glomerular filtration rate 597.2 5. Chronic respiratory diseases 490.1 6.0 6. Smoking 478.3 6. Diarrheal/LRI/other 466.9 5.8 7. Low physical activity 441.8 7. Digestive diseases 160.4 2.0 Others 7.6 70 years of age and over 1. High systolic blood pressure 1,910.6 1. Cardiovascular diseases 2,810.5 46.6 2. High fasting plasma glucose 1,388.5 2. Diabetes 1,031.6 17.1 3. High body-mass index 1,325.1 3. Neoplasms 725.9 12.0 4. Dietary risks 1,306.6 4. Neurological disorders 446.5 7.4 5. Low glomerular filtration rate 518.5 5. Diarrheal/LRI/other 356.3 5.9 6. Low physical activity 437.0 6. Chronic respiratory diseases 126.1 2.1 7. High total cholesterol 354.9 7. Digestive diseases 122.1 2.0 Others 7.0 109

Total population 1. High systolic blood pressure 177.1 1. Cardiovascular diseases 243.2 33.5 All age 2. Dietary risks 146.1 2. Neoplasms 125.3 17.2 3. High fasting plasma glucose 129.6 3. Diabetes 109.8 15.1 4. High body-mass index 119.4 4. Diarrheal/LRI/other 38.9 5.4 5. Smoking 50.5 5. Neurological disorders 37.5 5.2 6. Low physical activity 41.4 6. Chronic respiratory diseases 24.8 3.4 7. Air pollution 36.0 7. Unintentional injuries 23.4 3.2 Others 17.0 1. High systolic blood pressure 186.9 1. Cardiovascular diseases 251.5 29.5 All age 2. Dietary risks 163.1 2. Neoplasms 157.9 18.5 3. High fasting plasma glucose 127.6 3. Diabetes 115.0 13.5 4. High body-mass index 97.6 4. Diarrheal/LRI/other 44.7 5.3 5. Smoking 59.5 5. Neurological disorders 42.7 5.0 6. Low glomerular filtration rate 55.0 6. Chronic respiratory diseases 38.0 4.5 7. Alcohol and drug use 52.6 7. Self-harm & intersonal violence 35.5 4.2 Others 19.7 1. High systolic blood pressure 167.5 1. Cardiovascular diseases 235.0 39.0 All age 2. High body-mass index 141.0 2. Diabetes 104.6 17.4 3. High fasting plasma glucose 131.7 3. Neoplasms 93.2 15.4 4. Dietary risks 129.3 4. Diarrheal/LRI/other 33.1 5.5 5. Low glomerular filtration rate 46.0 5. Neurological disorders 32.3 5.4 6. Low physical activity 39.2 6. Other non-communicable 15.2 2.5 7. High total cholesterol 35.4 7. Neonatal disorders 14.6 2.4 Others 12.3 110

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) 53 66 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 $10,890.00 Per capita GDP-PPP outlay on healthcare $789.00 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, 2012 49.3 (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 9,877 25.62% 23.39% 28.63% 2. Neoplasms 14,042 7,098 6,944 17.34% 15.27% 20.13% 3. Diabetes 9,377 4,678 4,699 11.58% 10.07% 13.62% 4. Diarrheal/LRI/Other 8,563 4,568 3,996 10.58% 9.83% 11.58% 5. Transport injuries 5,094 3,970 1,125 6.29% 8.54% 3.26% 6. Self-harm & intersonal violence 4,759 3,999 760 5.88% 8.61% 2.20% 7. Unintentional injuries 3,864 2,805 1058 4.77% 6.04% 3.07% 8. Chronic respiratory diseases 3,590 2,231 1,359 4.43% 4.80% 3.94% 9.Cirrhosis 3,095 2035 1,060 3.82% 4.38% 3.07% 10. Neurological disorders 2,738 1,354 1384 3.38% 2.91% 4.01% 11. Digestive diseases 2,613 1,436 1177 3.23% 3.09% 3.41% 12. Neonatal disorders 2,486 1,426 1060 3.07% 3.07% 3.07% TOTAL 80,969 46,469 34,500 100.0% 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 2015. 53 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 1,842,482 2,002,007 8.66% Years lived with disability (YLD) 319,927 518,731 62.14% Years of life lost (YLL) 1,522,557 1,483,277-2.58% 39856 59,718 49.83% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,102,377 1,245,901 13.02% Years lived with disability (YLD) 186,086 279,210 50.04% Years of life lost (YLL) 916,293 966,692 5.50% 23,244 36,095 55.29% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 740,105 756,106 2.16% Years lived with disability (YLD) 133,841 239,521 78.96% Years of life lost (YLL) 606,264 516,585-14.79% 16,612 23,623 42.20% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 20,002,007 10% 518,731 100% 1,483,277 100% 59,718 100% 1,248,901 6.24% 279,210 53.83% 966,692 65.17% 36,095 60.44% 756,106 3.78% 239,521 46.17% 516,585 34.83% 23,623 39.56% 112

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 145.1 1. Diarrheal/LRI/other 180.0 30.7 2. Unsafe water, sanitation and handwashing 33.0 2. Neonatal disorders 3. Air pollution 13.2 3. Other non-communicable 120.2 20.5 4. Smoking 8.8 4. Unintentional injuries 38.4 6.5 5. Low glomerular filtration rate 4.0 5. Nutritional deficiencies 25.7 4.4 6. Alcohol and drug use 2.5 6. Transport injuries 15.6 2.7 155.6 26.5 7. Unsafe sex 2.4 7. Diabetes 12.0 2.1 Others 6.7 Children under 5 years 1. Child and maternal malnutrition 153.2 1. Diarrheal/LRI/other 189.5 30.3 2. Unsafe water, sanitation and handwashing 35.3 2. Neonatal disorders 3. Air pollution 13.9 3. Other non-communicable 123.0 19.7 4. Smoking 9.3 4. Unintentional injuries 39.5 6.3 5. Low glomerular filtration rate 4.3 5. Nutritional deficiencies 27.6 4.4 174.5 28.0 6. Alcohol and drug use 2.6 6. Transport injuries 17.5 2.8 7. Unsafe sex 2.3 7. Diabetes 12.8 2.0 Others 6.5 Children under 5 years 1. Child and maternal malnutrition 136.6 1. Diarrheal/LRI/other 170.1 31.1 2. Unsafe water, sanitation and handwashing 30.7 2. Neonatal disorders 3. Air pollution 12.5 3. Other non-communicable 117.3 21.5 4. Smoking 8.3 4. Unintentional injuries 37.1 6.8 5. Low glomerular filtration rate 3.7 5. Nutritional deficiencies 23.8 4.4 135.8 24.9 6. Unsafe sex 2.5 6. Transport injuries 13.6 2.5 7. Alcohol and drug use 2.3 7. Diabetes 11.2 2.1 Others 6.9 113

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.0 1. Transport injuries 2. Alcohol and drug use 1.6 2. Diarrheal/LRI/other 8.2 16.7 3. Low glomerular filtration rate 1.0 3. Unintentional injuries 7.5 15.3 4. Air pollution 0.5 4. Neoplasms 6.0 12.2 5. Child and maternal malnutrition 0.3 5. Self-harm & intersonal violence 3.5 7.1 10.9 22.1 6. High systolic blood pressure 0.3 6. Cardiovascular diseases 2.6 5.3 7. High fasting plasma glucose 0.3 7. Other non-communicable 2.6 5.2 Others 16.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.2 1. Transport injuries 2. Alcohol and drug use 1.9 2. Unintentional injuries 9.5 17.1 3. Low glomerular filtration rate 1.0 3. Diarrheal/LRI/other 8.9 15.9 4. Air pollution 0.5 4. Neoplasms 6.6 11.8 5. Child and maternal malnutrition 0.4 5. Self-harm & intersonal violence 3.9 7.0 13.3 23.9 6. High systolic blood pressure 0.3 6. Cardiovascular diseases 2.8 4.9 7. High fasting plasma glucose 0.2 7. Other non-communicable 2.7 4.9 Others 14.5 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.8 1. Transport injuries 2. Alcohol and drug use 1.2 2. Diarrheal/LRI/other 7.5 17.8 3. Low glomerular filtration rate 1.0 3. Unintentional injuries 5.5 12.9 4. Air pollution 0.4 4. Neoplasms 5.3 12.7 5. Child and maternal malnutrition 0.3 5. Self-harm & intersonal violence 3.0 7.2 8.3 19.7 6. High fasting plasma glucose 0.3 6. Cardiovascular diseases 2.5 5.9 7. High systolic blood pressure 0.3 7. Other non-communicable 2.4 5.6 Others 18.3 114

Total population 15 to 49 years of age 1. Alcohol and drug use 35.4 1. Self-harm & intersonal violence 45.7 21.1 2. Dietary risks 21.9 2. Transport injuries 35.1 16.2 3. High body-mass index 15.2 3. Cardiovascular diseases 26.7 12.3 4. High systolic blood pressure 14.8 4. Neoplasms 25.0 11.5 5. High fasting plasma glucose 12.2 5. Unintentional injuries 19.7 9.1 6. Unsafe sex 10.5 6. Diabetes 13.3 6.1 7. High total cholesterol 9.2 7. HIV/AIDS 12.9 6.0 Others 17.6 15 to 49 years of age 1. Alcohol and drug use 61.0 1. Self-harm & intersonal violence 77.7 25.6 2. Dietary risks 27.1 2. Transport injuries 58.9 19.5 3. High systolic blood pressure 19.1 3. Unintentional injuries 34.6 11.4 4. High body-mass index 15.0 4. Cardiovascular diseases 32.4 10.7 5. High fasting plasma glucose 14.4 5. Neoplasms 20.4 6.7 6. High total cholesterol 12.3 6. HIV/AIDS 19.2 6.4 7. Unsafe sex 11.8 7. Diabetes 14.8 4.9 Others 14.8 15 to 49 years of age 1. Dietary risks 16.6 1. Neoplasms 29.6 22.6 2. High body-mass index 15.5 2. Cardiovascular diseases 21.0 16.1 3. High systolic blood pressure 10.4 3. Self-harm & intersonal violence 13.7 10.5 4. High fasting plasma glucose 10.0 4. Diabetes 11.9 9.1 5. Alcohol and drug use 9.8 5. Transport injuries 11.3 8.7 6. Unsafe sex 9.1 6. Diarrheal/LRI/other 7.5 5.7 7. Low glomerular filtration rate 7.7 7. Maternal disorders 6.8 5.3 Others 22.0 115

Total population 50 to 69 years of age 1. Dietary risks 217.8 1. Cardiovascular diseases 229.0 25.1 2. High systolic blood pressure 174.1 2. Neoplasms 211.5 23.2 3. High body-mass index 156.4 3. Diabetes 144.8 15.9 4. High fasting plasma glucose 152.9 4. Cirrhosis 61.4 6.7 5. Alcohol and drug use 99.2 5. Transport injuries 47.1 5.2 6. Low glomerular filtration rate 91.5 6. Diarrheal/LRI/other 41.7 4.6 7. High total cholesterol 61.1 7. Self-harm & intersonal violence 30.4 3.3 Others 16.1 50 to 69 years of age 1. Dietary risks 277.2 1. Cardiovascular diseases 287.8 25.5 2. High systolic blood pressure 217.0 2. Neoplasms 204.3 18.1 3. High fasting plasma glucose 171.5 3. Diabetes 158.1 14.0 4. Alcohol and drug use 165.8 4. Cirrhosis 88.7 7.8 5. High body-mass index 150.6 5. Transport injuries 74.9 6.6 6. Low glomerular filtration rate 105.2 6. Self-harm & intersonal violence 54.0 4.8 7. Smoking 95.9 7. Diarrheal/LRI/other 52.5 4.6 Others 18.6 50 to 69 years of age 1. High body-mass index 162.0 1. Neoplasms 218.4 31.0 2. Dietary risks 161.0 2. Cardiovascular diseases 172.7 24.5 3. High fasting plasma glucose 135.0 3. Diabetes 132.0 18.8 4. High systolic blood pressure 133.1 4. Cirrhosis 35.3 5.0 5. Low glomerular filtration rate 78.5 5. Diarrheal/LRI/other 31.2 4.4 6. High total cholesterol 47.6 6. Digestive diseases 23.4 3.3 7. Alcohol and drug use 35.3 7. Transport injuries 20.5 2.9 Others 10.0 116

Total population 70 years of age and over 1. High systolic blood pressure 1,211.1 1. Cardiovascular diseases 1,958.8 33.4 2. Dietary risks 1,182.8 2. Neoplasms 1,042.0 17.8 3. High fasting plasma glucose 774.7 3. Diabetes 720.0 12.3 4. Smoking 590.4 4. Diarrheal/LRI/other 546.9 9.3 5. Low glomerular filtration rate 564.9 5. Chronic respiratory diseases 407.7 7.0 6. High body-mass index 421.2 6. Neurological disorders 314.2 5.4 7. High total cholesterol 310.2 7. Digestive diseases 215.9 3.7 Others 11.2 70 years of age and over 1. Dietary risks 1,310.0 1. Cardiovascular diseases 2,036.1 31.2 2. High systolic blood pressure 1,238.5 2. Neoplasms 1,248.7 19.1 3. High fasting plasma glucose 754.2 3. Diabetes 725.2 11.1 4. Smoking 641.3 4. Diarrheal/LRI/other 588.4 9.0 5. Low glomerular filtration rate 607.0 5. Chronic respiratory diseases 549.1 8.4 6. High body-mass index 431.5 6. Neurological disorders 321.2 4.9 7. Low physical activity 325.5 7. Digestive diseases 238.3 3.7 Others 12.5 70 years of age and over 1. High systolic blood pressure 1,187.8 1. Cardiovascular diseases 1,893.0 35.7 2. Dietary risks 1,074.5 2. Neoplasms 866.1 16.3 3. High fasting plasma glucose 792.2 3. Diabetes 715.7 13.5 4. High body-mass index 678.3 4. Diarrheal/LRI/other 511.7 9.7 5. Low glomerular filtration rate 576.3 5. Neurological disorders 308.2 5.8 6. High total cholesterol 344.3 6. Chronic respiratory diseases 287.4 5.4 7. Low physical activity 267.7 7. Digestive diseases 196.9 3.7 Others 9.9 117

Total population 1. Dietary risks 92.5 1. Cardiovascular diseases 131.9 23.5 All age 2. High systolic blood pressure 84.4 2. Neoplasms 89.3 15.9 3. High fasting plasma glucose 61.0 3. Diabetes 59.6 10.6 4. High body-mass index 53.7 4. Diarrheal/LRI/other 54.4 9.7 5. Low glomerular filtration rate 43.5 5. Transport injuries 32.4 5.8 6. Alcohol and drug use 41.4 6. Self-harm & intersonal violence 30.3 5.4 7. Smoking 30.8 7. Unintentional injuries 24.6 4.4 Others 24.9 1. Dietary risks 103.3 1. Cardiovascular diseases 138.2 21.4 All age 2. High systolic blood pressure 88.6 2. Neoplasms 90.2 14.0 3. Alcohol and drug use 65.0 3. Diabetes 59.5 9.2 4. High fasting plasma glucose 60.6 4. Diarrheal/LRI/other 58.1 9.0 5. High body-mass index 45.0 5. Self-harm & intersonal violence 50.8 7.9 6. Low glomerular filtration rate 44.2 6. Transport injuries 50.5 7.8 7. Smoking 43.6 7. Unintentional injuries 35.7 5.5 Others 25.3 1. Dietary risks 81.7 1. Cardiovascular diseases 125.6 26.3 All age 2. High systolic blood pressure 80.1 2. Neoplasms 88.3 18.4 3. High body-mass index 62.4 3. Diabetes 59.7 12.5 4. High fasting plasma glucose 61.4 4. Diarrheal/LRI/other 50.8 10.6 5. Low glomerular filtration rate 42.7 5. Neurological disorders 17.6 3.7 6. High total cholesterol 26.0 6. Chronic respiratory diseases 17.3 3.6 7. Low physical activity 18.3 7. Digestive diseases 15.0 3.1 Others 21.8 118

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) 55 63 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 $7,764.00 Per capita GDP-PPP outlay on healthcare $539.00 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, 2012 48.3 (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 5,088 25.0% 20.30% 31.07% 2.Diabetes 4,975 2,664 2,311 13.3% 12.69% 14.11% 3. Self-harm & intersonal violence 4,852 4,185 667 13.0% 19.94% 4.07% 4.Neoplasms 4,807 2,016 2,791 12.9% 9.60% 17.04% 5. Diarrheal/LRI/Other 3,124 1,589 1,535 8.4% 7.57% 9.37% 6. Chronic respiratory diseases 2,192 991 1,202 5.9% 4.72% 7.34% 7. Transport injuries 2,114 1,616 498 5.7% 7.70% 3.04% 8. Neurological disorders 1,694 802 891 4.5% 3.82% 5.44% 9.Cirrhosis 1,285 805 480 3.4% 3.84% 2.93% 10. Unintentional injuries 11.Mental & substance use disorders 1,037 685 352 2.8% 3.26% 2.15% 994 949 45.3 2.7% 4.52% 0.28% 12. Digestive diseases 942 426 516 2.5% 2.03% 3.15% TOTAL 37,366 20,990 16,376 100.0% 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 2015. 55 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 1,146,070 1,130,828-1.33% Years lived with disability (YLD) 147,943 215,303 45.53% Years of life lost (YLL) 998,129 915,527-8.28% 26871 37,053 37.89% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 743,657 722,061-2.90% Years lived with disability (YLD) 89,499 117,136 30.88% Years of life lost (YLL) 654,160 604,927-7.53% 16,019 20,098 25.46% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 402,413 408,767 1.58% Years lived with disability (YLD) 58,444 98,167 67.97% Years of life lost (YLL) 343,969 310,600-9.70% 10,852 16,955 56.24% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,130,828 100% 215,303 100% 915,527 100% 37,053 100% 722,061 63.85% 117,136 54.41% 604,927 66.07% 20,098 54.24% 408,767 36.15% 98,167 45.59% 310,600 33.93% 16,955 45.76% 120

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 38.9 1. Other non-communicable 92.2 33.8 2. Unsafe water, sanitation and handwashing 14.3 2. Neonatal disorders 3. Air pollution 5.4 3. Diarrheal/LRI/other 53.3 19.6 4. Unsafe sex 1.6 4. Unintentional injuries 6.1 2.3 5. Low glomerular filtration rate 1.5 5. Nutritional deficiencies 5.9 2.2 6. Smoking 1.3 6. Diabetes 4.7 1.7 86.6 31.8 7. High systolic blood pressure 0.6 7. Self-harm & intersonal violence 4.5 1.7 Others 7.0 Children under 5 years 1. Child and maternal malnutrition 44.2 1. Neonatal disorders 100.6 32.8 2. Unsafe water, sanitation and handwashing 16.4 2. Other non-communicable 3. Air pollution 6.1 3. Diarrheal/LRI/other 60.8 19.9 4. Low glomerular filtration rate 1.6 4. Unintentional injuries 6.9 2.2 5. Unsafe sex 1.6 5. Nutritional deficiencies 5.9 1.9 100.5 32.8 6. Smoking 1.4 6. Diabetes 5.4 1.8 7. High systolic blood pressure 0.7 7. Self-harm & intersonal violence 4.9 1.6 Others 7.0 Children under 5 years 1. Child and maternal malnutrition 33.4 1. Other non-communicable 83.6 35.2 2. Unsafe water, sanitation and handwashing 12.1 2. Neonatal disorders 3. Air pollution 4.5 3. Diarrheal/LRI/other 45.4 19.2 4. Unsafe sex 1.7 4. Nutritional deficiencies 5.8 2.5 5. Low glomerular filtration rate 1.4 5. Unintentional injuries 5.4 2.3 72.0 30.3 6. Smoking 1.2 6. Self-harm & intersonal violence 4.1 1.7 7. High systolic blood pressure 0.6 7. Diabetes 4.0 1.7 Others 7.1 121

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.3 1. Transport injuries 2. Low glomerular filtration rate 0.7 2. Self-harm & intersonal violence 5.5 18.9 3. Alcohol and drug use 0.6 3. Diarrheal/LRI/other 4.6 15.9 4. High systolic blood pressure 0.3 4. Unintentional injuries 2.9 9.9 5. Air pollution 0.2 5. Neoplasms 2.8 9.5 5.6 19.5 6. Child and maternal malnutrition 0.2 6. Other non-communicable 2.0 6.8 7. High fasting plasma glucose 0.2 7. Cardiovascular diseases 1.8 6.2 Others 13.2 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.7 1. Transport injuries 2. Alcohol and drug use 0.7 2. Self-harm & intersonal violence 6.4 19.8 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 5.1 15.7 4. Air pollution 0.2 4. Unintentional injuries 3.5 11.0 5. High systolic blood pressure 0.2 5. Neoplasms 3.1 9.6 6.9 21.3 6. Child and maternal malnutrition 0.2 6. Other non-communicable 2.0 6.0 7. High fasting plasma glucose 0.1 7. Cardiovascular diseases 1.7 5.2 Others 11.3 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.0 1. Self-harm & intersonal violence 2. Low glomerular filtration rate 0.8 2. Diarrheal/LRI/other 4.4 17.1 3. Alcohol and drug use 0.5 3. Diarrheal/LRI/other 4.1 16.2 4. High systolic blood pressure 0.3 4. Neoplasms 2.4 9.4 5. Air pollution 0.2 5. Unintentional injuries 2.2 8.5 4.5 17.7 6. Child and maternal malnutrition 0.2 6. Other non-communicable 2.0 7.9 7. High fasting plasma glucose 0.2 7. Cardiovascular diseases 1.9 7.6 Others 15.8 122

Total population 15 to 49 years of age 1. Alcohol and drug use 47.0 1. Self-harm & intersonal violence 123.9 41.6 2. Dietary risks 21.3 2. Transport injuries 33.7 11.3 3. High body-mass index 16.8 3. Neoplasms 23.8 8.0 4. Low glomerular filtration rate 15.1 4. Cardiovascular diseases 23.4 7.9 5. High systolic blood pressure 13.6 5. Diabetes 21.7 7.3 6. High fasting plasma glucose 12.3 6. Mental and substance use disorders 16.1 5.4 7. Unsafe sex 9.9 7. Unintentional injuries 11.2 3.8 Others 14.8 15 to 49 years of age 1. Alcohol and drug use 90.1 1. Self-harm & intersonal violence 232.2 48.2 2. Dietary risks 26.8 2. Transport injuries 60.7 12.6 3. Low glomerular filtration rate 22.1 3. Mental and substance use disorders 33.1 6.9 4. High systolic blood pressure 20.8 4. Cardiovascular diseases 29.4 6.1 5. High fasting plasma glucose 16.2 5. Diabetes 29.2 6.1 6. High body-mass index 15.6 6. Unintentional injuries 20.5 5.3 7. Smoking 11.5 7. Cirrhosis 19.5 4.0 Others 10.9 15 to 49 years of age 1. High body-mass index 17.8 1. Neoplasms 29.3 21.5 2. Dietary risks 16.6 2. Self-harm & intersonal violence 28.7 21.1 3. Unsafe sex 11.5 3. Cardiovascular diseases 18.2 13.4 4. Alcohol and drug use 9.1 4. Diabetes 15.1 11.1 5. Low glomerular filtration rate 8.9 5. Transport injuries 10.0 7.4 6. High fasting plasma glucose 8.8 6. Diarrheal/LRI/other 7.2 5.3 7. High systolic blood pressure 7.3 7. Maternal disorders 4.8 3.5 Others 16.7 123

Total population 50 to 69 years of age 1. Dietary risks 249.0 1. Cardiovascular diseases 245.2 22.9 2. High body-mass index 210.6 2. Diabetes 222.6 20.7 3. High systolic blood pressure 180.3 3. Neoplasms 194.1 18.1 4. High fasting plasma glucose 176.4 4. Cirrhosis 62.5 5.8 5. Low glomerular filtration rate 143.7 5. Diarrheal/LRI/other 59.3 5.5 6. Alcohol and drug use 104.0 6. Self-harm & intersonal violence 57.6 5.4 7. High total cholesterol 61.8 7. Transport injuries 57.0 5.3 Others 16.3 50 to 69 years of age 1. Dietary risks 304.0 1. Cardiovascular diseases 298.1 21.1 2. High systolic blood pressure 255.4 2. Diabetes 291.3 20.6 3. High fasting plasma glucose 217.2 3. Neoplasms 174.5 12.4 4. Low glomerular filtration rate 216.8 4. Self-harm & intersonal violence 111.3 7.9 5. Alcohol and drug use 192.2 5. Mental and substance use disorders 100.3 7.1 6. High body-mass index 182.1 6. Transport injuries 97.6 6.9 7. Smoking 94.1 7. Cirrhosis 91.8 6.5 Others 17.6 50 to 69 years of age 1. High body-mass index 232.1 1. Cardiovascular diseases 208.8 25.6 2. Dietary risks 207.6 2. Diabetes 205.4 25.1 3. High fasting plasma glucose 145.7 3. Neoplasms 170.9 20.9 4. High systolic blood pressure 123.8 4. Self-harm & intersonal violence 46.4 5.7 5. Low glomerular filtration rate 88.7 5. Mental and substance use disorders 40.4 4.9 6. High total cholesterol 52.7 6. Transport injuries 34.7 4.2 7. Air pollution 51.8 7. Cirrhosis 26.4 3.2 Others 10.3 124

Total population 70 years of age and over 1. Dietary risks 1,294.0 1. Cardiovascular diseases 2,126.3 33.9 2. High systolic blood pressure 1,027.4 2. Diabetes 803.5 12.8 3. High fasting plasma glucose 834.5 3. Neoplasms 792.8 12.6 4. High body-mass index 648.8 4. Diarrheal/LRI/other 617.2 9.8 5. Low glomerular filtration rate 640.8 5. Chronic respiratory diseases 564.4 9.0 6. Air pollution 467.1 6. Neurological disorders 494.0 7.9 7. Smoking 356.7 7. Digestive diseases 194.8 3.1 Others 10.9 70 years of age and over 1. Dietary risks 1,396.1 1. Cardiovascular diseases 2,119.1 31.3 2. High systolic blood pressure 1,138.0 2. Diabetes 931.1 13.7 3. High fasting plasma glucose 874.3 3. Neoplasms 861.2 12.7 4. Low glomerular filtration rate 786.9 4. Diarrheal/LRI/other 674.1 10.0 5. Air pollution 461.8 5. Chronic respiratory diseases 587.2 8.7 6. High body-mass index 399.1 6. Neurological disorders 545.2 8.1 7. Smoking 397.6 7. Transport injuries 211.8 3.1 Others 12.5 70 years of age and over 1. Dietary risks 1,219.2 1. Cardiovascular diseases 2,131.6 36.1 2. High systolic blood pressure 946.3 2. Neoplasms 742.7 12.6 3. High body-mass index 831.8 3. Diabetes 710.0 12.0 4. High fasting plasma glucose 805.3 4. Diarrheal/LRI/other 575.6 9.7 5. Low glomerular filtration rate 533.8 5. Chronic respiratory diseases 547.6 9.3 6. Air pollution 471.1 6. Neurological disorders 456.5 7.7 7. High total cholesterol 366.0 7. Digestive diseases 204.1 3.5 Others 9.2 125

Total population 1. Dietary risks 104.8 1. Cardiovascular diseases 147.4 23.4 All age 2. High systolic blood pressure 79.5 2. Diabetes 78.4 12.5 3. High fasting plasma glucose 68.8 3. Self-harm & intersonal violence 76.5 12.2 4. High body-mass index 66.0 4. Neoplasms 75.8 12.0 5. Low glomerular filtration rate 57.0 5. Diarrheal/LRI/other 49.2 7.8 6. Alcohol and drug use 45.5 6. Chronic respiratory diseases 34.6 5.5 7. Air pollution 34.4 7. Transport injuries 33.3 5.3 Others 21.3 1. Dietary risks 108.3 1. Cardiovascular diseases 141.8 19.1 All age 2. High systolic blood pressure 88.7 2. Self-harm & intersonal violence 139.2 18.7 3. Alcohol and drug use 78.2 3. Diabetes 88.6 11.9 4. High fasting plasma glucose 70.5 4. Neoplasms 67.1 9.0 5. Low glomerular filtration rate 69.9 5. Transport injuries 53.7 7.2 6. High body-mass index 45.4 6. Diarrheal/LRI/other 52.8 7.1 7. Smoking 33.9 7. Chronic respiratory diseases 33.0 4.4 Others 22.5 1. Dietary risks 101.7 1. Cardiovascular diseases 152.4 29.0 All age 2. High body-mass index 84.5 2. Neoplasms 83.6 15.9 3. High systolic blood pressure 71.3 3. Diabetes 69.3 13.2 4. High fasting plasma glucose 67.2 4. Diarrheal/LRI/other 46.0 8.8 5. Low glomerular filtration rate 45.4 5. Chronic respiratory diseases 36.0 6.9 6. Air pollution 35.3 6. Neurological disorders 26.7 5.1 7. High total cholesterol 29.4 7. Self-harm & intersonal violence 20.0 3.8 Others 17.4 126

