Health and education

SIDS receive high scores in human development and adult literacy

Success in human development can be a vital factor of wellbeing for the population and a driver of further economic growth (see Productive capacity). The HDIHuman development index (HDI) is a summary measure of average achievement of human development in three dimensions: health, education and standards of living. The health dimension is assessed by life expectancy at birth, the education dimension by mean of years of schooling for adults aged 25 years and more, and expected years of schooling for children of school entering age. The standard of living dimension is measured by GNI per capita. The HDI is the geometric mean of normalized indices for each of the three dimensions. The cut off points are: HDI of less than 0.550 for low human development, 0.550–0.699 for medium human development, 0.700–0.799 for high human development and 0.800 or greater for very high human development. -—
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—- was created to emphasize that expanding human choices should be the ultimate criteria for assessing development results -—
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—-. In 2019, Palau, Bahamas, Barbados and Mauritius were included in the group of countries with very high human development, classified as countries with HDI scores above 0.80. In addition, 14 SIDSsmall island developing States (SIDS) were recognized as a distinct group of developing countries at the Earth Summit in Rio de Janeiro in June 1992.
More information on UNCTAD official page. were in the high human development category (ranked between 0.70 to 0.79). Perhaps more importantly, none of the SIDS belong to the group of countries with low human development (ranked less than 0.55). On average, SIDS score close to the global average (almost 0.65 in 2000) and have followed a similar trend. Among SIDS, Mauritius has taken a leap from a medium human development country in 2000 (score 0.68) to a very high human development country in 2019 (0.80).

Figure 1. Human development in SIDS

(Index score)

Source: UNCTAD calculations based on -—
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Note: No data for Nauru and Tuvalu. The figure presents a simple average of available country scores for SIDS and World aggregates.

The human assets indexHuman Assets Index (HAI) is a summary measure of the level of human capital. It is composed of six indicators with each indicator carrying an equal weight. It comprises the under-five mortality rate, prevalence of stunting, maternal mortality rate, gross secondary school enrollment ratio, adult literacy rate and gender parity index for gross secondary school enrollment.-—
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—- also ranks SIDS highly. Except for Comoros, Solomon Islands and Timor-Leste, SIDS were above world average in 2020. In 20 years, SIDS have improved their human assets index by 10 per cent as a group. This is the result of improvement across all the sub-indices, especially in reduced maternal and under-five mortality as well as prevalence of stunting. Improvements in school enrolment and adult literacy have also contributed to higher scores in the human assets index.

Figure 2. Human assets index in SIDS, 2020

(Index score)

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Adult literacy is one of the sub-indices of the human assets index. SIDS’ adult literacy rateAdult literacy rate is the percentage of the population aged 15 years and over that can read and write -—
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—-. is relatively high, at 91.2 per cent, and above the world average of 89.9 per cent. The Comoros and Timor-Leste have the lowest rates, with 58.8 and 68.1 per cent, respectively. In Timor-Leste, Cabo Verde, Comoros and Solomon Islands, adult literacy rate is significantly higher for men, with a gender difference between 7.7 and 14.7 percentage points. In contrast, in Jamaica women outscore men in literacy by 9.3 percentage points.

Looking at the data available for 19 SIDS, the Caribbean SIDS reach the highest regional average of 96.8 per cent. Adult literacy is also high, at 90.6 per cent, in Pacific SIDS. Atlantic and Indian Ocean SIDS reach a rate of 87.2, which masks large country differences.

Figure 3. Adult literacy rate, 2018 or latest available year

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Note: Data refer to 2017 for Sao Tome and Principe; 2016 for Trinidad and Tobago; 2015 for Cabo Verde, Grenada and Palau; 2014 for Barbados, Maldives and Samoa; 2011 for Antigua and Barbuda; 2010 for the Comoros and 2009 for Vanuatu.

SIDS’ citizens have a long school life expectancy

Education is one of the three dimensions of human development. Average school life expectancy of SIDS was 11.7 years in 2019. Tonga, Palau and Grenada had the longest school life expectancy in primary and secondary educationSecondary education provides learning and educational activities building on primary education and preparing for both first labour market entry as well as post-secondary non-tertiary and tertiary education. Broadly speaking, secondary education aims at learning at an intermediate level of complexity. ISCED distinguishes lower and upper secondary education -—
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—-., on average 13.5 years. These and most other SIDS were above the world average of 10.5 years of school life expectancy.

