Introduction
Alongside a reputation as one of the world’s most peaceful countries, Costa Rica is famed for its wealth of biodiversity and high number of volcanoes. These features contribute to an abundance of natural beauty that attracts tourists from all over the world. Costa Rica is also well-known for its fine selection of rich, artisan chocolates and coffees – but what impact do these high-quality treats have on the health of the Costa Rican population?
Read on to find out more about the genomics and healthcare fields in one of the happiest countries in the world!
Population of Costa Rica
Costa Rica is a small nation in Central America. It occupies only 0.03% of the world’s surface, yet it is home to over 5% of the total global biodiversity. It is bordered by Nicaragua to the north and Panama to the south and is also bounded by the Pacific Ocean and the Caribbean Sea.
Christopher Columbus resided in Costa Rica for 18 days during his fourth, and final, voyage across the Atlantic in 1502. The discovery of Costa Rica by these European travellers led to the region subsequently coming under the control of the Spanish. Despite this, Europeans did not settle en masse in Costa Rica until later that century. Spanish rule persisted in the nation for more than 300 years, and much of the country’s culture has been influenced by the Spaniards.
Costa Rica is known for having a more peaceful history than that of other Central American nations, facing little bloodshed over the centuries. However, this does not equate to an altogether happy history – Spanish rulers notoriously neglected the colony, and poverty was rife in Costa Rica until the turn of the 21st century. Following the Mexican War of Independence, Costa Rica and other Spanish colonies unilaterally declared independence from Spain in 1821. The short-lived Costa Rican Civil War of the 1940s in response to political unrest led to the drafting of a new constitution in 1949, and the region has had a relatively stable history since.
Today, Costa Rica is the most popular tourist destination in Central America. Given how long the country was under Spanish control, the vast majority of inhabitants are of European descent. However, the 2000 census showed that almost 10% of Costa Rican residents were migrants from nearby Central American nations.
Geographic and Population Statistics
Summary Statistics
- Land area: 330,803 km2
- Gross domestic product (GDP):
- Total: $129.95 billion (2022)
- Per capita: $24,837 (2022)
Population Statistics
- Population size: 5.2 million (2022)
- Birth rate: 12 per 1000 (2020)
- Death rate: 6 per 1000 (2020)
- Infant mortality rate: 6 per 1000 (2021)
- Average life expectancy: 79 (2020)
- Male: 77 (2020)
- Female: 82 (2020)
- Ethnicity: 83.6% white or Mestizo (Mixed European/Indigenous ancestry), 6.7% Mulatto (Mixed African/European ancestry), 2.4% Indigenous Costa Rican, 1.1% Black, 6.2% Other.
Healthcare System
The Costa Rican health system is highly regarded, with the World Health Organisation ranking it 36th in the world. It is one of few Central American nations that provide universal healthcare.
Healthcare is governed by the Costa Rican Social Security Fund (CCSS), which operates autonomously from the Costa Rican Ministry of Health. All citizens and permanent residents are entitled to care through the CCSS, so long as they are enrolled in the system and contribute via their wages. Employers are also mandated by law to contribute to the CCSS. These contributions entitle employees and their dependents to high quality primary care, specialist and in-patient care and prescription medications.
The CCSS also provides emergency care free-of-charge to those who do not contribute, such as the unemployed and even undocumented migrants. To receive further care, these individuals must pay out-of-pocket or enrol in a private health care scheme. However, the vast majority of Costa Ricans are covered fully by the CCSS.
The CCSS controls and funds 30 hospitals and 250 healthcare clinics across the country. Despite its overall good reputation, the public health system has faced criticism for the concentration of resources in urban areas and long wait times. A private health sector exists to combat these issues, and around a third of the population have some form of private coverage. Private health care premiums are determined by the individual’s income, with higher earners paying more. Private insurance in Costa Rica costs comparatively less than similar schemes in other nations, yet the care provided is known for being high quality.
In 2020, there were thought to be around 3 physicians per 1,000 individuals in Costa Rica, equalling the global average.