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) 57 69 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 $52,980.00 Per capita GDP-PPP outlay on healthcare $9,146.00 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, 2012 40.8 (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 870,626 421,663 448,963 33.71% 32.28% 35.18% 2.Neoplasms 634,437 338,419 296,018 24.57% 25.91% 23.20% 3. Neurological disorders 327,002 138,553 188,449 12.66% 10.61% 14.77% 4.Diabetes 191,851 95,509 96,342 7.43% 7.31% 7.55% 5. Chronic respiratory diseases 182,748 94,300 88,448 7.08% 7.22% 6.93% 6. Diarrheal/LRI/Other 97,765 45,984 51,781 3.79% 3.52% 4.06% 7. Unintentional injuries 8. Self-harm & intersonal violence 71,536 38,778 32,758 2.77% 2.97% 2.57% 58,897 46,340 12,557 2.28% 3.55% 0.98% 9.Cirrhosis 53,262 33718 19,543 2.06% 2.58% 1.53% 10. Transport injuries 47,199 32,931 14,268 1.83% 2.52% 1.12% 11. Digestive diseases 47,000 19,965 27,035 1.82% 1.53% 2.12% TOTAL 2,582,323 1,306,160 1,276,162 100.0% 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 2015. 57 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 58,138,877 62,533,721 7.56% Years lived with disability (YLD) 9,024,798 14,177,004 57.09% Years of life lost (YLL) 49,114,079 48,356,702-1.54% 2778458 2,910,420 4.75% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 35,676,516 36,460,321 2.20% Years lived with disability (YLD) 5,075,680 7,459,194 46.96% Years of life lost (YLL) 30,600,836 29,001,112-5.23% 1,467,282 1,467,181-0.01% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 22,462,361 26,073,400 16.08% Years lived with disability (YLD) 3,949,118 6,717,810 70.11% Years of life lost (YLL) 18,513,243 19,355,590 4.55% 1,311,176 1,443,239 10.07% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 62,533,721 100% 14,177,004 100% 48,356,702 100% 2,910,420 100% 36,460,321 58.31% 7,459,194 52.61% 29,001,112 59.97% 1,467,181 50.41% 26,073,400 41.69% 6,717,810 47.39% 19,355,590 40.03% 1,443,239 49.59% 128

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 1.5 1. Neonatal disorders 55.6 41.8 2. Alcohol and drug use 0.7 2. Other non-communicable 42.4 31.8 3. Low glomerular filtration rate 0.3 3. Unintentional injuries 10.4 7.8 4. Unsafe sex 0.3 4. Diarrheal/LRI/other 5.5 4.1 5. High fasting plasma glucose 0.2 5. Transport injuries 3.8 2.9 6. Air pollution 0.2 6. Diabetes 3.3 2.5 7. Unsafe water, sanitation and handwashing 0.2 7. Neoplasms 3.1 2.3 Others 6.8 Children under 5 years 1. Child and maternal malnutrition 1.7 1. Neonatal disorders 61.4 42.2 2. Alcohol and drug use 0.8 2. Other non-communicable 44.7 30.7 3. Low glomerular filtration rate 0.4 3. Unintentional injuries 12.4 8.5 4. Unsafe sex 0.3 4. Diarrheal/LRI/other 6.2 4.2 5. High fasting plasma glucose 0.2 5. Transport injuries 4.1 2.8 6. Air pollution 0.2 6. Diabetes 3.7 2.5 7. Unsafe water, sanitation and handwashing 0.2 7. Neoplasms 3.3 2.3 Others 6.8 Children under 5 years 1. Child and maternal malnutrition 1.2 1. Neonatal disorders 49.6 41.3 2. Alcohol and drug use 0.7 2. Other non-communicable 39.9 33.2 3. Unsafe sex 0.3 3. Unintentional injuries 8.3 6.9 4. Low glomerular filtration rate 0.3 4. Diarrheal/LRI/other 4.8 4.0 5. High fasting plasma glucose 0.2 5. Transport injuries 3.4 2.9 6. Air pollution 0.2 6. Neoplasms 2.9 2.4 7. Unsafe water, sanitation and handwashing 0.2 7. Diabetes 2.9 2.4 Others 6.7 129

Total population 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Transport injuries 3.0 22.8 2. High fasting plasma glucose 0.1 2. Neoplasms 2.8 21.0 3. Low glomerular filtration rate 0.1 3. Unintentional injuries 2.1 15.7 4. Sexual abuse and violence 0.1 4. Self-harm & intersonal violence 1.1 8.5 5. Unsafe water, sanitation and handwashing 0.1 5. Other non-communicable 6. Air pollution 0.1 6. Diabetes 0.8 6.1 1.0 7.6 7. High systolic blood pressure 0.1 7. Diarrheal/LRI/other 0.6 4.7 Others 13.6 5 to 14 years of age 1. Alcohol and drug use 0.5 1. Transport injuries 3.5 23.2 2. High fasting plasma glucose 0.1 2. Neoplasms 3.0 19.6 3. Low glomerular filtration rate 0.1 3. Unintentional injuries 2.7 18.1 4. Sexual abuse and violence 0.0 4. Self-harm & intersonal violence 1.5 9.9 5. Air pollution 0.1 5. Other non-communicable 1.0 6.9 6. High systolic blood pressure 0.1 6. Diabetes 0.8 5.6 7. Unsafe water, sanitation and handwashing 0.1 7. Cardiovascular diseases 0.6 4.2 Others 12.5 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Neoplasms 2.5 22.8 2. High fasting plasma glucose 0.1 2. Transport injuries 2.5 22.3 3. Low glomerular filtration rate 0.1 3. Unintentional injuries 1.4 12.3 4. Unsafe water, sanitation and handwashing 0.1 4. Other non-communicable 5. Air pollution 0.1 5. Diabetes 0.8 6.8 1.0 8.7 6. High systolic blood pressure 0.1 6. Self-harm & intersonal violence 0.7 6.6 7. Sexual abuse and violence 0.1 7. Diarrheal/LRI/other 0.6 5.6 Others 14.8 130

Total population 15 to 49 years of age 1. Alcohol and drug use 35.1 1. Neoplasms 25.6 18.1 2. Dietary risks 19.4 2. Self-harm & intersonal violence 23.9 16.9 3. High body-mass index 19.0 3. Cardiovascular diseases 22.8 16.1 4. Smoking 13.5 4. Transport injuries 17.2 12.2 5. High systolic blood pressure 11.1 5. Mental and substance use disorders 14.5 10.3 6. High total cholesterol 9.5 6. Diabetes 7.9 5.6 7. High fasting plasma glucose 7.1 7. Unintentional injuries 6.3 4.4 Others 16.4 15 to 49 years of age 1. Alcohol and drug use 50.4 1. Self-harm & intersonal violence 38.0 20.5 2. Dietary risks 26.7 2. Cardiovascular diseases 31.3 16.8 3. High body-mass index 24.4 3. Transport injuries 25.3 13.6 4. Smoking 16.6 4. Neoplasms 24.2 13.1 5. High systolic blood pressure 15.9 5. Mental and substance use disorders 20.0 10.8 6. High total cholesterol 14.3 6. Unintentional injuries 9.6 5.2 7. High fasting plasma glucose 9.7 7. Diabetes 9.4 5.1 Others 15.0 15 to 49 years of age 1. Alcohol and drug use 19.6 1. Neoplasms 26.9 27.8 2. High body-mass index 13.5 2. Cardiovascular diseases 14.3 14.7 3. Dietary risks 12.1 3. Self-harm & intersonal violence 9.6 9.9 4.Smoking 10.4 4. Transport injuries 9.1 9.4 5. High systolic blood pressure 6.2 5. Mental and substance use disorders 8.9 9.2 6. Sexual abuse and violence 5.0 6. Diabetes 6.4 6.6 7. High total cholesterol 4.7 7. Cirrhosis 4.0 4.2 Others 18.1 131

Total population 50 to 69 years of age 1. Smoking 217.3 1. Neoplasms 317.8 37.4 2. Dietary risks 210.2 2. Cardiovascular diseases 234.7 27.6 3. High body-mass index 169.2 3. Diabetes 64.2 7.6 4. High systolic blood pressure 127.3 4. Chronic respiratory diseases 52.3 6.2 5. High fasting plasma glucose 81.8 5. Cirrhosis 37.0 4.4 6. Alcohol and drug use 78.6 6. Neurological disorders 24.6 2.9 7. High total cholesterol 71.5 7. Self-harm & intersonal violence 21.1 2.5 Others 11.5 50 to 69 years of age 1. Dietary risks 293.2 1. Neoplasms 361.1 34.1 2. Smoking 278.2 2. Cardiovascular diseases 322.6 30.5 3. High body-mass index 213.0 3. Diabetes 77.3 7.3 4. High systolic blood pressure 173.3 4. Chronic respiratory diseases 58.8 5.6 5. Alcohol and drug use 112.7 5. Cirrhosis 53.0 5.0 6. High fasting plasma glucose 110.4 6. Self-harm & intersonal violence 33.3 3.2 7. High total cholesterol 97.8 7. Neurological disorders 27.2 2.6 Others 11.8 50 to 69 years of age 1. Smoking 160.3 1. Neoplasms 277.3 42.4 2. Dietary risks 132.6 2. Cardiovascular diseases 152.6 23.4 3. High body-mass index 128.3 3. Diabetes 52.0 8.0 4. High systolic blood pressure 84.3 4. Chronic respiratory diseases 46.2 7.1 5. High fasting plasma glucose 54.9 5. Neurological disorders 22.1 3.4 6. High total cholesterol 47.0 6. Cirrhosis 22.0 3.4 7. Alcohol and drug use 46.8 7. Diarrheal/LRI/other 16.3 2.5 Others 9.9 132

Total population 70 years of age and over 1. Dietary risks 1,243.1 1. Cardiovascular diseases 2,218.1 36.7 2. High systolic blood pressure 1,036.3 2. Neoplasms 1,177.1 19.5 3. Smoking 875.4 3. Neurological disorders 1,032.3 17.1 4. High body-mass index 627.0 4. Chronic respiratory diseases 467.7 7.7 5. High fasting plasma glucose 584.3 5. Diabetes 438.1 7.2 6. Low glomerular filtration rate 367.7 6. Diarrheal/LRI/other 261.5 4.3 7. High total cholesterol 354.1 7. Unintentional injuries 156.1 2.6 Others 4.9 70 years of age and over 1. Dietary risks 1,357.7 1. Cardiovascular diseases 2,231.1 34.2 2. Smoking 1,089.5 2. Neoplasms 1,478.2 22.6 3. High systolic blood pressure 983.8 3. Neurological disorders 1,017.7 15.6 4. High body-mass index 665.5 4. Chronic respiratory diseases 564.6 8.7 5. High fasting plasma glucose 664.1 5. Diabetes 474.7 7.3 6. Low glomerular filtration rate 368.7 6. Diarrheal/LRI/other 275.7 4.2 7. Low physical activity 344.8 7. Unintentional injuries 168.2 2.6 Others 4.9 70 years of age and over 1. Dietary risks 1,160.0 1. Cardiovascular diseases 2,208.7 38.8 2. High systolic blood pressure 1,074.3 2. Neurological disorders 1,043.0 18.3 3. Smoking 720.1 3. Neoplasms 958.5 16.8 4. High body-mass index 599.0 4. Diabetes 411.5 7.2 5. High fasting plasma glucose 526.4 5. Chronic respiratory diseases 397.4 7.0 6. High total cholesterol 416.5 6. Diarrheal/LRI/other 251.1 4.4 7. Low glomerular filtration rate 366.9 7. Unintentional injuries 147.3 2.6 Others 4.9 133

Total population 1. Dietary risks 175.8 1. Cardiovascular diseases 273.8 32.4 All age 2. Smoking 140.7 2. Neoplasms 199.5 23.6 3. High systolic blood pressure 132.3 3. Neurological disorders 102.9 12.2 4. High body-mass index 108.4 4. Diabetes 60.3 7.1 5. High fasting plasma glucose 77.5 5. Chronic respiratory diseases 57.5 6.8 6. High total cholesterol 54.8 6. Diarrheal/LRI/other 30.8 3.6 7. Alcohol and drug use 50.0 7. Unintentional injuries 22.5 2.7 Others 11.5 1. Dietary risks 190.9 1. Cardiovascular diseases 269.5 30.9 All age 2. Smoking 161.3 2. Neoplasms 216.3 24.8 3. High systolic blood pressure 127.2 3. Neurological disorders 88.6 10.2 4. High body-mass index 115.7 4. Diabetes 61.0 7.0 5. High fasting plasma glucose 83.8 5. Chronic respiratory diseases 60.3 6.9 6. Alcohol and drug use 66.0 6. Self-harm & intersonal violence 29.6 3.4 7. High total cholesterol 51.6 7. Diarrheal/LRI/other 29.4 3.4 Others 13.5 1. Dietary risks 161.1 1. Cardiovascular diseases 278.0 34.0 All age 2. High systolic blood pressure 137.3 2. Neoplasms 183.3 22.4 3. Smoking 120.9 3. Neurological disorders 116.7 14.3 4. High body-mass index 101.5 4. Diabetes 59.7 7.3 5. High fasting plasma glucose 71.4 5. Chronic respiratory diseases 54.8 6.7 6. High total cholesterol 57.8 6. Diarrheal/LRI/other 32.1 3.9 7. Low physical activity 45.9 7. Unintentional injuries 20.3 2.5 Others 9.0 134

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) 59 62 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 $11,646.00 Per capita GDP-PPP outlay on healthcare $729.00 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 296 127 169 36.27% 31.50% 40.82% 2. Neoplasms 142 74 68 17.40% 18.41% 16.43% 3.Diabetes 128 52 76 15.69% 12.94% 18.36% 4. Diarrheal/LRI/Other 49 22 27 6.00% 5.47% 6.52% 5. Neurological disorders 36 18 19 4.41% 4.48% 4.59% 6. Unintentional injuries 29 19 10 3.55% 4.73% 2.42% 7. Chronic respiratory diseases 8. Self-harm & intersonal violence 26 17 8 3.19% 4.23% 1.93% 25 21 4 3.06% 5.22% 0.96% 9. Transport injuries 19 15 5 2.33% 3.73% 1.14% 10.HIV/AIDS 19 14 5 2.33% 3.48% 1.27% 11. Digestive diseases 18 9 9 2.21% 2.30% 2.17% 12.Non-communicable diseases 16 7 9 1.96% 1.70% 2.17% 13.Neonatal disorders 13 7 5 1.59% 1.83% 1.21% TOTAL 816 402 414 100.0% 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 2015. 59 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 21,100 22,230 5.36% Years lived with disability (YLD) 3,602 4,947 37.34% Years of life lost (YLL) 17,502 17,289-1.22% 768 888 15.63% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 10,931 12,234 11.92% Years lived with disability (YLD) 1,864 2,537 36.11% Years of life lost (YLL) 9,071 9,703 6.97% 361 419 16.07% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 10,169 9,996-1.70% Years lived with disability (YLD) 1,738 2,410 38.67% Years of life lost (YLL) 8,431 7,586-10.02% 407 469 15.23% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 22,230 100% 4,947 100% 17,289 100% 888 100% 12,234 55.03% 2,537 51.28% 9,703 56.12% 419 47.18% 9,996 44.97% 2,410 48.72% 7,586 43.88% 469 52.82% 136

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 29.7 1. Neonatal disorders 127.6 47.3 2. Unsafe water, sanitation and handwashing 10.5 2. Other non-communicable 3. Air pollution 2.6 3. Diarrheal/LRI/other 35.8 13.6 4. Unsafe sex 2.4 4. Unintentional injuries 13.8 5.2 5. Smoking 1.5 5. Nutritional deficiencies 9.5 3.6 6. Low glomerular filtration rate 1.1 6. Diabetes 6.0 2.3 53.3 20.1 7. Alcohol and drug use 0.9 7. Cardiovascular diseases 4.2 1.6 Others 6.4 Children under 5 years 1. Child and maternal malnutrition 32.9 1. Neonatal disorders 142.9 47.8 2. Unsafe water, sanitation and handwashing 11.9 2. Other non-communicable 3. Air pollution 2.7 3. Diarrheal/LRI/other 39.5 13.5 4. Unsafe sex 2.4 4. Unintentional injuries 15.5 5.3 5. Smoking 1.5 5. Nutritional deficiencies 10.8 3.7 57.7 19.7 6. Low glomerular filtration rate 1.2 6. Diabetes 6.4 2.2 7. Alcohol and drug use 1.1 7. Cardiovascular diseases 4.1 1.4 Others 6.4 Children under 5 years 1. Child and maternal malnutrition 26.3 1. Neonatal disorders 111.5 46.6 2. Unsafe water, sanitation and handwashing 9.0 2. Other non-communicable 3. Unsafe sex 2.4 3. Diarrheal/LRI/other 31.9 13.6 4. Air pollution 2.4 4. Unintentional injuries 12.0 5.1 5. High fasting plasma glucose 1.6 5. Nutritional deficiencies 8.2 3.5 48.7 20.7 6. Low glomerular filtration rate 1.0 6. Diabetes 5.6 2.4 7. Alcohol and drug use 0.8 7. Cardiovascular diseases 4.2 1.8 Others 6.3 137

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Unintentional injuries 2. Alcohol and drug use 1.0 2. Transport injuries 4.2 13.6 3. Low glomerular filtration rate 0.6 3. Diarrheal/LRI/other 4.1 13.2 4. Child and maternal malnutrition 0.3 4. Neoplasms 3.7 12.1 5. Air pollution 0.3 5. Other non-communicable 2.9 9.4 6. High fasting plasma glucose 0.2 6. Diabetes 2.2 7.1 5.3 17.3 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.2 7.1 Others 20.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Unintentional injuries 2. Alcohol and drug use 1.2 2. Transport injuries 5.2 15.2 3. Low glomerular filtration rate 0.5 3. Diarrheal/LRI/other 4.2 12.4 4. Child and maternal malnutrition 0.2 4. Neoplasms 4.0 11.9 5. Air pollution 0.2 5. Other non-communicable 3.0 8.7 6.9 20.2 6. High fasting plasma glucose 0.2 6. Self-harm & intersonal violence 2.1 6.3 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.1 6.0 Others 19.3 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.7 2. Unintentional injuries 3.7 13.6 3. Low glomerular filtration rate 0.6 3. Neoplasms 3.4 12.4 4. High fasting plasma glucose 0.3 4. Transport injuries 3.1 11.5 5. Child and maternal malnutrition 0.3 5. Other non-communicable 2.8 10.3 3.9 14.3 6. Air pollution 0.2 6. Diabetes 2.3 8.6 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.3 8.4 Others 20.9 138

Total population 15 to 49 years of age 1. Alcohol and drug use 39.4 1. Cardiovascular diseases 35.7 15.8 2. Dietary risks 27.9 2. Self-harm & intersonal violence 32.2 14.3 3. High body-mass index 24.3 3. Neoplasms 30.7 13.6 4. High systolic blood pressure 24.0 4. Diabetes 22.2 9.8 5. Unsafe sex 21.3 5. HVI/AIDS 21.5 9.6 6. High fasting plasma glucose 15.7 6. Unintentional injuries 20.1 8.9 7. Smoking 13.4 7. Transport injuries 19.6 8.7 Others 19.2 15 to 49 years of age 1. Alcohol and drug use 62.1 1. Self-harm & intersonal violence 53.9 18.3 2. Dietary risks 34.2 2. Cardiovascular diseases 43.6 14.8 3. High systolic blood pressure 30.7 3. Unintentional injuries 33.4 11.4 4. High body-mass index 24.8 4. Transport injuries 31.6 10.8 5. Unsafe sex 23.6 5. HVI/AIDS 29.3 10.0 6. Smoking 20.1 6. Neoplasms 26.2 8.9 7. High fasting plasma glucose 17.7 7. Diabetes 23.3 7.9 Others 17.9 15 to 49 years of age 1. High body-mass index 23.7 1. Neoplasms 35.4 23.0 2. Dietary risks 21.3 2. Cardiovascular diseases 27.4 17.8 3. Unsafe sex 18.9 3. Diabetes 21.0 13.7 4. High systolic blood pressure 17.1 4. HVI/AIDS 13.4 8.8 5. Alcohol and drug use 15.7 5. Self-harm & intersonal violence 9.5 6.2 6. High fasting plasma glucose 13.7 6. Transport injuries 7.0 4.6 7. Low glomerular filtration rate 7.8 7. Unintentional injuries 6.2 4.1 Others 21.9 139

Total population 50 to 69 years of age 1. Alcohol and drug use 428.6 1. Cardiovascular diseases 524.5 35.5 2. Dietary risks 399.1 2. Self-harm & intersonal violence 329.7 22.3 3. High body-mass index 356.8 3. Neoplasms 270.8 18.3 4. High systolic blood pressure 289.1 4. Diabetes 46.8 3.2 5. Unsafe sex 183.0 5. HVI/AIDS 42.2 2.9 6. High fasting plasma glucose 120.8 6. Unintentional injuries 41.2 2.8 7. Smoking 117.7 7. Transport injuries 35.7 2.4 Others 12.6 50 to 69 years of age 1. Dietary risks 505.6 1. Cardiovascular diseases 636.6 35.7 2. High systolic blood pressure 481.3 2. Neoplasms 359.0 20.1 3. High body-mass index 322.0 3. Diabetes 273.1 15.3 4. High fasting plasma glucose 302.2 4. Cirrhosis 68.8 3.9 5. Smoking 295.3 5. Chronic respiratory diseases 64.0 3.6 6. Alcohol and drug use 173.7 6. Unintentional injuries 55.4 3.1 7. High total cholesterol 146.0 7. Diarrheal/LRI/other 54.3 3.0 Others 15.3 50 to 69 years of age 1. High body-mass index 389.2 1. Cardiovascular diseases 420.2 35.3 2. Dietary risks 357.1 2. Neoplasms 302.4 25.4 3. High systolic blood pressure 322.7 3. Diabetes 268.7 22.6 4. High fasting plasma glucose 276.9 4. Diarrheal/LRI/other 29.0 2.4 5. Low physical activity 100.3 5. Cirrhosis 26.4 2.2 6. High total cholesterol 91.4 6. Digestive diseases 25.6 2.2 7. Low glomerular filtration rate 82.2 7. Chronic respiratory diseases 22.0 1.9 Others 8.2 140

Total population 70 years of age and over 1. High systolic blood pressure 2,229.3 1. Cardiovascular diseases 3,712.8 41.7 2. Dietary risks 1,900.2 2. Neoplasms 1,413.0 15.9 3. High fasting plasma glucose 1,512.2 3. Diabetes 1,404.0 15.8 4. High body-mass index 1,161.0 4. Diarrheal/LRI/other 627.5 7.1 5. Low physical activity 685.2 5. Neurological disorders 579.1 6.5 6. Low glomerular filtration rate 671.6 6. Chronic respiratory diseases 314.2 3.5 7. Smoking 581.4 7. Digestive diseases 182.9 2.1 Others 7.4 70 years of age and over 1. High systolic blood pressure 2,047.2 1. Cardiovascular diseases 3,393.1 36.1 2. Dietary risks 1,861.5 2. Neoplasms 1,999.3 21.3 3. High fasting plasma glucose 1,272.9 3. Diabetes 1,238.1 13.2 4. Smoking 951.0 4. Neurological disorders 691.2 7.4 5. High body-mass index 763.5 5. Diarrheal/LRI/other 595.4 6.3 6. Low physical activity 635.9 6. Chronic respiratory diseases 542.1 5.8 7. Low glomerular filtration rate 632.8 7. Digestive diseases 182.4 1.9 Others 8.0 70 years of age and over 1. High systolic blood pressure 2,343.1 1. Cardiovascular diseases 3,912.8 45.6 2. Dietary risks 1,924.4 2. Diabetes 1,507.8 17.6 3. High fasting plasma glucose 1,661.9 3. Neoplasms 1,046.3 12.2 4. High body-mass index 1,409.5 4. Diarrheal/LRI/other 647.6 7.6 5. Low physical activity 715.9 5. Neurological disorders 508.9 5.9 6. Low glomerular filtration rate 695.9 6. Digestive diseases 183.1 2.1 7. High total cholesterol 472.3 7. Unintentional injuries 174.4 2.0 Others 7.0 141

Total population 1. High systolic blood pressure 180.0 1. Cardiovascular diseases 279.1 34.8 All age 2. Dietary risks 169.4 2. Neoplasms 133.8 16.7 3. High fasting plasma glucose 124.3 3. Diabetes 120.7 15.0 4. High body-mass index 120.2 4. Diarrheal/LRI/other 46.1 5.7 5. Smoking 61.7 5. Neurological disorders 34.3 4.3 6. Low physical activity 54.7 6. Unintentional injuries 27.0 3.4 7. Alcohol and drug use 52.2 7. Chronic respiratory diseases 24.4 3.0 Others 17.2 1. High systolic blood pressure 159.4 1. Cardiovascular diseases 239.8 30.2 All age 2. Dietary risks 157.2 2. Neoplasms 140.1 17.6 3. High fasting plasma glucose 98.7 3. Diabetes 97.6 12.3 4. Smoking 86.7 4. Diarrheal/LRI/other 41.0 5.2 5. High body-mass index 85.4 5. Self-harm & intersonal violence 39.0 4.9 6. Alcohol and drug use 73.2 6. Unintentional injuries 35.5 4.5 7. Low physical activity 47.9 7. Neurological disorders 33.4 4.2 Others 21.2 1. High systolic blood pressure 200.7 1. Cardiovascular diseases 318.5 39.3 All age 2. Dietary risks 181.6 2. Diabetes 143.9 17.7 3. High body-mass index 155.2 3. Neoplasms 127.5 15.7 4. High fasting plasma glucose 149.9 4. Diarrheal/LRI/other 51.3 6.3 5. Low physical activity 61.6 5. Neurological disorders 35.2 4.3 6. Low glomerular filtration rate 59.3 6. Unintentional injuries 18.4 2.3 7. High total cholesterol 45.7 7. Digestive diseases 17.2 2.1 Others 12.3 142

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) 61 72 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 853.9 Macroeconomic indicators, 2013 Per capita GDP 17,812 dollars Main, 2010 (Principals causes in the Caribbean) Percentage 31. Ischemic heart disease 15,532 32.8% 32. Stroke 9,648 20.3% 33. Diabetes 4,962 10.5% 34. Lower respiratory infection 3,257 6.9% 35. HIV/AIDS 3,004 6.3% 36. Hytensive health disease 2,797 5.9% 37. Road injuries 2,615 5.5% 38. Prostate cancer 2,267 4.8% 39. Preterm birth complications 1,702 3.6% 40. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 4. 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 2015. 61 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

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) 63 62 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 $7,297.00 Per capita GDP-PPP outlay on healthcare $467.00 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, 2012 55.9 (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 6,845 19.3% 18.2% 20.7% 2. Cardiovascular diseases 11,595 5,480 6,115 15.5% 13.2% 18.5% 3. Neoplasms 8,495 3,780 4,715 11.4% 9.1% 14.2% 4. Self-harm & intersonal violence 7,751 6,567 1,184 10.4% 15.8% 3.6% 5. Diabetes 7,661 3,476 4,185 10.3% 8.4% 12.6% 6. Nutritional deficiencies 4,571 2,187 2,384 6.1% 5.3% 7.2% 7. Neonatal disorders 3,749 2,166 1,583 5.0% 5.2% 4.8% 8.Cirrhosis 3,415 2,284 1,131 4.6% 5.5% 3.4% 9. Chronic respiratory diseases 2,895 1522 1,374 3.9% 3.7% 4.1% 10. Unintentional injuries 2,800 1,915 886 3.8% 4.6% 2.7% 11. Neurological disorders 2,720 1,417 1304 3.6% 3.4% 3.9% 12. Digestive diseases 2,434 1,218 1216 3.3% 2.9% 3.7% 11.Mental and substance use disorders 2,142 1,925 217 2.9% 4.6% 0.7% TOTAL 74,613 41,477 33,139 100.0% 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 2015. 63 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 3,143,388 2,877,654-8.45% Years lived with disability (YLD) 260,157 445,644 71.30% Years of life lost (YLL) 2,883,232 2,432,011-15.65% 51582 65,500 26.98% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,875,169 1,868,510-0.36% Years lived with disability (YLD) 169,214 266,719 57.62% Years of life lost (YLL) 1,705,956 1,601,792-6.11% 29,969 39,356 31.32% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,268,219 1,009,144-20.43% Years lived with disability (YLD) 90,943 178,925 96.74% Years of life lost (YLL) 1,177,276 830,219-29.48% 21,613 26,144 20.96% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 2,877,654 100% 445,644 100% 2,432,011 100% 65,500 100% 1,868,510 64.93% 266,719 59.85% 1,601,792 65.86% 39,356 60.09% 1,009,144 35.07% 178,925 40.15% 830,219 34.14% 26,144 39.91% 146

