Colombia's leading health indicators indicated consistent improvement over the long term. During the 1950s, life expectancy at birth was under fifty years for the average citizen. In 1988 this indicator had reached approximately sixty-eight years for females and sixty-four years for males. The estimated life expectancy range for the rural population was 10 percent to 30 percent below the national average, varying regionally. In the eastern plains, the Amazon Basin, the southern rural Caribbean coastal region, and especially in the southern and northern Pacific coast, the rate of improvement in life expectancy was substantially lower than the national average in some of the poorest areas, no perceptible change had occurred between the 1950s and the 1980s.

Higher life expectancies were closely correlated with the "spatial" distribution of the population. The higher the level of urbanization, the greater the average life expectancy. The five major cities--with nearly 30 percent of the population--in the early 1980s reported average life expectancies nearly 10 percent above the national average. Analysts anticipated that projected increases in urbanization in the 1990s would have a positive impact on the life expectancy of the nation as a whole.

In 1984 analysts estimated Colombia's infant mortality rate at 52 per 1,000 live births (see table 6, Appendix). The annual rate of decrease fluctuated between 2.4 percent and 2.9 percent during the 1950-84 period, peaking during the second half of the 1970s. Some observers suggested that this pattern was closely associated with greater public expenditures for nutrition and basic care for pregnant women and newborns in rural areas.

Despite these improvements, Colombia's infant mortality indicators were among the poorest of the major Latin American countries. Colombia's figure stood substantially above these countries' norm of 42.8 per 1,000 live births and was more than 200 percent greater than the lowest level recorded for national infant mortality in the region (19.5 per 1,000 live births) during the first half of the 1980s.

Moreover, complementary data suggested that infants and children were the least protected segment of the population. Although Colombia's death rate declined 51 percent from 1970 to 1985, infant mortality diminished only 19.8 percent over the same period. Indeed, despite the gradual improvement of infant health indicators, the benefits of better medical care and living conditions were strongly concentrated in the upper levels of the age pyramid. Infant death rates also were higher in rural areas. Moreover, maternal mortality was high by Latin American standards. Between 20 and 30 percent of maternal deaths were related to complications arising from induced abortion, the vast majority of them performed outside the formal medical system because of legal, cultural, and religious sanctions.

Nutrition in Colombian society improved significantly after the 1950s. The average nutrient and caloric intake improved in quality and quantity, as did the perfo 1000 ormance of the main indicators of nutritional status,ออออออออ such as height, weight, and malnutritionrelated mortality and morbidity. The improvements resulted from increased agricultural productivity in the early 1970s, modernization of eating habits, higher levels of nutritional awareness, and explicit public policies supporting nutritional programs aimed at the poorest segments of society (see The Politics of Health: Priorities, Institutions, and Public Policy , this ch.).

In the 1980s, the health and hazard causes for death were, to a significant degree, considered preventable, treatable, or curable. Most infant and child deaths were linked to diarrheal diseases, digestive tract infections, nutritional disorders, and complications related to immunizable viruses. Many adult deaths resulted from "social pathologies," including homicide and accidents. In addition, as their society aged, Colombians were exhibiting a surge in diseases common to the industrialized world, such as coronary and heart disorders, hypertension-related illnesses, and cancer.

One-fifth of all infant and child deaths (zero to four years of age) resulted from diarrheal and infectious digestive disorders accompanied by the inevitable dehydration complications. These diseases were associated with poor sanitation and living conditions, malnutrition, and lack of parental nutritional awareness. Another fifth of infant mortality originated in complications associated with delivery and birth. This mortality reflected the low level of basic health care for rural pregnant women, which was also associated with high levels of maternal mortality. Respiratory diseases caused another fifth of the deaths in children under four.

Violent criminal attacks and homicide--referred to in Colombia as "blood deaths"--accounted for 45 percent of deaths in persons between fifteen and forty-four years of age. The high rate of homicide and violent deaths was associated with the structural problems of poor law enforcement, high levels of social and political violence, and criminal activities related to narcotics production and distribution (see Post-National Front Political Developments , ch. 4 Internal Security Problems , ch. 5). The impact of violence was exacerbated by a health care system that was designed to handle "normal" or "formal" health disorders and not well suited for emergency medical care. Colombians considered the poor quality of emergency treatment as one of the major flaws of their nation's health care system.

The major causes of death for those over forty-four years of age were coronary and heart degenerative disorders, cancer, and cerebrovascular diseases. Diet--composed of sugars, starches, salted food, and fats high in cholesterol--along with the prevalence of smoking and alcohol consumption contributed to the unusually high incidence of these maladies.

In the early 1980s, the most prevalent illnesses striking Colombians were respiratory infections, ophthalmological and vision problems, digestive tract parasitic diseases, acute upper respiratory tract infections, peripheral vascular problems such as varicose veins, and malnutrition disorders. Over 14.2 million cases of individual illness were attributed to these diseases.

In the 1980s, the duality of the Colombian health profile was also present in the social and regional distribution of morbidity. The poorest segments and regions suffered the most from preventable and curable causes, such as gastrointestinal disorders and certain types of respiratory ailments, whereas the incidence of the degenerative and chronic diseases--typical of urban dwellers and higher-income earners--was relatively low in comparison. Tropical diseases continued to be endemic to certain areas of the country. Because of the acceleration of migratory flows to the unexplored tropical hinterland, diseases such as malaria, dengue, and ye db4 llow fever were increasing. Malaria affected approximately 15 percent of the population--equivalent to roughly one-half of all rural inhabitants.

In the late 1980s, geriatric issues increasingly challenged the country's health care system. The combination of increasing life expectancy, reduction of fertility rates, and diminishing mortality rates produced an older society. Those persons over forty-five increased from 13.5 percent of the population in the mid-1960s to 17 percent in the late 1980s. In absolute terms, this trend meant that more than 4.6 million people in 1990 would enter a period of life characterized by major health concerns related to chronic, catastrophic, and degenerative diseases. The proportional increase in these types of ailments demanded a specific framework for health care, medical technology, and professional specialization that was not widely available in the public health system.

Acquired immune deficiency syndrome (AIDS) was another major health challenge in the late 1980s. Like many other less-developed countries, Colombia was sluggish in tackling the issue of AIDS within its borders and recognizing it as a potentially disastrous health threat. The cultural environment--strongly influenced by traditional values toward sexuality, virility, and homosexuality-- slowed public debate, distorted factual information about the incidence and spread of the virus, and inhibited the formulation of policy and preventive guidelines. In the first quarter of 1988, the official number of confirmed cases of AIDS was fifty-nine. By April that figure had to be revised upward to 153 confirmed cases.

Some sources contended, however, that this dramatic increase showed only a fraction of the total cases. New projections in 1988 suggested that there were 7,650 AIDS carriers. Of that total, 2 percent suffered the terminal stages of the disease, 25 percent were experiencing related opportunistic illnesses, and the remaining 73 percent were in the asymptomatic stage. A doubling of the total number of positive carriers was expected to occur within six months to one year because of the high levels of underreporting, the weakness of preventive measures, and the high incidence of carriers among female prostitutes.

The high cost of health care for AIDS victims would seriously strain the already scarce resources available to treat other diseases. Analysts believed that major funding and resources would not be channeled into the fight against AIDS. As of 1988, the Colombian government had taken few steps beyond attempting to protect the national blood supply.

Data as of December 1988