Costa Rica: Achievements of a Heterodox Health Policy
Costa Rica is a middle-income country with a strong governmental emphasis on human development. For more than half a century, its health policies have applied the principles of equity and solidarity to strengthen access to care through public services and universal social health insurance. Costa Rica’s population measures of health service coverage, health service use, and health status are excellent, and in the Americas, life expectancy in Costa Rica is second only to that in Canada. Many of these outcomes can be linked to the performance of the public health care system. However, the current emphasis of international aid organizations on privatization of health services threatens the accomplishments and universality of the Costa Rican health care system. [publication abstract] [American Journal of Public Health, April 2008, Vol 98, No. 4, pp.636-643]
Discourses on Violence in Costa Rica, El Salvador, and Nicaragua: Laws and the Construction of Drug- and Gender-Related Violence
In Central America, legislation aiming to reduce violence and crime has become an important topic in the security debate. Focusing on Costa Rica, El Salvador, and Nicaragua, this paper analyzes laws and other legal texts regarding the trade in and consumption of drugs on the one hand, and gender-related violence on the other. It shows how the content and the wording of legal texts contribute to the social construction of stereotyped offenders, such as youth gang members, drug users, or foreign nationals. The legal texts in Costa Rica, El Salvador, and Nicaragua reflect both the hegemonic and the counter-discursive influences on each country's legal discourse. [author abstract] [Click on One-Click Download to open document in a new page] [GIGA Research Programme: Violence, Power and Security, N° 72 March 2008]
Factors associated with hypertension prevalence, unawareness and treatment among Costa Rican elderly
Background: Reliable information on the prevalence of hypertension is crucial in the development of health policies for prevention, control, and early diagnosis of this condition. This study describes the prevalence of hypertension among Costa Rican elderly, and identifies co-factors associated with its prevalence, unawareness and treatment. Methods: The prevalence of hypertension is estimated for the Costa Rican elderly. Measurement error is assessed, and factors associated with high blood pressure are explored. Data for this study came from a nationally representative sample of about 2,800 individuals from CRELES (Costa Rica: Longevity and Healthy Aging Study). Two blood pressure measures were collected using digital monitors. Self reports of previous diagnosis, and medications taken were also recorded as part of the study. Results: No evidence of information bias was found among interviewers, or over time. Hypertension prevalence in elderly Costa Ricans was found to be 65% (Males = 60%, Females = 69%). Twenty-five percent of the studied population did not report previous diagnoses of hypertension, but according to our measurement they had high blood pressure. The proportion of unaware men is higher than the proportion of unaware women (32% vs. 20%). The main factors associated with hypertension are: age, being overweight or obese, and family history of hypertension. For men, current smokers are 3 times more likely to be unaware of their condition than non smokers. Both men and women are less likely to be unaware of their condition if they have a family history of hypertension. Those women who are obese, diabetic, have suffered heart disease or stroke, or have been home visited by community health workers are less likely to be unaware of their hypertension. The odds of being treated are higher in educated individuals, those with a family history of hypertension, elderly with diabetes or those who have had heart disease. Conclusion: Sex differences in terms of hypertension prevalence, unawareness, and treatment in elderly people have been found. Despite national programs for hypertension detection and education, unawareness of hypertension remains high, particularly among elderly men. Modifiable factors identified to be associated with prevalence such as obesity and alcohol intake could be used in educational programs aimed at the detection and treatment of those individuals who have the condition. [author abstract] [BMC Public Health 2008, 8:275]
Health in the Americas 2007: Costa Rica
As a health agency, the Pan American Health Organization’s core discipline is epidemiology, which enables the measurement, definition, and comparison of health problems and conditions and their distribution from the perspectives of population, geography, and time. This publication on Costa Rica addresses the issue of health as a human right, taking into account both the individual and community contexts, and examines various critical determinants of health, including those of a biological, social, cultural, economic, and political nature. That examination reveals the existence of gaps, disparities, and inequities that persist in Costa Rica, especially those related to access to basic services, health, nutrition, housing, and adequate living conditions as well as to the lack of opportunities for human development—all of which contribute to the greater vulnerability to diseases and health risks of some population groups. [Adapted from the preface of Health in the Americas 2007]
Health Sector Reform in Costa Rica: Reinforcing a Public System