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 216.4 1. Diarrheal/LRI/other 241.4 41.2 2. Unsafe water, sanitation and handwashing 72.5 2. Neonatal disorders 3. Air pollution 35.3 3. Other non-communicable 57.6 9.8 4. Smoking 6.2 4. Nutritional deficiencies 37.6 6.4 5. Low glomerular filtration rate 4.0 5. Unintentional injuries 19.3 3.3 6. Unsafe sex 3.8 6. Diabetes 12.9 2.2 165.2 28.2 7. High fasting plasma glucose 1.3 7. Self-harm & intersonal violence 9.0 1.5 Others 7.4 Children under 5 years 1. Child and maternal malnutrition 231.6 1. Diarrheal/LRI/other 259.7 40.8 2. Unsafe water, sanitation and handwashing 78.8 2. Neonatal disorders 3. Air pollution 38.0 3. Other non-communicable 60.6 9.5 4. Smoking 6.2 4. Nutritional deficiencies 38.1 6.0 5. Low glomerular filtration rate 4.4 5. Unintentional injuries 20.8 3.3 186.7 29.4 6. Unsafe sex 3.7 6. Diabetes 14.0 2.2 7. High fasting plasma glucose 1.5 7. Self-harm & intersonal violence 10.1 1.6 Others 7.3 Children under 5 years 1. Child and maternal malnutrition 200.5 1. Diarrheal/LRI/other 222.2 41.6 2. Unsafe water, sanitation and handwashing 65.9 2. Neonatal disorders 3. Air pollution 32.4 3. Other non-communicable 54.5 10.2 4. Smoking 6.3 4. Nutritional deficiencies 37.1 7.0 5. Unsafe sex 3.9 5. Unintentional injuries 17.8 3.3 142.7 26.7 6. Low glomerular filtration rate 3.7 6. Diabetes 11.7 2.2 7. High fasting plasma glucose 1.0 7. Self-harm & intersonal violence 7.9 1.5 Others 7.5 147

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 6.6 1. Diarrheal/LRI/other 2. Air pollution 1.8 2. Self-harm & intersonal violence 5.6 11.4 3. Low glomerular filtration rate 1.2 3. Unintentional injuries 5.2 10.6 4. Alcohol and drug use 0.5 4. Neoplasms 4.4 9.0 5. Child and maternal malnutrition 0.4 5. Nutritional deficiencies 3.1 6.3 6. High fasting plasma glucose 0.4 6. Transport injuries 3.1 6.3 16.0 32.5 7. High systolic blood pressure 0.2 7. Diabetes 3.0 6.1 Others 17.8 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 7.0 1. Diarrheal/LRI/other 2. Air pollution 1.8 2. Self-harm & intersonal violence 7.0 12.9 3. Low glomerular filtration rate 1.2 3. Unintentional injuries 6.5 12.0 4. Alcohol and drug use 0.6 4. Neoplasms 4.9 8.9 5. Child and maternal malnutrition 0.4 5. Transport injuries 4.0 7.4 16.5 30.3 6. High fasting plasma glucose 0.4 6. Nutritional deficiencies 3.2 5.8 7. High systolic blood pressure 0.2 7. Diabetes 3.0 5.5 Others 17.2 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 6.3 1. Diarrheal/LRI/other 2. Air pollution 1.7 2. Self-harm & intersonal violence 4.2 9.6 3. Low glomerular filtration rate 1.3 3. Neoplasms 4.0 9.1 4. Child and maternal malnutrition 0.4 4. Unintentional injuries 3.8 8.7 5. High fasting plasma glucose 0.4 5. Nutritional deficiencies 3.0 6.9 15.5 35.3 6. Alcohol and drug use 0.3 6. Diabetes 3.0 6.9 7. Unsafe sex 0.2 7. Transport injuries 2.1 4.8 Others 18.7 148

Total population 15 to 49 years of age 1. Alcohol and drug use 47.9 1. Self-harm & intersonal violence 86.5 31.3 2. Dietary risks 18.9 2. Diarrheal/LRI/other 24.5 8.9 3. High body-mass index 16.4 3. Neoplasms 23.2 8.4 4. High fasting plasma glucose 14.3 4. Cardiovascular diseases 19.9 7.2 5. Unsafe sex 10.2 5. Mental and substance use disorders 18.4 6.7 6. Air pollution 10.0 6. Cirrhosis 17.9 6.5 7. High systolic blood pressure 8.7 7. Diabetes 17.2 6.2 Others 24.9 15 to 49 years of age 1. Alcohol and drug use 88.0 1. Neoplasms 157.9 39.4 2. Dietary risks 21.7 2. Self-harm & intersonal violence 33.4 8.8 3. High body-mass index 15.8 3. Diarrheal/LRI/other 28.7 7.2 4. High fasting plasma glucose 15.6 4. Cardiovascular diseases 28.5 7.1 5. High systolic blood pressure 11.5 5. Diabetes 26.1 6.5 6. Air pollution 11.1 6. Maternal disorders 23.5 5.9 7. Unsafe sex 9.6 7. Cirrhosis 22.1 5.5 Others 19.5 15 to 49 years of age 1. High body-mass index 16.9 1. Neoplasms 27.5 16.8 2. Dietary risks 16.4 2. Self-harm & intersonal violence 21.5 13.2 3. High fasting plasma glucose 13.1 3. Diarrheal/LRI/other 20.9 12.8 4. Alcohol and drug use 11.5 4. Cardiovascular diseases 17.8 10.9 5. Unsafe sex 10.8 5. Diabetes 16.3 10.0 6. Air pollution 8.9 6. Maternal disorders 10.9 6.7 7. Low glomerular filtration rate 7.4 7. Cirrhosis 8.0 4.9 Others 24.8 149

Total population 50 to 69 years of age 1. Dietary risks 212.3 1. Neoplasms 200.0 18.0 2. High fasting plasma glucose 189.9 2. Cardiovascular diseases 195.1 17.5 3. High body-mass index 158.5 3. Diabetes 192.3 17.3 4. High systolic blood pressure 136.3 4. Diarrheal/LRI/other 124.9 11.2 5. Alcohol and drug use 117.6 5. Cirrhosis 91.6 8.2 6. Air pollution 83.8 6. Self-harm & intersonal violence 49.7 4.5 7. Low glomerular filtration rate 74.9 7. Digestive diseases 45.5 4.1 Others 19.2 50 to 69 years of age 1. Dietary risks 230.0 1. Cardiovascular diseases 209.5 16.6 2. Alcohol and drug use 195.3 2. Diabetes 182.7 14.5 3. High fasting plasma glucose 178.1 3. Neoplasms 170.8 13.6 4. High systolic blood pressure 154.0 4. Diarrheal/LRI/other 136.3 10.8 5. High body-mass index 127.2 5. Cirrhosis 125.8 10.0 6. Air pollution 89.7 6. Self-harm & intersonal violence 87.8 7.0 7. Low glomerular filtration rate 78.8 7. Mental and substance use disorders 85.4 6.8 Others 20.8 50 to 69 years of age 1. High fasting plasma glucose 200.1 1. Neoplasms 225.4 22.9 2. Dietary risks 196.8 2. Diabetes 200.6 20.4 3. High body-mass index 185.6 3. Cardiovascular diseases 182.5 18.6 4. High systolic blood pressure 120.9 4. Diarrheal/LRI/other 114.9 11.7 5. Air pollution 78.6 5. Cirrhosis 61.8 6.3 6. Low glomerular filtration rate 71.5 6. Digestive diseases 43.2 4.4 7. Alcohol and drug use 50.0 7. Nutritional deficiencies 42.5 4.3 Others 11.5 150

Total population 70 years of age and over 1. Dietary risks 944.3 1. Cardiovascular diseases 1,571.7 24.8 2. High systolic blood pressure 847.7 2. Diarrheal/LRI/other 1,037.5 16.4 3. High fasting plasma glucose 769.3 3. Neoplasms 815.1 12.9 4. Air pollution 610.9 4. Diabetes 734.7 11.6 5. Low glomerular filtration rate 421.1 5. Nutritional deficiencies 539.9 8.5 6. High body-mass index 291.5 6. Neurological disorders 469.2 7.4 7. Smoking 277.0 7. Chronic respiratory diseases 422.2 6.7 Others 11.7 70 years of age and over 1. Dietary risks 992.1 1. Cardiovascular diseases 1,527.1 23.1 2. High systolic blood pressure 860.5 2. Diarrheal/LRI/other 1,099.3 16.6 3. High fasting plasma glucose 671.7 3. Neoplasms 882.9 13.4 4. Air pollution 613.1 4. Diabetes 690.5 10.4 5. Low glomerular filtration rate 426.8 5. Nutritional deficiencies 529.2 8.0 6. Smoking 336.6 6. Neurological disorders 516.4 7.8 7. Alcohol and drug use 274.5 7. Chronic respiratory diseases 480.0 7.3 Others 13.4 70 years of age and over 1. Dietary risks 903.4 1. Cardiovascular diseases 1,610.0 26.5 2. High fasting plasma glucose 853.0 2. Diarrheal/LRI/other 984.6 16.2 3. High systolic blood pressure 836.6 3. Diabetes 772.7 12.7 4. Air pollution 609.1 4. Neoplasms 756.8 12.4 5. Low glomerular filtration rate 416.1 5. Nutritional deficiencies 549.1 9.0 6. High body-mass index 360.9 6. Neurological disorders 428.7 7.0 7. High total cholesterol 241.2 7. Chronic respiratory diseases 372.6 6.1 Others 10.1 151

Total population 1. Dietary risks 55.6 1. Diarrheal/LRI/other 92.9 18.0 All age 2. High fasting plasma glucose 46.5 2. Cardiovascular diseases 74.9 14.5 3. High systolic blood pressure 41.4 3. Neoplasms 54.9 10.6 4. Alcohol and drug use 39.3 4. Self-harm & intersonal violence 50.1 9.7 5. Air pollution 35.8 5. Diabetes 49.5 9.6 6. Child and maternal malnutrition 34.0 6. Nutritional deficiencies 29.5 5.7 7. High body-mass index 30.3 7. Neonatal disorders 24.2 4.7 Others 27.1 1. Alcohol and drug use 65.4 1. Diarrheal/LRI/other 99.8 16.9 All age 2. Dietary risks 57.1 2. Self-harm & intersonal violence 86.9 14.7 3. High systolic blood pressure 42.6 3. Cardiovascular diseases 72.6 12.3 4. High fasting plasma glucose 41.3 4. Neoplasms 50.0 8.5 5. Child and maternal malnutrition 37.4 5. Diabetes 46.0 7.8 6. Air pollution 36.2 6. Cirrhosis 30.2 5.1 7. Unsafe water, sanitation and handwashing 24.9 7. Nutritional deficiencies 29.0 4.9 Others 29.7 1. Dietary risks 54.2 1. Diarrheal/LRI/other 86.3 19.4 All age 2. High fasting plasma glucose 51.5 2. Cardiovascular diseases 77.1 17.3 3. High systolic blood pressure 40.2 3. Neoplasms 59.5 13.4 4. High body-mass index 36.5 4. Diabetes 52.8 11.9 5. Air pollution 35.5 5. Nutritional deficiencies 30.1 6.8 6. Air pollution 30.6 6. Neonatal disorders 20.0 4.5 7. Low glomerular filtration rate 24.0 7. Chronic respiratory diseases 17.3 3.9 Others 22.9 152

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) 65 52 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 $1,702.00 Per capita GDP-PPP outlay on healthcare $160.00 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, 2012 59.2 (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 11,722 27.89% 23.73% 31.97% 2. Diarrheal/LRI/Other 11,389 6,133 5,256 15.66% 17.01% 14.33% 3. HIV/AIDS 9,068 4,669 4,399 12.47% 12.95% 12.00% 4. Neoplasms 6,994 3,397 3,597 9.62% 9.42% 9.81% 5. Diabetes 5,946 2,397 3,549 8.18% 6.65% 9.68% 6. Neonatal disorders 5,261 2,936 2,325 7.24% 8.14% 6.34% 7. Nutritional deficiencies 4,100 2,058 2,042 5.64% 5.71% 5.57% 8. Unintentional injuries 3,643 2,154 1,489 5.01% 5.98% 4.06% 9. Transport injuries 2,269 1343 926 3.12% 3.73% 2.53% 10. Digestive diseases 2,104 1,179 926 2.89% 3.27% 2.53% 11. Self-harm & intersonal violence 1,661 1,226 435 2.28% 3.40% 1.19% TOTAL 72,712 36,047 36,666 100.0% 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 2015. 65 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 4,030,956 3,184,705-20.99% Years lived with disability (YLD) 328,593 501,506 52.62% Years of life lost (YLL) 3,702,362 2,683,199-27.53% 77254 85,500 10.67% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 2,189,511 1,620,304-26.00% Years lived with disability (YLD) 173,631 256,390 47.66% Years of life lost (YLL) 2,015,879 1,363,914-32.34% 38,681 39,686 2.60% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,841,445 1,564,401-15.04% Years lived with disability (YLD) 154,962 245,116 58.18% Years of life lost (YLL) 1,686,483 1,319,285-21.77% 38,573 45,814 18.77% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 3,184,705 100% 501,506 100% 2,683,199 100% 85,500 100% 1,620,304 50.88% 256,390 51.12% 1,363,914 50.83% 39,686 46.42% 1,564,401 49.12% 245,116 48.88% 1,319,285 49.17% 45,814 53.58% 154

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 499.6 1. Diarrheal/LRI/other 437.4 30.8 2. Unsafe water, sanitation and handwashing 194.5 2. Neonatal disorders 3. Unsafe sex 71.6 3. Nutritional deficiencies 182.3 12.8 4. Air pollution 59.6 4. Other non-communicable 102.7 7.2 5. Alcohol and drug use 5.4 5. Communicable, maternal, neonatal, and nutritional diseases 427.9 30.2 82.5 5.8 6. Smoking 4.0 6. Unintentional injuries 49.0 3.4 7. Low glomerular filtration rate 1.9 7. Cardiovascular diseases 43.3 3.0 Others 6.8 Children under 5 years 1. Child and maternal malnutrition 554.7 1. Diarrheal/LRI/other 487.3 31.3 2. Unsafe water, sanitation and handwashing 230.0 2. Neonatal disorders 3. Unsafe sex 70.6 3. Nutritional deficiencies 195.5 12.5 4. Air pollution 63.6 4. Other non-communicable 118.6 7.6 5. Alcohol and drug use 6.2 6. Smoking 3.7 5. Communicable, maternal, neonatal, and nutritional diseases 6. Unintentional injuries 469.0 30.2 83.6 5.4 7. High fasting plasma glucose 2.1 7. Cardiovascular diseases 44.0 2.8 55.2 3.5 Others 6.6 Children under 5 years 1. Child and maternal malnutrition 442.5 1. Diarrheal/LRI/other 385.6 30.0 2. Unsafe water, sanitation and handwashing 157.6 2. Neonatal disorders 3. Unsafe sex 72.6 3. Nutritional deficiencies 168.6 13.2 4. Air pollution 55.5 4. Other non-communicable 86.2 6.7 5. Alcohol and drug use 4.5 5. Communicable, maternal, neonatal, and nutritional diseases 385.3 30.1 81.3 6.3 6. Smoking 4.2 6. Unintentional injuries 42.6 3.3 7. High fasting plasma glucose 1.8 7. Cardiovascular diseases 42.5 3.3 Others 7.0 155

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 7.8 1. Diarrheal/LRI/other 2. Unsafe sex 2.8 2. HIV/AIDS 15.1 16.3 3. Air pollution 2.1 3. Unintentional injuries 9.6 10.2 4. Child and maternal malnutrition 1.5 4. Nutritional deficiencies 7.8 8.4 5. Alcohol and drug use 1.0 5. Cardiovascular diseases 6.5 7.0 6. High fasting plasma glucose 0.7 6. Transport injuries 6.4 6.9 20.7 22.2 7. Low glomerular filtration rate 0.6 7. Diabetes 4.8 5.2 Others 23.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 9.0 1. Diarrheal/LRI/other 2. Unsafe sex 2.6 2. HIV/AIDS 15.8 15.3 3. Air pollution 2.1 3. Unintentional injuries 11.6 11.2 4. Child and maternal malnutrition 1.3 4. Transport injuries 7.8 7.5 5. Alcohol and drug use 1.2 5. Nutritional deficiencies 7.4 7.1 24.3 23.5 6. Low glomerular filtration rate 0.8 6. Cardiovascular diseases 6.8 6.6 7. High fasting plasma glucose 0.6 7. Other non-communicable 5.3 5.1 Others 23.7 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 6.5 1. Diarrheal/LRI/other 2. Unsafe sex 3.0 2. HIV/AIDS 14.4 17.6 3. Air pollution 2.1 3. Nutritional deficiencies 8.3 10.0 4. Child and maternal malnutrition 1.8 4. Unintentional injuries 7.4 9.0 5. High fasting plasma glucose 0.8 5. Cardiovascular diseases 6.2 7.5 17.0 20.6 6. Alcohol and drug use 0.7 6. Transport injuries 5.0 6.1 7. Low glomerular filtration rate 0.4 7. Diabetes 4.8 5.8 Others 23.5 156

Total population 15 to 49 years of age 1. Unsafe sex 94.1 1. HIV/AIDS 114.5 32.2 2. Alcohol and drug use 32.2 2. Cardiovascular diseases 45.6 12.8 3. Dietary risks 23.4 3. Diarrheal/LRI/other 31.1 8.7 4. High systolic blood pressure 24.2 4. Self-harm & intersonal violence 22.6 6.3 5. Air pollution 20.8 5. Neoplasms 22.3 6.3 6. High body-mass index 20.3 6. Unintentional injuries 20.6 5.8 7. High fasting plasma glucose 15.1 7. Transport injuries 18.0 5.0 Others 23.0 15 to 49 years of age 1. Unsafe sex 88.2 1. HIV/AIDS 113.3 30.3 2. Alcohol and drug use 47.2 2. Cardiovascular diseases 45.4 12.0 3. Dietary risks 30.3 3. Diarrheal/LRI/other 35.5 9.3 4. High systolic blood pressure 25.8 4. Self-harm & intersonal violence 34.9 9.2 5. Air pollution 21.4 5. Unintentional injuries 30.1 7.9 6. High fasting plasma glucose 15.3 6. Transport injuries 24.3 6.4 7. High body-mass index 15.3 7. Neoplasms 20.6 5.4 Others 19.5 15 to 49 years of age 1. Unsafe sex 99.8 1. HIV/AIDS 115.6 34.4 2. Dietary risks 28.5 2. Cardiovascular diseases 45.7 13.6 3. High body-mass index 25.1 3. Maternal disorders 31.7 9.5 4. High systolic blood pressure 22.7 4. Diarrheal/LRI/other 26.9 8.0 5. Air pollution 20.2 5. Neoplasms 24.0 7.1 6. Alcohol and drug use 17.9 6. Diabetes 17.4 5.2 7. High fasting plasma glucose 14.9 7. Transport injuries 12.0 3.6 Others 18.8 157

Total population 50 to 69 years of age 1. High systolic blood pressure 465.7 1. Cardiovascular diseases 653.0 35.9 2. Dietary risks 448.3 2. Neoplasms 237.9 13.1 3. High body-mass index 280.0 3. Diabetes 196.0 10.8 4. Air pollution 256.7 4. HIV/AIDS 168.6 9.3 5. High fasting plasma glucose 227.8 5. Diarrheal/LRI/other 136.9 7.5 6. Smoking 160.5 6. Unintentional injuries 73.8 4.1 7. Unsafe sex 119.3 7. Digestive diseases 63.7 3.5 Others 15.9 50 to 69 years of age 1. Dietary risks 425.3 1. Cardiovascular diseases 606.2 32.2 2. High systolic blood pressure 416.2 2. Neoplasms 229.1 12.2 3. Air pollution 247.6 3. HIV/AIDS 204.5 10.9 4. Smoking 211.1 4. Diabetes 163.4 8.7 5. High fasting plasma glucose 196.2 5. Diarrheal/LRI/other 150.2 8.0 6. Alcohol and drug use 160.8 6. Unintentional injuries 93.3 5.0 7. High body-mass index 155.8 7. Digestive diseases 78.5 4.2 Others 19.0 50 to 69 years of age 1. High systolic blood pressure 510.9 1. Cardiovascular diseases 695.7 39.5 2. Dietary risks 469.3 2. Neoplasms 245.9 13.9 3. High body-mass index 393.4 3. Diabetes 225.7 12.8 4. Air pollution 265.1 4. HIV/AIDS 135.7 7.8 5. High fasting plasma glucose 256.5 5. Diarrheal/LRI/other 124.9 7.1 6. Unsafe sex 115.9 6. Unintentional injuries 55.9 3.2 7. Smoking 114.3 7. Digestive diseases 50.1 2.8 Others 12.9 158

Total population 70 years of age and over 1. High systolic blood pressure 2,072.0 1. Cardiovascular diseases 3,459.3 41.8 2. Dietary risks 1,745.2 2. Neoplasms 1,009.5 12.2 3. Air pollution 1,099.9 3. Diabetes 875.5 10.6 4. High fasting plasma glucose 983.5 4. Diarrheal/LRI/other 816.4 9.9 5. High body-mass index 630.1 5. Neurological disorders 412.7 5.0 6. Low glomerular filtration rate 522.5 6. Unintentional injuries 314.1 3.8 7. Low physical activity 518.6 7. Digestive diseases 265.7 3.2 Others 13.5 70 years of age and over 1. High systolic blood pressure 1,687.3 1. Cardiovascular diseases 3,018.5 36.9 2. Dietary risks 1,573.9 2. Neoplasms 1,176.9 14.4 3. Air pollution 1,041.9 3. Diarrheal/LRI/other 845.3 10.3 4. High fasting plasma glucose 784.4 4. Diabetes 713.4 8.7 5. Smoking 557.4 5. Neurological disorders 493.5 6.0 6. Low physical activity 461.5 6. Chronic respiratory diseases 310.2 3.8 7. Low glomerular filtration rate 455.4 7. Unintentional injuries 310.1 3.8 Others 16.1 70 years of age and over 1. High systolic blood pressure 2,374.8 1. Cardiovascular diseases 3,806.2 45.7 2. Dietary risks 1,879.9 2. Diabetes 1,003.0 12.0 3. Air pollution 1,145.5 3. Neoplasms 877.8 10.5 4. High fasting plasma glucose 1,140.1 4. Diarrheal/LRI/other 793.7 9.5 5. High body-mass index 863.7 5. Neurological disorders 349.1 4.2 6. Low glomerular filtration rate 575.2 6. Unintentional injuries 317.3 3.8 7. Low physical activity 563.4 7. Digestive diseases 252.2 3.0 Others 11.2 159

Total population 1. High systolic blood pressure 120.4 1. Cardiovascular diseases 196.9 24.6 All age 2. Dietary risks 111.8 2. Diarrheal/LRI/other 110.6 13.8 3. Air pollution 76.5 3. HIV/AIDS 88.1 11.0 4. Unsafe sex 73.0 4. Neoplasms 67.9 8.5 5. Child and maternal malnutrition 68.7 5. Diabetes 57.7 7.2 6. High fasting plasma glucose 60.0 6. Neonatal disorders 51.1 6.4 7. High body-mass index 57.8 7. Nutritional deficiencies 39.8 5.0 Others 23.6 1. Dietary risks 98.6 1. Cardiovascular diseases 168.2 20.8 All age 2. High systolic blood pressure 98.4 2. Diarrheal/LRI/other 120.6 14.9 3. Child and maternal malnutrition 74.6 3. HIV/AIDS 91.8 11.4 4. Air pollution 70.8 4. Neoplasms 66.8 8.3 5. Unsafe sex 68.8 5. Neonatal disorders 57.7 7.2 6. Alcohol and drug use 51.0 6. Diabetes 47.1 5.8 7. High fasting plasma glucose 48.0 7. Unintentional injuries 42.3 5.2 Others 26.4 1. High systolic blood pressure 141.8 1. Cardiovascular diseases 224.9 28.3 All age 2. Dietary risks 124.7 2. Diarrheal/LRI/other 100.9 12.7 3. High body-mass index 82.9 3. HIV/AIDS 84.4 10.7 4. Air pollution 82.1 4. Neoplasms 69.0 8.7 5. Unsafe sex 77.1 5. Diabetes 68.1 8.6 6. High fasting plasma glucose 71.7 6. Neonatal disorders 44.6 5.6 7. Child and maternal malnutrition 63.0 7. Nutritional deficiencies 39.2 4.9 Others 20.6 160

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) 67 64 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 $4,292.00 Per capita GDP-PPP outlay on healthcare $400.00 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, 2012 57.0 (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 6,513 34.27% 32.76% 35.93% 2. Neoplasms 4,482 2,026 2,457 11.80% 10.21% 13.55% 3.Chronic respiratory diseases 3,800 1,804 1,996 10.01% 9.09% 11.01% 4. Diarrheal/LRI/Other 3,591 1,876 1,715 9.46% 9.45% 9.46% 5. Self-harm & intersonal violence 2,976 2,377 600 7.84% 11.98% 3.31% 6.Diabetes 2,555 1,260 1,295 6.73% 6.35% 7.14% 7. Neurological disorders 1,744 861 884 4.59% 4.34% 4.88% 8. Digestive diseases 1,681 902 780 4.43% 4.55% 4.30% 9. Neonatal disorders 1,588 930 658 4.18% 4.69% 3.63% 10. HIV/AIDS 1,357 700 658 3.57% 3.53% 3.63% 11. Other noncommunicable diseases 1,180 608 571 3.11% 3.06% 3.15% TOTAL 37,967 19,844 18,127 100.0% 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 2015. 67 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 1,094,989 1,322,144 20.74% Years lived with disability (YLD) 126,115 226,888 79.91% Years of life lost (YLL) 968,874 1,095,256 13.04% 23873 41,276 72.90% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 458,626 587,897 28.19% Years lived with disability (YLD) 74,294 122,571 64.98% Years of life lost (YLL) 384,332 465,326 21.07% 13,477 21,232 57.54% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 636,363 734,247 15.38% Years lived with disability (YLD) 51,821 104,317 101.30% Years of life lost (YLL) 584,542 629,930 7.76% 10,396 20,044 92.80% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,322,144 100% 226,888 100% 1,095,256 100% 41,276 100% 587,897 44.47% 122,571 54.02% 465,326 42.49% 21,232 51.44% 734,247 55.53% 104,317 45.98% 629,930 57.51% 20,044 48.56% 162

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 65.6 1. Neonatal disorders 157.9 33.1 2. Unsafe water, sanitation and handwashing 44.7 2. Other non-communicable diseases 3. Air pollution 8.0 3. Diarrheal/LRI/other 95.9 20.1 4. Unsafe sex 7.9 4. Chronic respiratory diseases 35.2 7.4 5. Smoking 1.3 5. Cardiovascular diseases 15.3 3.2 6. High systolic blood pressure 1.1 6. Diabetes 13.0 2.7 97.9 20.5 7. Alcohol and drug use 0.9 7. Unintentional injuries 12.0 2.5 Others 10.6 Children under 5 years 1. Child and maternal malnutrition 73.5 1. Neonatal disorders 180.9 35.1 2. Unsafe water, sanitation and handwashing 52.2 2. Diarrheal/LRI/other 3. Air pollution 8.6 3. Other non-communicable diseases 99.1 19.2 4. Unsafe sex 7.6 4. Chronic respiratory diseases 36.4 7.0 5. Smoking 1.4 5. Cardiovascular diseases 16.1 3.1 6. High systolic blood pressure 1.2 7. Alcohol and drug use 1.0 6. Diabetes 7. Communicable, maternal, neonatal, and nutritional diseases 107.4 13.6 20.8 2.6 11.6 2.3 Others 9.9 Children under 5 years 1. Child and maternal malnutrition 57.4 1. Neonatal disorders 133.8 30.6 2. Unsafe water, sanitation and handwashing 36.9 2. Other non-communicable diseases 3. Unsafe sex 8.1 3. Diarrheal/LRI/other 83.7 19.2 4. Air pollution 7.3 4. Chronic respiratory diseases 34.0 7.8 5. Smoking 1.2 5. Cardiovascular diseases 14.5 3.3 96.7 22.1 6. High systolic blood pressure 1.0 6. Unintentional injuries 12.7 2.9 7. Alcohol and drug use 0.7 7. Diabetes 12.3 2.8 Others 11.3 163