School life expectancy remains below 10 years in Tuvalu (9.5 years), Jamaica (9.3 years), Bahamas (9.0 years) and Marshall Islands (8.7 years). For most SIDS, the expected years of schooling exceed the duration of compulsory primary and secondary education. However, in the Marshall Islands and the Bahamas, it remains below the number of compulsory years of education defined in their national legislation.

Globally, the average number of years in primary and secondary education has increased from 8.9 years in 2000 to 10.5 years in 2019. The number of years has increased more for women (from 8.5 years to 10.4) than for men (from 9.3 years to 10.6), making the situation almost equal from a genderGender refers to the roles, behaviours, activities, and attributes that a given society at a given time considers appropriate for women and men. In addition to the social attributes and opportunities associated with being male and female and the relationships between women and men and girls and boys, gender also refers to the relations between women and those between men. These attributes, opportunities and relationships are socially constructed and are learned through socialization processes. They are context/ time-specific and changeable. Gender determines what is expected, allowed and valued in a woman or a man in a given context. -—
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—- perspective. In those SIDS where data are available for both years (2000 and 2019), the situation was already relatively equal in 2000, and in 2019 there was practically no difference between women and men.

Interestingly, there is little difference in average school life expectancy across SIDS regions, with the average ranging from 11.5 years for Atlantic and Indian Ocean SIDS to 11.9 years for Pacific SIDS. Tuvalu and the Marshall Islands in the Pacific, the Bahamas and Jamaica in the Caribbean, and the Comoros in the Atlantic and Indian Ocean were below the global average.

Figure 4. School life expectancy and compulsory education , 2019 or latest available year

(Years)

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Note: Data refer to 2018 for Antigua and Barbuda, Bahamas, Cabo Verde, Comoros, Grenada, and Saint Vincent and the Grenadines; 2017 for Sao Tome and Principe; 2016 for Saint Kitts and Nevis and Samoa; 2015 for Tonga and Vanuatu; and 2014 for Palau.

The net primary educationPrimary education provides learning and educational activities typically designed to provide students with fundamental skills in reading, writing and mathematics (i.e. literacy and numeracy), and to establish a sound foundation for learning and solid understanding of core areas of knowledge and personal development, preparing for lower secondary education. It aims at learning at a basic level of complexity with little if any specialisation -—
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—-. enrolment rate was on average 93.9 per cent in SIDS based on latest statistics available for each country. According to the -—
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—-, the global average was 90.5 per cent in 2018, 0.6 percentage points higher than ten years earlier. Primary education enrolment was slightly lower for girls, at 89.5 per cent in 2018 – little changed from the 89.2 per cent reported in 2009.

Globally, high income countries reached enrolment rates of 96.3 per cent on average, while low income countries remained at 80.5 per cent. Among SIDS, primary education enrolment was below the global average in Marshall Islands (74.1 per cent in 2019), Bahamas (76.5 per cent in 2018), Comoros (81.8 per cent in 2018), Jamaica (82.8 per cent in 2019) and Tuvalu (85.1 per cent in 2019). In the Comoros, the rate has increased significantly from 67.5 per cent in 2000. In Jamaica, on the other hand, the rate dropped from 92.8 per cent in 2000 to 82.8 per cent in 2019, at an equal rate for girls and boys.

SIDS invest in education, but country variation is large

Between 2015 and 2019, government expenditure on education as a percentage of GDPGross domestic product (GDP) was on average 5 per cent for SIDS, above the world median of 4.4 per cent in 2019. The Education 2030 Framework -—
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—- urges all countries to adhere to allocating at least 4 per cent of GDP and at least 15 per cent of total public expenditure to education. This is considered an important prerequisite for achieving SDGSustainable Development Goals (SDG) 4 to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

Among the countries with a higher share of government expenditure on education relative to GDP are Cabo Verde (12.4 per cent in 2015), Bahamas (9.8 per cent in 2010) and Mauritius (6.7 per cent in 2018). In contrast, Dominica (2.6 per cent in 2019), Comoros (2.5 per cent in 2015), and Antigua and Barbuda (2.5 per cent in 2009) allocate the smallest share of government expenditure to education -—
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—-. The absolute differences in investment in education are large across the islands. In Mauritius, for instance, 6.7 per cent equates to an expenditure of US$952 million, meaning about US$750 per capita, while the 2.5 per cent in Comoros equates to an expenditure of US$25 million, approximately US$32 per capita.

