HEALTH
CONDITIONS
1965- 1968
fifW m
1 CJ £ [ ^ 1 => 5? I
A
P A N A M ER I C A N H EA LT H O R G A N I Z A T I O N
Pan A m e rica n Sa n it a r y Bu re au - Re g io n a l O f f ice o f t h e
IN THE AM ERICAS 1 9 6 5 - 1 9 6 8
P REP A RED FO R
T
H E X V I I I P A N A M ER IC A N S A N I T A R Y C O N FER EN C E
S c i e n t i f i c P u b l i c a t i o n N o . 2 0 7
P A N A M E R I C A N H E A L T H O R G A N I Z A T I O N
P a n A m e r i c a n S a n i t a r y B u r e a u - R e g i o n a l O f f i c e o f t h e
W O R L D H E A L T H O R G A N I Z A T I O N
5 2 5 Tw e n t y - Th i r d St r eet , N . W .
T w en ty y ears have elapsed since th e P an A m erican S an itary B ureau in itia te d , at th e m an d ate o f th e G overning B odies, th e co llectio n and analysis o f d ata fro m th e G overnm ents w hich have p e rm itte d th e p u b lic a tio n o f H e a l t h C o n d i t i o n s i n t h e A m e r i c a s . T his series is to d a y m ore th a n a p ro file fo r th e c o n te n t acq u ired over th e p erio d is sufficient to u n d e rsta n d an d in te rp re t th e evolution o f c ertain h e a lth p ro b lem s, th e d istrib u tio n and use o f resources to solve th e m , th e m o d ificatio n o f p rio rities as a result o f advances or recessions; in su m m ary , a tru e sequence enabling co m parative analyses o f th e co u n tries.
T his re p o rt is th e fifth o f th e series in itia te d in 195 4 an d covers th e years 1 9 6 5 -1 9 6 8 . All d ep ict stages in th e n a tu ra l h isto ry o f h e a lth an d disease in th e C o n tin e n t. T he language th a t describes it is derived from th e in te rp re ta tio n o f th e d a ta an d , above all, o f the actio n s w hich, based o n reco rd ed ex p erien ce, c o n trib u te to th e re d u c tio n o f th e im p act o f m o rb id ity an d m o rta lity . It has b een well said th a t h isto ry is n o t th e sim ple n a rra tio n o f th e events w hich have ta k e n place b u t the stu d y o f h u m an re a lity , th a t is th e reflectio n o f th e life o f th o se w ho c o n stru c t it and w ho advance and tran sfo rm it.
T h ere w o u ld be n o p u rp o se in co n tin u in g w ith these perio d ic p u b licatio n s if th e y w ere n o t o f value in fo rm u latin g an d execu tin g plans, program s and p ro je c ts in accordance w ith th e characteristics o f each c o u n try , th e tren d s o f d ev elo p m en t, th e p rio rities estab lish ed , th e availability o f reso u rces—h u m an , m aterial and fin an cial—and th e resulting ev o lu tio n . V ital and h e a lth statistics o f o u r tim es are conceived as d y n am ic in stru m e n ts, fo r reference an d ap p licatio n , to be c o n sta n tly im proved. D espite progress, m u c h rem ains to b e done to p e rfe c t th e ir q u ality and accuracy a n d to analyze and p u b lish th em c u rre n tly . F o r th is reason th e greatest significance is given to th is fu n c tio n , one o f th e pillars o f th e in fra stru c tu re w h ich is indispensable in o rd er to b e n e fit th o se w ho m o st n eed it. It is evident th a t the societies o f th e C o n tin e n t w ill have, to a variable degree, a d isequilibrium b etw een w h at th e y require to achieve th eir asp iratio n s and w h at is available. W henever p rio rities m u st be established a n d resources d istrib u te d in acco rd an ce w ith th em , know ledge o f th e reality is inescapable, w ith in fo rm a tio n carefully co llected and as specific as th e ch aracteristics o f each p ro b lem dem and.
F OREWORD. . . . . . . . . i i i
I NT RODUCT I ON. . . . . . x x i
CHAPTER I . POPUL ATI ON . . . 1
CHAPTER I I . VI TAL STATI STI CS . . . 9
Bi r t hs . . . 9
Li f e Ex p e c t a n c y . . . 13
D e a t h s . . . 14
Chi l d Mo r t a l i t y . . . 25
CHAPTER I I I . COMMUNI CABLE DI SEASES. . . 104
Ch a g a s ’ Di s e a s e . . . 104
D e n g u e . . . 105
Di p h t h e r i a . . . 106
Enc ephal i t i s , v i r a l . . . 107
I nf ec t i ous Hep a t i t i s . . . 108
L e p r o s y . . . 109
Ma l a r i a . . . 110
Meas l es . . . I l l P l a g u e . . . 112
Pol i omy el i t i s . . . 113
R a b i e s . . . 114
Sc hi s t os omi as i s . . . 115
Smal l pox . . . . . . 116
S y p h i l i s . . . 1. 18 T e t a n u s . . . 120
Tuber c u l os i s . . . 120
Ty phoi d Fev er . . . . . . 122
Ty phus , L o u s e - b o r n e . . . 122
Whoopi ng Cough . . . 123
Y a w s . . . 124
Yel l ow Fev er . . . . . . 124
Z o o n o s e s . . . 126
CHAPTER I V. HEALTH SERVI CES . . . 138
Heal t h Ex pendi t ur es . . . 138
Pr ov i s i on of He a l t h Ser v i c es . . . 140
Di agnos i s of Cl i ni c Pat i ent s . . . 145
Page
CHAPTER V. HOSPI TAL SERVI CES . . . 148
Hos pi t al Fac i l i t i es . . . . . . 148
Ut i l i z at i o n of Ho s p i t al s . . . 153
Mor b i di t y . . . 155
CHAPTER VI . ENVI RONMENTAL HEAL TH . . . 162
CHAPTER VI I . HEALTH MANP OWE R. . . 167
P h y s i c i a n s . . . 168
N u r s e s . . . 171
D e n t i s t s . . . 173
Ot her Heal t h P e r s o n n e l . . . 173
1 Po pu l at i o n b y Re g i o n of t he Amer i c a s f r om 1930 t o 1960 and
Es t i mat e d Popul at i o n 1970 t o 2000 . . . 2
2
Urban and Rural Population in Twenty Latin American
Count r i es , 1960 t o 1980 .
.
. . . 33 Per c ent age Di s t r i b ut i o n of Po pu l a t i o n by Br oad Age Gr oups ,
i n t he Amer i c as , 1968 . . . 4
4 Tot al and Per Capi t a Gr os s Domes t i c Pr oduc t at Fac t o r Cos t
by Count r y , 1968 . . . 6
5 Number of St udent s At t en di n g Pr i mar y or Sec ondar y Sc hool s
and Rat i os t o Popul at i o n 5-14 y ear s , b y Count r y , 1967 . . . 6
6 Numb er of Li v e Bi r t hs and Fer t i l i t y Rat es per 1, 000 Women
15 - 44 Year s of Age, by Count r y , 1965- 1968 . . . 11
7 Li f e Ex pec t anc y at Bi r t h, by Count r y , Ar ou nd 1950, 1960 and 1968 . 13
8 Cr ude and Age Adj us t ed De at h Rat es per 1, 000 Popul at i on,
by C o u n t r y . . . 15
9 Fi v e Pr i nc i pal Caus es of Deat h by Rank Or der i n
22 Count r i es , 1967 . . . 17
10 Nu mb e r and Per Cent of Dea t h s f r om I nf ec t i v e and Par as i t i c Di s eas es
and Gas t r i t i s , Ent er i t i s , et c . wi t h Rat es per 100, 000 Po p ul at i on
b y Count r y , 1964 and 1968 . . . 20
11 Number and Per c ent age of Deat hs Under 5 Year s of Age,
by C o u n t r y . . . 25
12 Ac hi ev ement s i n Reduc i ng De a t h Rat es under 5 Year s of Age i n
Rel at i on t o Goal s of t he Char t er of Pun t a del Es t e, 1968 . . . . 27
13 Neonat al and Pos t n eonat al Mor t a l i t y and Per c ent age of Tot al I nf ant
Mor t a l i t y by Count r y , Ar ound 1967 . . . 28
Table
Page
14 Ag e Spec i f i c De a t h Rat es Un d e r 5 Year s of Age pe r 1, 000 Popul at i o n
wi t h Rat i os t o Rat es i n t he Uni t ed St at es , 1967 . . . 28