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 4.6 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.5 2. Self-harm & intersonal violence 5.4 12.4 3. Child and maternal malnutrition 0.4 3. Unintentional injuries 4.6 10.6 4. Unsafe sex 0.4 4. Cardiovascular diseases 4.0 9.4 5. Air pollution 0.4 5. Neoplasms 3.8 8.8 6. High systolic blood pressure 0.3 6. Other non-communicable diseases 3.2 7.4 7.7 17.8 7. Low glomerular filtration rate 0.2 7. Transport injuries 2.7 6.3 Others 27.4 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 5.2 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.6 2. Self-harm & intersonal violence 6.7 13.7 3. Child and maternal malnutrition 0.4 3. Unintentional injuries 5.6 11.5 4. Air pollution 0.4 4. Neoplasms 4.6 9.6 5. Unsafe sex 0.3 5. Cardiovascular diseases 4.5 9.3 8.5 17.5 6. High systolic blood pressure 0.3 6. Transport injuries 3.4 7.1 7. Low glomerular filtration rate 0.1 7. Other non-communicable diseases 3.1 6.4 Others 25.0 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 4.0 1. Diarrheal/LRI/other 2. Child and maternal malnutrition 0.5 2. Self-harm & intersonal violence 4.1 10.7 3. Unsafe sex 0.4 3. Cardiovascular diseases 3.6 9.5 4. Alcohol and drug use 0.4 4. Unintentional injuries 3.6 9.4 5. Air pollution 0.4 5. Other non-communicable diseases 3.3 8.7 6.8 18.1 6. High systolic blood pressure 0.2 6. Neoplasms 2.9 7.7 7. Low glomerular filtration rate 0.2 7. Diabetes 2.8 7.4 Others 28.5 164

Total population 15 to 49 years of age 1. Dietary risks 25.3 1. Self-harm & intersonal violence 53.4 27.0 2. Alcohol and drug use 19.7 2. Cardiovascular diseases 33.8 17.2 3. Unsafe sex 18.2 3. Neoplasms 20.1 10.2 4. High body-mass index 16.0 4. HIV/AIDS 19.9 7.8 5. High systolic blood pressure 15.0 5. Transport injuries 13.5 6.9 6. High total cholesterol 12.4 6. Unintentional injuries 13.0 6.6 7. Air pollution 10.9 7. Diarrheal/LRI/other 8.4 4.3 Others 20.1 15 to 49 years of age 1. Alcohol and drug use 32.5 1. Self-harm & intersonal violence 88.4 34.9 2. Dietary risks 29.1 2. Cardiovascular diseases 38.2 15.1 3. High systolic blood pressure 19.4 3. Unintentional injuries 22.3 8.8 4. Unsafe sex 15.9 4. Transport injuries 21.7 8.6 5. High total cholesterol 15.3 5. HIV/AIDS 18.5 6.2 6. Smoking 13.9 6. Neoplasms 15.6 5.9 7. High body-mass index 12.5 7. Diarrheal/LRI/other 9.2 3.6 Others 16.9 15 to 49 years of age 1. Dietary risks 21.5 1. Cardiovascular diseases 29.5 20.7 2. High body-mass index 20.5 2. Neoplasms 24.5 17.2 3. Unsafe sex 19.5 3. Self-harm & intersonal violence 21.2 13.3 4. High systolic blood pressure 10.7 4. HIV/AIDS 18.9 11.1 5. Air pollution 9.9 5. Diabetes 7.5 5.3 6. High total cholesterol 9.5 6. Diarrheal/LRI/other 7.5 5.3 7. Alcohol and drug use 7.0 7. Maternal disorders 7.1 5.2 Others 21.9 165

Total population 50 to 69 years of age 1. Dietary risks 376.6 1. Cardiovascular diseases 463.0 35.8 2. High systolic blood pressure 292.5 2. Neoplasms 218.6 16.9 3. High body-mass index 210.0 3. Chronic respiratory diseases 101.2 7.8 4. Air pollution 151.4 4. Diabetes 100.9 7.8 5. Smoking 147.4 5. Diarrheal/LRI/other 66.5 5.2 6. High total cholesterol 125.3 6. Cirrhosis 62.0 4.8 7. High fasting plasma glucose 122.6 7. Digestive diseases 56.2 4.3 Others 17.4 50 to 69 years of age 1. Dietary risks 446.9 1. Cardiovascular diseases 541.8 36.3 2. High systolic blood pressure 344.6 2. Neoplasms 202.4 13.6 3. Smoking 225.3 3. Chronic respiratory diseases 101.9 6.8 4. Air pollution 167.0 4. Diabetes 101.6 6.8 5. High body-mass index 162.2 5. Cirrhosis 89.4 6.0 6. High total cholesterol 143.4 6. Self-harm & intersonal violence 82.8 5.6 7. High fasting plasma glucose 133.6 7. Diarrheal/LRI/other 75.2 5.0 Others 20.0 50 to 69 years of age 1. Dietary risks 307.7 1. Cardiovascular diseases 385.8 35.2 2. High body-mass index 256.8 2. Neoplasms 234.6 21.4 3. High systolic blood pressure 241.4 3. Chronic respiratory diseases 100.5 9.2 4. Air pollution 136.1 4. Diabetes 100.1 9.1 5. High fasting plasma glucose 111.7 5. Diarrheal/LRI/other 58.0 5.3 6. High total cholesterol 107.6 6. Digestive diseases 43.0 3.9 7. Smoking 71.1 7. Cirrhosis 35.0 3.2 Others 12.8 166

Total population 70 years of age and over 1. Dietary risks 1,810.3 1. Cardiovascular diseases 3,231.0 40.8 2. High systolic blood pressure 1,707.1 2. Chronic respiratory diseases 1,010.2 12.8 3. Air pollution 954.1 3. Neoplasms 747.7 9.4 4. High body-mass index 697.4 4. Diarrheal/LRI/other 672.6 8.5 5. High fasting plasma glucose 637.0 5. Neurological disorders 569.3 7.2 6. High total cholesterol 457.9 6. Diabetes 531.6 6.7 7. Smoking 441.7 7. Digestive diseases 405.5 5.1 Others 9.5 70 years of age and over 1. Dietary risks 1,906.0 1. Cardiovascular diseases 3,180.7 39.1 2. High systolic blood pressure 1,627.5 2. Chronic respiratory diseases 1,013.4 12.5 3. Air pollution 888.6 3. Neoplasms 765.9 9.4 4. Smoking 628.4 4. Diarrheal/LRI/other 694.3 8.6 5. High fasting plasma glucose 607.2 5. Neurological disorders 594.5 7.3 6. Low physical activity 423.4 6. Diabetes 566.4 7.0 7. Low glomerular filtration rate 414.6 7. Digestive diseases 424.4 5.2 Others 10.9 70 years of age and over 1. High systolic blood pressure 1,773.9 1. Cardiovascular diseases 3,273.2 42.3 2. Dietary risks 1,729.8 2. Chronic respiratory diseases 1,007.4 13.0 3. Air pollution 1,009.1 3. Neoplasms 732.5 9.4 4. High body-mass index 935.1 4. Diarrheal/LRI/other 654.4 8.5 5. High fasting plasma glucose 662.1 5. Neurological disorders 548.1 7.1 6. High total cholesterol 518.1 6. Diabetes 502.4 6.5 7. Low glomerular filtration rate 442.2 7. Digestive diseases 389.7 5.0 Others 8.3 167

Total population 1. Dietary risks 102.9 1. Cardiovascular diseases 160.5 30.2 All age 2. High systolic blood pressure 86.6 2. Neoplasms 55.3 10.4 3. Air pollution 49.5 3. Chronic respiratory diseases 46.9 8.8 4. High body-mass index 49.2 4. Diarrheal/LRI/other 44.3 8.4 5. High fasting plasma glucose 34.1 5. Self-harm & intersonal violence 36.7 6.9 6. High total cholesterol 32.1 6. Diabetes 31.5 5.9 7. Smoking 31.9 7. Neurological disorders 21.5 4.1 Others 25.4 1. Dietary risks 109.0 1. Cardiovascular diseases 160.2 28.1 All age 2. High systolic blood pressure 86.9 2. Self-harm & intersonal violence 58.6 10.3 3. Air pollution 47.1 3. Neoplasms 49.9 8.7 4. Smoking 45.8 4. Diarrheal/LRI/other 46.3 8.2 5. High body-mass index 33.1 5. Chronic respiratory diseases 44.5 7.8 6. High fasting plasma glucose 32.9 6. Diabetes 31.1 5.4 7. High total cholesterol 32.0 7. Neonatal disorders 22.9 4.1 Others 27.4 1. Dietary risks 96.8 1. Cardiovascular diseases 160.8 32.5 All age 2. High systolic blood pressure 86.3 2. Neoplasms 60.7 12.2 3. High body-mass index 65.3 3. Chronic respiratory diseases 49.3 10.0 4. Air pollution 51.9 4. Diarrheal/LRI/other 42.3 8.6 5. High fasting plasma glucose 35.2 5. Diabetes 32.0 6.5 6. High total cholesterol 32.1 6. Neurological disorders 21.8 4.4 7. Low physical activity 23.6 7. Digestive diseases 19.3 3.9 Others 21.8 168

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) 69 68.3 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 15,532 32.8% 42. Stroke 9,648 20.3% 43. Diabetes 4,962 10.5% 44. Lower respiratory infection 3,257 6.9% 45. HIV/AIDS 3,004 6.3% 46. Hytensive health disease 2,797 5.9% 47. Road injuries 2,615 5.5% 48. Prostate cancer 2,267 4.8% 49. Preterm birth complications 1,702 3.6% 50. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 5. 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 2015. 69 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

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) 71 67.1 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 15,532 32.8% 52. Stroke 9,648 20.3% 53. Diabetes 4,962 10.5% 54. Lower respiratory infection 3,257 6.9% 55. HIV/AIDS 3,004 6.3% 56. Hytensive health disease 2,797 5.9% 57. Road injuries 2,615 5.5% 58. Prostate cancer 2,267 4.8% 59. Preterm birth complications 1,702 3.6% 60. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 6. 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 2015. 71 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

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) 73 67 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 $16,387.00 Per capita GDP-PPP outlay on healthcare $1,061.00 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, 2012 47.2 (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 7,944 23.6% 11.9% 16.3% 2.Diabetes 127,192 9,044 9,034 20.4% 13.9% 18.5% 3.Neoplasms 85,339 4,379 5,071 13.7% 6.7% 10.4% 4.Cirrhosis 41,204 4,655 1,837 6.6% 7.2% 3.8% 5. Chronic respiratory diseases 38,727 2,411 2,328 6.2% 3.7% 4.8% 6. Diarrheal/LRI/Other 31,710 2,527 2,141 5.1% 3.9% 4.4% 7. Neurological disorders 29,158 1,599 1,676 4.7% 2.5% 3.4% 8. Self-harm & intersonal violence 28,664 3,247 3,372 4.6% 5.0% 6.9% 9.Trandport injuries 24,627 2,300 5,435 3.9% 3.5% 11.1% 10.Unintentionals Injuries 21,744 1,702 6,949 3.5% 2.6% 14.2% 11. Digestive diseases 20,332 9,721 1,384 3.3% 14.9% 2.8% 12. Other non-communicable diseases 14,492 7,633 886 2.3% 11.7% 1.8% 13. Neonatal disorders 13,619 8,063 821 2.2% 12.4% 1.7% TOTAL 624,283 65,043 48,879 100.0% 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 2015. 73 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 20,502,355 19,813,630-3.36% Years lived with disability (YLD) 2,929,174 4,700,207 60.46% Years of life lost (YLL) 17,573,181 15,113,423-14.00% 455793 630,893 38.42% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 12,199,673 11,820,273-3.11% Years lived with disability (YLD) 1,659,176 2,384,845 43.74% Years of life lost (YLL) 10,540,497 9,435,428-10.48% 263,023 365,683 39.03% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 8,302,682 7,993,357-3.73% Years lived with disability (YLD) 1,269,998 2,315,362 82.31% Years of life lost (YLL) 7,032,684 5,677,995-19.26% 192,770 265,210 37.58% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 19,813,630 100% 4,700,207 100% 15,113,423 100% 630,893 100% 11,820,273 59.66% 2,384,845 50.74% 9,435,428 62.43% 365,683 57.96% 7,993,357 40.34% 2,315,362 49.26% 5,677,995 37.57% 265,210 42.04% 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 47.0 1. Neonatal disorders 120.4 35.7 2. Unsafe water, sanitation and handwashing 14.5 2. Other non-communicable diseases 3. Air pollution 5.2 3. Diarrheal/LRI/other 59.5 17.7 4. Low glomerular filtration rate 2.0 4. Unintentional injuries 17.9 5.3 5. Smoking 1.8 5. Nutritional deficiencies 8.4 2.5 6. Unsafe sex 1.5 6. Neoplasms 7.7 2.3 91.0 27.0 7. Alcohol and drug use 1.2 7. Diabetes 7.6 2.3 Others 7.2 Children under 5 years 1. Child and maternal malnutrition 52.5 1. Neonatal disorders 139.5 37.5 2. Unsafe water, sanitation and handwashing 15.5 2. Other non-communicable diseases 3. Air pollution 5.9 3. Diarrheal/LRI/other 66.3 17.8 4. Low glomerular filtration rate 2.1 4. Unintentional injuries 16.9 4.5 5. Smoking 2.0 5. Nutritional deficiencies 9.0 2.4 6. Unsafe sex 1.5 6. Diabetes 7. Alcohol and drug use 1.3 7. Neoplasms 8.3 2.2 97.7 8.5 26.2 2.3 Others 7.1 Children under 5 years 1. Child and maternal malnutrition 41.2 1. Neonatal disorders 100.5 33.5 2. Unsafe water, sanitation and handwashing 13.4 2. Other non-communicable diseases 3. Air pollution 4.5 3. Diarrheal/LRI/other 52.4 17.5 4. Low glomerular filtration rate 1.8 4. Unintentional injuries 18.9 6.3 5. Smoking 1.6 5. Nutritional deficiencies 7.8 2.6 84.1 28.0 6. Unsafe sex 1.5 6. Neoplasms 7.1 2.3 7. Alcohol and drug use 1.1 7. Diabetes 6.7 2.2 Others 7.6 175

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.8 1. Neoplasms 2. Low glomerular filtration rate 1.0 2. Transport injuries 4.9 17.2 3. Alcohol and drug use 0.9 3. Unintentional injuries 4.3 14.9 4. High fasting plasma glucose 0.3 4. Diarrheal/LRI/other 3.6 12.6 5. High systolic blood pressure 0.2 5. Other non-communicable diseases 2.6 9.0 6. Air pollution 0.1 6. Diabetes 1.9 6.8 4.9 17.2 7. Child and maternal malnutrition 0.1 7. Self-harm & intersonal violence 1.9 6.7 Others 15.6 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.9 1. Transport injuries 2. Alcohol and drug use 1.1 2. Neoplasms 5.6 17.0 3. Low glomerular filtration rate 1.0 3. Unintentional injuries 5.3 16.0 4. High fasting plasma glucose 0.3 4. Diarrheal/LRI/other 3.8 11.4 5. High systolic blood pressure 0.3 5. Other non-communicable diseases 2.7 8.1 6.4 19.3 6. Child and maternal malnutrition 0.1 6. Self-harm & intersonal violence 2.5 7.7 7. Air pollution 0.1 7. Diabetes 2.0 5.9 Others 14.6 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.6 1. Neoplasms 2. Low glomerular filtration rate 1.0 2. Diarrheal/LRI/other 3.4 14.2 3. Alcohol and drug use 0.6 3. Transport injuries 3.4 14.1 4. High fasting plasma glucose 0.3 4. Unintentional injuries 3.2 13.3 5. High systolic blood pressure 0.2 5. Other non-communicable diseases 2.5 10.3 4.2 17.6 6. Air pollution 0.1 6. Diabetes 1.9 8.0 7. Child and maternal malnutrition 0.1 7. Self-harm & intersonal violence 1.3 5.3 Others 17.2 176

Total population 15 to 49 years of age 1. Alcohol and drug use 36.9 1. Self-harm & intersonal violence 33.5 18.7 2. High body-mass index 21.2 2. Transport injuries 22.5 12.6 3. Dietary risks 21.0 3. Diabetes 22.3 12.4 4. High fasting plasma glucose 18.8 4. Neoplasms 21.7 12.1 5. Low glomerular filtration rate 12.3 5. Cardiovascular diseases 18.4 10.2 6. High systolic blood pressure 12.1 6. Cirrhosis 16.7 9.3 7. High total cholesterol 8.1 7. Unintentional injuries 11.9 6.6 Others 18.1 15 to 49 years of age 1. Alcohol and drug use 64.2 1. Self-harm & intersonal violence 62.6 23.7 2. Dietary risks 28.6 2. Transport injuries 39.5 14.9 3. High body-mass index 25.6 3. Diabetes 29.2 11.1 4. High fasting plasma glucose 23.4 4. Neoplasms 26.5 10.0 5. Low glomerular filtration rate 14.7 5. Cardiovascular diseases 24.9 9.4 6. High systolic blood pressure 14.7 6. Cirrhosis 21.2 8.0 7. High total cholesterol 12.4 7. Unintentional injuries 18.7 7.1 Others 15.8 15 to 49 years of age 1. High body-mass index 17.0 1. Neoplasms 24.4 24.3 2. High fasting plasma glucose 14.4 2. Diabetes 18.4 18.3 3. Dietary risks 14.1 3. Cardiovascular diseases 12.2 12.2 4. Alcohol and drug use 11.5 4. Transport injuries 6.8 6.7 5. Low glomerular filtration rate 10.1 5. Self-harm & intersonal violence 6.5 6.4 6. High systolic blood pressure 9.7 6. Cirrhosis 5.1 5.1 7. Unsafe sex 6.1 7. Diarrheal/LRI/other 4.3 4.3 Others 22.7 177

Total population 50 to 69 years of age 1. High fasting plasma glucose 305.5 1. Diabetes 300.1 28.2 2. High body-mass index 290.8 2. Cardiovascular diseases 221.0 20.8 3. Dietary risks 272.2 3. Neoplasms 190.1 17.9 4. High systolic blood pressure 191.8 4. Cirrhosis 110.5 10.4 5. Low glomerular filtration rate 163.6 5. Chronic respiratory diseases 41.9 3.9 6. Alcohol and drug use 116.8 6. Digestive diseases 32.0 3.0 7. High total cholesterol 72.4 7. Diarrheal/LRI/other 29.9 2.8 Others 13.0 50 to 69 years of age 1. High fasting plasma glucose 358.0 1. Diabetes 333.2 24.9 2. Dietary risks 348.2 2. Cardiovascular diseases 290.0 21.7 3. High body-mass index 310.8 3. Neoplasms 193.0 14.5 4. High systolic blood pressure 241.7 4. Cirrhosis 174.0 13.0 5. Low glomerular filtration rate 182.7 5. Chronic respiratory diseases 52.3 3.9 6. High total cholesterol 178.2 6. Self-harm & intersonal violence 49.1 3.7 7. Smoking 119.9 7. Transport injuries 45.3 3.4 Others 14.9 50 to 69 years of age 1. High body-mass index 274.1 1. Diabetes 272.6 32.5 2. High fasting plasma glucose 261.8 2. Neoplasms 187.6 22.4 3. Dietary risks 209.0 3. Cardiovascular diseases 163.6 19.5 4. High systolic blood pressure 150.2 4. Cirrhosis 57.6 6.9 5. Low glomerular filtration rate 147.7 5. Chronic respiratory diseases 33.2 4.0 6. Alcohol and drug use 65.6 6. Digestive diseases 28.5 3.4 7. Low physical activity 42.5 7. Diarrheal/LRI/other 23.7 2.8 Others 8.5 178

Total population 70 years of age and over 1. High fasting plasma glucose 1,243.3 1. Cardiovascular diseases 1,904.2 31.0 2. Dietary risks 1,240.7 2. Diabetes 1,187.8 19.3 3. High systolic blood pressure 1,097.6 3. Neoplasms 726.1 11.8 4. High body-mass index 788.7 4. Chronic respiratory diseases 566.8 9.2 5. Low glomerular filtration rate 705.1 5. Neurological disorders 475.7 7.7 6. Smoking 399.4 6. Diarrheal/LRI/other 296.4 4.8 7. High total cholesterol 353.4 7. Digestive diseases 235.3 3.8 Others 12.2 70 years of age and over 1. Dietary risks 1,393.4 1. Cardiovascular diseases 2,021.7 29.3 2. High fasting plasma glucose 1,387.9 2. Diabetes 1,239.0 18.0 3. High systolic blood pressure 1,196.1 3. Neoplasms 912.1 13.2 4. High body-mass index 776.4 4. Chronic respiratory diseases 693.9 10.1 5. Low glomerular filtration rate 741.8 5. Neurological disorders 520.5 7.6 6. Smoking 644.3 6. Diarrheal/LRI/other 332.2 4.8 7. High total cholesterol 459.6 7. Cirrhosis 311.8 4.5 Others 12.5 70 years of age and over 1. High fasting plasma glucose 1,133.9 1. Cardiovascular diseases 1,815.4 32.6 2. Dietary risks 1,125.2 2. Diabetes 1,149.1 20.6 3. High systolic blood pressure 1,023.1 3. Neoplasms 585.5 10.5 4. High body-mass index 797.9 4. Chronic respiratory diseases 470.7 8.5 5. Low glomerular filtration rate 677.4 5. Neurological disorders 441.7 7.9 6. Smoking 295.2 6. Diarrheal/LRI/other 263.3 4.8 7. Low physical activity 287.4 7. Digestive diseases 235.2 4.2 Others 10.9 179

Total population 1. High fasting plasma glucose 104.2 1. Cardiovascular diseases 120.5 22.5 All age 2. Dietary risks 100.6 2. Diabetes 103.9 19.4 3. High body-mass index 84.2 3. Neoplasms 36.7 13.0 4. High systolic blood pressure 78.9 4. Cirrhosis 33.7 6.3 5. Low glomerular filtration rate 58.9 5. Chronic respiratory diseases 31.7 5.9 6. Alcohol and drug use 46.0 6. Diarrheal/LRI/other 25.9 4.8 7. Smoking 29.6 7. Neurological disorders 23.8 4.4 Others 21.7 1. Dietary risks 111.9 1. Cardiovascular diseases 126.6 20.7 All age 2. High fasting plasma glucose 110.4 2. Diabetes 104.4 17.0 3. High systolic blood pressure 83.6 3. Neoplasms 70.7 11.5 4. High body-mass index 82.5 4. Cirrhosis 49.6 8.1 5. Alcohol and drug use 69.1 5. Self-harm & intersonal violence 42.7 7.0 6. Low glomerular filtration rate 59.3 6. Chronic respiratory diseases 35.0 5.7 7. Smoking 44.4 7. Transport injuries 32.4 5.3 Others 24.7 1. High fasting plasma glucose 98.4 1. Cardiovascular diseases 114.8 24.7 All age 2. Dietary risks 90.0 2. Diabetes 103.6 22.3 3. High body-mass index 85.9 3. Neoplasms 68.8 14.8 4. High systolic blood pressure 74.5 4. Chronic respiratory diseases 28.5 6.1 5. Low glomerular filtration rate 58.5 5. Neurological disorders 23.6 5.1 6. Alcohol and drug use 24.4 6. Diarrheal/LRI/other 23.4 5.1 7. Low physical activity 21.0 7. Cirrhosis 18.7 4.0 Others 17.9 180

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) 75 64 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 $4,579.00 Per capita GDP-PPP outlay on healthcare $382.00 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, 2012 40.5(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 3,375 28.18% 24.62% 32.63% 2. Diabetes 3,642 2,018 1,624 15.65% 15.60% 15.70% 3. Neoplasms 3,099 1,497 1,602 13.31% 11.58% 15.49% 4. Diarrheal/LRI/Other 1,750 989 761 7.52% 7.65% 7.36% 5. Chronic respiratory diseases 1,363 730 633 5.86% 5.64% 6.12% 6. Neonatal disorders 1,157 676 482 4.97% 5.23% 4.66% 7. Neurological disorders 1,123 576 547 4.82% 4.45% 5.29% 8. Cirrhosis 1,069 765 303 4.59% 5.92% 2.93% 9. Self-harm & intersonal violence 10. Other noncommunicable diseases 1,031 843 188 4.43% 6.52% 1.82% 880 474 406 3.78% 3.67% 3.93% 11. Transport injuries 734 595 139 3.15% 4.60% 1.34% 12. Unintentional Injuries 869 586 283 3.73% 4.53% 2.74% TOTAL 23,277 12,933 10,343 100.0% 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 2015. 75 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 761,039 385,845-49.30% Years lived with disability (YLD) 59,226 95,329 60.96% Years of life lost (YLL) 701,813 290,516-58.60% 11882 11,250-5.32% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 41,221 17,686-57.09% Years lived with disability (YLD) 3,234 3,546 9.65% Years of life lost (YLL) 37,987 14,140-62.78% 642 452-29.60% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 719,818 368,159-48.85% Years lived with disability (YLD) 55,992 91,783 63.92% Years of life lost (YLL) 663,826 276,376-58.37% 11,240 10,798-3.93% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 385,845 100% 95,329 100% 290,516 100% 11,250 100% 17,686 4.58% 3,546 3.72% 14,140 4.87% 452 4.02% 368,159 95.42% 91,783 96.28% 276,376 95.13% 10,798 95.98% 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 100.9 1. Neonatal disorders 170.4 34.6 2. Unsafe water, sanitation and handwashing 33.6 2. Diarrheal/LRI/other 3. Air pollution 14.5 3. Other non-communicable diseases 112.7 22.9 4. Unsafe sex 8.0 4. Nutritional deficiencies 23.1 4.7 5. Smoking 5.1 5. Unintentional injuries 20.6 4.2 6. Low glomerular filtration rate 3.2 6. Communicable, maternal, neonatal, and nutritional diseases 121.1 24.6 9.1 1.9 7. Alcohol and drug use 0.9 7. Diabetes 7.2 1.5 Others 5.6 Children under 5 years 1. Child and maternal malnutrition 116.1 1. Neonatal disorders 194.7 35.5 2. Unsafe water, sanitation and handwashing 37.5 2. Diarrheal/LRI/other 142.2 25.8 3. Air pollution 17.6 3. Other non-communicable diseases 120.7 22.0 4. Unsafe sex 7.7 4. Nutritional deficiencies 23.6 4.3 5. Smoking 6.0 5. Unintentional injuries 22.2 4.0 6. Low glomerular filtration rate 3.4 6. Communicable, maternal, neonatal, and nutritional diseases 9.0 1.6 7. Alcohol and drug use 1.0 7. Diabetes 7.7 1.4 Others 5.4 Children under 5 years 1. Child and maternal malnutrition 84.9 1. Neonatal disorders 144.9 33.5 2. Unsafe water, sanitation and handwashing 29.6 2. Other non-communicable diseases 104.3 24.1 3. Air pollution 11.3 3. Diarrheal/LRI/other 99.1 22.9 4. Unsafe sex 8.3 4. Nutritional deficiencies 22.6 5.2 5. Smoking 4.1 5. Unintentional injuries 19.0 4.4 6. Low glomerular filtration rate 2.9 6. Communicable, maternal, neonatal, and nutritional diseases 9.3 2.2 7. Alcohol and drug use 0.8 7. Neoplasms 6.9 1.6 Others 6.0 183

