What a fascinating time to have traveled in Colombia. In addition to being scorching hot (it is bisected by the equator), the country recently settled a painful 55-year Marxist uprising, to say nothing of the extraordinary level of despair on its eastern border with Venezuela. Last week there were large street protests in the capital city of Bogota against proposed changes by President Duque to adjudicate the nearly one million pending cases from the half-century long conflict that claimed 250k lives.
Colombia measures over 440k square miles with a population of 50 million people, which is estimated to have just expanded by over one million Venezuelans fleeing the repressive and wholly incompetent regime of President Maduro. The last two decades saw dramatic GDP growth, which is estimated to be $345 billion in 2019 by Trading Economics (or approximately $7k per capita). Colombia is deemed to be one of only 18 “megadiverse” countries in the world given the level of bio-diversity of the environment.
Notwithstanding the very high level and very visible police and military presence, the peace accords appear to have directly benefitted the well-being and health of the Colombian population. Against initial expectations that a country which had weathered such a grinding protracted insurrection would have an inferior and devastated healthcare infrastructure, the World Health Organization ranked Columbia #22 in the Top 100 Health Systems with an overall Healthcare Efficiency Index of 0.91. For context, France ranked #1 scored 0.99, while the United States was ranked #37 with an index of 0.84. Sierra Leone was ranked last at #191 with 0.00 score.
The Revolutionary Armed Forces of Colombia (FARC), which led the insurgency for all those years, numbered 18k militia at its peak and survived on a diet of extortion, kidnaping and drug smuggling. Estimates are that the organization earned $300 million annually, but over the last decade, the FARC became less of a disruptive force as the government pushed aggressively to integrate the combatants. Notably, in 2008, the Venezuelan President Chavez recognized the FARC as the proper Colombian army, which furthered strained relations between the two countries. Sadly, locals told us to save our smaller bills for the numerous Venezuelan pan-handlers which were more visible than the police and military.
In the 1980’s, the Colombian government made a massive commitment to healthcare. In 1993 only 21% of the population was covered by any health or social security programs; by 2012 that number was 96%. Notwithstanding that according to the most recent data (2017) from the National Administrative Department of Statistics that 26.9% of the population lives below the poverty level (7.4% is in “extreme” poverty – there are three billionaires with aggregate net worth of $17.1 billion per Forbes), Colombia has become one of the main destinations for medical tourism, particularly for cardiology, neurology and dental procedures. In fact, the microkeratome and keratomileusis techniques (affectionately known as LASIK) were invented in Colombia.
Determining Healthcare Efficiency Index is complicated and wrestles with a number of variables to assess progress against three principle goals: (i) has the health of the population improved; (ii) has the responsiveness of the healthcare system increased; and, (iii) is there intrinsic fairness and reduced financial risk to all. Colombia ranks #49 in healthcare expenditures per capita globally and now has average life expectancy of 74.8 years (71.2 for men, 78.4 for women). Good progress.
The success of the Colombian healthcare system shows up in other important metrics, particularly in light of the civil strife for so many years. The country ranks #119 of the 183 countries monitored for incidence of suicides with 7.0 per 100k which compares quite favorably to other South American countries (Uruguay had 16.5 per 100k, Chile had 9.7 per 100k). According to the International Diabetes Foundation, 7.4% of Colombians had diabetes which ranked it an attractive #86 of the 194 countries tracked. Unfortunately, the incidence of obesity is 20.7% according to recent World Health Organization data.
The “peace dividend” appears to be paying off in other interesting ways. According to recently published country data by Numbeo, Colombia ranked #54 on the Pollution Index with a score of 61.7 of the 106 countries measured. As a point of comparison, Finland at #1 scored 11.9 with the United States at #21 with a 34.0 score; choking at the end of list was Mongolia, ranked #106 with score of 93.1.
Of perhaps of greatest importance, Numbeo ranked Colombia #57 with a score of 108.4 on the Quality of Life Index, which while a significant distance from #1 Denmark at 198.6, it was comfortably ahead of Egypt in last place with 84.0. The United States eased in at #13 with score of 179.2.
While there, I learned of an island off the western coast of Colombia called Santa Cruz del Islote (below), which may have dinged Colombia’s Quality of Life score. The size of just over two football fields (~130k square feet), this island is home to 1,250 people and lays claim as being the most densely populated island in the world. Good thing for the residents of del Islote that they are not separately ranked.