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Colombia is a developing country located in the northern part of South America. The country experiences regular social and economic difficulties such as the armed conflict in the 20th century and the current illegal drug trade. This state of affairs also contributes to high rates of disease transmission and health risks among the country’s major population groups. Colombia is selected for the analysis as it is reasonable to determine the impact of the above and other negative factors on the health condition of various gender and social groups. Moreover, it is necessary to examine the effectiveness of the governmental measures aimed at minimizing the transmission of diseases.

Healthcare System in Colombia

Finally, the relevant nursing implications should be formulated. This will allow determining the key health priorities and the corresponding interventions necessary for addressing the existing challenges. In general, the health situation in Colombia is very difficult, but it can be improved considerably if proper interventions are designed.

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Location/Geography

Colombia is located in the northwestern part of South America. It borders with the following countries: Panama, Brazil, Venezuela, Peru and Ecuador. It also has maritime borders with other countries. There are six major environmental regions in the country. They are very different according to their climate characteristics. The regions include both the Andes mountain region and the Amazon rainforest one. Colombia also corresponds to the Ring of Fire – the region of the world where substantial volcanic eruptions occur regularly. It creates substantial risks for the population, and the government has to direct major resources towards preventing the potential negative consequences. There are many large rivers in the country. The main ones are Cauca, Magdalena, Atrato and Guaviare. The problem of deforestation also exists, but its scope is lower in comparison with other countries from this region.

Population

The current population of Colombia is approximately 48 million people. Colombia is the third most populated country in the region (after Brazil and Mexico). The country is characterized by the stable increase of its population over the recent years.

Government

Colombia is the traditional presidential democratic republic. This form of the government is included in the country’s 1991 Constitution. The usual division of powers into the legislative, executive and judiciary branches is present in the country. The President of Colombia performs the functions of both the head of state and government. In such a way, he/she utilizes the opportunities of the executive branch to the maximum possible extent. Congress represents the major element of the national legislative branch. It has two Chambers: the Chamber of Representatives and Senate. Four-year terms are used for selecting both representatives and the President. There are four high courts in the country that form the major element of the judicial branch. The country is divided into 32 administrative departments and one capital district. Local governments are organized in all departments, and concentrate on satisfying the needs of the local population.

Economy

The Colombian economy has demonstrated high rates of economic growth in the 20th century. The country has become much more urbanized and industrialized than in previous historical periods. The current national GDP is $377.7 billion (The World Bank, 2015). The country is characterized by stable and positive rates of economic growth. They are presented in Fig. 2 (Trading Economics, 2015).

The country is characterized by a sustainable economic growth. Although the rates of economic growth are not significantly high (the maximum rate is 2.7%), the country has all chances to avoid recession as of the previous several years, and the overall standard of living tends to increase. The largest fraction of the country’s GDP is generated by insurance, finance, real estate, and business services. At the same time, the impact of manufacturing and construction industries is also considerable. Moreover, taxes in Colombia are high, and they do not allow actual and potential entrepreneurs to receive the desired amounts of profit. It also contributes to the growth of illegal drug trade in the country and similar problems.
Despite these economic difficulties, the country’s GDP per capita has a stable and positive dynamics. It is presented in Fig. 3.

The population’s standards of living tend to increase. Taking into account that the country’s population also increases, Colombia shows a very serious economic progress. However, the current GDP per capita is around $4,500, and it is a comparatively low level even for developing countries (Trading Economics, 2015). It means that Colombia should facilitate its economic development to reduce the gap between its economy and those of developed countries. Colombia enjoys a strong position in terms of developing alternative sources of energy. Renewable sources constitute the largest fraction of energy produced in the country. In particular, hydroelectric generation is well-developed in the country. Colombia has one of the most efficient green energy sectors in the world. However, the innovation potential in other spheres of the national economy is still low.

Thus, the Colombian government tries to minimize the existing misbalances of the national economy through declining the fraction of illegal trade and balancing the interests of the private and public sectors. However, the substantial fiscal burden does not create favorable conditions for the national entrepreneurial development. Therefore, further reforms in this sphere as well as a more productive cooperation with international partners and organizations are required.

State of Health

The current state of health in Colombia is not optimal even in comparison with other developing countries. The current life expectancy in Colombia is equal to 78.1 years. More specifically, it is 81.0 years for women and 75.1 years for men (WHO, 2015). The major causes of deaths in Colombia include coronary heart disease (17%), violence (11%), stroke (8%), lung disease (6%), and influenza (5%). HIV/AIDS is the 19th cause of death in the country. The current healthcare expenditure per capita is $533 (The World Bank, 2015). Although it is much lower than that of the developed countries, it is better than in many neighboring developing countries.