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.7 1. Neoplasms 2. Low glomerular filtration rate 1.5 2. Diarrheal/LRI/other 6.3 16.0 3. Alcohol and drug use 0.8 3. Unintentional injuries 5.6 14.4 4. Unsafe sex 0.4 4. Transport injuries 5.1 13.2 5. Air pollution 0.3 5. Diabetes 3.0 7.7 6. High fasting plasma glucose 0.3 6. Self-harm & intersonal violence 3.0 7.6 6.4 16.5 7. High systolic blood pressure 0.2 7. Other non-communicable diseases 2.6 6.6 Others 18.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.9 1. Unintentional injuries 2. Low glomerular filtration rate 1.7 2. Neoplasms 7.4 16.3 3. Alcohol and drug use 1.0 3. Transport injuries 7.1 15.7 4. Air pollution 0.4 4. Diarrheal/LRI/other 6.8 14.9 5. Unsafe sex 0.3 5. Self-harm & intersonal violence 3.3 7.2 7.7 17.1 6. High fasting plasma glucose 0.3 6. Diabetes 3.1 6.9 7. High systolic blood pressure 0.2 7. Other non-communicable diseases 2.7 6.0 Others 15.8 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.6 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 1.3 2. Neoplasms 5.5 16.7 3. Alcohol and drug use 0.5 3. Unintentional injuries 3.4 10.5 4. Unsafe sex 0.4 4. Transport injuries 3.1 9.5 5. High fasting plasma glucose 0.4 5. Diabetes 2.9 8.9 5.7 17.6 6. Air pollution 0.3 6. Self-harm & intersonal violence 2.6 8.0 7. Child and maternal malnutrition 0.2 7. Other non-communicable diseases 2.4 7.4 Others 21.3 184

Total population 15 to 49 years of age 1. Alcohol and drug use 23.4 1. Self-harm & intersonal violence 25.1 18.9 2. Low glomerular filtration rate 12.6 2. Neoplasms 17.1 12.9 3. Dietary risks 12.4 3. Diabetes 16.9 12.7 4. High body-mass index 12.0 4. Cardiovascular diseases 12.8 9.6 5. High systolic blood pressure 11.7 5. Transport injuries 12.7 9.6 6. High fasting plasma glucose 9.5 6. Cirrhosis 9.2 6.9 7. Unsafe sex 9.1 7. Unintentional injuries 9.2 6.9 Others 22.6 15 to 49 years of age 1. Alcohol and drug use 42.6 1. Self-harm & intersonal violence 42.5 23.0 2. Low glomerular filtration rate 19.3 2. Diabetes 23.4 12.7 3. High systolic blood pressure 16.9 3. Transport injuries 22.4 12.1 4. Dietary risks 14.7 4. Unintentional injuries 16.2 8.8 5. High body-mass index 12.4 5. Cirrhosis 15.8 8.6 6. High fasting plasma glucose 12.2 6. Cardiovascular diseases 14.3 7.8 7. Unsafe sex 9.5 7. Neoplasms 13.1 7.1 Others 20.0 15 to 49 years of age 1. High body-mass index 11.6 1. Neoplasms 21.0 25.2 2. Dietary risks 10.1 2. Cardiovascular diseases 11.3 13.5 3. Unsafe sex 8.8 3. Diabetes 10.6 12.7 4. High fasting plasma glucose 6.9 4. Self-harm & intersonal violence 8.3 10.0 5. High systolic blood pressure 6.8 5. Maternal disorders 5.4 6.5 6. Low glomerular filtration rate 6.2 6. Cirrhosis 4.2 5.1 7. Alcohol and drug use 4.9 7. Diarrheal/LRI/other 3.8 4.6 Others 22.5 185

Total population 50 to 69 years of age 1. Dietary risks 205.2 1. Diabetes 208.1 25.6 2. High body-mass index 202.5 2. Cardiovascular diseases 200.1 24.6 3. High systolic blood pressure 198.2 3. Neoplasms 155.6 19.2 4. High fasting plasma glucose 186.5 4. Cirrhosis 66.5 8.2 5. Low glomerular filtration rate 144.1 5. Chronic respiratory diseases 29.9 3.7 6. Alcohol and drug use 83.2 6. Diarrheal/LRI/other 22.5 2.8 7. Smoking 52.4 7. Transport injuries 19.4 2.4 Others 13.6 50 to 69 years of age 1. High systolic blood pressure 253.1 1. Diabetes 260.6 25.6 2. Dietary risks 249.1 2. Cardiovascular diseases 234.9 23.1 3. High fasting plasma glucose 219.0 3. Neoplasms 148.6 14.6 4. Low glomerular filtration rate 200.5 4. Cirrhosis 103.4 10.2 5. High body-mass index 192.6 5. Mental and substance use disorders 38.4 3.8 6. Alcohol and drug use 142.1 6. Chronic respiratory diseases 36.0 3.5 7. Smoking 79.6 7. Transport injuries 33.7 3.3 Others 15.8 50 to 69 years of age 1. High body-mass index 211.5 1. Cardiovascular diseases 168.3 26.8 2. Dietary risks 165.1 2. Neoplasms 162.1 25.9 3. High fasting plasma glucose 156.8 3. Diabetes 160.0 25.5 4. High systolic blood pressure 148.1 4. Cirrhosis 32.7 5.2 5. Low glomerular filtration rate 92.6 5. Chronic respiratory diseases 24.4 3.9 6. Air pollution 43.6 6. Diarrheal/LRI/other 17.2 2.7 7. Unsafe sex 38.5 7. Digestive diseases 16.0 2.6 Others 7.4 186

Total population 70 years of age and over 1. High systolic blood pressure 1,509.6 1. Cardiovascular diseases 2,447.8 40.7 2. Dietary risks 1,448.1 2. Diabetes 854.9 14.2 3. High fasting plasma glucose 898.4 3. Neoplasms 720.8 12.0 4. High body-mass index 799.2 4. Chronic respiratory diseases 546.9 9.1 5. Low glomerular filtration rate 702.1 5. Neurological disorders 491.1 8.2 6. Air pollution 521.8 6. Diarrheal/LRI/other 279.8 4.7 7. Smoking 313.2 7. Cirrhosis 171.5 2.9 Others 8.4 70 years of age and over 1. High systolic blood pressure 1,589.5 1. Cardiovascular diseases 2,475.6 37.9 2. Dietary risks 1,578.9 2. Diabetes 901.9 13.8 3. High fasting plasma glucose 830.9 3. Neoplasms 852.0 13.1 4. Low glomerular filtration rate 787.4 4. Chronic respiratory diseases 640.2 9.8 5. High body-mass index 579.8 5. Neurological disorders 541.4 8.3 6. Air pollution 531.5 6. Diarrheal/LRI/other 309.2 4.7 7. Smoking 498.9 7. Cirrhosis 216.4 3.3 Others 9.0 70 years of age and over 1. High systolic blood pressure 1,443.2 1. Cardiovascular diseases 2,424.7 43.3 2. Dietary risks 1,339.3 2. Diabetes 815.8 14.6 3. High body-mass index 981.8 3. Neoplasms 611.7 10.9 4. High fasting plasma glucose 954.7 4. Chronic respiratory diseases 469.3 8.4 5. Low glomerular filtration rate 631.1 5. Neurological disorders 449.1 8.0 6. Air pollution 513.7 6. Diarrheal/LRI/other 255.3 4.6 7. Low physical activity 295.1 7. Digestive diseases 155.0 2.8 Others 7.4 187

Total population 1. High systolic blood pressure 76.1 1. Cardiovascular diseases 107.9 26.0 All age 2. Dietary risks 75.0 2. Diabetes 59.9 14.5 3. High fasting plasma glucose 53.8 3. Neoplasms 51.0 12.3 4. High body-mass index 53.5 4. Diarrheal/LRI/other 28.8 6.9 5. Low glomerular filtration rate 45.2 5. Chronic respiratory diseases 22.4 5.4 6. Alcohol and drug use 28.3 6. Neonatal disorders 19.0 4.6 7. Air pollution 26.0 7. Neurological disorders 18.5 4.5 Others 25.8 1. High systolic blood pressure 81.9 1. Cardiovascular diseases 105.9 22.6 All age 2. Dietary risks 80.0 2. Diabetes 67.2 14.3 3. Low glomerular filtration rate 54.7 3. Neoplasms 49.8 10.6 4. High fasting plasma glucose 53.4 4. Diarrheal/LRI/other 32.9 7.0 5. Alcohol and drug use 46.2 5. Self-harm & intersonal violence 28.1 6.0 6. High body-mass index 43.3 6. Cirrhosis 25.4 5.4 7. Air pollution 26.3 7. Chronic respiratory diseases 24.3 5.2 Others 28.8 1. High systolic blood pressure 70.3 1. Cardiovascular diseases 109.9 30.3 All age 2. Dietary risks 70.2 2. Diabetes 52.9 14.6 3. High body-mass index 63.5 3. Neoplasms 52.1 14.4 4. High fasting plasma glucose 54.2 4. Diarrheal/LRI/other 24.8 6.8 5. Low glomerular filtration rate 36.0 5. Chronic respiratory diseases 20.6 5.7 6. Air pollution 25.7 6. Neurological disorders 17.8 4.9 7. Low physical activity 14.9 7. Neonatal disorders 15.7 4.3 Others 18.9 188

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) 77 67 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 $19,416.00 Per capita GDP-PPP outlay on healthcare $796.00 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, 2012 51.9(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 2,559 31.3% 29.1% 34.5% 2.Neoplasms 3,358 1,849 1,510 19.0% 18.0% 20.3% 3.Diabetes 2,034 1,028 1,005 11.5% 10.0% 13.5% 4. Diarrheal/LRI/Other 1,259 697 562 7.1% 6.8% 7.6% 5. Neurological disorders 1,065 561 503 6.0% 5.5% 6.8% 6. Chronic respiratory diseases 1,028 569 458 5.8% 5.5% 6.2% 7. Self-harm & intersonal violence 913 798 115 5.2% 7.8% 1.5% 8. Transport injuries 738 597 140 4.2% 5.8% 1.9% 9. Unintentional Injuries 716 508 208 4.0% 4.9% 2.8% 10.HIV/AIDS 561 429 132 3.2% 4.2% 1.8% 11. Other noncommunicable diseases 489.33 260 229 2.8% 2.5% 3.1% TOTAL 17,710 10,289 7,422 100.0% 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 2015. 77 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 2,254,404 1,777,256-21.17% Years lived with disability (YLD) 231,158 373,755 61.69% Years of life lost (YLL) 2,023,245 1,403,502-30.63% 42192 44,020 4.33% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,236,290 943,950-23.65% Years lived with disability (YLD) 124,861 190,386 52.48% Years of life lost (YLL) 1,111,428 753,565-32.20% 21,909 21,422-2.22% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 1,018,114 833,306-18.15% Years lived with disability (YLD) 106,297 183,369 72.51% Years of life lost (YLL) 911,817 649,937-28.72% 20,283 22,598 11.41% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,777,256 100% 373,755 100% 1,403,502 100% 44,020 100% 943,950 53.11% 190,386 50.94% 753,565 53.69% 21,422 48.66% 833,306 46.89% 183,369 49.06% 649,937 46.31% 22,598 51.34% 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 64.7 1. Neonatal disorders 107.1 28.3 2. Unsafe water, sanitation and handwashing 24.8 2. Other non-communicable diseases 3. Air pollution 2.6 3. Diarrheal/LRI/other 76.0 20.1 4. Low glomerular filtration rate 2.4 4. Unintentional injuries 25.6 6.8 5. Unsafe sex 2.2 5. Nutritional deficiencies 21.9 5.8 6. Smoking 2.0 6. Chronic respiratory diseases 8.1 2.1 101.6 26.8 7. Alcohol and drug use 1.8 7. Neoplasms 7.5 2.0 Others 8.2 Children under 5 years 1. Child and maternal malnutrition 69.0 1. Neonatal disorders 121.3 29.4 2. Unsafe water, sanitation and handwashing 27.1 2. Other non-communicable diseases 3. Air pollution 2.9 3. Diarrheal/LRI/other 82.8 20.1 4. Low glomerular filtration rate 2.5 4. Unintentional injuries 29.8 7.2 5. Smoking 2.4 5. Nutritional deficiencies 22.2 5.4 6. Unsafe sex 2.2 6. Chronic respiratory diseases 7. Alcohol and drug use 1.9 7. Diabetes 7.7 1.9 107.0 8.6 25.9 2.1 Others 8.1 Children under 5 years 1. Child and maternal malnutrition 60.1 1. Other non-communicable diseases 95.9 28.0 2. Unsafe water, sanitation and handwashing 22.3 2. Neonatal disorders 3. Air pollution 2.4 3. Diarrheal/LRI/other 68.8 20.1 4. Low glomerular filtration rate 2.3 4. Nutritional deficiencies 21.6 6.3 5. Unsafe sex 2.3 5. Unintentional injuries 21.2 6.2 92.2 26.8 6. Alcohol and drug use 1.7 6. Chronic respiratory diseases 7.6 2.2 7. Smoking 1.7 7. Neoplasms 7.2 2.1 Others 8.3 191

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.6 1. Unintentional injuries 2. Alcohol and drug use 0.9 2. Diarrheal/LRI/other 5.5 16.2 3. Low glomerular filtration rate 0.8 3. Neoplasms 4.9 14.4 4. High fasting plasma glucose 0.2 4. Transport injuries 4.5 13.2 5. Child and maternal malnutrition 0.1 5. Other non-communicable diseases 3.3 9.5 6. High systolic blood pressure 0.1 6. Self-harm & intersonal violence 2.2 6.6 6.0 17.5 7. Air pollution 0.1 7. Diabetes 2.0 5.9 Others 16.8 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.9 1. Unintentional injuries 2. Alcohol and drug use 1.2 2. Diarrheal/LRI/other 6.1 15.3 3. Low glomerular filtration rate 0.9 3. Transport injuries 5.8 14.4 4. High fasting plasma glucose 0.1 4. Neoplasms 5.3 13.3 5. High systolic blood pressure 0.1 5. Other non-communicable diseases 3.4 8.4 8.3 20.7 6. Air pollution 0.1 6. Self-harm & intersonal violence 3.0 7.4 7. Child and maternal malnutrition 0.1 7. Diabetes 2.2 5.4 Others 15.2 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.4 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.8 2. Neoplasms 4.5 16.0 3. Alcohol and drug use 0.6 3. Unintentional injuries 3.6 12.7 4. High fasting plasma glucose 0.2 4. Transport injuries 3.2 11.3 5. Child and maternal malnutrition 0.2 5. Other non-communicable diseases 3.2 11.2 4.9 17.5 6. Unsafe sex 0.1 6. Diabetes 1.9 6.8 7. Air pollution 0.1 7. Self-harm & intersonal violence 1.5 5.3 Others 19.2 192

Total population 15 to 49 years of age 1. Alcohol and drug use 27.5 1. Self-harm & intersonal violence 36.6 22.8 2. Dietary risks 14.0 2. Neoplasms 22.7 14.2 3. Unsafe sex 13.2 3. Transport injuries 22.4 14.0 4. High body-mass index 11.7 4. Cardiovascular diseases 17.0 10.6 5. High systolic blood pressure 11.3 5. HIV/AIDS 15.2 9.5 6. High fasting plasma glucose 7.4 6. Unintentional injuries 12.2 7.6 7. Low glomerular filtration rate 6.4 7. Diabetes 10.5 6.5 Others 14.9 15 to 49 years of age 1. Alcohol and drug use 45.4 1. Self-harm & intersonal violence 63.9 28.4 2. Dietary risks 18.2 2. Transport injuries 37.5 16.7 3. Unsafe sex 16.6 3. HIV/AIDS 23.0 10.3 4. High systolic blood pressure 15.9 4. Cardiovascular diseases 22.0 9.8 5. High body-mass index 13.2 5. Unintentional injuries 21.0 9.4 6. High fasting plasma glucose 9.2 6. Neoplasms 19.0 8.4 7. Low glomerular filtration rate 8.2 7. Diabetes 12.2 5.4 Others 11.6 15 to 49 years of age 1. High body-mass index 10.1 1. Neoplasms 26.5 28.3 2. Unsafe sex 9.7 2. Cardiovascular diseases 11.8 12.6 3. Dietary risks 9.6 3. Diabetes 8.7 9.3 4. Alcohol and drug use 8.9 4. Self-harm & intersonal violence 8.3 8.8 5. High systolic blood pressure 6.6 5. HIV/AIDS 7.1 7.6 6. High fasting plasma glucose 5.6 6. Transport injuries 6.8 7.2 7. Low glomerular filtration rate 4.5 7. Diarrheal/LRI/other 4.8 5.1 Others 21.1 193

Total population 50 to 69 years of age 1. Dietary risks 193.3 1. Cardiovascular diseases 200.9 28.5 2. High systolic blood pressure 155.9 2. Neoplasms 189.8 26.9 3. High body-mass index 138.3 3. Diabetes 100.2 14.2 4. High fasting plasma glucose 107.7 4. Cirrhosis 29.8 4.2 5. Smoking 66.6 5. HIV/AIDS 28.1 4.0 6. Low glomerular filtration rate 59.9 6. Chronic respiratory diseases 27.6 3.9 7. Alcohol and drug use 55.5 7. Diarrheal/LRI/other 24.9 3.5 Others 14.7 50 to 69 years of age 1. Dietary risks 255.1 1. Cardiovascular diseases 269.5 30.2 2. High systolic blood pressure 207.3 2. Neoplasms 204.2 22.9 3. High body-mass index 140.5 3. Diabetes 110.9 12.4 4. High fasting plasma glucose 125.0 4. HIV/AIDS 45.7 5.2 5. Smoking 109.8 5. Cirrhosis 41.0 4.6 6. Alcohol and drug use 79.3 6. Transport injuries 40.2 4.5 7. Low glomerular filtration rate 73.5 7. Chronic respiratory diseases 34.8 3.9 Others 16.4 50 to 69 years of age 1. High body-mass index 136.3 1. Neoplasms 175.8 33.7 2. Dietary risks 133.1 2. Cardiovascular diseases 133.9 25.7 3. High systolic blood pressure 105.7 3. Diabetes 89.8 17.2 4. High fasting plasma glucose 90.9 4. Chronic respiratory diseases 20.6 4.0 5. Low glomerular filtration rate 46.7 5. Cirrhosis 18.8 3.6 6. Alcohol and drug use 32.3 6. Diarrheal/LRI/other 17.8 3.4 7. High total cholesterol 29.5 7. Digestive diseases 11.2 2.1 Others 10.3 194

Total population 70 years of age and over 1. Dietary risks 1,320.8 1. Cardiovascular diseases 2,183.5 38.5 2. High systolic blood pressure 1,241.3 2. Neoplasms 952.4 16.8 3. High fasting plasma glucose 742.3 3. Diabetes 655.7 11.6 4. Smoking 550.2 4. Neurological disorders 503.3 8.9 5. High body-mass index 499.0 5. Chronic respiratory diseases 422.2 7.5 6. Low glomerular filtration rate 494.0 6. Diarrheal/LRI/other 362.2 6.4 7. High total cholesterol 263.9 7. Digestive diseases 147.1 2.6 Others 7.8 70 years of age and over 1. Dietary risks 1,516.7 1. Cardiovascular diseases 2,318.4 36.6 2. High systolic blood pressure 1,326.6 2. Neoplasms 1,216.9 19.2 3. Smoking 740.8 3. Diabetes 662.6 10.5 4. High fasting plasma glucose 734.5 4. Neurological disorders 558.2 8.8 5. Low glomerular filtration rate 592.9 5. Chronic respiratory diseases 490.1 7.7 6. High body-mass index 389.5 6. Diarrheal/LRI/other 405.4 6.4 7. Low physical activity 252.1 7. Digestive diseases 151.7 2.4 Others 8.5 70 years of age and over 1. High systolic blood pressure 1,167.0 1. Cardiovascular diseases 2,065.9 40.7 2. Dietary risks 1,150.1 2. Neoplasms 722.0 14.2 3. High fasting plasma glucose 749.1 3. Diabetes 649.7 12.8 4. High body-mass index 594.4 4. Neurological disorders 455.5 9.0 5. Low glomerular filtration rate 461.8 5. Chronic respiratory diseases 363.0 7.1 6. Smoking 384.0 6. Diarrheal/LRI/other 324.5 6.4 7. High total cholesterol 282.0 7. Digestive diseases 143.2 2.8 Others 7.1 195

Total population 1. Dietary risks 98.9 1. Cardiovascular diseases 143.6 28.6 All age 2. High systolic blood pressure 88.3 2. Neoplasms 86.9 17.3 3. High fasting plasma glucose 55.3 3. Diabetes 52.6 10.5 4. High body-mass index 50.2 4. Diarrheal/LRI/other 32.6 6.5 5. Smoking 38.5 5. Neurological disorders 27.5 5.5 6. Low glomerular filtration rate 36.2 6. Chronic respiratory diseases 26.6 5.3 7. Alcohol and drug use 31.6 7. Self-harm & intersonal violence 23.6 4.7 Others 21.6 1. Dietary risks 113.1 1. Cardiovascular diseases 153.2 26.7 All age 2. High systolic blood pressure 96.7 2. Neoplasms 94.7 16.5 3. High fasting plasma glucose 55.2 3. Diabetes 52.7 9.2 4. Smoking 52.3 4. Self-harm & intersonal violence 40.9 7.1 5. Alcohol and drug use 45.7 5. Diarrheal/LRI/other 35.7 6.2 6. High body-mass index 44.2 6. Transport injuries 30.6 5.3 7. Low glomerular filtration rate 38.7 7. Chronic respiratory diseases 29.2 5.1 Others 23.9 1. Dietary risks 84.5 1. Cardiovascular diseases 133.7 31.3 All age 2. High systolic blood pressure 79.8 2. Neoplasms 78.9 18.4 3. High body-mass index 56.3 3. Diabetes 52.6 12.3 4. High fasting plasma glucose 55.4 4. Diarrheal/LRI/other 29.4 6.9 5. Low glomerular filtration rate 33.6 5. Neurological disorders 26.3 6.2 6. Smoking 24.5 6. Chronic respiratory diseases 24.0 5.6 7. High total cholesterol 20.3 7. Other non-communicable diseases 12.0 2.8 Others 16.6 196

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) 79 65 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 $8,093.00 Per capita GDP-PPP outlay on healthcare $724.00 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, 2012 52.4(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 5,633 34.21% 31.60% 37.46% 2. Neoplasms 5,843 3,053 2,790 17.30% 16.29% 18.55% 3. Diabetes 4,102 1,875 2,227 12.14% 10.00% 14.81% 4. Diarrheal/LRI/Other 2,498 1,337 1,161 7.39% 7.13% 7.72% 5. Transport injuries 1,600 1,297 303 4.74% 6.92% 2.02% 6. Self-harm & intersonal violence 1,449 1,209 240 4.29% 6.45% 1.60% 7. Neonatal disorders 1,393 844 548 4.12% 4.50% 3.64% 8. Neurological disorders 1,327 725 602 3.93% 3.87% 4.00% 9. Chronic respiratory diseases 1,188 798 390 3.52% 4.26% 2.59% 10. Unintentional Injuries 1,128 768 360 3.34% 4.10% 2.39% 11. Digestive diseases 898 475 423 2.66% 2.53% 2.81% 12. Other noncommunicable diseases TOTAL 799 440 360 2.37% 2.35% 2.39% 33,781 18,744 15,037 100.00% 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 2015. 79 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 36,489 37,274 2.15% Years lived with disability (YLD) 5,659 6,040 6.73% Years of life lost (YLL) 30,830 31,234 1.31% 933 1,251 34.08% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 20,712 22,864 10.40% Years lived with disability (YLD) 3,252 3,294 1.30% Years of life lost (YLL) 17,460 19,570 12.10% 489 696 42.30% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 15,777 14,410-8.70% Years lived with disability (YLD) 2,407 2,746 14.10% Years of life lost (YLL) 13,370 11,664-12.80% 444 555 25.00% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 37,274 100% 6,040 100% 31,234 100% 1,251 100% 22,864 61.30% 3,294 54.50% 19,570 62.70% 696 55.60% 14,410 38.70% 2,746 45.50% 11,664 37.30% 555 44.40% 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 48.8 1. Neonatal disorders 179.8 41.4 2. Unsafe sex 34.8 2. Other non-communicable diseases 84.8 19.5 3. Unsafe water, sanitation and handwashing 20.6 4. Air pollution 7.6 3. Diarrheal/LRI/other 68.8 4. Communicable, maternal, neonatal, and nutritional diseases 36.0 5. Smoking 2.4 5. Unintentional injuries 18.5 4.3 6. Alcohol and drug use 1.6 6. Nutritional deficiencies 12.9 3.0 15.8 8.3 7. Low glomerular filtration rate 1.5 7. Diabetes 7.9 1.8 Others 6.1 Children under 5 years 1. Child and maternal malnutrition 53.7 1. Neonatal disorders 213.3 43.5 2. Unsafe sex 34.2 3. Unsafe water, sanitation and handwashing 22.0 4. Air pollution 8.5 2. Other non-communicable diseases 3. Diarrheal/LRI/other 4. Communicable, maternal, neonatal, and nutritional diseases 92.8 76.1 18.9 15.5 35.7 7.3 5. Smoking 2.7 5. Unintentional injuries 21.2 4.3 6. Alcohol and drug use 1.8 6. Nutritional deficiencies 7. Low glomerular filtration rate 1.7 7. Diabetes 8.3 1.7 13.9 2.8 Others 6.1 Children under 5 years 1. Child and maternal malnutrition 43.6 1. Neonatal disorders 144.8 38.5 2. Unsafe sex 35.3 2. Other non-communicable diseases 76.5 20.3 3. Unsafe water, sanitation and handwashing 19.2 4. Air pollution 6.6 3. Diarrheal/LRI/other 4. Communicable, maternal, neonatal, and nutritional diseases 61.1 16.3 36.3 9.7 5. Smoking 2.1 5. Unintentional injuries 15.7 4.2 6. Alcohol and drug use 1.3 6. Nutritional deficiencies 11.7 3.1 7. Low glomerular filtration rate 1.3 7. Diabetes 7.4 2.0 Others 6.0 199

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.6 1. Diarrheal/LRI/other 2. Unsafe sex 1.5 2. Transport injuries 6.2 16.6 3. Alcohol and drug use 1.3 3. Unintentional injuries 5.7 15.3 4. Low glomerular filtration rate 0.6 4. Neoplasms 5.1 13.7 5. Air pollution 0.6 5. Other non-communicable diseases 2.6 6.9 6. High fasting plasma glucose 0.2 6. Self-harm & intersonal violence 2.2 6.0 7. High systolic blood pressure 0.1 7. Communicable, maternal, neonatal, and nutritional diseases 7.4 19.8 1.7 4.5 Others 17.2 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.8 1. Transport injuries 2. Alcohol and drug use 1.7 2. Diarrheal/LRI/other 8.3 18.6 3. Unsafe sex 1.4 3. Unintentional injuries 8.1 18.1 4. Air pollution 0.7 4. Neoplasms 5.9 13.1 5. Low glomerular filtration rate 0.6 5. Other non-communicable diseases 2.7 6.1 8.4 18.7 6. High fasting plasma glucose 0.2 6. Self-harm & intersonal violence 2.6 5.7 7. Child and maternal malnutrition 0.1 7. Communicable, maternal, neonatal, and nutritional diseases 1.7 3.8 Others 15.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 2.4 1. Diarrheal/LRI/other 2. Unsafe sex 1.6 2. Neoplasms 4.4 14.6 3. Alcohol and drug use 0.9 3. Transport injuries 4.0 13.5 4. Low glomerular filtration rate 0.6 4. Unintentional injuries 3.3 11.0 5. Child and maternal malnutrition 0.5 5. Other non-communicable diseases 2.4 8.0 6.5 21.5 6. High fasting plasma glucose 0.2 6. Self-harm & intersonal violence 1.9 6.4 7. High systolic blood pressure 0.2 7. Communicable, maternal, neonatal, and nutritional diseases 1.7 5.7 Others 19.3 200

Total population 15 to 49 years of age 1. Alcohol and drug use 32.8 1. Self-harm & intersonal violence 31.4 18.7 2. Dietary risks 21.6 2. Transport injuries 28.9 17.2 3. High body-mass index 18.0 3. Cardiovascular diseases 24.9 14.8 4. High systolic blood pressure 15.2 4. Neoplasms 24.3 14.5 5. Smoking 10.2 5. Unintentional injuries 11.4 6.8 6. High fasting plasma glucose 9.4 6. Diabetes 9.5 5.6 7. Unsafe sex 9.1 7. HIV/AIDS 7.6 4.5 Others 17.9 15 to 49 years of age 1. Alcohol and drug use 56.8 1. Self-harm & intersonal violence 53.4 23.4 2. Dietary risks 27.0 2. Transport injuries 49.7 21.7 3. High body-mass index 19.8 3. Cardiovascular diseases 30.4 13.3 4. High systolic blood pressure 19.6 4. Neoplasms 20.1 8.8 5. Smoking 16.2 5. Unintentional injuries 19.2 8.4 6. High fasting plasma glucose 11.5 6. HIV/AIDS 11.6 5.1 7. Air pollution 10.9 7. Diabetes 10.5 4.6 Others 14.7 15 to 49 years of age 1. High body-mass index 16.2 1. Neoplasms 28.6 26.8 2. Dietary risks 16.1 2. Cardiovascular diseases 19.3 18.1 3. Unsafe sex 11.3 3. Self-harm & intersonal violence 9.1 8.5 4. High systolic blood pressure 10.8 4. Maternal disorders 8.8 8.4 5. Alcohol and drug use 8.4 5. Diabetes 8.4 7.8 6. High fasting plasma glucose 7.3 6. Transport injuries 7.9 7.4 7. Air pollution 6.5 7. Diarrheal/LRI/other 5.4 5.1 Others 18.0 201