15 Caus es of De at h Rank ed as t he Fi r s t Fi v e f or Chi l d r e n Un d e r One
Year of Age and 1 - 4 Year s of Age i n 24 Count r i es , 1967 . . . . 30
16 Deat hs f r om Av i t ami nos i s and Ot her Nu t r i t i o n a l Def i c i enc y
St at es per 100, 000 Po p u l a t i o n Amo n g Chi l d r e n under One Ye a r
and 1- 4 Year s of Ag e i n Ei g ht Count r i es , 1961- 1963 and 1967 . . , 131
17 Number of Repor t ed Cas es of Amer i c a n Tr y panos omi as i s , by Count r y , 1965- 1968 . . . 105
18 Number of Repor t ed Cas es of Dengue by Count r y , 1963- 1969 . . . 106
19 Number of Per s ons I mmuni z ed agai ns t Di pht her i a, b y Count r y , 1965- 1968 . . . 107
20 Repor t ed Cas es of Vi r a l Enc ephal i t i s b y Count r y , 1960- 1969 . . . . 107
21 Number of Repor t ed Cas es of Lepr os y wi t h Rat es per 100, 000 Popul at i on, by Count r y , 1965- 1968 . . . 110
22 Repor t ed Cas es of Pl ague, b y Count r y , 1940- 1969 . . . 113
23 Per s ons I mmuni z ed wi t h At t enuat ed Li v e Pol i ov i r us Vac c i ne, b y Count r y , 1965- 1968 . . . 114
24 Number of Repor t ed Cas es and Deat hs f r om Rabi es b y Count r y , 1965- 1968 . . . 115
25 Repor t ed Cas es of Sc hi s t os omi as i s b y Count r y , 1959- 1968 . . . 116
26 Repor t ed Cas es of Smal l pox b y Count r y , 1960- 1969 . . . 117
27 Smal l pox Vac c i nat i ons i n t he Amer i c as , 1966- 1968 . . . 118
28 Repor t ed Cas es of Ear l y Sy phi l i s wi t h Rat es per 100, 000 Popul at i o n b y Count r y , 1960- 1968 . . . 119
29 Number of Per s ons Vac c i na t e d agai ns t Tuber c ul os i s ( BCG) , by Count r y , 1965- 1968 . . . 122
30 Repor t ed Cas es of Lo u s e - bor ne Ty phus , b y Count r y , 1960- 1969 . . . . 122
31 Deat hs f r om Whoo p i n g Cough b y Age Gr oups under One Year , and 1- 4 Year s wi t h Rat es per 100, 000 Popul at i on, 1968 . . . 124
32 Repor t ed Cas es of Yaws by Count r y , 1965- 1968 . . . 124
33 Repor t ed Cas es of J ungl e Ye l l o w Fev er , by Count r y , 1960- 1969 . . . 124
34 Number of Vac c i nat i ons agai ns t Ye l l o w Fev er , b y Count r y , 1964- 1968 125
35 Nu mb e r of Re por t ed Cas es and Deat hs f r om An t h r a x and Br uc el l os i s ,
b y Count r y , 1965- 1968 . . . 126
36 Nu mb er of Re po r t ed Cas es and Deat hs f r om Hy dat i dos i s and
Lept os pi r os i s , by Count r y , 1965- 1968 . . . . . . . 127
37 He al t h Es t abl i s h me n t s wi t h Out pat i ent Ser v i c es , b y Count r y , 1968 . 140
38 Nu mb er of Per s ons At t en di n g He a l t h Es t abl i s hment s , To t a l Vi s i t s
and Rat i os per 100 Po pu l at i o n b y Count r y , 1968 . . . 141
39 Ma t e r n a l Hea l t h Cent er s and Ser v i c es b y Count r y , Ar ound 1968 . . . 142
40 Chi l d Heal t h Cent er s andSer v i c es by Count r y , Ar o u nd 1968 . . . 143
41 De n t a l He al t h Cl i ni c s andSer v i c es , Ar ound 1964 and 1968 . . . 144
42 Nu mb e r of Me n t a l Cl i ni c s and Re h a b i l i t at i on Cent er s , Ar ound 1964
and 1968 . . . 144
43 Nu mb e r of Pu bl i c He al t h Labor at or i es and Ex ami nat i ons , Ar ound 1964
and 1968 . . . 144
44 Nu mb er of Pat i ent s At t e n di n g Out pat i ent Cl i ni c s by Di agnos i s wi t h
Rat i os per 1, 000 Pop ul a t i o n i n Fi v e Count r i es , 1968 . . . 145
45 Nu mb er of Ho s p i t al s and Beds wi t h Rat i os per 1, 000 Pop ul a t i o n i n
t he Thr ee Regi ons of t he Amer i c as , 1964 and 1968 . . . 148
46 Ho s p i t a l Beds wi t h Ra t i os per 1, 000 Popul at i o n i n Capi t al s and Lar ge
Ci t i es and t he Remai nder of Fi f t een Count r i es Ar ound 1968 . . . . 150
47 Nu mb e r and Per c en t a ge of Ho s p i t al s and Beds of Gov er nment Owner s hi p
by Count r y , 1968 . . . 151
48 Numbe r and Per c ent ag e Di s t r i bu t i o n of Hos pi t al s and Beds by
Hos pi t al Si z e, by Count r y , Ar ound 1968 . . . . . . . 152
49 Di s c har ges f r om Gener al Ho s p i t al s and Pat i ent Day s wi t h Rat i os
per 100 Pop ul a t i o n f or 15 Count r i es , 1968 . . . 153
50 I ndi c es of Ut i l i z a t i o n of Shor t St ay Hos pi t al s i n t he Amer i c as . . 154
51 Ho s p i t a l Di s c ha r ge s by Gr oups of Ma t e r na l Caus es wi t h Rat es per
1, 000 Pop u l a t i o n i n Si x Count r i es of t he A me r i c a s . . . 156
52 Ho s p i t a l Di s c ha r ge s by Sel ec t ed Gr oups of I nf ec t i ous I nt es t i nal
Di s eas es wi t h Rat es per 1, 000 Po pu l at i o n i n Si x Count r i es of
t he Amer i c as . . . 156
53 Ho s p i t a l Di s c har ges b y Nu t r i t i o n a l Def i c i enc i es and An e mi a wi t h
Rat es per 100, 000 Popul at i on, i n Si x Count r i es of t he Amer i c as . . 156
54 Hos p i t a l Di s c har ges b y Tuber c ul os i s and Ma l a r i a wi t h Rat es per
100, 000 Popul at i on, i n Si x Count r i es of t he A me r i c a s . . . 1 5 6
55 Ho s p i t a l Di s c har ges and Pa t i e n t Day s by Br oa d Gr oups of Di s eas es
i n Si x Co u n t r i e s . . . 1 5 7
56 Ur ban and Ru r a l Po p ul at i o n Ser v ed b y Pi p e d Wa t e r and Sewer age
Sy s t ems i n L a t i n Amer i c a, 1969 . . . 163
57 Numb er of Phy s i c i ans wi t h Rat i os per 10, 000 Po p u l a t i on i n Thr ee
Regi ons of t he Amer i c as , 1957, 1960, 1964 and 1968 . . . 168
58 Number of Phy s i c i ans and Rat i os per 10, 000 Popul at i o n i n Capi t al s
and Lar ge Ci t i es and i n Res t of Count r y , Ar o u n d 1968 . . . 169
59 Di s t r i b u t i on of Phy s i c i ans b y Spec i al t y , b y Count r y . . . 170
60 Number of Me d i c a l Sc hool s i n 1969 and Admi s s i ons and Gr aduat es
i n 1968, b y C o u n t r y . . . 171
61 Number of Gr aduat e Nur s es and Nur s i n g Aux i l i ar i es wi t h Rat i os
per 10, 000 Po pu l a t i o n i n Th r e e Regi ons of t he Amer i c as ,
1964 and 1968 . . . 172
62 Number of Dent i s t s wi t h Rat i os per 10, 000 Po p u l a t i o n i n Thr ee
Regi ons of t he Amer i c as , 1957, 1960, 1964 and 1968 . . . 173
I Cens us es i n t he Amer i c as wi t h Es t i mat ed Popul at i ons and
Gr owt h Rat es f r om 1963- 1968 . . . 7
I I Mi dy ear Popul at i on Es t i mat es f or Count r i es i n t he Amer i c as . . 8
I I I Numbe r of Li v e Bi r t hs wi t h Rat es p e r 1, 000 Popul at i on,
by C o u n t r y . . . •. . . 32
I V Number of Deat hs wi t h Rat es per 1, 000 Popul at i on,
b y Count r y , 1960 and 1965- 1968 . . . 33
V Number of Deat hs f r om Spec i f i c Caus es wi t h Rat es
per 100, 000 Pop ul a t i o n . . . 34
VI - A. Number of Deat hs f r om Spec i f i c Caus es Cl as s i f i ed b y t he Ei ght h
Rev i s i on of t he I n t e r n at i o n al Cl as s i f i c a t i o n of Di s eas es ,
by Count r y , 1968 . . . 60
B. Deat h Rat e per 100, 000 Popul at i o n f r om Spec i f i c Caus es Cl as s i f i ed by t he Ei ght h Rev i s i on of t he I nt er nat i onal Cl as s i f i c at i on of