One of the measures of resource sufficiency for education is the ratio of pupils per trained teacher. SDG target 4.c aims to substantially increase the supply of qualified teachers by 2030. The global average of pupils per one teacher in primary education was 27.9 in 2019. Sao Tome and Principe had by far the highest ratio among SIDS with 114 pupils per one teacher in primary education in 2017. In preprimary education, i.e., in early childhood education, Solomon Islands also had a high ratio: 94 pupils per teacher in 2018. Figure 5 illustrates the ratios for preprimary, primary and secondary education among SIDS.

Figure 5. Pupil-trained teacher ratio by type of education

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Technology skills are crucial for SIDS

As discussed in Trade vulnerabilities, due to their remoteness, digital connectivity is important and quite well utilized in SIDS. Unfortunately, data are available to assess ICTInformation and communications technology (ICT) skills of the population for only two SIDS (Cabo Verde and Jamaica). Only Jamaica has data disaggregated by gender, which show slightly better ICT skills for women, depending on type of skill. Men were reported to be more skilled in writing code and installing software. Considering the lack of these statistics for other island economies, SDG indicator 17.8.1 on the proportion of individuals using the Internet is presented as a proxy. The indicator on the use of technology should to some extent reflect the ability of the population to use technology better than indicators that focus on access to technology only.

As a region, SIDS have been on par with the global share of Internet users since 2011, when they reached the 30 per cent mark for the first time. By 2017, almost half of SIDS’ population and of the global population were using the Internet. LDCsLeast developed countries (LDCs) are low-income countries confronting severe structural impediments to sustainable development. They are highly vulnerable to economic and environmental shocks and have low levels of human assets -—
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—-. were far behind with a share of 18 per cent. Caribbean SIDS have been ahead of other island economies; by 2017 64 per cent of the population were using the Internet. Three SIDS exceeded 80 per cent, all in the Caribbean, namely: the Bahamas, Barbados and Saint Kitts and Nevis.

Figure 6. Internet users as a percentage of population (SDG 17.8.1)

(Percentage of population)

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Substantial differences in life expectancy across SIDS

In 2018, average life expectancy at birth in SIDS was 72.3 years (74.6 for women and 70.1 for men). Life expectancy varies greatly among SIDS, for example, there is a difference of 15 years in the life expectancy for inhabitants of the Comoros (64.1 years) compared with those living in Barbados (79.1 years).

From 1995 to 2018, life expectancy increased by 5 years in SIDS -—
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—-. The increase was somewhat larger for women (5.1 years) than for men (4.8 years). From 1995, Timor-Leste saw the largest increase of 15.7 years, while Jamaica (+0.2 years) and Seychelles (+0.4 years) barely improved on 1995 levels. In Seychelles, on the other hand, female life expectancy has fallen by 2.1 years during the same period. In Grenada, life expectancy has also decreased gradually by 0.7 years between 2007 and 2018.

Figure 7. Life expectancy at birth in SIDS

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Note: No data for Dominica, Marshall Islands, Nauru, Palau, Tuvalu and Saint Kitts and Nevis.

SIDS’ health expenditure below global average

Health expenditure as a percentage of GDP varies widely between SIDS. Countries such as Tuvalu, Marshall Islands, Federated States of Micronesia and Kiribati had the highest expenditure on health relative to GDP in 2018. In contrast, Vanuatu and Fiji did not exceed 4 per cent of health expenditure in GDP. SIDS’ average of 7.2 per cent remains well below the global average of 9.9 per cent. SIDS’ median expenditure is even lower, at 4.5 per cent, with 22 SIDS below the global average.