Total population 50 to 69 years of age 1. Dietary risks 378.2 1. Cardiovascular diseases 414.0 35.8 2. High body-mass index 323.6 2. Neoplasms 279.1 24.1 3. High systolic blood pressure 302.2 3. Diabetes 175.9 15.2 4. High fasting plasma glucose 209.8 4. Diarrheal/LRI/other 44.1 3.8 5. Smoking 189.6 5. Cirrhosis 38.5 3.3 6. Air pollution 123.3 6. Transport injuries 35.5 3.1 7. Low glomerular filtration rate 100.0 7. Chronic respiratory diseases 30.6 2.6 Others 12.1 50 to 69 years of age 1. Dietary risks 452.3 1. Cardiovascular diseases 503.4 36.4 2. High systolic blood pressure 358.5 2. Neoplasms 293.4 21.2 3. High body-mass index 320.2 3. Diabetes 171.0 12.4 4. Smoking 304.7 4. Cirrhosis 62.1 4.5 5. High fasting plasma glucose 221.3 5. Transport injuries 54.8 4.0 6. Alcohol and drug use 156.1 6. Diarrheal/LRI/other 54.5 3.9 7. Air pollution 156.0 7. Chronic respiratory diseases 46.9 3.4 Others 14.2 50 to 69 years of age 1. High body-mass index 327.0 1. Cardiovascular diseases 323.2 34.8 2. Dietary risks 302.8 2. Neoplasms 264.5 28.5 3. High systolic blood pressure 245.0 3. Diabetes 180.9 19.5 4. High fasting plasma glucose 198.0 4. Diarrheal/LRI/other 33.5 3.6 5. Air pollution 90.1 5. Digestive diseases 23.6 2.5 6. Low glomerular filtration rate 89.4 6. Transport injuries 15.9 1.7 7. Air pollution 72.5 7. Cirrhosis 14.4 1.6 Others 7.9 202

Total population 70 years of age and over 1. Dietary risks 1,898.9 1. Cardiovascular diseases 3,038.0 42.8 2. High systolic blood pressure 1,770.5 2. Neoplasms 1,079.0 15.2 3. High body-mass index 1,218.0 3. Diabetes 939.0 13.2 4. High fasting plasma glucose 1,097.9 4. Diarrheal/LRI/other 517.5 7.3 5. Smoking 854.0 5. Neurological disorders 467.8 6.6 6. Air pollution 679.6 6. Chronic respiratory diseases 342.6 4.8 7. Low glomerular filtration rate 655.3 7. Digestive diseases 222.7 3.1 Others 6.9 70 years of age and over 1. Dietary risks 1,904.5 1. Cardiovascular diseases 2,970.9 39.9 2. High systolic blood pressure 1,707.0 2. Neoplasms 1,281.3 17.2 3. Smoking 1,180.9 3. Diabetes 846.9 11.4 4. High fasting plasma glucose 993.6 4. Neurological disorders 540.1 7.3 5. High body-mass index 968.0 5. Diarrheal/LRI/other 525.0 7.1 6. Air pollution 715.8 6. Chronic respiratory diseases 481.5 6.5 7. Low glomerular filtration rate 640.8 7. Digestive diseases 225.6 3.0 Others 7.6 70 years of age and over 1. Dietary risks 1,894.2 1. Cardiovascular diseases 3,095.7 45.6 2. High systolic blood pressure 1,825.1 2. Diabetes 1,018.2 15.0 3. High body-mass index 1,433.0 3. Neoplasms 905.0 13.3 4. High fasting plasma glucose 1,187.7 4. Diarrheal/LRI/other 511.0 7.5 5. Low glomerular filtration rate 667.8 5. Neurological disorders 405.7 6.0 6. Air pollution 648.5 6. Chronic respiratory diseases 223.2 3.3 7. Smoking 572.8 7. Digestive diseases 220.2 3.2 Others 6.1 203

Total population 1. Dietary risks 123.2 1. Cardiovascular diseases 169.6 31.9 All age 2. High systolic blood pressure 106.3 2. Neoplasms 85.8 16.1 3. High body-mass index 91.1 3. Diabetes 60.2 11.3 4. High fasting plasma glucose 68.7 4. Diarrheal/LRI/other 36.7 6.9 5. Smoking 58.3 5. Transport injuries 23.5 4.4 6. Air pollution 44.2 6. Self-harm & intersonal violence 21.3 4.0 7. Low glomerular filtration rate 38.4 7. Neonatal disorders 20.4 3.9 Others 21.6 1. Dietary risks 129.7 1. Cardiovascular diseases 172.4 29.2 All age 2. High systolic blood pressure 108.3 2. Neoplasms 88.9 15.1 3. Smoking 83.4 3. Diabetes 54.6 9.2 4. High body-mass index 80.0 4. Diarrheal/LRI/other 38.9 6.6 5. High fasting plasma glucose 64.7 5. Transport injuries 37.7 6.4 6. Alcohol and drug use 57.2 6. Self-harm & intersonal violence 35.2 6.0 7. Air pollution 48.6 7. Neonatal disorders 24.6 4.2 Others 23.4 1. Dietary risks 116.7 1. Cardiovascular diseases 166.7 35.2 All age 2. High systolic blood pressure 104.4 2. Neoplasms 82.6 17.4 3. High body-mass index 102.2 3. Diabetes 65.9 13.9 4. High fasting plasma glucose 72.8 4. Diarrheal/LRI/other 34.4 7.3 5. Air pollution 39.7 5. Neurological disorders 17.8 3.8 6. Low glomerular filtration rate 38.9 6. Neonatal disorders 16.2 3.5 7. Smoking 32.8 7. Digestive diseases 12.5 2.6 Others 16.3 204

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) 81 67 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 $11,773.00 Per capita GDP-PPP outlay on healthcare $626.00 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, 2012 48.1(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 14,465 22.2% 21.1% 23.3% 2.Neoplasms 25,896 11,977 13,919 20.4% 18.4% 22.4% 3. Diarrheal/LRI/Other 22,486 11,323 11,162 17.7% 17.4% 18.0% 4. Diabetes 11,447 5,378 6,069 9.0% 8.3% 9.8% 5. Chronic respiratory diseases 8,414 4,396 4,018 6.6% 6.8% 6.5% 6. Unintentional Injuries 6,439 3,992 2,447 5.1% 6.1% 3.9% 7. Cirrhosis 5,836 3,738 2,098 4.6% 5.7% 3.4% 8. Transport injuries 4,911 3,533 1,378 3.9% 5.4% 2.2% 9. Neonatal disorders 4,885 2,805 2,080 3.8% 4.3% 3.4% 10. Neurological disorders 4,486 2,054 2,432 3.5% 3.2% 3.9% 11. Digestive diseases 4,138 2,151 1,987 3.3% 3.3% 3.2% TOTAL 127,142 65,085 62,055 100.0% 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 2015. 81 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 4,786,043 3,111,282-34.99% Years lived with disability (YLD) 632,941 967,143 52.80% Years of life lost (YLL) 4,153,102 2,144,139-48.37% 90046 89,030-1.13% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 2,706,943 1,765,431-34.78% Years lived with disability (YLD) 365,090 516,787 41.55% Years of life lost (YLL) 2,341,853 1,248,644-46.68% 48,468 46,189-4.70% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 2,079,100 1,345,851-35.27% Years lived with disability (YLD) 267,851 450,356 68.14% Years of life lost (YLL) 1,811,249 895,495-50.56% 41,578 42,841 3.04% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 3,111,282 100% 967,143 100% 2,144,139 100% 89,030 100% 1,765,431 56.74% 516,787 53.43% 1,248,644 58.24% 46,189 51.88% 1,345,851 43.26% 450,356 46.57% 895,495 41.76% 42,841 48.12% 206

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 55.3 1. Neonatal disorders 165.3 37.0 2. Unsafe water, sanitation and handwashing 13.6 2. Diarrheal/LRI/other 3. Air pollution 11.3 3. Other non-communicable diseases 64.6 14.5 4. Unsafe sex 9.5 4. Unintentional injuries 46.8 10.5 5. Low glomerular filtration rate 2.9 5. Diabetes 11.4 2.6 6. Alcohol and drug use 1.8 6. Transport injuries 11.2 2.5 7. High systolic blood pressure 1.5 7. Communicable, maternal, neonatal, and nutritional diseases 99.1 22.2 11.0 2.5 Others 8.4 Children under 5 years 1. Child and maternal malnutrition 59.9 1. Neonatal disorders 185.6 38.0 2. Unsafe water, sanitation and handwashing 15.2 2. Other non-communicable diseases 3. Air pollution 12.4 3. Diarrheal/LRI/other 68.8 14.1 4. Unsafe sex 9.3 106.8 4. Communicable, maternal, neonatal, and nutritional diseases 50.1 5. Low glomerular filtration rate 3.2 5. Unintentional injuries 12.6 2.6 6. Alcohol and drug use 2.0 6. Nutritional deficiencies 7. High systolic blood pressure 1.7 7. Diabetes 11.3 2.3 12.2 21.9 10.2 2.5 Others 8.4 Children under 5 years 1. Child and maternal malnutrition 50.4 1. Neonatal disorders 144.0 35.7 2. Unsafe water, sanitation and handwashing 11.9 2. Diarrheal/LRI/other 3. Air pollution 10.3 3. Other non-communicable diseases 60.2 14.9 4. Unsafe sex 9.7 4. Unintentional injuries 43.4 10.8 5. Low glomerular filtration rate 2.5 5. Communicable, maternal, neonatal, and nutritional diseases 91.0 22.6 11.1 2.7 6. Alcohol and drug use 1.6 6. Diabetes 10.6 2.6 7. High systolic blood pressure 1.2 7. Nutritional deficiencies 10.4 2.6 Others 8.1 207

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.7 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.8 2. Unintentional injuries 5.5 15.5 3. Air pollution 0.7 3. Transport injuries 5.5 15.5 4. Low glomerular filtration rate 0.6 4. Neoplasms 4.9 13.8 5. Unsafe sex 0.4 5. Cardiovascular diseases 2.6 7.5 6. High systolic blood pressure 0.2 6. Other non-communicable diseases 1.6 4.5 7.5 21.0 7. Child and maternal malnutrition 0.2 7. Diabetes 1.6 4.4 Others 17.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.8 1. Diarrheal/LRI/other 2. Alcohol and drug use 1.0 2. Transport injuries 6.9 16.9 3. Air pollution 0.8 3. Unintentional injuries 6.6 16.3 4. Low glomerular filtration rate 0.6 4. Neoplasms 5.7 14.2 5. Unsafe sex 0.3 5. Cardiovascular diseases 3.0 7.5 8.2 20.3 6. High systolic blood pressure 0.3 6. Other non-communicable diseases 1.7 4.1 7. Child and maternal malnutrition 0.2 7. Diabetes 1.6 3.9 Others 16.9 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.6 2. Unintentional injuries 4.4 14.4 3. Air pollution 0.6 3. Transport injuries 4.1 13.5 4. Low glomerular filtration rate 0.6 4. Neoplasms 4.0 13.3 5. Unsafe sex 0.4 5. Cardiovascular diseases 2.3 7.4 6.7 22.0 6. High systolic blood pressure 0.2 6. Other non-communicable diseases 1.5 5.1 7. Child and maternal malnutrition 0.2 7. Diabetes 1.5 5.0 Others 19.3 208

Total population 15 to 49 years of age 1. Alcohol and drug use 20.4 1. Neoplasms 20.9 17.2 2. Dietary risks 12.6 2. Cardiovascular diseases 16.8 13.8 3. High body-mass index 9.3 3. Transport injuries 14.6 12.0 4. High systolic blood pressure 7.1 4. Unintentional injuries 11.3 9.3 5. Smoking 6.0 5. Diarrheal/LRI/other 10.0 8.2 6. High total cholesterol 5.8 6. Self-harm & intersonal violence 9.6 7.9 7. Air pollution 5.6 7. HIV/AIDS 7.6 6.3 Others 25.3 15 to 49 years of age 1. Alcohol and drug use 33.5 1. Transport injuries 23.2 15.2 2. Dietary risks 16.1 2. Cardiovascular diseases 21.1 13.7 3. High systolic blood pressure 9.9 3. Unintentional injuries 17.5 11.4 4. High body-mass index 9.7 4. Neoplasms 16.4 10.7 5. Smoking 8.5 5. Self-harm & intersonal violence 15.0 9.8 6. High fasting plasma glucose 8.0 6. Diarrheal/LRI/other 12.6 8.2 7. Air pollution 6.9 7. HIV/AIDS 10.8 7.2 Others 23.8 15 to 49 years of age 1. Dietary risks 9.0 1. Neoplasms 25.5 28.4 2. High body-mass index 8.9 2. Cardiovascular diseases 12.4 13.8 3. Alcohol and drug use 7.1 3. Diarrheal/LRI/other 7.4 8.3 4. Unsafe sex 6.6 4. Diabetes 6.1 6.8 5. Air pollution 4.4 5. Transport injuries 5.9 6.5 6. High systolic blood pressure 4.3 6. Unintentional injuries 5.1 5.7 7. Low glomerular filtration rate 3.8 7. Maternal disorders 4.7 5.3 Others 25.4 209

Total population 50 to 69 years of age 1. Dietary risks 144.2 1. Neoplasms 224.7 27.7 2. High body-mass index 113.2 2. Cardiovascular diseases 163.3 20.2 3. High systolic blood pressure 97.4 3. Diarrheal/LRI/other 84.4 10.4 4. Alcohol and drug use 91.6 4. Diabetes 79.0 9.8 5. Smoking 76.3 5. Cirrhosis 63.3 7.8 6. High fasting plasma glucose 67.0 6. Chronic respiratory diseases 39.8 4.9 7. Air pollution 55.5 7. Digestive diseases 28.7 3.5 Others 15.7 50 to 69 years of age 1. Dietary risks 175.4 1. Neoplasms 201.2 21.9 2. Alcohol and drug use 142.8 2. Cardiovascular diseases 193.8 21.1 3. High systolic blood pressure 118.3 3. Diarrheal/LRI/other 99.5 10.8 4. Smoking 108.9 4. Cirrhosis 88.9 9.7 5. High body-mass index 101.4 5. Diabetes 82.2 8.9 6. High fasting plasma glucose 72.9 6. Chronic respiratory diseases 47.1 5.1 7. Air pollution 63.6 7. Transport injuries 38.9 4.2 Others 18.4 50 to 69 years of age 1. High body-mass index 124.5 1. Neoplasms 134.1 35.1 2. Dietary risks 114.4 2. Cardiovascular diseases 134.1 19.0 3. High systolic blood pressure 77.3 3. Diabetes 76.0 10.8 4. High fasting plasma glucose 61.3 4. Diarrheal/LRI/other 70.0 9.9 5. Air pollution 47.7 5. Cirrhosis 38.8 5.5 6. Low glomerular filtration rate 46.4 6. Chronic respiratory diseases 32.9 4.7 7. Smoking 45.1 7. Digestive diseases 23.7 3.4 Others 11.6 210

Total population 70 years of age and over 1. Dietary risks 854.6 1. Cardiovascular diseases 1,461.2 25.5 2. High systolic blood pressure 726.5 2. Diarrheal/LRI/other 1,113.9 19.4 3. Air pollution 461.3 3. Neoplasms 1,019.3 17.8 4. Smoking 449.9 4. Diabetes 533.5 9.3 5. High body-mass index 448.6 5. Chronic respiratory diseases 473.9 8.3 6. Low glomerular filtration rate 442.2 6. Neurological disorders 301.4 5.3 7. High fasting plasma glucose 359.7 7. Digestive diseases 180.6 3.2 Others 11.3 70 years of age and over 1. Dietary risks 894.2 1. Cardiovascular diseases 1,411.1 23.7 2. High systolic blood pressure 675.2 2. Diarrheal/LRI/other 1,149.1 19.3 3. Smoking 580.0 3. Neoplasms 1,129.5 18.9 4. Air pollution 455.2 4. Chronic respiratory diseases 531.9 8.9 5. Low glomerular filtration rate 414.9 5. Diabetes 522.7 8.8 6. High fasting plasma glucose 344.9 6. Neurological disorders 296.2 5.0 7. High body-mass index 327.3 7. Cirrhosis 217.6 3.7 Others 11.8 70 years of age and over 1. Dietary risks 822.9 1. Cardiovascular diseases 1,501.3 27.1 2. High systolic blood pressure 767.6 2. Diarrheal/LRI/other 1,085.7 19.6 3. High body-mass index 545.9 3. Neoplasms 931.0 16.8 4. Air pollution 466.3 4. Diabetes 542.3 9.8 5. Low glomerular filtration rate 464.0 5. Chronic respiratory diseases 427.5 7.7 6. High fasting plasma glucose 371.6 6. Neurological disorders 305.6 5.5 7. Smoking 345.6 7. Digestive diseases 177.3 3.2 Others 10.4 211

Total population 1. Dietary risks 61.6 1. Cardiovascular diseases 92.8 20.1 All age 2. High systolic blood pressure 47.2 2. Neoplasms 85.2 18.4 3. High body-mass index 38.8 3. Diarrheal/LRI/other 74.0 16.0 4. Smoking 32.3 4. Diabetes 37.7 8.2 5. Alcohol and drug use 31.9 5. Chronic respiratory diseases 27.7 6.0 6. Air pollution 30.8 6. Unintentional injuries 21.2 4.6 7. Low glomerular filtration rate 27.6 7. Cirrhosis 19.2 4.2 Others 22.6 1. Dietary risks 64.6 1. Cardiovascular diseases 90.2 18.8 All age 2. Alcohol and drug use 46.5 2. Neoplasms 78.6 16.4 3. High systolic blood pressure 45.9 3. Diarrheal/LRI/other 74.3 15.5 4. Smoking 40.4 4. Diabetes 35.3 7.4 5. High body-mass index 30.5 5. Chronic respiratory diseases 28.9 6.0 6. Air pollution 30.2 6. Unintentional injuries 26.2 5.5 7. Low glomerular filtration rate 25.1 7. Cirrhosis 24.5 5.1 Others 25.3 1. Dietary risks 58.5 1. Cardiovascular diseases 95.4 21.4 All age 2. High systolic blood pressure 48.5 2. Neoplasms 91.8 20.6 3. High body-mass index 47.1 3. Diarrheal/LRI/other 73.6 16.6 4. Air pollution 31.5 4. Diabetes 40.0 9.0 5. Low glomerular filtration rate 30.2 5. Chronic respiratory diseases 26.5 6.0 6. High fasting plasma glucose 27.3 6. Unintentional injuries 16.1 3.6 7. Smoking 24.1 7. Neurological disorders 16.0 3.6 Others 19.2 212

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) 83 63 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 $12,180.00 Per capita GDP-PPP outlay on healthcare $631.00 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, 2012 47.2(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 11,354 39.7% 36.7% 43.8% 2. Neoplasms 9,227 5,184 4,043 15.3% 15.1% 15.6% 3. Diabetes 4,975 2,487 2,488 8.2% 7.2% 9.6% 4. Diarrheal/LRI/Other 3,509 1,878 1,631 5.8% 5.5% 6.3% 5. Neonatal disorders 3,010 1,707 1,303 5.0% 5.0% 5.0% 6. Neurological disorders 2,877 1,632 1,245 4.8% 4.7% 4.8% 7. Transport injuries 2,869 2,306 564 4.8% 6.7% 2.2% 8. Chronic respiratory diseases 9. Self-harm & intersonal violence 10. Unintentional Injuries 11. Other noncommunicable diseases 2,493 1,496 997 4.1% 4.4% 3.8% 2,231 1,864 367 3.7% 5.4% 1.4% 1,986 1,339 647 3.3% 3.9% 2.5% 1,347 741 606 2.2% 2.2% 2.3% 12. Cirrhosis 1,814 1116 698 3.0% 3.2% 2.7% TOTAL 60,304 34,362 25,942 100.0% 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 2015. 83 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 1,380,606 1,834,182 32.85% Years lived with disability (YLD) 213,594 379,172 77.52% Years of life lost (YLL) 1,167,012 1,455,010 24.68% 34,619 71,616 106.87% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 802,049 1,070,520 33.47% Years lived with disability (YLD) 113,201 185,748 64.09% Years of life lost (YLL) 688,848 884,772 28.44% 19,837 39,947 101.38% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 578,557 763,662 31.99% Years lived with disability (YLD) 100,393 193,424 92.67% Years of life lost (YLL) 478,164 570,238 19.26% 14,782 31,669 114.24% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 1,834,182 100% 379,172 100% 1,455,010 100% 71,616 100% 1,070,520 58.36% 185,748 48.99% 884,772 60.81% 39,947 55.78% 763,662 41.64% 193,424 51.01% 570,238 39.19% 31,669 44.22% 214

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 70.4 1. Neonatal disorders 282.6 48.3 2. Unsafe water, sanitation and handwashing 25.3 2. Other non-communicable diseases 3. Air pollution 7.3 3. Diarrheal/LRI/other 94.9 16.2 4. Low glomerular filtration rate 3.4 4. Unintentional injuries 26.7 4.5 5. Alcohol and drug use 2.1 5. Nutritional deficiencies 15.3 2.6 6. Smoking 1.5 6. Diabetes 14.8 2.5 103.2 17.6 7. High fasting plasma glucose 1.4 7. Cardiovascular diseases 10.2 1.7 Others 6.6 Children under 5 years 1. Child and maternal malnutrition 78.0 1. Neonatal disorders 313.7 48.5 2. Unsafe water, sanitation and handwashing 27.2 2. Other non-communicable diseases 3. Air pollution 8.1 3. Diarrheal/LRI/other 104.8 16.1 4. Low glomerular filtration rate 3.8 4. Unintentional injuries 29.2 4.5 5. Alcohol and drug use 2.5 5. Nutritional deficiencies 18.2 2.8 6. Smoking 1.6 6. Diabetes 7. High fasting plasma glucose 1.3 7. Cardiovascular diseases 10.5 1.6 113.3 15.3 17.5 2.3 Others 6.8 Children under 5 years 1. Child and maternal malnutrition 62.4 1. Neonatal disorders 250.1 48.1 2. Unsafe water, sanitation and handwashing 23.3 2. Other non-communicable diseases 3. Air pollution 6.5 3. Diarrheal/LRI/other 84.6 16.2 4. Low glomerular filtration rate 3.0 4. Unintentional injuries 24.0 4.6 5. Alcohol and drug use 1.6 5. Diabetes 14.2 2.7 92.6 17.7 6. Smoking 1.5 6. Nutritional deficiencies 12.3 2.4 7. High fasting plasma glucose 1.4 7. Cardiovascular diseases 9.9 1.9 Others 6.4 215

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.8 1. Transport injuries 8.5 2. Alcohol and drug use 1.5 2. Unintentional injuries 6.8 15.5 3. Low glomerular filtration rate 1.1 3. Diarrheal/LRI/other 6.2 14.2 4. High fasting plasma glucose 0.5 4. Neoplasms 4.5 10.2 5. Air pollution 0.4 5. Diabetes 3.5 7.9 6. Child and maternal malnutrition 0.3 6. Other non-communicable diseases 3.2 7.4 19.5 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.8 6.4 Others 18.9 5 to 14 years of age 1. Alcohol and drug use 2.0 2. Unsafe water, sanitation and handwashing 1.9 1. Transport injuries 2. Unintentional injuries 3. Low glomerular filtration rate 1.1 3. Diarrheal/LRI/other 6.8 13.2 4. High fasting plasma glucose 0.5 4. Neoplasms 4.9 9.5 5. Air pollution 0.4 5. Diabetes 3.6 6.9 11.3 9.2 21.9 17.8 6. Child and maternal malnutrition 0.3 6. Other non-communicable diseases 3.5 6.8 7. High systolic blood pressure 0.3 7. Self-harm & intersonal violence 3.5 6.7 Others 17.4 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.7 1. Transport injuries 2. Alcohol and drug use 1.0 2. Diarrheal/LRI/other 5.6 15.7 3. Low glomerular filtration rate 1.0 3. Unintentional injuries 4.3 12.0 4. High fasting plasma glucose 0.6 4. Neoplasms 4.0 11.3 5. Air pollution 0.4 5. Diabetes 3.4 9.5 5.6 15.8 6. Child and maternal malnutrition 0.3 6. Other non-communicable diseases 3.0 8.4 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.7 7.7 Others 19.5 216

Total population 15 to 49 years of age 1. Alcohol and drug use 30.6 1. Cardiovascular diseases 32.0 18.0 2. Dietary risks 26.6 2. Transport injuries 30.6 17.2 3. High systolic blood pressure 19.9 3. Self-harm & intersonal violence 29.0 16.3 4. High body-mass index 19.7 4. Neoplasms 21.7 12.2 5. High total cholesterol 11.7 5. Unintentional injuries 13.2 7.4 6. Unsafe sex 11.2 6. HIV/AIDS 13.1 7.4 7. Smoking 10.2 7. Diabetes 12.0 6.8 Others 14.6 15 to 49 years of age 1. Alcohol and drug use 50.5 1. Transport injuries 51.9 21.6 2. Dietary risks 32.9 2. Self-harm & intersonal violence 49.6 20.7 3. High systolic blood pressure 25.2 3. Cardiovascular diseases 38.4 16.0 4. High body-mass index 21.7 4. Unintentional injuries 22.0 9.2 5. High total cholesterol 14.7 5. HIV/AIDS 17.2 7.3 6. Smoking 12.8 6. Neoplasms 17.2 7.2 7. Unsafe sex 12.0 7. Diabetes 13.6 5.7 Others 12.5 15 to 49 years of age 1. Dietary risks 20.4 1. Neoplasms 26.2 22.5 2. High body-mass index 17.6 2. Cardiovascular diseases 25.7 22.2 3. High systolic blood pressure 14.6 3. Diabetes 10.4 9.0 4. Alcohol and drug use 10.9 4. Transport injuries 9.4 8.1 5. Unsafe sex 10.4 5. HIV/AIDS 8.9 7.8 6. High total cholesterol 8.7 6. Self-harm & intersonal violence 8.6 7.4 7. smoking 7.8 7. Diarrheal/LRI/other 4.8 4.1 Others 18.8 217

Total population 50 to 69 years of age 1. Dietary risks 249.0 1. Cardiovascular diseases 453.5 42.6 2. High systolic blood pressure 210.6 2. Neoplasms 216.1 20.3 3. High body-mass index 180.3 3. Diabetes 113.1 10.6 4. Smoking 176.4 4. Cirrhosis 52.4 4.9 5. High fasting plasma glucose 143.7 5. Transport injuries 43.3 4.1 6. High total cholesterol 104.0 6. Chronic respiratory diseases 35.8 3.4 7. Low physical activity 61.8 7. Diarrheal/LRI/other 28.0 2.6 Others 11.4 50 to 69 years of age 1. Dietary risks 304.0 1. Cardiovascular diseases 559.9 42.6 2. High systolic blood pressure 255.4 2. Neoplasms 228.8 17.4 3. High body-mass index 217.2 3. Diabetes 127.3 9.7 4. Smoking 216.8 4. Transport injuries 70.5 5.4 5. High fasting plasma glucose 192.2 5. Cirrhosis 69.1 5.3 6. High total cholesterol 182.1 6. Self-harm & intersonal violence 48.2 3.7 7. Low physical activity 94.1 7. Chronic respiratory diseases 47.0 3.6 Others 12.5 50 to 69 years of age 1. Dietary risks 232.1 1. Cardiovascular diseases 349.4 42.7 2. High systolic blood pressure 207.6 2. Neoplasms 203.7 24.9 3. High body-mass index 145.7 3. Diabetes 99.3 12.1 4. Smoking 123.8 4. Transport injuries 36.0 4.4 5. High fasting plasma glucose 88.7 5. Cirrhosis 24.9 3.0 6. High total cholesterol 52.7 6. Self-harm & intersonal violence 21.4 2.6 7. Low physical activity 51.8 7. Chronic respiratory diseases 16.7 2.0 Others 8.2 218