Di s eas es , by Count r y , 1968 . . . 62
VI I - A. Nu mb er of Deat hs b y Age and Sex, b y Co u n t r y . . . 64
B. Deat h Rat es per 1, 000 Po pu l at i o n b y Age and Sex , wi t h Cr ude
and Age Adj u s t ed Rat es , b y C o u n t r y . . . 65
VI I I Fi r s t Fi v e Pr i nc i p a l Caus es of Deat h wi t h Rat es per 100, 000
Popul at i on, b y Count r y , Rec ent Year s . . . 94
I X Numbe r of Ma t e r na l Deat hs wi t h Rat es pe r 10, 000 Li v e Bi r t hs ,
b y Count r y , 1960 and 1965- 1968 . . . 97
X Nu mber of I nf ant Deat hs wi t h Rat es per 1, 000 Li v e Bi r t hs , b y
Count r y , 1960 and 1965- 1968 . . . 98
XI Number of Deat hs 1- 4 Year s of Age wi t h Rat es per 1, 000 Popul at i on,
by Count r y , 1960 and 1965- 1968 . . . 99
XI I Fi r s t Fi v e Pr i nc i pl e Caus es of Deat h Amo ng Chi l d r en under 5 Year s
of Age, under One Ye a r of Age, and 1- 4 Year s wi t h Rat es per
100, 000 Popul at i on, b y Count r y , Rec ent Year s . . . 100
XI I I Di pht he r i a - Number of Re por t ed Cas es and Deat hs wi t h Rat es
XI V I nf ec t i ous Hepat i t i s - Numb er of Repor t ed Cas es and Deat hs wi t h
Rates per
100, 000Population, by Country,
1965- 1968 . . . 129XV Ma l a r i a - Nu mb er of Repor t ed Cas es and Deat hs wi t h Rat es per
100. 000 Popul at i on, b y Count r y , 1965- 1968 . . . 130
XVI Meas l es - Nu mb e r of Repor t ed Cas es and Deat hs wi t h Rat es per
100. 000 Popul at i on, b y Count r y , 1965- 1968 . . . 131
XVI I Pol i omy el i t i s - Number of Repor t ed Cas es and Deat hs wi t h Rat es
per 100, 000 Popul at i on, b y Count r y , 1965- 1968 . . . 132
XVI I I
Syphilis - Number of Reported Cases and Deaths with Rates per
100. 000 Popul at i on, b y Count r y , 1965- 1968 . . . 133
XI X Tet anus - Nu mb e r of Repor t ed Cas es and Deat hs wi t h Rat es per
100. 000 Popul at i on, b y Count r y , 1965- 1968 . . . 134
XX Tuber c ul os i s - Number of Repor t ed Cas es and Deat hs wi t h Rat es
per 100, 000 Popul at i on, by Count r y , 1965- 1968 . . . 135
XXI
Typhoid Fever - Number of Reported Cases and Deaths with Rates
per 100, 000 Popul at i on, by Count r y , 1965- 1968 . . . 136
XXI I Who op i n g Cough - Number of Rep or t ed Cas es and Deat hs wi t h Rat es
per 100, 000 Popul at i on, by Count r y , 1965- 1968 . . . 137
XXI I I To t a l Gov er nment Ex pendi t ur e and Ex pendi t ur es f or Heal t h,
b y Count r y , Ar o un d 1968 . . . 147
XXI V To t a l and Per Capi t a Ex pendi t ur es f or Hea l t h i n Nat i on al Cur r enc y
and U.S. Dollars, Around
1964and
1968 . . . 147XXV Nu mb er of Hos pi t al s by Ty p e i n t he Amer i c as , by Count r y . . . . 158
XXVI Number of Hos p i t a l Beds b y Ty p e of Ho s p i t a l wi t h Rat es per
100. 000 Popul at i on, by Count r y . . . 159
XXVI I Nu mb er of Di s c har ges f r om Hos pi t al s wi t h Rat es p er 1, 000
Popul at i on, Pat i ent Day s and Av er age L e ng t h of St ay by
Di agnos i s i n Four Count r i es , 1967 . . . 160
XXVI I I Nu mbe r of Di s c har ges f r om Hos pi t al s wi t h Rat es per 1, 000
Popul at i on, Pa t i ent Day s and Av er age Le ng t h of St ay by
XXI X Nu mb e r and Per Cent of Po p ul at i on Ser v ed b y Pi pe d Wa t e r Suppl y
Sy s t ems i n L a t i n Amer i c a, 1969 . . . 165
XXX Numbe r and Per Cent of Po pu l at i o n Ser v ed b y Sewage Di s pos al
Sy s t ems i n L a t i n Amer i c a, 1969 . . . 166
XXXI Nu mbe r of Phy s i c i ans , Dent i s t s , Gr adu a t e Nur s es , and Nur s i ng
Aux i l i ar i es wi t h Rat i os per 10, 000 Popul at i on, b y Count r y . . 174
XXXI I Ot her He a l t h Pe r s o n n e l b y Count r y , 1968 . . . 175
1 Gr owt h of Pop u l a t i on i n No r t h e r n and L a t i n Amer i c a, 1930- 1960 and
Es t i mat ed Gr owt h, 1960- 2000 . . . 1
2 Per c ent age of La t i n Amer i c a n Popul at i on L i v i ng i n Ru r a l Ar eas ,
1950- 1980 . . . 2
3 Gr owt h of Ur ban and Rur al Popul at i ons i n L at i n Amer i c a . . . 2
4 Per c ent age Di s t r i bu t i o n of Pop u l a t i o n by Age Gr oups i n Th r e e Regi ons
of t he Amer i c as , 1968 . . . 3
5 Per c ent age of Popul at i on under 15 Year s and 65 Year s or Ol der b y
Regi on of t he Amer i c as , 1960, 1970 and 1980 . . . 4
6 Per c en t a g e Ec ono mi c a l l y Ac t i v e and Pe r c en t ag e Di s t r i b u t i o n of La b or
For c e b y Sec t or i n Four Regi ons of La t i n Amer i c a, 1960- 1980 . . . . 5
7 Per c ent age I nc r eas e i n Per Capi t a Gr os s Domes t i c Pr oduc t at Fac t or
Cos t i n Regi ons of t he Amer i c as , 1963- 1968 . . . 5
8 St udent s i n L a t i n Amer i c a At t endi ng Pr i mar y or Sec ondar y Sc hool s
i n Re l a t i on t o Po pu l at i o n i n Age Gr oup 5-14 Y e a r s . . . 5
9 Bi r t hs , Deat hs and Ex c es s of Bi r t hs ov er De a t h s per 1, 000 Popul a t i on i n Thr ee Regi ons of t he Amer i c as , 1959- 1968 . . . 9
10 Age Spec i f i c Fer t i l i t y Rat es per 1, 000 Wo men i n Thr ee Reg i ons of
t he Amer i c as , Rec ent Y e a r s . . . 10
11 Fer t i l i t y Rat es per 1, 000 Women, b y Age, i n Si x Count r i es Ar ound
1950, 1960 and 1968 . . . 11
12 Age Spec i f i c Fer t i l i t y Rat es per 1, 000 Women, f or Sel ec t ed Ar eas
of Thr ee Count r i es , 1967 . . . 12
13 Age Adj us t ed Fer t i l i t y Rat es per 1, 000 Women of 15- 44 Year s i n
Rel at i on t o Per c ent age of Popul at i on Li v i ng i n Ur ba n Communi t i es
of 2, 000 or Mor e I nhabi t ant s , i n 15 Lat i n Ame r i c an Count r i es ,
Rec ent Year s . . . 12
14 Per c ent age of Li v e Bi r t hs of Fi r s t Or der and of Four t h or Hi gher
Or der i n Si x Count r i es i n Thr ee Year s Bet ween 1957 and 1968 . . . 12
15 Av er age Annual Changes i n Li f e Ex pec t anc y i n Two Rec ent Dec ades , i n
14 Count r i es Ar r anged by Lev el of Li f e Ex pec t anc y Ar ound 1960 . . 14
16 I nc r eas e i n Li f e Ex pec t an c y i n Two Regi ons of L a t i n Ame r i c a . . . . 14
17 Deat hs per 1, 000 Po p u l a t i o n b y Age i n 19 Count r i es , 1968
or 1967 . . . 16
18 Deat hs f r om Al l Caus es p e r 1, 000 Po p u l a t i o n b y Age i n Chi l e, Mex i c o, and t he Uni t ed St at es 1940, 1961 and 1968 . . . 16
19 Fi v e Pr i nc i p a l Caus es of Deat h as a Per c en t a ge of To t a l Deat hs i n
Thr ee Regi ons of t he Amer i c as , 1967 . . . * 8
20 Per c ent age of Deat hs f r om I nf ec t i ous and Par as i t i c Di s eas es i n t he Thr ee Regi ons of t he A me r i c a s . . . .
21 Deat hs f r om I nf ec t i v e and Par as i t i c Di s eas es per 100, 000 Popul at i on b y Age and Count r y , 1967 . . .
^
22 Deat hs f r om Gas t r i t i s , Ent er i t i s , et c. per 100, 000 Po p u l a t i o n b y
Ag e and Count r y , 1967 . . .