Figure 8. Current health expenditure as a percentage of GDP, 2018

(Percentage of GDP)

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Maternal and under five mortality reducing

Most SIDS have been exhibiting a downward trend in maternal mortality since 2000. SDG target 3.1 aims to reduce the global maternal mortality ratio to less than 70 per 100 000 live births by 2030. In 2017, the average rate for SIDS was 80. Twelve SIDS were already at 70 or below; Grenada and Barbados had the lowest ratios, 25 and 27, respectively. The overall declining trend suggests that meeting the SDG target is a realistic prospect for SIDS as a group (see figure 9).

However, a few SIDS have experienced setbacks. Maternal mortality increased in Saint Lucia from 86 in 2000 to 117 per 100 000 live births in 2017. The only other countries with increasing ratios are Jamaica (from 77 to 80) and Mauritius (from 59 to 61).

The Solomon Islands and Timor-Leste saw the highest decreases in maternal mortality from 2000 to 2017, by 58 per cent and 81 per cent, respectively. Regardless of the positive trend in Timor-Leste (from 745 to 142), it remains one of the small island economies with the highest maternal mortality ratio, along with Comoros (273) and Sao Tome and Principe (130).

Figure 9. Maternal mortality ratio in SIDS and path to the SDG target 3.1 (SDG 3.1.1)

(Ratio per 100 000 live births)

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Note: A modelled estimate by WHOWorld Health Organization (WHO), UNICEFUnited Nations International Children's Emergency Fund (UNICEF), UNFPAUnited Nations Population Fund (UNFPA), World Bank Group and the United Nations Population Division. The dotted line illustrates a trend towards the SDG target of 70 by 2030. No data for Dominica, Marshall Islands, Nauru, Palau, Tuvalu and Saint Kitts and Nevis.

SDG target 3.2 aims to reduce preventable deaths of children under 5 years of age to at least 25 per 1 000 live births. In 2019, the rate for most SIDS was below the world average of 37.7. Only Comoros (62.9), Kiribati (50.9) and Timor-Leste (44.2) exhibit a higher rate. In total, 18 SIDS already met SDG target 3.2 and two, namely Fiji and Vanuatu, were very close with rates of 25.7 and 25.9 respectively. Child mortality is declining in SIDS, except for in Dominica, Fiji, Grenada and Saint Lucia. In 2019, in almost all SIDS, the mortality rate for boys under the age of 5 was between 15 and 27 per cent higher than that of girls. In contrast, Tonga has an 18 per cent lower mortality rate for boys than for girls.

Lifestyle diseases common in SIDS

As countries develop economically, changes in food consumption habits and other factors contribute to the increase of non-communicable diseasesNon-communicable diseases, also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental and behaviours factors -—
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—-., such as cancer, diabetes, cardiovascular diseases, digestive diseases, skin diseases, musculoskeletal diseases and congenital anomalies. In 2016, 16 SIDS were above the world average of 71.2 per cent in prevalence of non-communicable diseases, with an average of 74.5 per cent for SIDS. Mauritius, Fiji and Maldives were the three countries with the highest percentage of deaths related to non-communicable diseases.

Figure 10. SIDS with the largest share of non-communicable diseases as a cause of death, 2016

(Percentage of all deaths)

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Note: Data are not available for Dominica, Saint Kitts and Nevis, Marshall Islands, Nauru, Palau and Tuvalu.

ObesityObesity for adults is defined as a body mass index (BMI) greater than or equal to 30. Globally, 13 per cent were obese in 2016 -—
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—-. can be linked to many ill health effects, including to the prevalence of non-communicable diseases. BMIBody mass index (BMI) formerly called the Quetelet index, is a measure for indicating nutritional status in adults. It is defined as a person’s weight in kilograms divided by the square of the person’s height in metres (kg/m2). For example, an adult who weighs 70 kg and whose height is 1.75 m will have a BMI of 22.9. -—
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—- is used commonly to evaluate the likelihood of risks associated with being overweightOverweight for adults is defined as a body mass index (BMI) greater than or equal to 25. Globally, over 39 per cent of adults were overweight in 2016 -—
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—-.. A BMI of over 25 is considered overweight, while a value over 30 is considered obese. Residents of SIDS have quite a high average body mass indexBody mass index (BMI) formerly called the Quetelet index, is a measure for indicating nutritional status in adults. It is defined as a person’s weight in kilograms divided by the square of the person’s height in metres (kg/m2). For example, an adult who weighs 70 kg and whose height is 1.75 m will have a BMI of 22.9. -—
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—- which may contribute to the high rate of deaths due to non-communicable diseases. In 2016, only Sao tome and Principe, Comoros, Cabo Verde and Timor-Leste had an average BMI of under 25. In Nauru, Samoa, Tonga, Tuvalu, Kiribati and Saint Lucia, the average BMI exceeded 30.