Total population 70 years of age and over 1. High systolic blood pressure 2,153.2 1. Cardiovascular diseases 3,541.8 49.2 2. Dietary risks 1,819.3 2. Neoplasms 1,095.1 15.2 3. High body-mass index 1,041.1 3. Neurological disorders 569.1 7.9 4. Smoking 864.8 4. Diabetes 565.7 7.9 5. Low glomerular filtration rate 644.2 5. Chronic respiratory diseases 384.4 5.3 6. High fasting plasma glucose 629.6 6. Diarrheal/LRI/other 374.7 5.2 7. Low physical activity 578.1 7. Cirrhosis 179.0 2.5 Others 6.8 70 years of age and over 1. High systolic blood pressure 2,108.7 1. Cardiovascular diseases 3,604.1 45.6 2. Dietary risks 1,926.9 2. Neoplasms 1,441.3 18.2 3. Smoking 1,094.2 3. Neurological disorders 667.9 8.5 4. High body-mass index 677.0 4. Diabetes 528.7 6.7 5. Low glomerular filtration rate 633.7 5. Chronic respiratory diseases 482.8 6.1 6. Low physical activity 600.8 6. Diarrheal/LRI/other 383.6 4.9 7. High fasting plasma glucose 579.6 7. Cirrhosis 210.0 2.7 Others 7.5 70 years of age and over 1. High systolic blood pressure 2,193.7 1. Cardiovascular diseases 3,485.3 53.2 2. Dietary risks 1,721.7 2. Neoplasms 780.8 11.9 3. High body-mass index 1,371.8 3. Diabetes 599.4 9.1 4. High fasting plasma glucose 674.9 4. Neurological disorders 479.4 7.3 5. Smoking 656.5 5. Diarrheal/LRI/other 366.6 5.6 6. Low glomerular filtration rate 653.7 6. Chronic respiratory diseases 294.9 4.5 7. Low physical activity 557.6 7. Cirrhosis 150.8 2.3 Others 6.0 219

Total population 1. High systolic blood pressure 147.9 1. Cardiovascular diseases 230.3 37.7 All age 2. Dietary risks 138.9 2. Neoplasms 88.7 14.5 3. High body-mass index 85.8 3. Diabetes 47.8 7.8 4. Smoking 65.7 4. Diarrheal/LRI/other 33.7 5.5 5. High fasting plasma glucose 48.3 5. Neonatal disorders 28.9 4.8 6. Low glomerular filtration rate 44.0 6. Neurological disorders 27.7 4.5 7. High total cholesterol 42.2 7. Transport injuries 27.6 4.5 Others 20.7 1. Dietary risks 153.8 1. Cardiovascular diseases 242.3 34.7 All age 2. High systolic blood pressure 153.8 2. Neoplasms 99.6 14.2 3. Smoking 80.7 3. Diabetes 47.8 6.8 4. High body-mass index 71.8 4. Transport injuries 44.3 6.3 5. Alcohol and drug use 55.2 5. Diarrheal/LRI/other 36.1 5.2 6. High fasting plasma glucose 47.9 6. Self-harm & intersonal violence 35.8 5.1 7. Low glomerular filtration rate 45.5 7. Neonatal disorders 32.8 4.7 Others 22.9 1. High systolic blood pressure 142.0 1. Cardiovascular diseases 218.3 41.6 All age 2. Dietary risks 123.9 2. Neoplasms 77.8 14.8 3. High body-mass index 99.9 3. Diabetes 47.8 9.1 4. Smoking 50.7 4. Diarrheal/LRI/other 31.4 6.0 5. High fasting plasma glucose 48.8 5. Neonatal disorders 25.1 4.8 6. Low glomerular filtration rate 42.5 6. Neurological disorders 23.9 4.6 7. High total cholesterol 41.9 7. Chronic respiratory diseases 19.2 3.7 Others 15.4 220

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) 85 64.1 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 15,532 32.8% 62. Stroke 9,648 20.3% 63. Diabetes 4,962 10.5% 64. Lower respiratory infection 3,257 6.9% 65. HIV/AIDS 3,004 6.3% 66. Hytensive health disease 2,797 5.9% 67. Road injuries 2,615 5.5% 68. Prostate cancer 2,267 4.8% 69. Preterm birth complications 1,702 3.6% 70. Cirrhosis 1,608 3.4% Total 10 main causes 47,392 100.0% Impact of leading preventable risks in the Caribbean Disability adjusted life years of risks factor Increase in deaths to risk factors: 2010 vs 1990 (%) 2010 7. 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 2015. 85 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

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) 87 63 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 $10,514.00 Per capita GDP-PPP outlay on healthcare $555.00 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 270 125 145 36.7% 32.1% 41.9% 2. Neoplasms 127 69 58 17.3% 17.7% 16.8% 3. Diabetes 106 49 58 14.4% 12.6% 16.8% 4. Diarrheal/LRI/Other 39 20 19 5.3% 5.1% 5.5% 5. Neurological disorders 31 17 14 4.2% 4.4% 4.0% 6. Unintentional Injuries 26 18 8 3.5% 4.6% 2.3% 7. Self-harm & intersonal violence 25 21 4 3.4% 5.4% 1.1% 8. HIV/AIDS 22 16 6 3.0% 4.1% 1.7% 9. Neonatal disorders 21 12 9 2.9% 3.0% 2.6% 10. Chronic respiratory diseases 20 14 6 2.7% 3.6% 1.7% 11. Transport injuries 17 13 4 2.3% 3.3% 1.2% 12. Other noncommunicable diseases 16 8 8 2.2% 1.9% 2.3% 13. Digestive diseases 15 8 7 2.0% 2.2% 2.0% TOTAL 735 390 346 100.0% 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 2015. 87 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 21,216 21,355 0.66% Years lived with disability (YLD) 4,023 5,469 35.94% Years of life lost (YLL) 17,193 15,886-7.60% 750 801 6.80% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 11,384 11,945 4.93% Years lived with disability (YLD) 2,144 2,900 35.26% Years of life lost (YLL) 9,240 9,045-2.11% 353 399 13.03% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 9,832 9,410-4.29% Years lived with disability (YLD) 1,879 2,569 36.72% Years of life lost (YLL) 7,953 6,841-13.98% 397 402 1.26% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 21,355 100% 5,469 100% 15,886 100% 801 100% 11,945 55.94% 2,900 53.03% 9,045 56.94% 399 49.81% 9,410 44.06% 2,569 46.97% 6,841 43.06% 402 50.19% 224

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 57.3 1. Neonatal disorders 229.5 49.6 2. Unsafe water, sanitation and handwashing 18.2 2. Other non-communicable diseases 3. Air pollution 4.8 3. Diarrheal/LRI/other 65.2 13.8 4. Smoking 4.1 4. Unintentional injuries 25.4 5.4 5. Low glomerular filtration rate 2.3 5. Nutritional deficiencies 17.9 3.8 6. Alcohol and drug use 1.3 6. Diabetes 11.3 2.4 83.2 17.7 7. High fasting plasma glucose 1.1 7. Cardiovascular diseases 7.9 1.7 Others 5.8 Children under 5 years 1. Child and maternal malnutrition 64.2 1. Neonatal disorders 256.9 49.9 2. Unsafe water, sanitation and handwashing 20.9 2. Other non-communicable diseases 3. Air pollution 5.3 3. Diarrheal/LRI/other 73.2 14.0 4. Smoking 4.2 4. Unintentional injuries 29.1 5.6 5. Low glomerular filtration rate 2.4 5. Nutritional deficiencies 20.4 3.9 6. Alcohol and drug use 1.5 6. Diabetes 7. High fasting plasma glucose 1.1 7. Cardiovascular diseases 8.0 1.5 89.0 12.0 17.1 2.3 Others 5.9 Children under 5 years 1. Child and maternal malnutrition 50.3 1. Neonatal disorders 201.3 49.2 2. Unsafe water, sanitation and handwashing 15.6 2. Other non-communicable diseases 3. Air pollution 4.4 3. Diarrheal/LRI/other 57.1 13.6 4. Smoking 4.0 4. Unintentional injuries 21.7 5.2 5. Low glomerular filtration rate 2.1 5. Nutritional deficiencies 15.3 3.6 77.2 18.5 6. Alcohol and drug use 1.1 6. Diabetes 10.5 2.5 7. High fasting plasma glucose 1.0 7. Cardiovascular diseases 7.8 1.9 Others 5.6 225

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Unintentional injuries 2. Alcohol and drug use 0.9 2. Transport injuries 5.6 13.9 3. Low glomerular filtration rate 0.8 3. Diarrheal/LRI/other 5.0 12.5 4. High fasting plasma glucose 0.4 4. Neoplasms 4.9 12.2 5. Child and maternal malnutrition 0.3 5. Other non-communicable diseases 3.8 9.4 6. Air pollution 0.3 6. Diabetes 2.9 7.3 7.0 17.4 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.8 7.0 Others 20.3 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.6 1. Unintentional injuries 2. Alcohol and drug use 1.2 2. Transport injuries 7.2 15.5 3. Low glomerular filtration rate 0.8 3. Neoplasms 5.5 11.8 4. Child and maternal malnutrition 0.3 4. Diarrheal/LRI/other 5.5 11.7 5. Air pollution 0.3 5. Other non-communicable diseases 4.0 8.6 9.4 20.2 6. High fasting plasma glucose 0.3 6. Self-harm & intersonal violence 3.3 7.1 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.9 6.2 Others 19.1 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.8 2. Unintentional injuries 4.5 13.5 3. Alcohol and drug use 0.7 3. Neoplasms 4.2 12.7 4. High fasting plasma glucose 0.5 4. Transport injuries 3.9 11.8 5. Child and maternal malnutrition 0.4 5. Other non-communicable diseases 3.5 10.5 4.5 13.5 6. Air pollution 0.3 6. Diabetes 3.0 8.9 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.7 8.2 Others 20.9 226

Total population 15 to 49 years of age 1. Alcohol and drug use 27.3 1. Self-harm & intersonal violence 32.0 15.3 2. Dietary risks 25.8 2. Cardiovascular diseases 30.6 14.7 3. Unsafe sex 24.0 3. Neoplasms 29.5 14.1 4. High body-mass index 23.8 4. HIV/AIDS 24.3 11.7 5. High systolic blood pressure 21.2 5. Diabetes 20.9 10.0 6. High fasting plasma glucose 14.8 6. Unintentional injuries 17.1 8.2 7. Smoking 11.7 7. Transport injuries 15.7 7.5 Others 18.6 15 to 49 years of age 1. Alcohol and drug use 43.8 1. Self-harm & intersonal violence 54.0 19.7 2. Dietary risks 31.0 2. Cardiovascular diseases 36.9 13.5 3. Unsafe sex 28.4 3. HIV/AIDS 33.4 12.3 4. High systolic blood pressure 26.5 4. Unintentional injuries 28.4 10.4 5. High body-mass index 24.8 5. Neoplasms 25.4 9.3 6. Smoking 18.8 6. Transport injuries 25.1 9.2 7. High fasting plasma glucose 16.9 7. Diabetes 22.5 8.2 Others 17.5 15 to 49 years of age 1. High body-mass index 22.8 1. Neoplasms 33.8 23.9 2. Dietary risks 20.4 2. Cardiovascular diseases 24.1 17.0 3. Unsafe sex 19.5 3. Diabetes 19.2 13.5 4. High systolic blood pressure 15.6 4. HIV/AIDS 14.8 10.6 5. High fasting plasma glucose 12.6 5. Self-harm & intersonal violence 9.2 6.5 6. Alcohol and drug use 10.2 6. Transport injuries 5.9 4.1 7. Low glomerular filtration rate 7.2 7. Unintentional injuries 5.3 3.7 Others 20.7 227

Total population 50 to 69 years of age 1. Dietary risks 343.9 1. Cardiovascular diseases 398.8 34.2 2. High systolic blood pressure 305.1 2. Neoplasms 268.0 23.0 3. High body-mass index 298.9 3. Diabetes 214.0 18.4 4. High fasting plasma glucose 224.5 4. Cirrhosis 38.0 3.3 5. Smoking 125.5 5. HIV/AIDS 32.3 2.8 6. Low physical activity 92.8 6. Diarrheal/LRI/other 31.9 2.7 7. High total cholesterol 75.3 7. Chronic respiratory diseases 31.3 2.7 Others 12.9 50 to 69 years of age 1. Dietary risks 386.6 1. Cardiovascular diseases 459.8 33.7 2. High systolic blood pressure 347.2 2. Neoplasms 284.6 20.9 3. High body-mass index 268.5 3. Diabetes 214.6 15.7 4. High fasting plasma glucose 231.2 4. Cirrhosis 54.7 4.0 5. Smoking 206.7 5. HIV/AIDS 50.1 3.7 6. Alcohol and drug use 106.8 6. Chronic respiratory diseases 45.4 3.3 7. Low physical activity 105.5 7. Unintentional injuries 42.1 3.1 Others 15.6 50 to 69 years of age 1. High body-mass index 330.1 1. Cardiovascular diseases 335.9 35.0 2. Dietary risks 300.0 2. Neoplasms 250.8 26.1 3. High systolic blood pressure 261.7 3. Diabetes 213.3 22.2 4. High fasting plasma glucose 217.6 4. Diarrheal/LRI/other 22.4 2.3 5. Low physical activity 79.8 5. Cirrhosis 20.7 2.2 6. Low glomerular filtration rate 67.8 6. Digestive diseases 19.4 2.0 7. High total cholesterol 62.5 7. Chronic respiratory diseases 16.8 1.8 Others 8.5 228

Total population 70 years of age and over 1. High systolic blood pressure 2,109.2 1. Cardiovascular diseases 3,462.9 46.3 2. Dietary risks 1,753.6 2. Neoplasms 1,164.8 15.6 3. High fasting plasma glucose 1,191.8 3. Diabetes 1,051.2 14.1 4. High body-mass index 1,106.3 4. Neurological disorders 498.6 6.7 5. Low glomerular filtration rate 609.2 5. Diarrheal/LRI/other 420.7 5.6 6. Low physical activity 597.4 6. Chronic respiratory diseases 223.6 3.0 7. Air pollution 386.1 7. Digestive diseases 141.3 1.9 Others 6.9 70 years of age and over 1. High systolic blood pressure 1,905.6 1. Cardiovascular diseases 3,152.3 40.8 2. Dietary risks 1,699.1 2. Neoplasms 1,532.7 19.8 3. High fasting plasma glucose 1,044.1 3. Diabetes 954.9 12.4 4. High body-mass index 771.3 4. Neurological disorders 586.0 7.6 5. Smoking 569.9 5. Diarrheal/LRI/other 427.6 5.5 6. Low glomerular filtration rate 557.1 6. Chronic respiratory diseases 352.3 4.6 7. Low physical activity 554.8 7. Digestive diseases 145.8 1.9 Others 7.5 70 years of age and over 1. High systolic blood pressure 2,267.6 1. Cardiovascular diseases 3,704.4 50.9 2. Dietary risks 1,796.1 2. Diabetes 1,126.2 15.5 3. High body-mass index 1,367.0 3. Neoplasms 878.6 12.1 4. High fasting plasma glucose 1,306.7 4. Neurological disorders 430.7 5.9 5. Low glomerular filtration rate 649.7 5. Diarrheal/LRI/other 415.3 5.7 6. Low physical activity 630.5 6. Digestive diseases 137.8 1.9 7. High total cholesterol 400.8 7. Unintentional injuries 133.0 1.8 Others 6.2 229

Total population 1. High systolic blood pressure 160.8 1. Cardiovascular diseases 246.3 35.2 All age 2. Dietary risks 152.6 2. Neoplasms 115.7 16.5 3. High body-mass index 113.5 3. Diabetes 97.0 13.8 4. High fasting plasma glucose 100.9 4. Diarrheal/LRI/other 35.5 5.1 5. Low physical activity 46.6 5. Neurological disorders 28.6 4.1 6. Low glomerular filtration rate 45.6 6. Unintentional injuries 23.4 3.3 7. Smoking 43.3 7. Self-harm & intersonal violence 23.1 3.3 Others 18.7 1. Dietary risks 149.4 1. Cardiovascular diseases 225.4 30.5 All age 2. High systolic blood pressure 149.2 2. Neoplasms 124.5 16.9 3. High fasting plasma glucose 89.8 3. Diabetes 87.8 11.9 4. High body-mass index 88.7 4. Self-harm & intersonal violence 38.7 5.2 5. Smoking 67.5 5. Diarrheal/LRI/other 36.8 5.0 6. Alcohol and drug use 50.7 6. Unintentional injuries 31.9 4.3 7. Low physical activity 43.9 7. Neurological disorders 30.6 4.2 Others 22.1 1. High systolic blood pressure 172.6 1. Cardiovascular diseases 267.5 40.4 All age 2. Dietary risks 155.8 2. Neoplasms 106.8 16.1 3. High body-mass index 138.8 3. Diabetes 106.5 16.1 4. High fasting plasma glucose 112.2 4. Diarrheal/LRI/other 34.2 5.2 5. Low glomerular filtration rate 50.0 5. Neurological disorders 26.6 4.0 6. Low physical activity 49.4 6. Neonatal disorders 16.6 2.5 7. High total cholesterol 34.3 7. Unintentional injuries 14.7 2.2 Others 13.4 230

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) 89 63 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 $10,488.00 Per capita GDP-PPP outlay on healthcare $898.00 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 485 221 265 36.1% 31.7% 40.8% 2. Neoplasms 237 134 104 17.7% 19.2% 16.0% 3. Diabetes 214 94 120 15.9% 13.5% 18.4% 4. Neurological disorders 76 41 35 5.7% 5.9% 5.4% 5. Diarrheal/LRI/Other 75 38 38 5.6% 5.5% 5.9% 6. Chronic respiratory diseases 7. Self-harm & intersonal violence 50 36 15 3.7% 5.2% 2.3% 40 33 7 3.0% 4.7% 1.1% 8. Unintentional Injuries 38 24 14 2.8% 3.4% 2.2% 9. Digestive diseases 27 15 13 2.0% 2.1% 2.0% 10. HIV/AIDS 26 18 8 1.9% 2.6% 1.2% 11. Transport injuries 25 18 6 1.9% 2.6% 1.0% 12. Other non-communicable diseases 24 11 13 1.8% 1.6% 2.0% 13. Neonatal disorders 25 14 11 1.9% 2.0% 1.7% TOTAL 1,342 697 649 100.0% 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 2015. 89 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 30,391 32,545 7.09% Years lived with disability (YLD) 5,519 8,707 57.76% Years of life lost (YLL) 24,872 23,838-4.16% 1088 1,286 18.20% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 16,970 18,878 11.24% Years lived with disability (YLD) 2,911 4,446 52.73% Years of life lost (YLL) 14,059 14,432 2.65% 559 646 15.56% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 13,421 13,667 1.83% Years lived with disability (YLD) 2,608 4,261 63.38% Years of life lost (YLL) 10,813 9,406-13.01% 529 640 20.98% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 32,545 100% 8,707 100% 23,838 100% 1,286 100% 18,878 58.01% 4,446 51.06% 14,432 60.54% 646 50.23% 13,667 41.99% 4,261 48.94% 9,406 39.46% 640 49.77% 232

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 46.6 1. Neonatal disorders 175.5 48.1 2. Unsafe water, sanitation and handwashing 16.4 2. Other non-communicable diseases 3. Air pollution 4.0 3. Diarrheal/LRI/other 53.3 14.7 4. Smoking 2.6 4. Unintentional injuries 17.3 4.8 5. Low glomerular filtration rate 1.8 5. Nutritional deficiencies 13.0 3.6 6. Alcohol and drug use 1.2 6. Diabetes 8.3 2.3 69.2 19.0 7. High fasting plasma glucose 0.8 7. Cardiovascular diseases 6.1 1.7 Others 5.9 Children under 5 years 1. Child and maternal malnutrition 52.1 1. Neonatal disorders 198.4 48.8 2. Unsafe water, sanitation and handwashing 18.7 2. Other non-communicable diseases 3. Air pollution 4.4 3. Diarrheal/LRI/other 59.6 14.8 4. Smoking 2.7 4. Unintentional injuries 19.9 4.9 5. Low glomerular filtration rate 2.0 5. Nutritional deficiencies 14.6 3.6 6. Alcohol and drug use 1.4 6. Diabetes 7. High fasting plasma glucose 0.8 7. Cardiovascular diseases 6.2 1.5 73.5 9.1 18.2 2.3 Others 6.0 Children under 5 years 1. Child and maternal malnutrition 41.0 1. Neonatal disorders 151.9 47.2 2. Unsafe water, sanitation and handwashing 14.1 2. Other non-communicable diseases 3. Air pollution 3.6 3. Diarrheal/LRI/other 46.8 14.6 4. Smoking 2.5 4. Unintentional injuries 14.8 4.6 5. Low glomerular filtration rate 1.5 5. Nutritional deficiencies 11.4 3.5 64.8 20.2 6. Alcohol and drug use 1.0 6. Diabetes 7.5 2.3 7. High fasting plasma glucose 0.8 7. Cardiovascular diseases 6.1 1.9 Others 5.8 233

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.4 1. Unintentional injuries 2. Alcohol and drug use 1.0 2. Transport injuries 4.4 13.3 3. Low glomerular filtration rate 0.6 3. Diarrheal/LRI/other 4.3 13.1 4. High fasting plasma glucose 0.3 4. Neoplasms 4.3 13.0 5. Child and maternal malnutrition 0.3 5. Other non-communicable diseases 3.3 10.0 6. Air pollution 0.2 6. Self-harm & intersonal violence 2.4 7.4 5.1 15.4 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.3 7.1 Others 20.8 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Unintentional injuries 2. Alcohol and drug use 1.3 2. Transport injuries 5.7 14.9 3. Low glomerular filtration rate 0.7 3. Neoplasms 5.0 12.9 4. Air pollution 0.3 4. Diarrheal/LRI/other 4.7 12.2 5. Child and maternal malnutrition 0.2 5. Other non-communicable diseases 3.5 9.0 6.9 17.9 6. High fasting plasma glucose 0.2 6. Self-harm & intersonal violence 3.0 8.0 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.4 6.3 Others 19.0 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.2 1. Diarrheal/LRI/other 2. Alcohol and drug use 0.7 2. Neoplasms 3.6 13.2 3. Low glomerular filtration rate 0.6 3. Unintentional injuries 3.2 11.9 4. High fasting plasma glucose 0.3 4. Other non-communicable diseases 3.1 11.4 5. Child and maternal malnutrition 0.3 5. Transport injuries 3.0 11.0 3.9 14.4 6. Air pollution 0.2 6. Diabetes 2.2 8.2 7. High systolic blood pressure 0.2 7. Cardiovascular diseases 2.2 8.2 Others 21.7 234

Total population 15 to 49 years of age 1. Alcohol and drug use 26.8 1. Self-harm & intersonal violence 29.2 16.4 2. Dietary risks 23.8 2. Cardiovascular diseases 28.3 16.0 3. High body-mass index 22.1 3. Neoplasms 26.8 15.1 4. High systolic blood pressure 19.6 4. Diabetes 18.0 10.1 5. Unsafe sex 17.3 5. HIV/AIDS 17.1 9.8 6. High fasting plasma glucose 13.2 6. Unintentional injuries 12.5 7.0 7. Smoking 11.2 7. Transport injuries 12.4 7.0 Others 18.5 15 to 49 years of age 1. Alcohol and drug use 43.2 1. Self-harm & intersonal violence 49.7 21.0 2. Dietary risks 29.9 2. Cardiovascular diseases 35.7 15.1 3. High systolic blood pressure 26.0 3. Neoplasms 23.8 10.1 4. High body-mass index 23.4 4. HIV/AIDS 23.6 10.1 5. Unsafe sex 19.9 5. Unintentional injuries 21.3 9.0 6. Smoking 17.8 6. Transport injuries 20.6 8.7 7. High fasting plasma glucose 15.6 7. Diabetes 20.0 8.5 Others 17.6 15 to 49 years of age 1. High body-mass index 20.7 1. Neoplasms 29.6 24.8 2. Dietary risks 17.9 2. Cardiovascular diseases 21.2 17.7 3. Unsafe sex 14.9 3. Diabetes 15.9 13.3 4. High systolic blood pressure 13.4 4. HIV/AIDS 10.8 9.2 5. High fasting plasma glucose 11.0 5. Self-harm & intersonal violence 9.3 7.8 6. Alcohol and drug use 10.9 6. Transport injuries 4.5 3.8 7. Sexual abuse and violence 6.1 7. Diarrheal/LRI/other 4.4 3.7 Others 19.8 235

Total population 50 to 69 years of age 1. Dietary risks 317.0 1. Cardiovascular diseases 364.6 33.6 2. High body-mass index 283.8 2. Neoplasms 252.4 23.3 3. High systolic blood pressure 280.1 3. Diabetes 207.9 19.2 4. High fasting plasma glucose 217.4 4. Cirrhosis 33.7 3.1 5. Smoking 125.5 5. Chronic respiratory diseases 33.1 3.1 6. Low physical activity 84.5 6. Diarrheal/LRI/other 30.2 2.8 7. Alcohol and drug use 73.6 7. Self-harm & intersonal violence 24.7 2.3 Others 12.7 50 to 69 years of age 1. Dietary risks 372.8 1. Cardiovascular diseases 441.5 33.7 2. High systolic blood pressure 339.8 2. Neoplasms 281.0 21.5 3. High body-mass index 258.0 3. Diabetes 210.4 16.1 4. High fasting plasma glucose 226.1 4. Chronic respiratory diseases 49.9 3.8 5. Smoking 206.9 5. Cirrhosis 49.8 3.8 6. Alcohol and drug use 110.3 6. Self-harm & intersonal violence 41.9 3.2 7. Low physical activity 98.4 7. Diarrheal/LRI/other 39.7 3.0 Others 14.9 50 to 69 years of age 1. High body-mass index 308.3 1. Cardiovascular diseases 291.5 33.5 2. Dietary risks 264.0 2. Neoplasms 225.1 25.8 3. High systolic blood pressure 223.4 3. Diabetes 205.5 23.6 4. High fasting plasma glucose 209.2 4. Diarrheal/LRI/other 21.2 2.4 5. Low physical activity 71.3 5. Cirrhosis 18.4 2.1 6. Low glomerular filtration rate 57.7 6. Digestive diseases 17.3 2.0 7. High total cholesterol 56.1 7. Chronic respiratory diseases 17.1 2.0 Others 8.6 236

Total population 70 years of age and over 1. High systolic blood pressure 1,875.4 1. Cardiovascular diseases 3,140.6 41.4 2. Dietary risks 1,554.9 2. Neoplasms 1,208.8 15.9 3. High fasting plasma glucose 1,245.0 3. Diabetes 1,193.4 15.7 4. High body-mass index 1,021.5 4. Neurological disorders 602.4 7.9 5. Low glomerular filtration rate 565.7 5. Diarrheal/LRI/other 459.9 6.1 6. Low physical activity 554.3 6. Chronic respiratory diseases 329.6 4.3 7. Smoking 508.1 7. Digestive diseases 138.2 1.8 Others 6.8 70 years of age and over 1. High systolic blood pressure 1,720.8 1. Cardiovascular diseases 2,845.5 35.6 2. Dietary risks 1,554.6 2. Neoplasms 1,649.0 20.6 3. High fasting plasma glucose 1,082.4 3. Diabetes 1,079.1 13.5 4. Smoking 808.7 4. Neurological disorders 714.7 8.9 5. High body-mass index 754.8 5. Diarrheal/LRI/other 536.2 6.7 6. Low glomerular filtration rate 536.2 6. Chronic respiratory diseases 459.0 5.7 7. Low physical activity 514.3 7. Digestive diseases 140.2 1.8 Others 7.2 70 years of age and over 1. High systolic blood pressure 1,996.6 1. Cardiovascular diseases 3,372.2 46.4 2. Dietary risks 1,555.1 2. Diabetes 1,283.1 17.6 3. High fasting plasma glucose 1,372.5 3. Neoplasms 863.5 11.9 4. Smoking 1,230.7 4. Neurological disorders 514.3 7.1 5. High body-mass index 588.8 5. Diarrheal/LRI/other 460.5 6.3 6. Low glomerular filtration rate 585.6 6. Chronic respiratory diseases 167.5 2.3 7. Low physical activity 381.1 7. Unintentional injuries 136.6 1.9 Others 6.5 237