^
23 Per c ent age of Deat hs due t o I l l - def i ned and Un k n own Caus es i n
Count r i es of t he Amer i c as , 1964 and 1967 . . . 21
24 Mat e r n al Deat hs per 10, 000 L i v e Bi r t hs i n t he Th r e e Regi ons of
t he Amer i c as , 1960- 1968 . . . . . . 21
25 Age Adj us t e d Deat h Rat es per 100, 000 Po p u l a t i o n f r o m Di s eas e of t he Hear t i n 10 Count r i es wi t h Hi g h e s t Rat es , by Sex, 1967 . . . 21
26 Age Adj u s t e d Deat h Rat es f r om Ma l i g n a n t Neopl as ms p e r 100, 000
Popul at i on, b y Sex , i n 22 Count r i es , 1967 . . . 22
27 Age Adj us t ed Deat h Rat es per 100, 000 Pop ul a t i on f r om Ma l i g na nt Neopl as ms of St omac h i n Count r i es wi t h Ten Hi g h e s t Rat es ,
b y Sex, 1967 . . . 23
28 Age Adj us t ed Deat h Rat es per 100, 000 Pop ul a t i on f r om Mal i gnant
Neopl as ms of Tr ac hea, Br onc hus and Lung i n Count r i es wi t h Ten
Hi g he s t Rat es Among Mal es , b y Sex, 1967 . . . 23
29 Age Adj u s t ed Deat h Rat es f r om Ma l i g n a n t Neopl as ms of t he Cer v i x Ut er i
per 100, 000 Wo me n i n Te n Count r i es wi t h t he Hi g h e s t Rat e i n t he
Amer i c as , 1967 . . . 23
30 Per c ent age of Deat hs due t o Al l Ac c i dent s , b y Age and Sex , i n Thr ee
Regi ons of t he Amer i c as , 1967 . . . 24
31 Per c ent age of Deat hs f r om Mo t o r Ve hi c l e Ac c i dent s , b y Age and Sex,
i n t he Thr ee Regi ons of t he Amer i c as , 1967 . . . 24
32 Per c ent age of Deat hs under 5 Year s of Age i n Th r e e Regi ons of t he
Amer i c as , 1964 and 1968 . . . 26
33 Reduc t i o n i n Deat h Rat es under 5 Year s of Age, 1961- 1968, Compar ed
wi t h Goal s f or t he Dec ade, 1961- 1971 . . . 26
34 Rat i o of Deat h Rat es under 5 Year s of Age t o Cor r es pondi ng Rat es
i n t he Uni t ed St at es , b y Age, i n Fi v e La t i n Ame r i c a n Count r i es ,
1968 . . . 29
35 Es t i mat ed Deat hs Under 5 Year s of Age i n La t i n Ame r i c a and Ex pec t ed
Deat hs on t he Bas i s of Rat es of Uni t ed St at es , 1968 . . . 29
36 Deat hs of Chi l dr en Und er 5 Year s of Age per 100, 000 Popul at i on,
by Gr oups of Caus es , i n L a t i n Amer i c a, 1956 and 1967 . . . 31
37 Oc c ur r enc e of Dengue i n t he Car i bbean, 1963- 1965, 1966- 1967 and
1968- 1969 . . . 105
38 Repor t ed Cas es of Di p h t h er i a per 100, 000 Po pu l a t i o n i n Thr ee Regi ons
of t he Amer i c as , 1959- 1968 . . . 106
39 Deat hs f r om Di pht her i a per 100, 000 Popul at i on i n Thr ee Regi ons of
t he Amer i c as , 1959- 1968 . . . 106
40 Out br eak s of Ar t h r opod- bor ne Enc ephal i t i s b y Ty pe, i n t he Amer i c as ,
1962- 1964 and 1966- 1969 . . . 108
41 Repor t ed Cas es of I nf ec t i ous Hepat i t i s per 100, 000 Pop ul at i on i n
Ei ght Count r i es , 1957- 1968 . . . 109
42 Repor t ed Cas es of I nf ec t i ous Hepat i t i s b y Mont h, Ar g en t i n a and t he
Uni t ed St at es , 1965- 1968 . . . 1° 9
43 Repor t ed Cas es of Lepr os y by Maj or Pol i t i c al Di v i s i ons of Eac h
Count r y , 1968 . . . H 0
44 Ma l a r i a Deat hs per 100, 000 Popul at i on i n Two Regi ons of t he
Amer i c as , 1955- 1967 . . . HI
45 Repor t ed Cas es of Ma l a r i a per 100, 000 Po p u l a t i on i n 12 Count r i es of
Lat i n Amer i c a, 1955- 1968 . . . m
46 Deat hs f r om Meas l es per 100, 000 Po p ul at i o n i n Thr ee Regi ons of t he
Amer i c as , 1959- 1968 . . . H 2
47 Repor t ed Cas es of Me as l es and Va c c i na t i on Pr ogr ams i n Si x Count r i es
of t he Amer i c as , 1959- 1968 . . . 112
48 Repor t ed Cas es of Pl ague b y Ma j o r Po l i t i c a l Di v i s i ons of Eac h
Count r y , 1940—1969 . . . 113
49 Repor t ed Cas es of Pol i omy el i t i s per 100, 000 Pop ul a t i o n i n Thr ee
Regi ons of t he Amer i c as , 1955- 1969 . . . .
50 Ra t i o of Re po r t e d Cas es of Rabi es i n Dogs and Cat s t o t he Hu ma n
Popul at i on, and Rep o r t ed Hu ma n Cas es , b y Count r y , 1968 . . . H 5
51 Repor t ed Cas es of Sc hi s t os omi as i s i n t he Four Ye a r Pe r i o d 1965- 1968
and Di s t r i bu t i o n and I nt ens i t y of I nf ec t i on wi t h Sc hi s t os oma
Ma ns oni i n t he A me r i c a s . . . .116
52 Repor t ed Cas es of Smal l po x i n t he Amer i c as , 1949, 19 59, 1969 . . . H ?
53 St at us of t he Smal l pox Er a d i c a t i o n Campai gn i n Br az i l , Mas s
Vac c i nat i on Pr ogr am, Dec ember 1969 . . . 118
54 Per c ent ag e of Pop ul a t i on Va c c i na t e d Aga i n s t Smal l pox b y Count r y ,
Sout h Amer i c a, 1966- 1969 . . . 118
55 Repor t ed Cas es of Sy phi l i s ( al l f or ms ) per 100, 000 Pop ul at i o n i n
Thr ee Regi ons of t he Amer i c as , 1959- 1968 . . . H 9
56 Deat hs f r om Sy phi l i s per 100, 000 Popul at i on i n Thr ee Regi ons of t he
Amer i c as , 1956- 1967 . . . H 9
57 Per c ent age of Deat hs f r om Tet anus Cor r es pondi ng t o I nf ant s Under
One Year of Age, b y Count r y , 1967 . . . 120
58 Deat hs f r om Tuber c ul os i s per 100, 000 Popul at i on i n Thr ee Regi ons
of t he Amer i c as , 1953- 1967 . . . 120
59 Age Spec i f i c Deat h Rat es f r om Tuber c ul os i s per 100, 000 Popul at i on
b y Sex, i n Four Count r i es , 1967 . . . 121
60 Repor t ed Cas es of Tu ber c ul os i s per 100, 000 Po p u l a t i on i n t he Thr ee
Regi ons of t he Amer i c as , 1953- 1968 . . . 121
61 Av er age Ann u al Re po r t ed Cas es and Deat hs f r om Ty p h o i d Fev er per
100, 000 Po p u l a t i o n i n Two Regi ons of L a t i n Amer i c a, 1961- 1963
and 1966- 1968 . . . 122
62 Av er age An nu a l Repor t ed Cas es of Whoopi ng Cough per 100, 000
Pop ul at i on i n Th r e e Regi ons of t he Amer i c as , 1960- 1968 . . . 123
63 Deat hs f r om Wh o o p i n g Cough pe r 100, 000 Po p u l a t i o n i n t he Thr ee
Regi ons of t he Amer i c as , 1959- 1967 . . . 123
64 Re p or t ed Cas es of J un g l e Ye l l o w Fev er , b y Ma j o r Po l i t i c a l Di v i s i ons
of Eac h Count r y , 1966 and 1967- 1969 . . . 125
65 Per Ca pi t a Ex pend i t ur e f or He a l t h i n U. S. Dol l ar s , b y Count r y ,
Ar o un d 1964 and 1968 . . . 140
66 Vi s i t s per 100 Po p u l at i o n t o He al t h Es t abl i s hmen t s wi t h Out pat i ent
Ser v i c es , b y Count r y , 1968 . . . 142
67 Per c en t a ge of Del i v er i es At t e n d e d i n Hos pi t al s , i n 14 Count r i es ,
1968
...
1^3
68 Rat i o of I nf ant s At t e n d e d i n Chi l d Hea l t h Ser v i c es pe r 100 Li v e
Bi r t hs and of Ch i l d r e n 1- 4 At t e n d e d per I n f a nt At t e n d e d by
Count r y , 1968 . . . 143
69 Per c ent age of Per s ons Wh o Hav e Rec ei v ed Me d i c a l At t e nt i o n f or
Sel ec t ed Gr oups of Caus es , i n Out pat i ent Cl i ni c s i n Fi v e Count r i es ,
1568
...