Colombia also has unsatisfactory rates of cancer development in the country. The most common types of cancer include prostate cancer (16%), breast cancer (13%), stomach cancer (13%), lung cancers (11%), and cervical cancer (9%) (WHO, 2015). In comparison with other countries, Colombia has a weak position in relation to diseases associated with other neoplasms (8.6%), and it is the third largest level of this disease in the world. Colombia has a strong position in relation to oral cancer (1.5%) and uterin cancer (1%) (WHO, 2015). The smoking percentage is 31% among males and 5% among females. This level is much lower than the average one in the world. Thus, the health state regarding smoking is satisfactory. The obesity percentage is 16.1% among males and 25.7% among females. These levels are also satisfactory in comparison with other countries of the world. However, the current happiness score based on people’s subjective assessment of their living conditions in Colombia is 6.5, which makes it an average result compared to other countries of the world (WHO, 2015).

The probability of dying between 15 and 60 is 148 per 1,000 for males and 73 per 1,000 for females. The life expectancy at birth is equal to 75 years for men and 81 years for women (WHO, 2015). In general, women have much better health in comparison with men. Malaria is a serious health problem in Colombia. The country’s population has the following epidemiological profile. 15% of the population are characterized by a high transmission (>1 case per 1,000 people) and 8% of the population are characterized by a low transmission (<1 case per 1,000 people) (WHO, 2015). Taking into account this situation, the national healthcare agencies should be more oriented towards preventing the occurrence of such epidemic threats in the future. Tuberculosis is also a serious problem in the country. Although its rates tend to decline, they are still below the satisfactory level. The dynamics of tuberculosis in Colombia is presented in Fig. 4 (WHO, 2015).

The country has achieved a substantial progress for the previous 10 years, but the number of tuberculosis patients is still comparatively high. Violence is highly widespread in Colombia. It is the second major cause of death in the country. Moreover, the rates of violence are the seventh highest in the world (WHO, 2015). The annual number of deaths in Colombia caused by violence is equal to 18,075, and constitutes more than 10% of total deaths (WHO, 2015). The death rate is 37.6 per 100,000 of the population being among the highest in the world. One of the possible indirect causes of violence in the country is the illegal drug trade in Colombia. As the government is unable to reduce the distribution of drugs in the country, this social aspect remains almost unregulated. Criminals prefer using violent methods to achieve their objectives. Moreover, criminals often use Colombia as a center of the drug distribution to other countries and regions of the world.

Road traffic accidents are also widespread in the country. They constitute the sixth major cause of deaths in Colombia. The annual number of deaths because of road traffic accidents equals to 7,813 (4.6% of the total number of deaths) (WHO, 2015). The age adjusted death rate in Colombia is 17.05 per 100,000, which makes it approximately the average level compared to other countries of the world.

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Culture/Traditional Medicine

Culture is both diverse and well-developed in Colombia. Due to the country’s geographical location, it experiences the impact of many cultures and traditions. Both European and Native American views are widespread and coexist with one another. Moreover, in this environment, new cultural approaches are applied. The national Ministry of Culture is responsible for solving the most urgent problems in this area as well as promoting Colombian culture abroad. The national culture reflects the current social and economic trends such as globalization, migration and industrialization. Colombian culture both experiences the impact of other cultures and affects the global cultural environment.

The most well-known writer from Colombia is Gabriel Garcia Marquez. He is a Nobel Prize winner and one of the most influential novelists of the 20th century. The most popular music genres in Colombia include salsa, pop, rock, cumbia, etc. Shakira is the most famous Colombian pop-singer. Colombian music is very popular in the world because an effective cooperation between the private and public sectors exist in this context. Colombian cuisine is very different from cuisines of other countries. It includes many tropical fruits, soups, unique desserts and beverages such as coffee, cholado, and juices. Football, motor racing and boxing are the most popular kinds of sports in Colombia. In general, the country is well-integrated into the global sports system.

Traditional medicine is very popular in Colombia both for historical reasons and due to the comparatively low economic level of the population. Around 40% of the Colombian population relies on traditional medicine in various forms. It is the most popular kind of healthcare in the northern part of the country. Homeopathy has been recognized by the government as a legitimate system of medicine since 1905. The standardized requirements were implemented by the government in 1914 (WHO, 2015). In general, traditional medicine principles continue being highly popular in the country. They are of high demand not only among the members of the lower classes but also other social groups.