Healthcare Priorities
Due to the high-quality healthcare offered in the country, the Costa Rican population is known for being healthy. Life expectancy has increased steadily in the latter part of the 20th century and early 21st century. Infant mortality rates have also decreased significantly, from 68 per 1,000 in the 1960s to 6 per 1,000 in 2020.
The leading causes of death in Costa Rica are cardiovascular diseases and cancer. The country also suffers from the problem of an ageing population. This has led to an increase in chronic, noncommunicable diseases in the region. These diseases are thought to contribute to around 80% of deaths in Costa Rica. In response to this, care for the elderly has been highlighted by the CCSS and projects such as the Cartago Da Vida al Corazón were set up in the 2000s to improve heart health in the region.
Another significant contributor to the growing number of noncommunicable diseases in the country is obesity. Around a third of Costa Rican women and a quarter of men are obese, according the Global Nutrition Report. This is higher than the Central American average. These rising rates are due to the increased prevalence of high fat diets in the region and reduced physical activity. To combat this, the Government are implementing plans to improve the health of children and young people to prevent a further rise in the number of obese individuals.
Costa Rica has a relatively low alcohol consumption rate, partially due to strict laws around drinking in public spaces and a very low drink-driving tolerance. However, tobacco use is prominent in the nation and around 9% of the population are reported to be smokers. This number has however decreased in recent years following the introduction of one of the world’s strictest anti-smoking policies in 2012, banning tobacco use in a wide range of public places, including outdoor spaces such as parks.
The rate of stomach cancer in Costa Rica is second only to the rate in Japan. Since the early 2000s, Costa Rica has been trying to decrease mortality due to the disease, including by increasing screening capabilities.
Genomic Medicine Capabilities
Costa Rica has a well-established newborn screening program, with the majority of infants undergoing testing within the first few days of life. Implemented in 1990, the newborn screening program in Costa Rica includes tests for maple syrup urine disease, phenylketonuria and congenital hypothyroidism. The tests, and follow up care, are provided by the CCSS.
According to a 2020 publication by the Economist Intelligence Unit, Costa Rica is one of the best-prepared Latin American countries when it comes to implementing personalised medicine. The report determined that the nation already has a significant amount of the necessary infrastructure in place, including the use of electronic health records, unlike in many other Latin American states. However, one aspect holding the nation back is a lack of laboratory infrastructure to perform genetic testing, with much of this work being outsourced to third party nations.
As of 2019, genetic counselling was not a recognised career in much of Central America. Cuba and Brazil are the only nations with genetic counselling capabilities.
The results of a survey published in 2021 showed that the majority of Costa Ricans would happily donate their genetic data for research purposes, but only around a third of the population would willingly do this to facilitate for-profit initiatives. Currently there is no legislation governing the use of genetic data in the country, and many are concerned that their genetic data could be used by insurance companies or employers to discriminate against them.
Notable Projects
SARS-CoV-2 Surveillance: Latin America suffered devastating consequences due to COVID-19 and it was the worst hit region in the world. In response to this devastation, Costa Rican scientists carried out extensive surveillance of SARS-CoV-2 and mapped genetic variants of the virus to determine the origins of outbreaks in the country.
Clinical and Genetic Analysis of Costa Ricans with Parkinson’s Disease: This project was carried out by Costa Rican researchers to combat a lack of diversity in Parkinson’s disease research. With a goal to describe clinical and genetic factors for Parkinson’s disease specific to the Costa Rican and wider Latin American population, the team assessed over 100 patients for relevant biomarkers.
Genetics of Latin American Diversity (GLAD): Another project addressing the lack of diversity in healthcare research, GLAD is a database containing genomic data from Latin American individuals. With an aim to mitigate the lack of non-European representation in genomics research, the database contains genetic data from over 54,000 people, including a significant number from Costa Rica.
BioAlfa: BioAlfa is a project that aims to use DNA barcoding to identify every plant and animal species found in Costa Rica, highlighting the abundant biodiversity in the nation.