146
70 Nu mb er of Per s ons At t en di ng Ou t p a t i en t Cl i ni c s per 100 Popul a t i o n
wi t h Rat i os of To t a l Vi s i t s t o Fi r s t Vi s i t s , i n 12 Count r i es ,
1968 . . . 146
71 Tot al and Gene r a l Ho s p i t a l Beds p e r 1, 000 Popul at i on, b y Count r y ,
1968 149
72 Ho s p i t al Beds , Tot al and Gener al , per 1, 000 Po pu l a t i o n i n t he Thr ee
Regi ons of t he Amer i c as , 1960, 1964 and 1968 . . . 149
73 Ho s p i t a l Beds per 1, 000 Pop u l a t i on i n Capi t al s and Lar ge Ci t i es
and i n Remai nder of Count r i es , 1968 . . . 150
74 Di s t r i but i on of Hos pi t al s and Hos pi t a l Beds b y Si z e of Hos p i t al
i n Un i t e d St at es and 13 L a t i n Ame r i c an Count r i es , 1968 . . . 151
75 Us e of Gener al Hos pi t al s b y Po pu l a t i o n i n 11 Count r i es of t he
Amer i c as i n 1964 and 1968 . . . 153
76 I ndi c es of Ut i l i z at i on of Gener al Hos pi t al s i n Si x L a t i n Amer i c an
Count r i es , 1960- 1968 . . . 154
77 Di s c har ges per Hos pi t al Be d i n Gener al Hos pi t al s i n Te n Count r i es ,
Ar ound 1964 and 1968 . . . 155
78 Per c ent age of Hos pi t a l i z at i o n s due t o Fo u r Gr oups of Caus es . . . . 157
79 Deat hs Under 5 Year s of Ag e p er 1, 000 Pop ul at i on and Per c ent ag e of Homes wi t h Pi ped Wa t e r f or 8 Pr oj ec t s . . . 162
80 Per c ent age of Ur ban Po pu l a t i o n Ser v ed b y Wa t e r Suppl y Sy s t ems wi t h Hou s e Connec t i ons or Eas y Ac c es s , i n Count r i es i n L a t i n Amer i c a,
1969 163
81 Es t i mat e d Ur b a n and Rur al Po pu l a t i o n i n 1971 b y Ty p e of Wa t e r
Ser v i c e i n 1969 and Req ui r ement s t o Me e t Goal s of t he Char t er of
Pu n t a del E s t e . . . 163
82 Per c ent age of Ur b a n Po p u l a t i o n Ser v ed b y Sewer age Sy s t ems i n
Count r i es of L a t i n Amer i c a, 1969 . . . 164
83 Es t i mat ed Ur ban and Ru r a l Popul at i ons i n 1971 wi t h Number s Ser v ed
by Sewer age Sy s t ems and Requi r i ng Ser v i c e t o Me e t Goal s of t he
Char t er of Punt a del E s t e . . . 164
84 Per c ent age I nc r eas e i n Pop ul at i o n and i n Phy s i c i ans i n Th r e e Regi ons
of t he Amer i c as , 1960 t o 1968 . . . 168
85 Phy s i c i ans per 10, 000 Popul at i on, b y Count r y , 1968 . . . 168
86 Phy s i c i ans per 10, 000 Popul at i o n i n Capi t al and Lar ge Ci t i es and
i n Remai nder of Count r i es , 1968 . . . 169
87 Per c en t a ge of Phy s i c i ans i n Sel ec t e d Spec i al t i es , 1968 . . . 170
88 Nu r s i n g Per s onnel per 10, 000 Popul at i on, b y Count r y , 1968 . . . 172
89 Rat i os of Phy s i c i ans and Nur s es per 10, 000 Pop ul a t i on i n Thr ee
Regi ons of t he Amer i c as , 1964 and 1968 . . . 172
Dat a n ot a v a i l a b l e . . . .
No n e . . . —
Rat e under 0 . 0 5 . . . 0. 0
Pr ov i s i onal . . . *
B eginning w ith th e X IV Pan A m erican S anitary C onference in 1954 a four-year re p o rt on h ealth c o n d itio n s in th e A m ericas has b een p rep ared fo r each C onference. T he p resen t re p o rt fo r th e X V III Pan A m erican S an itary C onference covers th e years 1965-1968.
Sources o f d a ta fo r these rep o rts have b een th e replies to jo in t annual qu estio n n aires w hich th e W orld H ealth O rganization and th e Pan A m erican H ealth O rganization send to th e co u n tries fo r in fo rm atio n on m o rta lity , m o rb id ity , vaccinations and resources o f m an p o w er and in stitu tio n s. Also u tilized are the qu estio n n aires circu lated b y WHO at tw o an d four-year periods to com pile the R e p o rt on th e W orld H ealth S itu a tio n . A n answ er to th e qu estio n n aire for th e F o u rth R e p o rt on th e W orld H ealth S itu atio n for th e p erio d 1965-1968 was received from every m em b er c o u n try o f the A m ericas. In ad d itio n , p u b licatio n s o f th e co u n tries and o th e r official rep o rts fro m the co u n tries to th e Pan A m erican H ealth O rganization, th e W orld H ealth O rganization an d the U n ited N ations have served as basic d o cu m en ts for th e p resen t an d previous rep o rts.
T his re p o rt follow s th e plan o f th e previous re p o rt w ith chap ters on p o p u la tio n , vital statistics, com m unicable diseases, h e a lth services, hospitals, en v iro n m en tal h e a lth and h e a lth m anpow er. H ow ever, considerable m ore detail is now provided in reference tables at th e en d o f each ch ap ter. T he use o f electronic co m p u ters in processing and p resenting d ata on vital statistics an d com m unicable diseases has m ade possible greater d e p th and variety in analysis.
Inclu d ed in th e ch ap ter on p o p u la tio n are th e basic p o p u latio n figures used fo r calculating rates and ratio s to g e th e r w ith d ata on th e u rb an-rural and socio-econom ic ch aracteristics o f the p o p u la tio n o f the R egion. T he role o f h e a lth in th e eco n o m ic and social d evelopm ent o f L atin A m erica was clearly expressed in th e D eclaration o f th e P residents o f A m erica signed by 19 A m erican Chiefs o f S tate at P u n ta del E ste, U ruguay o n A pril 14, 1967. T he levels o f b o th h e a lth itse lf and h e a lth resources and services are closely related to socio-econom ic co n d itio n s. W herever a p p ro p ria te , tren d s o f h e a lth co n d itio n s are show n in relatio n to th e goals o f th e C h arter o f P u n ta del Este.
Im provem ents in statistical d ata have b een great over th e 18 years covered b y th e series o f rep o rts. R egistratio n o f vital events has im proved as has th e rep o rtin g o f m ajor com m u n icab le diseases. F o r som e diseases for w hich m o rb id ity an d m o rta lity is declining, a p p aren t increases are due to im proved registration o r rep o rtin g . M ore reliable in fo rm atio n is also becom ing available on resources o f m anpow er and in stitu tio n s. D espite th e advances m ad e, th e effo rts o f th e co u n tries o f the R egion to develop and im p lem en t h e a lth plans and to evaluate th eir program s has led to a grow ing aw areness o f th e need for im proving fu rth e r b o th th e q u ality and th e q u a n tity o f statistical in fo rm a tio n w hich is so essential to th eir planning, m an ag em en t and evaluation.
P O P U L A T I O N
The ch aracteristics o f a p o p u la tio n d eterm ine in p a rt its h ealth pro b lem s and its need fo r and u tilizatio n o f h ealth services. A m ong these characteristics are age d istrib u tio n , rate o f p o p u la tio n g ro w th , u rban-rural d istrib u tio n , ed u catio n al and cu ltu ral situ a tio n , incom e and occu p atio n .
C ensuses, th e basis o f p o p u la tio n d a ta w hich are essential to planning h e a lth and o th e r services, are tak en in m o st co u n tries o f th e A m ericas at ten-year intervals. M any have a long record o f censuses, d ating as far b ack as the late eig h teen th ce n tu ry (T able I). C uba, H on d u ras, N icaragua and th e U nited S tates h ad censuses befo re 1800 and on ly six — D om inican R epublic, E cu ad o r, El Salvador, H aiti, P anam a and Paraguay — o f the 26 cou n tries h ad a first census in th e tw e n tie th c e n tu ry . All b u t th ree co u n tries (Bolivia, C uba and H aiti) and all 23 territo ries h ad p o p u la tio n censuses in the 1 960’s, p rim arily in th e early years o f the decade. Plans fo r 1970 censuses already have been m ade b y all b u t tw o cou n tries. T h irteen censuses are scheduled in 1970, six in 1971, fo u r in 1972 and one in 1973. In territo ries w hich are p art o f the U n ited K ingdom censuses are also p lan n ed for 1970 as are th o se in th e C anal Z o n e, P u erto R ico and the U. S. Virgin Islands. In th e F ren ch territo ries censuses w ere ta k e n in 1967.
P o p u latio n estim ates used in this re p o rt m ay be subject to revision w hen 1970 census d ata beco m e available. F o r m o st rates and ratios th e p o p u la tio n s in T able II have b een used. T hese w ere ta k e n fro m T h e M o n t h l y B u l l e t i n o f S t a t i s t i c s , published by the U n ited N atio n s in Jan u ary
1970.
T he g ro w th ra te in L atin A m erica in the past decade has been the highest o f any large R egion o f the w orld, reaching 2.9 p er cent p er an n u m in th e years since 1960. W ithin L atin A m erica th e highest rate o f 3 .4 per ce n t is fo u n d in th e c o n tin e n ta l p o rtio n o f M iddle A m erica — th a t is, M exico, C entral A m erica and Panam a. T ropical S o u th A m erica is n ex t in o rd er o f g ro w th w ith a rate o f 3.1 p er c e n t, follow ed by th e C aribbean area (2 .3 per ce n t) and tem p erate S o u th A m erica (1 .9 p er cen t). N o rth e rn A m erica has h ad the low est grow th rate o f 1.4 per cen t p e r year.
T able 1 and Figure 1 sum m arize the g ro w th b etw een 1930 and 1960 in these regional divisions an d p ro jectio n s
o f the p o p u la tio n from 1970 to 2 0 0 0 . By 1970 th e estim ated p o p u la tio n o f N o rth ern A m erica (2 2 7 m illions) was 45 per cen t o f th e regional to ta l and th a t o f L atin A m erica (283 m illions) was 55 p e r cen t. By 200 0 th e p ro jected p o p u la tio n o f N o rth e rn A m erica (3 5 4 m illions) will be 36 p e r c e n t o f the regional to ta l as co m p ared to 64 p er cen t in L atin A m erica (6 3 8 m illions). T hese esti m ates, th e “ m e d iu m ” p ro jectio n s m ade by th e U n ited N ations, represent the fu tu re p o p u la tio n tre n d th a t appeared m o st reasonable in the early p a rt o f th e decade o f th e 1 960’s, based on p ast experiences and p resen t circum stances. V arying assu m p tio n s w ith respect to fu tu re tren d s o f fertility rates, crude b irth rates, d e a th rates and m igratory m ovem ents w ere m ade fo r groups o f co u n tries o f th e R egion. E stim ates fo rm u lated m ore recen tly fo r L atin A m erica do n o t differ greatly from th e estim ates show n, b u t u n fo rseen d evelopm ents could su b stan tially alter these p ro jectio n s, p articu larly those fo r th e end o f the c e n tu ry .