Healthcare System and Delivery

The healthcare system in Colombia is based on the close cooperation between the government and non-government agencies. The government performs the majority of controlling functions and organizes the work of other stakeholders. Non-governmental organizations are free to introduce innovations and realize independent projects as far as they do not contradict the existing norms and regulations. The general supervision of the healthcare industry is provided by the Ministry of Health and Social Protection of Colombia. It aims at providing the universal access to healthcare services for all Colombian citizens. It participates in all social projects that are related to healthcare issues. It tries to organize the public policy initiatives in an optimal way. The Ministry of Health and Social Protection is responsible for presenting and advocating for the national interests in the sphere of healthcare. The ministry investigates the long-term trends related to the quality of healthcare and life and designs the corresponding interventions.

Colombia experiences problems with the availability of nurses in the country. The current ratio is 1 nurse per 1,000 people (The World Bank, 2015). As the Colombia’s population is equal to around 48 million people, the number of nurses is around 48,000 professionals, and this does not allow satisfying the total demand for nurses and care in the country. The fraction of physicians in the country is lower in comparison with nurses. This situation is typical for both developed and developing countries. There is no need to educate and train as many physicians as nurses due to the specific structure of demand for healthcare services. The current number of physicians is 0.7 per 1,000 people (The World Bank, 2015). It means that the current number of physicians is around 33,600 professionals in Colombia. It seems to be satisfactory and adequate regarding the existing healthcare issues and threats in the country.

Colombia has a centralized system of nursing education. Licensure and similar functions are performed by the Ministry of Health and Social Protection while the nursing education is mostly organized by the Ministry of Education. In general, the government is able to regulate the performance of both of these Ministries in a way to achieve the maximum possible synergic effect. Both Ministries orient not only to the current level of healthcare needs but also to the expected future state of consumer demand. The government tries to allocate the available scarce resources rationally to promote the social well-being of the population. Colombia does not have a well-established network of healthcare organizations and tries to integrate its operations in the global healthcare system through cooperating with international nursing organizations. These include the Academy of Medical-Surgical Nurses, the Association of Child Neurology Nurses, the Emergency Nurses Association, etc. Colombia aims at expanding its cooperation with international nursing organizations.

Health Priorities

Colombia has several health priorities that should be addressed in the near future. It means that these issues require the close attention and the effective coordination of efforts between the public and private sectors. The first health priority is minimizing the spreading of coronary heart disease as it causes around 17% of all deaths in the country (WHO, 2015). It seems that the complex national strategy should be implemented to solve this problem. The government should increase its funding of healthcare initiatives related to dealing with the causes and effects of coronary heart disease. Consequently, healthcare providers should develop innovative mechanisms to address this problem.

The second health priority is minimizing the scope of violence in the country. It is a very serious problem because violence causes around 10% of deaths in the country, and the scope of violence is among the largest in all countries of the world (WHO, 2015). This problem is not only related to health but also requires improving the existing situation with illegal drug trade and other similar problems. The third health priority is examining tuberculosis- and malaria-related threats. Currently, Colombia is able to control the transmission of these diseases, but the risk and potential social harm are very high. Therefore, close attention should be paid to the epidemiological situation in the country. The fourth health priority is addressing the problems related to men’s health as men experience higher health problems in comparison with women in all age groups (Semenic, DeBruyn, & Ochoa-Marín, 2014). The causes of this state of affairs should be specified (including broad economic and social factors), and the corresponding measures should be taken.

Nursing Implications

The stated health priorities will impact the overall national healthcare strategy. They are especially important for nurses as they are the ones who adjust the strategies accordingly. The first priority refers to helping patients cope with coronary heart disease. Nurses should both increase their qualification in this field and be able to identify patients’ symptoms at earlier stages. In this way, the treatment process can be improved substantially, and the overall mortality rates can be reduced. Nurses may also implement changes at the national level regarding a more active use of modern technologies. Currently, Colombia does not have the necessary amount of modern equipment especially in the northern regions of the country. If this problem is addressed, nurses may become more capable of minimizing the risks associated with coronary heart disease.

The second health priority refers to violence-related issues. It seems that nurses cannot address this problem directly, but they can promote a more responsible attitude to one’s own health and that of others among the Colombian citizens. Nurses should focus on young people as they are often involved in the acts of violence (Mesurado et al., 2014). The third health priority is controlling the epidemiological situation in the country. Nurses should monitor the general epidemiological situation not only in Colombia but also other countries of Latin America (Caro Rios et al, 2014). In such a way, it is possible to identify the potential threats in advance and provide the corresponding preventive measures to the population.

The fourth health priority refers to improving the health state of men as this gender group is in a disadvantaged position in the country. Nurses should identify the related problems and the ultimate causes of this tendency. In particular, drug-related issues should be addressed. Nurses should provide additional rehabilitative services for patients who require them. Thus, nurses should play a central role in addressing the selected health priorities. The close cooperation with international nursing organizations may contribute to designing an optimal long-term strategy that will take into account the interests of all parties involved as well as address all major risks and threats.

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