Total population 1. High systolic blood pressure 170.2 1. Cardiovascular diseases 266.2 34.7 All age 2. Dietary risks 159.0 2. Neoplasms 130.1 17.0 3. High body-mass index 120.3 3. Diabetes 117.1 15.3 4. High fasting plasma glucose 118.3 4. Neurological disorders 41.8 5.5 5. Smoking 57.6 5. Diarrheal/LRI/other 41.1 5.4 6. Low physical activity 50.5 6. Chronic respiratory diseases 27.7 3.6 7. Low glomerular filtration rate 49.6 7. Self-harm & intersonal violence 22.1 2.9 Others 15.7 1. High systolic blood pressure 162.8 1. Cardiovascular diseases 246.4 30.3 All age 2. Dietary risks 161.1 2. Neoplasms 149.3 18.4 3. High fasting plasma glucose 104.0 3. Diabetes 104.7 12.9 4. High body-mass index 95.6 4. Neurological disorders 45.7 5.6 5. Smoking 87.4 5. Diarrheal/LRI/other 41.6 5.1 6. Alcohol and drug use 55.9 6. Chronic respiratory diseases 40.1 4.9 7. Low physical activity 47.7 7. Self-harm & intersonal violence 36.8 4.5 Others 18.3 1. High systolic blood pressure 177.3 1. Cardiovascular diseases 285.2 39.6 All age 2. Dietary risks 157.0 2. Diabetes 129.0 17.9 3. High body-mass index 144.2 3. Neoplasms 111.6 15.4 4. High fasting plasma glucose 132.1 4. Diarrheal/LRI/other 40.7 5.7 5. Low physical activity 53.2 5. Neurological disorders 38.1 5.3 6. Low glomerular filtration rate 52.2 6. Chronic respiratory diseases 15.7 2.2 7. Air pollution 35.8 7. Unintentional injuries 14.7 2.0 Others 12.0 238

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) 91 60 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 $30,445.00 Per capita GDP-PPP outlay on healthcare $1,663.00 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 1,933 36.29% 34.30% 39.03% 2. Diabetes 2,371 1,270 1,101 20.13% 18.61% 22.23% 3. Neoplasms 1,811 1,020 791 15.38% 14.95% 15.97% 4. Diarrheal/LRI/Other 490 274 216 4.16% 4.01% 4.36% 5. Neurological disorders 457 236 221 3.88% 3.46% 4.46% 6. Self-harm & intersonal violence 7. Chronic respiratory diseases 451 385 66 3.83% 5.64% 1.34% 335 237 98 2.84% 3.47% 1.98% 8. Unintentional Injuries 322 219 103 2.73% 3.21% 2.08% 9. Digestive diseases 291 171 120 2.47% 2.50% 2.42% 10. Transport injuries 290 229 61 2.46% 3.36% 1.23% 11. HIV/AIDS 275 216 58 2.34% 3.16% 1.18% 12. Other non-communicable diseases 186 93 93 1.58% 1.36% 1.88% 13. Neonatal disorders 224 134 90 1.90% 1.96% 1.82% TOTAL 11,777 6825 4952 100.0% 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 2015. 91 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 274,493 352,981 28.59% Years lived with disability (YLD) 48,403 72,977 50.77% Years of life lost (YLL) 226,090 280,004 23.85% 9756 14,332 46.90% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 149,319 209,955 40.61% Years lived with disability (YLD) 25,939 38,259 47.50% Years of life lost (YLL) 123,380 171,696 39.16% 5,591 8,506 52.14% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 125,174 143,026 14.26% Years lived with disability (YLD) 22,464 34,718 54.55% Years of life lost (YLL) 102,710 108,308 5.45% 4,165 5,826 39.88% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 352,981 100% 72,977 100% 280,004 100% 14,332 100% 209,955 59.48% 38,259 52.43% 171,696 61.32% 8,506 59.35% 143,026 40.52% 34,718 47.57% 108,308 38.68% 5,826 40.65% 240

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 36.4 1. Neonatal disorders 229.0 52.0 2. Unsafe water, sanitation and handwashing 12.1 2. Other non-communicable diseases 3. Smoking 2.2 3. Diarrheal/LRI/other 49.4 11.1 4. Low glomerular filtration rate 1.9 4. Unintentional injuries 20.2 4.6 5. Air pollution 1.6 5. Diabetes 9.4 2.1 6. Unsafe sex 1.5 6. Nutritional deficiencies 8.2 1.8 94.9 21.4 7. Alcohol and drug use 1.1 7. Cardiovascular diseases 6.5 1.5 Others 5.6 Children under 5 years 1. Child and maternal malnutrition 37.4 1. Neonatal disorders 269.1 54.9 2. Unsafe water, sanitation and handwashing 12.8 2. Other non-communicable diseases 3. Smoking 2.0 3. Diarrheal/LRI/other 52.8 10.7 4. Low glomerular filtration rate 1.9 4. Unintentional injuries 21.5 4.4 5. Air pollution 1.7 5. Diabetes 9.5 1.9 6. Unsafe sex 1.5 6. Nutritional deficiencies 7. Alcohol and drug use 1.2 7. Cardiovascular diseases 6.2 1.3 97.9 8.5 19.8 1.7 Others 5.4 Children under 5 years 1. Child and maternal malnutrition 35.4 1. Neonatal disorders 187.6 48.3 2. Unsafe water, sanitation and handwashing 11.5 2. Other non-communicable diseases 3. Smoking 2.3 3. Diarrheal/LRI/other 46.0 11.7 4. Low glomerular filtration rate 1.8 4. Unintentional injuries 18.9 4.8 5. Air pollution 1.5 5. Diabetes 9.2 2.3 91.8 23.4 6. Unsafe sex 1.5 6. Nutritional deficiencies 8.0 2.0 7. Alcohol and drug use 1.0 7. Cardiovascular diseases 6.8 1.7 Others 5.8 241

Total population 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.3 1. Unintentional injuries 2. Alcohol and drug use 0.9 2. Transport injuries 5.0 15.0 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 4.4 13.3 4. High fasting plasma glucose 0.3 4. Neoplasms 3.7 11.0 5. Child and maternal malnutrition 0.3 5. Other non-communicable diseases 3.2 9.7 6. High systolic blood pressure 0.2 6. Self-harm & intersonal violence 2.5 7.5 5.3 16.0 7. Air pollution 0.1 7. Diabetes 2.5 7.4 Others 20.3 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.5 1. Unintentional injuries 2. Alcohol and drug use 1.1 2. Transport injuries 6.3 16.6 3. Low glomerular filtration rate 0.7 3. Diarrheal/LRI/other 4.8 12.6 4. High fasting plasma glucose 0.3 4. Neoplasms 4.1 10.8 5. Child and maternal malnutrition 0.2 5. Other non-communicable diseases 3.3 8.6 7.1 18.6 6. High systolic blood pressure 0.2 6. Self-harm & intersonal violence 3.0 7.8 7. Air pollution 0.1 7. Diabetes 2.5 6.5 Others 18.6 5 to 14 years of age 1. Unsafe water, sanitation and handwashing 1.2 1. Diarrheal/LRI/other 2. Low glomerular filtration rate 0.7 2. Transport injuries 3.7 12.8 3. Alcohol and drug use 0.6 3. Unintentional injuries 3.6 12.5 4. High fasting plasma glucose 0.4 4. Neoplasms 3.2 11.3 5. Child and maternal malnutrition 0.3 5. Other non-communicable diseases 3.2 11.2 4.1 14.2 6. High systolic blood pressure 0.2 6. Diabetes 2.4 8.6 7. Air pollution 0.1 7. Cardiovascular diseases 2.2 7.5 Others 22.0 242

Total population 15 to 49 years of age 1. High body-mass index 36.5 1. Self-harm & intersonal violence 46.2 18.7 2. Dietary risks 36.3 2. Cardiovascular diseases 38.7 15.7 3. Alcohol and drug use 32.4 3. Neoplasms 30.0 12.2 4. Unsafe sex 25.6 4. Diabetes 26.5 10.7 5. High systolic blood pressure 25.5 5. HIV/AIDS 25.5 10.4 6. High fasting plasma glucose 20.4 6. Transport injuries 21.5 8.7 7. Smoking 19.0 7. Unintentional injuries 15.6 6.3 Others 17.3 15 to 49 years of age 1. Alcohol and drug use 53.8 1. Self-harm & intersonal violence 80.4 23.2 2. Dietary risks 47.8 2. Cardiovascular diseases 51.5 14.9 3. High body-mass index 41.8 3. HIV/AIDS 39.1 11.4 4. High systolic blood pressure 37.2 4. Transport injuries 36.2 10.5 5. Unsafe sex 34.0 5. Diabetes 31.0 9.0 6. Smoking 31.2 6. Unintentional injuries 26.1 7.6 7. High fasting plasma glucose 25.5 7. Neoplasms 25.6 7.4 Others 16.1 15 to 49 years of age 1. High body-mass index 31.1 1. Neoplasms 34.4 23.2 2. Dietary risks 24.8 2. Cardiovascular diseases 25.8 17.4 3. Unsafe sex 17.2 3. Diabetes 22.0 14.8 4. High fasting plasma glucose 15.4 4. HIV/AIDS 12.0 8.2 5. High systolic blood pressure 13.8 5. Self-harm & intersonal violence 12.1 8.1 6. Alcohol and drug use 11.0 6. Transport injuries 6.9 4.6 7. Sexual abuse and violence 7.6 7. Diarrheal/LRI/other 5.4 3.7 Others 19.9 243

Total population 50 to 69 years of age 1. Dietary risks 533.0 1. Cardiovascular diseases 540.5 35.7 2. High body-mass index 490.9 2. Diabetes 371.9 24.6 3. High systolic blood pressure 398.3 3. Neoplasms 275.0 18.2 4. High fasting plasma glucose 391.6 4. Cirrhosis 39.3 2.6 5. Smoking 208.3 5. Diarrheal/LRI/other 37.4 2.5 6. High total cholesterol 154.6 6. Chronic respiratory diseases 37.2 2.5 7. Low physical activity 154.2 7. Digestive diseases 36.3 2.4 Others 11.7 50 to 69 years of age 1. Dietary risks 692.9 1. Cardiovascular diseases 717.2 36.5 2. High systolic blood pressure 547.3 2. Diabetes 444.5 22.6 3. High body-mass index 545.5 3. Neoplasms 307.2 15.6 4. High fasting plasma glucose 478.5 4. Cirrhosis 61.1 3.1 5. Smoking 367.6 5. Self-harm & intersonal violence 57.7 2.9 6. High total cholesterol 205.6 6. Chronic respiratory diseases 56.6 2.9 7. Low physical activity 203.1 7. Diarrheal/LRI/other 52.5 2.7 Others 13.6 50 to 69 years of age 1. High body-mass index 438.6 1. Cardiovascular diseases 371.3 34.3 2. Dietary risks 379.9 2. Diabetes 302.3 27.9 3. High fasting plasma glucose 308.4 3. Neoplasms 244.1 22.5 4. High systolic blood pressure 255.7 4. Digestive diseases 23.0 2.1 5. Low physical activity 107.3 5. Diarrheal/LRI/other 22.9 2.1 6. High total cholesterol 105.8 6. Chronic respiratory diseases 18.6 1.7 7. Low glomerular filtration rate 77.5 7. Cirrhosis 18.4 1.7 Others 7.7 244

Total population 70 years of age and over 1. High systolic blood pressure 1,979.6 1. Cardiovascular diseases 3,328.5 43.1 2. Dietary risks 1,952.5 2. Diabetes 1,519.5 19.7 3. High fasting plasma glucose 1,645.3 3. Neoplasms 1,100.7 14.2 4. High body-mass index 1,446.3 4. Neurological disorders 484.4 6.3 5. Low physical activity 719.1 5. Diarrheal/LRI/other 355.8 4.6 6. Low glomerular filtration rate 617.7 6. Chronic respiratory diseases 260.8 3.4 7. Smoking 535.1 7. Digestive diseases 193.9 2.5 Others 6.3 70 years of age and over 1. Dietary risks 2,444.3 1. Cardiovascular diseases 3,840.3 40.1 2. High systolic blood pressure 2,425.5 2. Diabetes 1,787.7 18.7 3. High fasting plasma glucose 1,922.6 3. Neoplasms 1,647.9 17.2 4. High body-mass index 1,460.0 4. Neurological disorders 570.1 6.0 5. Smoking 1,085.7 5. Chronic respiratory diseases 444.5 4.7 6. Low physical activity 867.2 6. Diarrheal/LRI/other 415.7 4.3 7. Low glomerular filtration rate 705.6 7. Digestive diseases 231.8 2.4 Others 6.6 70 years of age and over 1. High systolic blood pressure 1,669.3 1. Cardiovascular diseases 2,972.4 46.1 2. Dietary risks 1,610.3 2. Diabetes 1,332.9 20.7 3. High fasting plasma glucose 1,452.5 3. Neoplasms 720.0 11.2 4. High body-mass index 1,436.8 4. Neurological disorders 424.7 6.6 5. Low physical activity 616.1 5. Diarrheal/LRI/other 314.1 4.9 6. Low glomerular filtration rate 556.5 6. Digestive diseases 167.5 2.6 7. High total cholesterol 474.1 7. Chronic respiratory diseases 133.0 2.1 Others 5.9 245

Total population 1. Dietary risks 238.3 1. Cardiovascular diseases 318.4 35.0 All age 2. High systolic blood pressure 206.2 2. Diabetes 176.6 19.4 3. High body-mass index 201.5 3. Neoplasms 134.9 14.8 4. High fasting plasma glucose 183.6 4. Diarrheal/LRI/other 36.5 4.0 5. Smoking 83.2 5. Neurological disorders 34.0 3.7 6. Low physical activity 76.6 6. Self-harm & intersonal violence 33.6 3.7 7. High total cholesterol 66.8 7. Chronic respiratory diseases 24.9 2.7 Others 16.7 1. Dietary risks 280.4 1. Cardiovascular diseases 352.6 32.9 All age 2. High systolic blood pressure 244.1 2. Diabetes 191.3 17.9 3. High body-mass index 201.6 3. Neoplasms 153.7 14.4 4. High fasting plasma glucose 200.6 4. Self-harm & intersonal violence 58.0 5.4 5. Smoking 142.3 5. Diarrheal/LRI/other 41.3 3.9 6. Low physical activity 87.9 6. Chronic respiratory diseases 35.6 3.3 7. High total cholesterol 77.0 7. Neurological disorders 35.5 3.3 Others 19.0 1. High body-mass index 201.3 1. Cardiovascular diseases 284.9 37.8 All age 2. Dietary risks 197.0 2. Diabetes 162.2 21.5 3. High systolic blood pressure 169.1 3. Neoplasms 116.5 15.4 4. High fasting plasma glucose 167.0 4. Neurological disorders 32.6 4.3 5. Low physical activity 65.5 5. Diarrheal/LRI/other 31.8 4.2 6. High total cholesterol 56.8 6. Digestive diseases 17.7 2.4 7. Low glomerular filtration rate 56.5 7. Unintentional injuries 15.2 2.0 Others 12.3 246

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) 93 68 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 $19,961.00 Per capita GDP-PPP outlay on healthcare $1,715.00 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 5,916 32.56% 28.8% 36.40% 2. Neoplasms 8,680 4,897 3,783 26.45% 29.6% 23.28% 3. Neurological disorders 3,525 1,362 2,163 10.74% 8.2% 13.31% 4. Chronic respiratory diseases 2,226 1,404 822 6.78% 8.5% 5.06% 5. Diabetes 1,881 910 971 5.73% 5.5% 5.97% 6. Diarrheal/LRI/Other 1,778 787 991 5.42% 4.8% 6.10% 7. Unintentional Injuries 921 494 427 2.81% 3.0% 2.63% 8. Digestive diseases 884 386 498 2.69% 2.3% 3.06% 9. Self-harm & intersonal violence 681 552 129 2.08% 3.3% 0.80% 10. Transport injuries 601 438 163 1.83% 2.6% 1.00% 11. Other noncommunicable diseases 416 191 225 1.27% 1.2% 1.38% 12. Cirrhosis 537 371 165 1.64% 2.2% 1.02% TOTAL 32,813 16,560 16,253 100.0% 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 2015. 93 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

Years of healthy life lost, centage growth by sex Concept Disability adjusted life years (DALY) Total 1990 2010 Grow rate 2010-1990 713,025 703,915-1.28% Years lived with disability (YLD) 108,206 141,200 30.49% Years of life lost (YLL) 604,819 562,715-6.96% 31103 34,120 9.70% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 468,007 441,274-5.71% Years lived with disability (YLD) 62,905 75,323 19.74% Years of life lost (YLL) 405,102 365,951-9.66% 18,737 19,269 2.84% Concept Disability adjusted life years (DALY) 1990 2010 Grow rate 2010-1990 245,018 262,641 7.19% Years lived with disability (YLD) 45,301 65,877 45.42% Years of life lost (YLL) 199,717 196,764-1.48% 12,366 14,851 20.10% Years of healthy life lost, centage growth by sex CONCEPT DALY YLD YLL DEATHS 2010 % 2010 % 2010 % 2010 % Total 703,915 100% 141,200 100% 562,715 100% 34,120 100% 441,274 62.69% 75,323 53.34% 365,951 65.03% 19,269 56.47% 262,641 37.31% 65,877 46.66% 196,764 34.97% 14,851 43.53% 248

Mayor risk factors and causes of death by age group and sex, 2013 Total population Children under 5 years 1. Child and maternal malnutrition 23.1 1. Neonatal disorders 78.4 35.6 2. Unsafe water, sanitation and handwashing 3.7 2. Other non-communicable diseases 3. Unsafe sex 1.8 3. Diarrheal/LRI/other 30.1 13.8 4. Smoking 1.3 4. Unintentional injuries 16.9 7.8 5. Low glomerular filtration rate 0.6 5. Neoplasms 3.8 1.8 6. Air pollution 0.5 6. Nutritional deficiencies 3.8 1.7 70.1 32.1 7. Alcohol and drug use 0.5 7. Diabetes 3.7 1.7 Others 5.6 Children under 5 years 1. Child and maternal malnutrition 25.6 1. Neonatal disorders 89.2 36.6 2. Unsafe water, sanitation and handwashing 3.8 2. Other non-communicable diseases 3. Unsafe sex 1.8 3. Diarrheal/LRI/other 33.4 13.9 4. Smoking 1.5 4. Unintentional injuries 19.9 8.3 5. Low glomerular filtration rate 0.8 5. Neoplasms 4.5 1.9 6. Air pollution 0.5 6. Nutritional deficiencies 7. Alcohol and drug use 0.5 7. Diabetes 4.2 1.8 73.6 4.4 30.4 1.8 Others 5.5 Children under 5 years 1. Child and maternal malnutrition 20.4 1. Neonatal disorders 67.0 34.3 2. Unsafe water, sanitation and handwashing 3.5 2. Other non-communicable diseases 3. Unsafe sex 1.8 3. Diarrheal/LRI/other 26.6 13.8 4. Smoking 1.1 4. Unintentional injuries 13.8 7.2 5. Low glomerular filtration rate 0.5 5. Diabetes 3.2 1.6 66.5 34.2 6. Air pollution 0.4 6. Nutritional deficiencies 3.1 1.6 7. Alcohol and drug use 0.4 7. Neoplasms 3.1 1.6 Others 5.8 249

Total population 5 to 14 years of age 1. Alcohol and drug use 0.5 1. Neoplasms 4.0 20.1 2. Low glomerular filtration rate 0.2 2. Transport injuries 3.9 19.2 3. High fasting plasma glucose 0.1 3. Unintentional injuries 3.8 18.7 4. Unsafe water, sanitation and handwashing 0.1 4. Other non-communicable diseases 5. Unsafe sex 0.1 5. Diarrheal/LRI/other 1.6 8.0 6. Smoking 0.1 6. Self-harm & intersonal violence 1.1 5.7 2.0 10.1 7. High systolic blood pressure 0.1 7. Diabetes 0.8 4.0 Others 14.2 5 to 14 years of age 1. Alcohol and drug use 0.7 1. Unintentional injuries 2. Low glomerular filtration rate 0.2 2. Transport injuries 4.9 20.9 3. High fasting plasma glucose 0.1 3. Neoplasms 4.7 19.9 4. Unsafe water, sanitation and handwashing 0.1 4. Other non-communicable diseases 5. Unsafe sex 0.1 5. Diarrheal/LRI/other 1.6 6.7 5.2 2.0 22.1 8.6 6. Sexual abuse and violence 0.1 6. Self-harm & intersonal violence 1.5 6.2 7. High systolic blood pressure 0.1 7. Neurological disorders 0.9 3.9 Others 11.8 5 to 14 years of age 1. Alcohol and drug use 0.4 1. Neoplasms 3.4 20.4 2. Low glomerular filtration rate 0.2 2. Transport injuries 2.8 16.8 3. High fasting plasma glucose 0.1 3. Unintentional injuries 2.3 13.7 4. Unsafe water, sanitation and handwashing 0.1 4. Other non-communicable diseases 5. Unsafe sex 0.1 5. Diarrheal/LRI/other 1.6 9.8 2.1 12.3 6. Smoking 0.1 6. Self-harm & intersonal violence 0.8 5.0 7. High systolic blood pressure 0.1 7. Diabetes 0.8 4.9 Others 17.2 250

Total population 15 to 49 years of age 1. Alcohol and drug use 22.0 1. Neoplasms 33.6 25.0 2. Smoking 15.3 2. Self-harm & intersonal violence 21.0 15.6 3. Dietary risks 13.8 3. Cardiovascular diseases 17.4 12.9 4. High body-mass index 12.9 4. Transport injuries 16.3 12.1 5. High systolic blood pressure 10.8 5. Unintentional injuries 11.8 8.8 6. Unsafe sex 7.0 6. HIV/AIDS 6.6 4.9 7. High total cholesterol 4.9 7. Diabetes 4.7 3.5 Others 17.2 15 to 49 years of age 1. Alcohol and drug use 36.9 1. Self-harm & intersonal violence 34.6 19.2 2. Smoking 21.8 2. Neoplasms 33.1 18.3 3. High body-mass index 18.2 3. Transport injuries 26.3 14.6 4. High body-mass index 16.0 4. Cardiovascular diseases 22.6 12.5 5. High systolic blood pressure 15.1 5. Unintentional injuries 18.4 10.2 6. High total cholesterol 7.3 6. HIV/AIDS 10.2 5.6 7. Unsafe sex 6.8 7. Mental and substance use disorders 8.5 4.7 Others 15.1 15 to 49 years of age 1. High body-mass index 9.8 1. Neoplasms 34.1 38.8 2. Dietary risks 9.4 2. Cardiovascular diseases 12.2 13.9 3. Smoking 8.8 3. Self-harm & intersonal violence 7.4 8.4 4. Unsafe sex 7.3 4. Transport injuries 6.1 7.0 5. Alcohol and drug use 6.9 5. Unintentional injuries 5.2 5.9 6. High systolic blood pressure 6.5 6. Diabetes 4.0 4.6 7. Sexual abuse and violence 3.2 7. Diarrheal/LRI/other 3.1 3.5 Others 18.0 251

Total population 50 to 69 years of age 1. Smoking 284.4 1. Neoplasms 437.1 41.5 2. Dietary risks 226.6 2. Cardiovascular diseases 287.4 27.3 3. High systolic blood pressure 205.6 3. Chronic respiratory diseases 59.3 5.6 4. High body-mass index 186.2 4. Diabetes 54.9 5.2 5. Alcohol and drug use 78.3 5. Cirrhosis 33.0 3.1 6. High fasting plasma glucose 61.4 6. Diarrheal/LRI/other 31.9 3.0 7. High total cholesterol 60.8 7. Self-harm & intersonal violence 28.8 2.7 Others 11.6 50 to 69 years of age 1. Smoking 500.2 1. Neoplasms 586.3 39.3 2. Dietary risks 341.3 2. Cardiovascular diseases 419.2 28.1 3. High systolic blood pressure 306.4 3. Chronic respiratory diseases 95.4 6.4 4. High body-mass index 243.4 4. Diabetes 69.5 4.7 5. Alcohol and drug use 128.7 5. Cirrhosis 57.7 3.9 6. High total cholesterol 92.2 6. Self-harm & intersonal violence 49.6 3.3 7. High fasting plasma glucose 83.3 7. Diarrheal/LRI/other 43.5 2.9 Others 11.4 50 to 69 years of age 1. High body-mass index 135.9 1. Neoplasms 305.9 45.7 2. Dietary risks 125.8 2. Cardiovascular diseases 171.4 25.6 3. High systolic blood pressure 117.1 3. Diabetes 42.1 6.3 4. Smoking 94.7 4. Chronic respiratory diseases 27.6 4.1 5. High fasting plasma glucose 42.1 5. Diarrheal/LRI/other 21.6 3.2 6. Alcohol and drug use 33.9 6. Neurological diseases 21.2 3.2 7. Low physical activity 33.5 7. Digestive diseases 18.3 2.7 Others 9.2 252

Total population 70 years of age and over 1. High systolic blood pressure 1,373.1 1. Cardiovascular diseases 2,455.7 35.7 2. Dietary risks 1,203.7 2. Neoplasms 1,495.3 21.7 3. Smoking 774.0 3. Neurological disorders 962.1 14.0 4. High body-mass index 684.8 4. Chronic respiratory diseases 514.2 7.5 5. High fasting plasma glucose 387.2 5. Diabetes 412.5 6.0 6. Low physical activity 350.5 6. Diarrheal/LRI/other 411.0 6.0 7. Low glomerular filtration rate 328.9 7. Digestive diseases 198.6 2.9 Others 6.4 70 years of age and over 1. High systolic blood pressure 1,544.8 1. Cardiovascular diseases 2,559.0 31.0 2. Smoking 1,527.6 2. Neoplasms 2,167.0 26.2 3. Dietary risks 1,439.4 3. Neurological disorders 974.2 11.8 4. High body-mass index 729.0 4. Chronic respiratory diseases 842.2 10.2 5. High fasting plasma glucose 412.9 5. Diabetes 502.6 6.1 6. Low physical activity 388.4 6. Diarrheal/LRI/other 442.4 5.4 7. Low glomerular filtration rate 372.2 7. Digestive diseases 210.9 2.6 Others 6.8 70 years of age and over 1. High systolic blood pressure 1,272.5 1. Cardiovascular diseases 2,395.2 39.4 2. Dietary risks 1,065.7 2. Neoplasms 1,101.9 18.1 3. High body-mass index 658.9 3. Neurological disorders 955.0 15.7 4. High fasting plasma glucose 372.2 4. Diarrheal/LRI/other 392.6 6.5 5. Smoking 332.7 5. Diabetes 359.7 5.9 6. Low physical activity 328.3 6. Chronic respiratory diseases 322.2 5.3 7. Low glomerular filtration rate 303.5 7. Digestive diseases 191.5 3.2 Others 6.0 253

Total population 1. High systolic blood pressure 184.5 1. Cardiovascular diseases 313.3 31.7 All age 2. Dietary risks 173.0 2. Neoplasms 254.5 25.8 3. Smoking 141.9 3. Neurological disorders 103.4 10.5 4. High body-mass index 112.2 4. Chronic respiratory diseases 65.3 6.6 5. High fasting plasma glucose 52.8 5. Diabetes 55.2 5.6 6. Low physical activity 47.1 6. Diarrheal/LRI/other 52.1 5.3 7. Alcohol and drug use 46.5 7. Unintentional injuries 27.0 2.7 Others 11.8 1. Smoking 224.8 1. Neoplasms 297.2 28.7 All age 2. Dietary risks 185.6 2. Cardiovascular diseases 289.3 27.9 3. High systolic blood pressure 185.5 3. Chronic respiratory diseases 85.2 8.2 4. High body-mass index 111.0 4. Neurological disorders 82.7 8.0 5. Alcohol and drug use 68.4 5. Diabetes 55.2 5.3 6. High fasting plasma glucose 49.9 6. Diarrheal/LRI/other 47.8 4.6 7. Low physical activity 45.7 7. Self-harm & intersonal violence 33.5 3.2 Others 14.0 1. High systolic blood pressure 183.6 1. Cardiovascular diseases 335.7 35.6 All age 2. Dietary risks 161.2 2. Neoplasms 214.6 22.8 3. High body-mass index 113.4 3. Neurological disorders 122.7 13.0 4. Smoking 64.5 4. Diarrheal/LRI/other 56.2 6.0 5. High fasting plasma glucose 55.5 5. Diabetes 55.1 5.8 6. Low physical activity 48.4 6. Chronic respiratory diseases 46.6 5.0 7. High total cholesterol 42.9 7. Digestive diseases 28.2 3.0 Others 8.8 254

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