COVID-19 in SIDS

In contrast to the COVID-19Infectious disease caused by the strain of coronavirus SARS-CoV-2 discovered in December 2019. Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes a coronavirus disease called COVID-19. pandemic’s disastrous impact on SIDS’ economies (see Trade), its epidemiological and health impact has been more muted compared with many other countries’ experiences. Of course, the situation is always evolving and this has the potential to change. Additionally, there is considerable heterogeneity in terms SIDS’ number of cases and deaths, with some SIDS, especially in the Pacific, experiencing very few cases and sometimes no recorded deaths, and others in the Caribbean and Atlantic and Indian Oceans experiencing higher case and death rates than the global average. Figure 11 illustrates the number of daily cases per 100 000 population by SIDS region. Care should be taken when interpreting COVID-19 data, as different governments and health systems have different reporting practices.

Figure 11. Daily new COVID-19 cases, rolling 7-day average

(per 100 000 people)

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Notes: Data is missing for Kiribati, the Federated States of Micronesia, Nauru, Palau, Tonga and Tuvalu.

We can see that Pacific SIDS have maintained remarkably low case numbers throughout the duration of the pandemic so far. The few cases they did report were almost always imported from abroad, with very few cases of community transmission -—
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—-. Pacific SIDS’ remoteness and relatively smaller economies likely aided them in combatting transmission and importation of the virus. Caribbean and Atlantic and Pacific Ocean SIDS have not been as untouched, with the Caribbean SIDS able to largely avoid initial outbreaks until August 2020, at which time the rate of new cases began to outpace the global average, before falling again until January 2021. Since then, Caribbean SIDS have again been experiencing higher rates of new infection than the global average. In terms of cases, Atlantic and Indian Ocean SIDS’ experiences closely mirror those of Caribbean SIDS, with the exception of not avoiding an initial outbreak from April to August 2020, tracking the global average closely over that time period. SIDS’ experiences in terms of deaths due to COVID-19 have been slightly different from that in terms of cases, as illustrated in figure 12.

Figure 12. Daily new COVID-19 deaths, rolling 7-day average

(per 100 000 people)

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Notes: Data is missing for Kiribati, the Federated States of Micronesia, Nauru, Palau, Tonga and Tuvalu.

For the majority of the pandemic so far, death rates in SIDS have remained well below the global average. The exceptions to this are both in Caribbean SIDS, between August and November 2020, and again more recently since February 2021. While Caribbean and Atlantic and Indian Ocean SIDS have had similar numbers of cumulative cases per 100 000 population so far, the number of deaths per 100 000 population has been about 1.7 times higher in Caribbean SIDS.

While many SIDS have been relatively less impacted by COVID-19 from a health perspective, the key to long-term management of the virus remains vaccines. Figure 13 illustrates the number of people vaccinated with at least a first dose per 100 000 population.

Figure 13. Cumulative number of people vaccinated with at least one dose

(per 100 000 people)

Source: UNCTAD calculations based on -—
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Notes: Data is not available for Comoros, Fiji, Kiribati, Marshall Islands, Federated States of Micronesia, Nauru, Palau, Samoa, Timor-Leste, Tonga, Tuvalu, Vanuatu.

Many SIDS have either not yet begun their vaccination campaigns or not begun reporting data on them, however, two SIDS in particular have already made rapid progress on this front. As of 11 April 2021, Seychelles had already inoculated almost 62 per cent of their population with at least a first dose and Barbados almost 25 per cent. Both rates comfortably outpace the global average and even many well-performing developed countries. As a group however, these two countries are not enough to prop up their respective regions, and the vaccination rate in all SIDS regions remains well below the world average.

In the near-term, COVID-19 remains primarily an economic rather than health issue for most SIDS. That does not mean that the situation cannot change, and these especially vulnerable countries should continue to be monitored until the global vaccination drive can mitigate the health impacts of the pandemic.