"The Costa Rican health sector is dominated by the state. A single public institution monopolizes health insurance and provides most of the curative and preventative services available in the country. The health sector reforms of the 1990s are unusual among Latin American cases because Costa Rican authorities rejected key aspects of the regional reform agenda, such as privatization and decentralization. Instead, Costa Rican health reforms have sought to improve the public system by completely overhauling the primary care network and deconcentrating administrative responsibility. This paper traces the political process of health sector reform in Costa Rica. After a summary of the history and organization of the sector as well as the major problems it faced on the eve of reform, the paper maps the evolution of the health reforms begun in the 1990s. The description begins with the reform program’s intellectual origins and negotiation with the World Bank and continues through two stages of implementation." [Prepared for the Woodrow Wilson Center Workshops on the Politics of Education and Health Reforms, Washington D.C., April 18-19, 2002]
Organisational and occupational risk factors associated with work related injuries among public hospital employees in Costa Rica
Aims: To explore the relation between occupational and organisational factors and work related injuries (WRI) among public hospital employees in Costa Rica. Methods: A cross-sectional survey was conducted among a stratified random sample of 1000 employees from 10 of the 29 public hospitals in Costa Rica. A previously validated, self-administered questionnaire which included occupational and organisational factors and sociodemographic variables was used. From the final eligible sample (n = 859), a total of 842 (response rate 98%) questionnaires were returned; 475 workers were analysed after excluding not-at-risk workers and incomplete questionnaires. WRI were computed for the past six months. Results: Workers exposed to chemicals (RR = 1.36) and physical hazards (RR = 1.26) had higher WRI rate ratios than non-exposed workers. Employees reporting job tasks that interfered with safety practices (RR = 1.46), and a lack of safety training (RR = 1.41) had higher WRI rate ratios than their counterparts. Low levels of safety climate (RR = 1.51) and safety practices (RR = 1.27) were individually associated with an increased risk of WRI. Also, when evaluated jointly, low levels of both safety climate and safety practices showed the highest association with WRI (RR = 1.92). Conclusions: When evaluated independently, most of the occupational exposures and organisational factors investigated were significantly correlated with an increased injury risk. As expected, some of these associations disappeared when evaluated jointly. Exposure to chemical and physical hazards, lack of safety training, and low levels of safety climate and safety practices remained significant risk factors for WRI. These results will be important to consider in developing future prevention interventions in this setting. [author abstract] [Occup Environ Med 2005; 62: 337–343]
Sterilization, Gender, and the Law in Costa Rica
"Sterilization rights play a central role in Costa Rican women’s reproductive autonomy. There, as in most of the world, women are sterilized at far greater rates than are men. In a 1997 study, for example, 20% of Costa Rican women relied on female sterilization, compared to 1% who relied on their partner being sterilized. This wide and persistent disparity in sterilization rates means that even facially neutral laws regarding sterilization automatically affect more women than men. This greater reliance on female sterilization may stem from ignorance about vasectomy and women’s more frequent contact with the healthcare system, but it also reflects the higher physical and sociological burdens that unwanted pregnancies place on women. Such burdens are particularly daunting in a country such as Costa Rica, where abortion is not legally available in most cases. Within this context, the option of sterilization rather than temporary forms of birth control is an appealing one to many women who want reliable control over their fertility. In this Note, I argue that both formal and informal laws regarding sterilization have reflected and created gender status in Costa Rica. Formal laws regulating access, though gender-neutral, have depended on societal conceptions of gender roles, and in turn have shaped those roles. At the same time, informal laws — the ways in which courts, agencies, service providers and the public have interpreted and applied laws about sterilization — have diverged sharply from the formal law but have just as powerful an effect on people’s lives. Throughout the evolution of sterilization law in Costa Rica, the gendered effects of facially-neutral laws, compounded by highly gendered application and interpretation of the laws, have tightly controlled women’s access to this form of contraception. However, advocacy rooted in demands for women’s rights and autonomy has led to increased reproductive choice for women." [Yale Human Rights & Development L.J. Vol. 4, 2001, pp.109-129]
Surgery in Costa Rica
This article describes how surgery developed in Costa Rica and how it was nurtured to its present status. The practice of surgery in Costa Rica developed slowly as a charitable service. In the past 3 decades, it became accessible to 87.6% of the population through the creation of a national health service system. Our objective herein is to give the reader an understanding of how surgical practice originated and matured in Costa Rica, viewed in the broader context of medical practice in a fledgling and poor New World colony. Also discussed are social and political sentiments in the country that are thought to have helped evolve the present surgical standard. [publication abstract] [Arch Surg, vol 137, Dec 2002, pp.1435-1440]

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