F i g u r e I
G R O W T H O F P O P U L A T I O N IN N O R T H E R N A N D L A T I N A M E R I C A 1 9 3 0 - 1 9 6 0 A N D E S T I M A T E D G R O W T H 1 9 6 0 - 2 0 0 0
By co u n try , annual g ro w th rates during the period 1963-1968 have varied from 1.2 per cen t in B arbados, U nited S tates and U ruguay to 3.7 p er ce n t in El Salvador. T he co u n tries o f N o rth ern A m erica and tem p erate S o u th A m erica have ex p erienced the greatest red u ctio n in g row th rates b etw een 1950-1960 and 1963-1968. F ifteen o f the 26 co u n tries in the R egion h ad grow th rates o f 3 per cent or greater b etw een 1963-1968, six h ad rates betw een 2.0 and 2.9 p er cen t and five had annual rates o f less th an 2 per cen t. O f the o th e r 23 areas in th e R egion all b u t th ree ap p aren tly increased th e ir p o p u latio n s and th e estim ated annual percen tag e increase ranged from 0.2 p er cent to 6.7 p er ce n t in th e C aym an Islands, 6.5 per ce n t in th e Baham as and 5.6 p er cen t in F rench G uiana.
T a b le 1 . P o p u la tio n b y R e g io n o f th e A m e r ic a s f r o m 1930 to 1960 a n d E s tim a te d P o p u la tio n 1970 to 2000
R eg io n
Y e a r
1930 1940 1950 1960 1970 1980 1990 2000
N o r th e r n A m e r ic a 134 144 166 199 227 262 306 354
L a tin A m e r ic a 108 130 163 213 283 378 498 638
T r o p ic a l S outh
A m e r ic a 55 67 84 112 154 210 2 8 0 362
C o n tin e n ta l
M id d le A m e r ic a 22 27 35 48 65 90 125 166
T e m p e r a te
So u th A m e r ic a 19 22 27 33 39 46 53 61
C a rib b e a n 12 14 17 20 26 32 40 50
S o u r c e s : D e m o g ra p h ic Y e a rb o o k , 1968 an d W o rld P o p u la tio n P r o s p e c ts a s A s s e s s e d in 1963, 1966. U n ited N a tio n s
P E R C E N T A G E O F L A T I N A M E R I C A N P O P U L A T IO N L I V IN G IN R U R A L A R E A S , 1 9 5 0 - 1 980 F ig u r e 2
PERCENTAGE
20 40
in T able 2. T he percentage living in rural areas in 1970 varies from 2 1 .4 p er cen t U ruguay to 8 2 .4 in H aiti. In 1980 the range is from 17.6 to 74 .7 p er cen t in the sam e tw o co u n tries. M igration to large cities has been great and th e grow th o f p o p u la tio n in very large cities is m uch m ore rapid th an th a t o f the rest o f L atin A m erica (F igure 3).
H ealth services in th e R egion m u st have a versatile stru c tu re to m eet th e h e a lth p roblem s in th e cities, created n o t only by highly u rbanized living b u t also b y th e high rate o f m igration from rural to u rb an areas and to furnish ad eq u ate h ealth care to a large and w idely dispersed rural p o p u latio n .
Ur b an - r u r al d i st r i b u t i o n
T he u rb an-rural d istrib u tio n o f L atin A m erica has ch aracteristics w hich have a d irect bearing on the h ealth problem s and the stru c tu re o f the h e a lth services in the R egion. In m any co u n tries a high p ro p o rtio n o f the p o p u la tio n lives in sm all co m m u n ities o r in rural areas. T his p ro p o rtio n has b een decreasing b u t at th e end o f the
decade o f th e 1 960’s w as 45 p er cen t o f the
p o p u la tio n o f L atin A m erica. E stim ates for 1980 show 40 p er cent o f the p o p u latio n living in rural areas o r in co m m u n ities o f less th an 2 ,0 0 0 p o p u la tio n . T he change in the rural d istrib u tio n o f the p o p u la tio n betw een 1950-1960 and the estim ated changes b etw een 1960 and 1980 are show n in Figure 2 . E stim ated urban-rural d istrib u tio n s for 1960, 1970 and 1980 by c o u n try appear
F i g u r e 3
T a b l e 2. U r b a n a n d R u r a l P o p u l a t i o n s i n T w e n ty L a ti n A m e r i c a n C o u n t r i e s , 1 9 6 0 to 1980
C o u n t r i e s
1 9 6 0 1970 19 8 0
P o p u la t io n
(in th o u s a n d s ) P e rc e n t r u r a l
P o p u la t io n
(in th o u s a n d s ) P e rc e n t r u r a l
P o p u la t io n
(in th o u s a n d s ) P e rc e n t r u r a l
U r b a n R u r a l U r b a n R u r a l U r b a n R u r a l
A r g e n t i n a 15 015 5 654 2 7 .4 18 674 5 376 2 2 . 4 22 4 6 8 5 1 1 2 18. 5
B o li v ia 1 1 0 4 2 592 7 0 . 1 1 6 5 2 3 0 0 6 6 4 . 5 2 504 3 4 7 1 58. 1
B r a z i l 2 8 217 41 924 5 9 . 8 4 4 5 9 8 4 8 694 5 2 .2 66 4 3 4 56 5 5 8 4 6 .0
C h ile 4 9 6 7 2 821 3 6 .2 7 0 3 7 2 9 3 2 2 9 .4 9 8 6 4 3 0 4 8 2 3. 6
C o lo m b ia 7 257 8 4 0 0 5 3 . 7 1 1 6 6 5 9 2 1 0 4 4 . 1 18 191 10 09 8 3 5. 7
C o s t a R i c a 386 849 6 8 . 7 6 1 2 1 1 9 7 6 6 .2 1 0 4 0 1 6 8 8 61. 9
C u b a 3 802 3 0 1 7 4 4 .2 5 1 1 3 3 2 2 8 3 8 .7 6 621 3 454 34. 3
D o m in ic a n R e p u b lic 874 2 1 5 6 7 1 . 2 1 6 3 7 2 640 6 1 . 7 2 9 4 2 3 232 5 2. 3
E c u a d o r 1 5 7 2 2 782 6 3 .9 2 9 4 4 3 1 4 9 5 1 . 7 4 9 0 9 3 564 4 2 . 1
E l S a lv a d o r 787 1 7 2 2 6 8 .6 1 309 2 1 3 2 6 2 . 0 2 271 2 639 53. 7
G u a te m a la 1 0 9 5 2 9 1 8 7 2 . 7 1 5 8 7 3 689 6 9 .9 2 5 2 7 4 664 64. 9
H a iti 5 13 3 6 2 7 8 7 . 6 9 2 7 4 328 82. 4 1 751 5 168 74. 7
H o n d u r a s 386 1 4 6 8 7 9 .2 724 1 8 7 9 7 2 .2 1 3 6 6 2 4 0 5 63. 8
M e x ic o 19 4 6 7 16 579 4 6 .0 31 319 19 351 3 8 . 2 4 9 8 0 5 22 587 31. 2
N i c a r a g u a 511 1 0 0 0 6 6 .2 7 9 7 12'27 6 0 .6 1 3 1 8 1 5 0 6 53. 3
P a n a m a 4 3 3 5 8 8 5 7 . 6 7 1 0 700 4 9 . 6 1 1 5 4 833 4 1 .9
P a r a g u a y 524 1 2 2 7 7 0 . 1 8 2 2 1 5 5 7 6 5 .4 1 3 8 5 1 9 7 6 5 8 .8
P e r u 3 8 7 7 6 1 4 8 6 1 . 3 6 6 8 7 6 899 5 0 . 8 1 0 7 8 6 7 741 4 1 .8
U r u g u a y 1 8 7 7 6 59 2 6 .0 2 2 6 8 618 2 1 . 4 2 6 8 2 573 17. 6
V e n e z u e la 4 6 1 1 2 7 2 0 3 7 .1 7 4 9 9 2 9 0 0 2 7 .9 1 1 7 5 6 3 0 9 2 2 0 . 8
S o u r c e : E s tu d i o E c o n & m ic o d e A m e r i c a L a tin a , 1 9 6 8 , E c o n o m ic C o m m is s io n f o r L a ti n A m e r i c a , U n ite d N a tio n s .
A g e
d i st
r i b u t i o n
T he c o u n trie s in the A m ericas divide in to tw o d istin ct groups w ith respect to age d istrib u tio n s. In 19 o f the 26 co u n tries over 40 per cen t o f th e p o p u la tio n is u n d er 15 y ears o f age and th e p ercentage is over 45 in 13 co untries. T h o s e w i t h t h e lo w e st p ro p o rtio n s u n d er 15 y ears—b etw een 29 and 37 p er c e n t—inclu d e U ruguay, A rgentina, U n ited S tates, C anada, B arbados and C uba. In these six the p ro p o rtio n s in th e age group o f 65 years and over are also th e highest, ranging fro m 4.5 p er cen t in C uba to 9.5 per cen t in the U n ited S tates. In areas in the Region o th e r th a n co u n tries the p ro p o rtio n o f the p o p u la tio n in th e age group u n d er 15 years is high b u t the percentage in th e age group o f 65 ajid over is higher th an in m o st L atin A m erican cou n tries.