Notable Institutions:
Costa Rican Institute for Research and Teaching in Nutrition and Health (INCIENSA): INCIENSA is a research institute that is responsible for public health research, including, but not limited to, food intake and diet. Additionally, the centre is responsible for epidemiological surveillance, and in early 2020 scientists at the institute successfully sequenced a SARS-CoV-2 genome.
University of Costa Rica: Located in San Jose, the University of Costa Rica is the country’s oldest higher education institution. Significant research is undertaken on the campus, including in a wide range of biological fields.
National Biodiversity Institute of Costa Rica (INBio): Given that Costa Rica is home to so many plant and animal species, it is no shock that INBio is one of the most prominent biodiversity institutes in the world. The institute was one of the first to use extensive computational biology methods to analyse biodiversity and pioneered the “Atta” system for tracking species.
Tropical Disease Research Program (PIET): Integral in the research of pathogens in Costa Rica, PIET performs significant virus research and has been using computational techniques for over 20 years. RNA sequencing and phylogenetic analyses are key components of research at PIET.
People:
Clodomiro Picado Twight: Twight was a famous Costa Rican scientist known for his research into snake venom and antivenoms. Similar to Scottish physician Alexander Fleming, Twight researched moulds in the 1920s and discovered a pre-cursor to penicillin, which he was using to treat patients prior to Fleming’s findings.
Karl Schosinsky: Schosinsky is a Costa Rican microbiologist who developed a technique to diagnose Wilson’s disease – a genetic condition that is more common in Costa Rica than in any other country. The disease was not diagnosed at such high rates until the advent of Schosinsky’s test.
Mavis Montero: A Costa Rican materials chemist, Montero is responsible for the development of biomaterials and nanoparticles for use in bone implants. These implants can be used to repair damaged or diseased bones.
Future Genomics Landscape
Overall, the use of genomic medicine in Costa Rica is still in its early stages, but it has the potential to significantly improve patient care and outcomes in a variety of medical settings. Despite the current lack of services such as genetic counselling, the Economist’s prediction that Costa Rica is one of the most prepared Latin American countries for the implementation of genomic medicine is something to be excited for.
In 2022, it was announced that a collaboration would be taking place between Costa Rica, Penn Medicine and the Children’s Hospital of Pennsylvania, allowing children from the Central American nation to receive CAR-T cell therapy in the US, before flying back to Costa Rica with a supply of the genetically engineered immune cells for further treatment. This partnership aims to increase Costa Rica’s cancer research output and contribute to global equality in the field of oncology.
The future of genomics research and medicine is further supported by companies such as Illumina increasing access to products throughout Latin America. Additionally, Wellcome Connecting Science have developed training modules in viral genomics, bioinformatics, single cell technologies and other omics approaches that are available free-of-charge to researchers in Latin America and the Caribbean.
These factors, alongside the development of projects like GLAD, should help put Costa Rica on the map in the field of genomics and allow genetic medicine to be at the forefront of the healthcare system in the coming years.
References
Britannica. Costa Rica. Available at: https://www.britannica.com/place/Costa-Rica
World Bank. Indicators. Available at: https://data.worldbank.org/indicator
Wikipedia. Healthcare in Costa Rica. Available at: https://en.wikipedia.org/wiki/Healthcare_in_Costa_Rica
Columbia University. Costa Rica Health Summary. Available at: https://www.publichealth.columbia.edu/research/others/comparative-health-policy-library/costa-rica-summary
Moreno E, Lomonte B, Gutiérrez JM. Computational biology in Costa Rica: the role of a small country in the global context of bioinformatics. PLoS Comput Biol. 2008 Mar 14;4(3):e1000040. doi: 10.1371/journal.pcbi.1000040. PMID: 18369430; PMCID: PMC2265517.
The Economist Intelligence Unit. 2020. Personalised Healthcare in Latin America. Available at: https://www.researchgate.net/publication/346061802_Personalised_Healthcare_in_Latin_America-_Universalising_the_promise_of_innovation
Brosco, J., Holzman Castellands, T. and Gelpi, A., 2022. Newborn Screening in Latin America: A Window on the Evolution of Health Policy. OBM Genetics, 6(1), pp.1-4.
