According to the World Bank in 2006, by the year 2004, Costa Rica had a per capita gross national income of about US$4,700 and a health expenditure of $310.
These figures are about one-tenth those in high-income countries. In the USA, these amounts were $41,400, and $5,700, respectively. Indicators of health services, such as, per capita physicians and hospital beds, are also substantially lower in Costa Rica. They equate to only one-third the number of USA physicians and, one-tenth the number of Japanese beds. It is perple-xing that a country with these modest levels of well- being, health investments, and infrastructure may be the one with the highest life expectancy among the elderly.
Robust data from a voter registry show that Costa Rican nonagenarians have an exceptionally high live expectancy. Mortality at age 90 in Costa Rica is at least 14% lower than an average of 13 high-income countries. This advantage increases with age by 1% per year. Males have an additional 12% advantage. Age-90 life expectancy for males is 4.4 years, one-half year more than any other country in the world. These estimates do not use problematic data on reported ages, but ages are computed from birth dates in the Costa Rican birth-registration ledgers. Census data confirm the exceptionally high survival of elderly Costa Ricans, especially males. Comparisons with the United States and Sweden show that the Costa Rican advantage comes mostly from reduced incidence of cardiovascular diseases, coupled with a low prevalence of obesity, as the only available explanatory risk factor. Costa Rican nonagenarians are survivors of cohorts that underwent extremely harsh health conditions when young, and their advantage might be just a heterogeneity in frailty effect that might disappear in more recent cohorts. The availability of reliable estimates for the oldest-old in low-income populations is extremely rare. These results may enlighten the debate over how harsh early-life health conditions affect older-age mortality.
According to the World Bank (2006), by 2004, Costa Rica had a per capita gross national income of about US$4,700 and a health expenditure of $310. These figures are about one-tenth those in high-income countries. In the United States, these amounts were $41,400 and $5,700, respectively. Indicators of health services, such as per capita physicians and hospital beds, are also substantially lower in Costa Rica: they equate to only one-third the number of U.S. physicians and one-tenth the number of Japanese beds. It is perplexing that a country with these modest levels of well-being, health investments, and infrastructure may be the one with the highest life expectancy among the elderly.
Broad explanations of Costa Rica’s health achievements in the literature include the orientation of the government toward equity and social development, with large social investments being possible, in part, because of the absence of military expenditures (Rosero-Bixby 1991). The 1949 constitution abolished the armed forces. Investments in education and the very high coverage of health insurance are often mentioned as key factors (Caldwell 1986). Health insurance covers 82% of the population, including the 9% population deemed destitute, whose insurance is paid by the government (Rosero-Bixby 2004). Provision of primary health care, particularly to remote or poor populations, has a quantifiable impact on death rates, especially among children (Rosero-Bixby 1986). A 17-year follow-up of a group of Costa Rican elderly has shown no meaningful differences in survival by socio economic condition (education or wealth) nor by being covered by the national health insurance9 (Rosero-Bixby, Dow, and Lacle 2005); this suggests that the Costa Rican advantage at old ages may be present across the entire society, with no clear-cut health interventions or classic socioeconomic gradients as explanation.
Smoking, past and present, is not a factor among males, nor is high blood pressure or elevated cholesterol or triglycerides levels. It does not seem that Costa Ricans have the genes or a diet that reduce these risk factors. The only lowered risk factor for which Costa Rican males have a clear advantage is a lesser prevalence of obesity. Prevalence of obesity in Costa Rican males is two-thirds that found in the United States. This probably results in the significantly lower prevalence of uncontrolled diabetes in males as measured by the glycohemoglobin level, the only other factor in Table 4 that shows a Costa Rican advantage. Other factors that may be worth investigating are levels of stress, support networks, and the like. The explanations, however, say nothing regarding why the Costa Rican advantage occurs mostly among males, or why the sex gap in mortality is so small. The only thing known so far is that this population exhibits low cardiovascular mortality and that Costa Rican males of these ages are thin. Comparatively, Costa Rican women tend to be obese, which perhaps is due to their high fertility in the past; each extra pregnancy usually increases mother’s weight, as shown, for example, by Arroyo et al. (1995) for Mexican women.
INQUIRIM VITAE 