In 1968 estim ates show 30 p er cen t o f th e p o p u latio n in N o rth e rn A m erica u n d er 15 years o f age an d 9 p e r cent 65 years or over (Figure 4 ). In M iddle A m erica the corresp o n d in g percentages are 45 and 3 an d in S o u th A m erica 4 2 and 4 . O nly slight changes in age stru c tu re are e x p ected in the A m ericas up to 1980 (F igure 5). In
N o rth e rn A m erica and tem p erate S o u th A m erica, the
p ro p o rtio n s u n d er 15 m ay decrease slightly w ith corresp o n d in g increases in th e p o p u la tio n 15 years and over. In th e rem ainder o f L atin A m erica th e percentage's u n d er 15 years and 65 years and over m ay increase slightly w ith decreases in th e groups fro m 15-64.
P ro jected declines in b irth rates m ay be o ffset by
decreases in m o rta lity rates. A long p erio d m ay be
req u ired to p ro d u ce a great change in age stru c tu re since the presen t large p o p u la tio n s a t the yo u n g er ages will serve to m ain tain relatively high b irth rates. In T able 3 the estim ated percen tag e d istrib u tio n ^ o f p o p u la tio n by b road age groups are show n fo r co u n tries o f th e R egion in 1968.
T he age co m p o sitio n o f a p o p u la tio n helps to p ro je c t the principal h e a lth pro b lem s and th e p o p u la tio n groups for w hich h e a lth services m u st be provided. T he high percentages in the age group u n d er 15 years th ro u g h o u t m u ch o f th e R egion clearly indicate th a t p rio rity a tte n tio n should be given to m atern al and child h ealth services.
F i g u r e 4
P E R C E N T A G E O F P O P U L A T I O N U N D E R 1 5 Y E A R S A N D 6 5 Y E A R S O R O L D E R
BY R E G IO N O F T H E A M E R I C A S , 1 9 6 0 , 1 9 7 0 A N D 1 98 0 PERCENTAGE
F ig u r e 5
10
UNDER 15 YEARS
20________ 30 40
65 YEARS AND OVER
0 10
NORTHERN AMERICA
CONTINENTAL MIDDLE AMERICA
TROPICAL SOUTH AMERICA
TEMPERATE SOUTH AMERICA
I 1960
T he d istrib u tio n o f a p o p u latio n by age affects the n u m b er o f b irth s and deaths in a p o p u la tio n and
c o n s e q u e n tly crude b irth and d eath rates. F o r
com parisons betw een cou n tries w ith differing age stru c tu re , ag e-sp ecific or age-adjusted rates should be used.
T a b le 3. P e r c e n t a g e D is tr ib u tio n of P o p u la tio n by B ro a d A ge G ro u p s , in th e A m e r ic a s , 1968
C o u n try T o ta l 15 y e a r sU n d e r 1 5 -4 4 4 5 -6 4 65 an d o v e r
A rg e n tin a 100 2 9 .7 44. 6 19. 0 6. 8
B a rb a d o s 100 37. 7 37. 9 17. 5 6. 9
B o liv ia 100 4 2 .0 43. 7 11. 3 3. 1
B r a z il 100 42. 8 43. 2 11. 3 2. 7
C an ad a 100 31. 6 42. 5 18. 1 7. 7
C h ile 100 4 0 .0 42. 4 13. 2 4. 4
C o lo m b ia 100 4 6 .6 40. 2 10. 2 3 .0
C o s ta R ic a 100 47. 9 3 8 . 8 10. 1 3 . 2
C u b a 100 37. 3 43. 1 15. 1 4. 5
D o m in ic a n
R e p u b lic 100 47. 3 4 0 .0 9. 8 3 .0
E c u a d o r 100 47. 7 39. 4 1 0 .0 2. 9
E l S a lv a d o r 100 45. 4 40. 7 10. 6 3. 3
G u a te m a la 100 46. 6 40. 6 1 0 .0 2. 9
G u y an a 100 46. 3 38. 4 1 2 .0 3. 4
H a iti 100 38. 3 45. 9 12. 6 3. 2
H o n d u ra s 100 52. 2 3 8 .0 8. 1 1. 6
J a m a ic a 100 45. 1 37. 2 13. 2 4. 6
M ex ico 100 46. 3 40. 2 10. 1 3. 3
N ic a ra g u a 100 48. 3 39. 7 9 .0 2. 9
P a n a m a 100 43. 7 41. 6 11. 2 3. 5
P a r a g u a y 100 46. 1 40. 3 10. 1 3. 5
P e r u 100 43. 3 41. 8 1 1 .0 3. 8
T r in id a d and
T o b ag o 100 42. 4 40. 8 13. 2 3 .6
U n ited
S la te s 100 30. 3 39. 9 20. 3 9. 5
U ru g u ay 100 2 8 .0 44. 4 19. 8 7. 8
V e n e z u e la 100 45. 7 • 4 1 .0 10. 6 2 .6
N o r th e r n
A m e r ic a 100 30. 4 40. 1 20. 1 9. 3
M id d le
A m e r ic a 100 45. 1 4 0 .7 10. 8 3. 4
S outh
A m e r ic a 100 41. 5 42. 7 12. 3 3. 6
L a b o r
f o
r ce
T hree sectors are generally used to describe the labor force: 1) those em ployed in agriculture and m ining, 2) those in in d u stry and c o n stru c tio n , and 3) those in trad e and services. T he differences b etw een th e R egions o f th e A m ericas have been great fo r m any years. Figure 6 show s the d istrib u tio n s in fo u r sections o f L atin A m erica fo r the years 1960, 1970, and 1980.
The percentage o f the econom ically active p o p u la tio n w orking in agriculture in N o rth ern A m erica is Small (9 per cen t) and has decreased gradually in th e p erio d . In L atin A m erica 54 p er cen t was in agriculture in 1950, 48 in 1960 and 44 in 1970. D uring the same perio d o f tim e the percentage in m an u factu rin g increased in L atin A m erica only from 18 to 20 per cen t and in tra d e and services from 28 to 36 per cen t. T he percentage em ployed in in d u stry in N o rth e rn A m erica is tw ice th a t in L atin A m erica.
T he econom ically active p o p u la tio n in L atin A m erica, c o n stitu tin g o n e-th ird o f the to ta l p o p u la tio n has a large d ep en d en t group for w hich to provide, an average o f tw o additional p ersons for each w orker. This ratio has rem ained fairly c o n sta n t for recen t decades and is. n o t ex p ected to change in the n e x t ten years.
In co m e
Average per cap ita incom e in L atin A m erica has been very low . A goal o f the C harier o f P u n ta del Este was to establish a m in im u m econom ic grow th rate in each c o u n try o f the R egion o f 2.5 per cent per capita per year.
F ig u r e 6
P E R C E N T A G E E C O N O M I C A L L Y A C T I V E A N D P E R C E N T A G E D I S T R IB U T IO N O F L ABO R F O R C E BY S E C T O R IN F O U R R E G I O N S O F L A T I N A M E R I C A , 1 9 6 0 - 1 98 0
ECONOMICALLY ACTIVE LABOR FORCE BY SECTOR
MIDDLE AMERICA (MAINLAND]
MIDDLE AMERICA [ MAINLAND]
TROPICAL SOUTH AMERICA
was $3,8 3 5 for N o rth ern A m erica, $56 7 fo r tem p erate S o u th A m erica, $49 8 fo r the M iddle A m erica m ainland, $365 for the C aribbean, and $ 334 fo r tro p ical S o u th A m erica. An increase b etw een 1963 and 1968 (F igure 7) to o k place in all the above regions. T he largest percentage increase w as in tem p erate S o u th A m erica and the sm allest in the C aribbean and tropical S o u th A m erica.
T he p er capita incom e as rep resen ted by gross dom estic p ro d u ct is closely related to the stru c tu re o f the p o p u la tio n . R elative to the num bers in the labor force, the percentage c o n trib u tio n o f the agriculture secto r to the gross dom estic p ro d u c t is low .
F i g u r e 7
PE R C E N T A G E I N C R E A S E IN P E R C A P I T A G R O S S D O M E S T I C P R O D U C T A T F A C T O R C O S T IN R E G I O N S O F T H E A M E R I C A S , 1 9 6 3 - 1 9 68
PERCENTAGE
0 10 20 30 40 50
1 r ---1--- 1 ---1
CONTINENTAL MIDDLE AMERICA
TROPICAL SOUTH AMERICA
TEMPERATE SOUTH AMERICA
Educat ion
V arious indices could be used to describe the educational level in the co u n tries o f the R egion. T he ratio show n in Table 5 and Figure 8 is the nu m b er o f children atten d in g prim ary and secondary schools in relation to p o p u latio n 5-14 years o f age. Since in m any co u n tries five y ear olds m ay n o t be eligible for adm ission to school and since m any children in secondary schools m ay be over 14 y ears—the ratio m ay be g reater th an one, as in the case o f the U nited S tates. B etw een 1954 and 1966 th e n um ber
F i g u r e 8
S T U D E N T S IN L A T I N A M E R I C A A T T E N D I N G P R I M A R Y O R S E C O N D A R Y S C H O O L S IN R E L A T I O N T O P O P U L A T I O N IN A G E G R O U P 5 - 1 4 Y E A R S
0 20 40 60 80
T a b le 4. T o ta l an d P e r C a p ita G r o s s D o m e s tic P r o d u c t a t F a c to r C o s t b y C o u n try , 1968
C o u n try (U. S. d o ll a r s
in m illio n s )
P e r c a p ita (U . S. d o lla r s )
A rg e n tin a (a) 13 950 B0C
B a r b a d o s (a) 105 423
B o liv ia 742 158
B r a z il (a) 24 883 291
C a n a d a 54 449 2 621
C h ile 4 845 518
C o lo m b ia (a) 5 779 301
C o s ta R ic a 690 422
C u b a (b) 4 039 518
D o m in ic a n R e p u b lic 1 0 5 0 261
E c u a d o r 1 2 1 8 214
E l S a lv a d o r 851 261
G u a te m a la 1443 297
G u y an a 203 283
H a iti 404 86
H o n d u ra s 599 248
J a m a ic a 891 466
M e x ico 2 6 1 6 0 553
N ic a r a g u a 662 359
P a n a m a 803 585
P a r a g u a y 479 215
P e r u 3 427 2 68
T r in id a d an d T o b ag o 764 749
U n ite d S ta te s 796 636 3 960
U ru g u a y 1 6 4 6 584
V e n e z u e la 9 4 6 7 977
N o r th e r n A m e r ic a 8 5 1 0 8 5 3 835
M id d le A m e ric a 3 1 2 0 8 498
C a rib b e a n 7 2 9 1 365
T r o p ic a l S outh
A m e r ic a 43 745 334
T e m p e r a te S o u th
A m e r ic a 27 521 567
(a) 1967 (b) 1966. S o u rc e s : S ta t is ti c a l Y e a rb o o k 1969 an d M o n th ly B u lle tin of S t a t i s t i c s , J u ly 1970, U n ite d N a tio n s .
