The overall health of Belizeans during the 1980s improved markedly from the colonial period. By 1989 life expectancy at birth had risen to sixty-seven years for males and seventy-two years for females. The death rate dropped from 11.5 per 1,000 in the 1950s to 4.9 per 1,000 in 1980, while the published infant mortality rate declined from 93 per 1,000 in the 1950s to 24.8 per 1,000 in 1986. However, actual infant mortality was probably higher because people living in remote rural areas rarely reported infant deaths. Even so, the infant mortality rate for the largely rural Toledo district was more than double the national rate.

The underreporting of infant deaths in rural areas led the World Health Organization to classify Belize's morbidity and mortality statistics as unreliable. Outside of Belize City, facilities for testing for cases of malaria and dengue fever were inadequate, so the incidence of these illnesses has probably been underestimated. The incidence of other diseases, such as acquired immune deficiency syndrome (AIDS), was also believed to be higher than reported.

Despite a massive Anopheles mosquito-eradication campaign in the 1970s, malaria remained Belize's top health problem in the 1980s. After increasing by an annual rate of 30 percent between 1980 and 1983, the number of new cases has since slowed. A more resistant Plasmodium facilparum organism (instead of the usual Plasmodium vivax variety) caused many of the new cases of the disease. Malaria affected all areas of the country, except for Belize City and the cays, which lacked the Anopheles mosquito.

Dengue fever, another disease transmitted by mosquitoes, experienced a resurgence in the 1980s the disease was thought to have been eradicated in the 1950s. Gastroenteritis and other intestinal diseases also continued to pose major health problems for Belizeans, especially for the rural poor. Although the Latin American cholera outbreak had not troubled Belize by the summer of 1991, health officials expressed fear that it was only a matter of time before the disease reached the country.

As elsewhere in the world, AIDS poses a serious and growing challenge to the Belizean health care system. Until 1990, Belize lacked facilities to test for the AIDS-causing human immunodeficiency virus (HIV). By August of 1990, ninety-four Belizeans had tested positive for HIV (up from an estimated three in 1986), and twenty-four persons had died of AIDS. Although every district of the country was affected, half of the people testing positive for HIV lived in Belize City.

Rivers, streams, and creeks provide 70 percent of Belizean domestic water needs. Although the threat from industrial pollution was still limited in 1990, the lack of effective sewage systems in most communities, along with the use of these same water sources for laundry and bathing, posed significant health risks. Pesticide and fertilizer run-off in agricultural areas also posed potential problems.

Belmopan, a planned capital, was the only Belizean community to be served fully by a municipal sewer system 1000 m in 1991. After more than ten years of financial and technical support from the Canadian International Development Agency (CIDA), a sewer system for Belize City was completed in the 1980s. However, as recently as 1991, most city households were still not connected to the system.

Government health policy emphasized primary health care, particularly for people most in need, such as children, pregnant women, and the poor. However, health care services were unevenly distributed between rural and urban areas, and many people in need lacked regular access. The government directed most of its health budget in the 1980s toward operating the eight hospitals located in the capital and district towns. Many of these hospitals were old, overcrowded, and in need of equipment and supplies. A new hospital, to be built with European funds, was planned for Belize City. Twenty-nine health centers served the remainder of the population, although less than 50 percent of the facilities were fully staffed. But even the fully staffed centers lacked a complete range of health care services. Only one facility specialized in caring for the disabled, and one in caring for the mentally ill. Both facilities were located in Belize District.

A lack of personnel hindered the development of the Belizean health care system. Fewer than 100 physicians worked in the country in the late 1980s. The country had a school of nursing and a program for medical technicians but lacked a school of medicine. Many Belizeans who went overseas to study medicine never returned home to practice. Indeed, during the 1980s, two of every three government doctors and virtually all of the dentists were foreign citizens.

Legislation protecting the health of Belizean citizens, particularly in the workplace, was weak and poorly enforced. Belize did, however, have a social security system, designed with the help of the United Nations International Labour Organisation. In addition to providing pensions for retired and injured workers, the system also provided short-term benefits for sickness and maternity leave.

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There is a small but growing body of literature on Belizean society. O. Nigel Bolland has been one of the most prolific contributors to this discourse. His Belize: A New Nation in Central America is the best general introduction to historical and contemporary social conditions, while his Colonialism and Resistance in Belize provides in-depth treatment of more specific issues. Norman Ashcraft's Colonialism and Underdevelopment: Processes of Political Economic Change in British Honduras, although dated, still provides a useful overview of rural life.

Most work on Belize, however, appears in the form of articles, conference papers, and unpublished dissertations. The journal Belizean Studies serves as a clearinghouse for much of this work. The Society for the Promotion of Education and Research in Belize City publishes collections of recent research, one of which is Belize: Ethnicity and Development. (For further information and complete citations, see Bibliography.)

Data as of January 1992