T a b le 5. N u m b e r of S tu d e n ts A tte n d in g P r i m a r y o r S e c o n d a ry S c h o o ls and R a tio s to P o p u la tio n 5 -1 4 Y e a r s ,
b y C o u n try , 1967
C o u n try Y e a r
S tu d e n ts e n r o lle d
N u m b e r R a tio p e r 100 p o p u la tio n
A rg e n tin a 1967 4 0 7 2 823 0. 91
B a rb a d o s 1966 68 647 1 .0 7
B o liv ia 1967 677 735 0. 58
B r a z il 1966 1 3 1 7 3 603 0. 59
C an ad a 1967 '5 2 9 4 3 0 1 1. 18
C h ile 1967 2 0 7 6 722 0. 93
C o lo m b ia 1966 2 923 200 0. 54
C o s ta R ic a 1966 350 180 3. 79
C uba 1967 1 530 773 0. 87
D o m in ic a n
R e p u b lic 1967 734 428 0 .6 5
E c u a d o r 1967 1 0 4 9 336 0 .6 7
E l S a lv a d o r 1967 543 264 0. 64
G u a te m a la 1967 5 4 5 8 2 7 0. 4?
G u yana 1967 190 278 0. 95
H a iti 1966 3 1 3 7 7 3 0. 30
H o n d u ra s 1966 3 5 9 1 6 6 0. 51
J a m a ic a 1965 362 399 0. 71
M ex ico 1967 3 398 342 0. 70
N ic a ra g u a 1966 254 306 0. 48
P a n a m a 1967 282 715 0. 81
P a r a g u a y 1966 405 588 0. 67
P e r u 1967 2 747 570 0. 84
T rin id a d and
T obago 1966 273 510 1 .0 3
U n ite d Slat.es 1967 52 293 203 1. 28
U ru g u a y 1966 497 408 1 .0 0
V e n e z u e la 1967 1 9 1 0 103 0. 77
S o u rc e : S ta t is ti c a l Y e a rb o o k . 19 6 9 , U n ite d N a tio n s .
F R O M 196 3 - 1968
A r e a
D a te o f f i r s t c e n s u s
D a te o f l a s t c e n s u s
D a te o f n e x t c e n s u s
P o p u la tio n (1 9 6 3 -1 9 6 8 )
A n n u a l p e r c e n t a g e
i n c r e a s e L a s t
c e n s u s
1968 M id y e a r e s t i m a t e
A r g e n ti n a 1869 30 IX 1960 1970 20 0 1 0 5 3 9 23 617 0 0 0 1. 5
B a r b a d o s 1881 7 IV 1960 1970 2 3 2 327 2 5 3 000 1 .2
B o liv ia 1831 5 IX 1950 1970 a ) 3 8 2 5 00 0 4 6 8 0 0 0 0 2. 6
B r a z i l 1872 1 IX 196 0 1970 7 0 1 1 9 071 8 8 2 0 9 000 3 . 0
C a n a d a 1871 1 V I 1966 1970 2 0 0 1 4 880 20 772 0 0 0 1. 9
C h ile 1835 29 X I 1960 1970 7 3 7 4 1 1 5 9 3 5 1 0 0 0 2. 4
C o lo m b ia 1825 15 V H 1964 1972 17 4 8 4 508 19 825 0 0 0 3 .2
C o s ta R ic a 1864 1 IV 1963 1973 1 3 3 6 274 1 634 000 3. 3
C u b a 1774 28 1.1953 1970 a ) 6 8 2 6 0 0 0 8 0 7 4 00 0 2 .2
D o m in ic a n R e p u b lic 192 0 7 V m 1960 1970 3 0 4 7 0 7 0 4 0 2 9 000 3 . 6
E c u a d o r 195 0 25 X I 1962 1972 4 6 4 9 6 4 8 5 695 000 3. 4
E l S a lv a d o r 193 0 1 V 1961 1971 2 5 1 0 984 3 2 6 6 00 0 3 . 7
G u a te m a la 188 0 18 IV 1964 1971 4 2 8 4 4 7 3 4 864 000 3. 1
G u y a n a 1831 7 IV 1960 5 6 0 3 3 0 7 1 9 00 0 3. 1
H a iti 1918 7 V IE 195 0 a ) 3 9 9 1 0 0 0 4 6 7 1 0 0 0 2 . 0
H o n d u r a s 1791 17 IV 1961 1971 1 8 8 4 7 6 5 2 4 1 3 000 3 .4
J a m a i c a 184 4 7 IV 1960 1970 1 6 0 9 814 1 9 1 3 000 2 . 4
M e x ic o 1895 8 V I 1960 1970 34 92 3 129 47 2 6 7 000 3. 5
N ic a r a g u a 1778 25 IV 1963 1971 1 5 3 5 588 1 8 4 2 000 3. 6
P a n a m a 1911 11 X H 19 6 0 1970 1 0 7 5 541 1 3 7 2 0 0 0 3 .3
P a r a g u a y 1936 14 X 1962 1972 1 8 1 9 103 2 2 3 1 0 0 0 3 .2
P e r u 1876 2 V H 1961 1971 9 9 0 6 746 12 772 000 3. 1
T r i n i d a d a n d T o b a g o 1891 7 IV 1960 1970 827-957 1 0 2 1 0 0 0 2 . 0
U n ite d S ta te s 1790 1 IV 1960 1970 179 3 2 3 1 7 5 199 8 7 0 0 0 0 1. 2
U r u g u a y 1852 16 X 1963 1972 2 592 563 2 818 00 0 1 .2
V e n e z u e la 1873 26 H 1961 1971 7 523 999 9 6 8 6 00 0 3. 5
A n tig u a 1911 7 IV 1960 1970 54 304 62 000 0 .2
B a h a m a I s la n d s 1891 15 X I 1963 1 3 6 368 177 0 0 0 6. 5
B e r m u d a 1861 23 X 1960 42 640 50 000 1. 5
B r i t i s h H o n d u ra s 1891 7 IV 1960 1970 9 0 1 2 1 116 0 0 0 3. 1
C a n a l Z o n e 1912 1 IV 1960 1970 4 2 1 2 2 5 6 0 0 0 2 . 3
C a y m a n I s la n d s 1934 7 IV 196 0 1970 7 622 9 000 6. 7
D o m in ic a 1860 7 IV 196 0 1970 5 9 916 72 000 2 . 7
F a lk l a n d I s la n d s 1881 18 IH 1962 2 1 7 2 2 000
F r e n c h G u ia n a 1946 16 X 1967 4 4 392 b ) 4 6 0 0 0 5. 6
G r e n a d a 1891 7 IV 1960 1970 8 8 677 103 00 0 2 . 1
G u a d e lo u p e 1946 16 X 1967 3 1 2 724 3 1 8 0 0 0 1. 3
M a r tin iq u e 1 94 6 16 X 1967 3 2 0 0 3 0 3 2 4 00 0 1. 4
M o n t s e r r a t 1911 7 IV 1960 1970 12 108 15 000 1 .9
N e th e r l a n d s A n tille s 1 960 31 X H 1960 1 8 8 914 2 1 5 000 1 .3
P u e r t o R ic o 1 860 1 IV 19 6 0 1970 2 3 4 9 544 2 723 000 1. 6
S t. K i t t s - N e v i s a n d A n g u illa 1921 7 IV 19 6 0 1970 5 6 591 5 6 0 0 0 0 .2
S t. L u c ia 1891 7 IV 1960 1970 8 6 1 0 8 1 0 8 0 0 0 2 . 8
S t. P i e r r e a n d M iq u e lo n 1888 12 V I 1967 5 1 8 6 5 000
S t. V in c e n t 1851 7 IV 1960 1970 79 948 93 0 0 0 2. 0
S u r in a m 1950 31 H I 1964 3 2 4 2 1 1 3 7 5 000 3. 7
T u r k s a n d C a ic o s I s la n d s 1871 7 IV 1960 1970 5 716 6 000
V ir g i n I s la n d s (UK) 1881 7 IV 1960 1970 7 34 0 9 000 1. 9
V ir g i n I s la n d s (US) 1917 1 IV 196 0 1970 32 099 5 8 0 0 0
