Changing Wealth – Changing Health


By: Lykke E. Andersen*

Bolivia has recently changed from a low income country to a lower-middle income country, and with that increase in incomes the disease burden has also changed. In 1990, Bolivia’s disease burden was dominated by infectious diseases and maternal health problems (pink group), which is typical of poor countries. By 2013, however, the blue group, which encompasses non-communicable diseases (such as cardiovascular diseases, cancer, diabetes and mental disorders) has become dominant, as it typically is in richer countries (see Figure 1).

Figure 1: Changes in Bolivia’s Disease Burden, 1990-2013

Source: Author’s elaboration based on data from Note: The disease burden is measured in Disability Adjusted Life Years (DALYs).

The excellent health data visualization site maintained by the Institute for Health Metrics and Evaluation allows us to explore changes in disease burdens in great detail. Figure 2 focuses on males only, but disaggregates the disease groups in much more detail. From that we can see that Lower Respiratory Infections and Diarrhea were the main contributors to the burden of disease in 1990, each accounting for 11% of the total disease burden for males. Road Injuries were also important, contributing 9% of the total male disease burden in 1990.

By 2013, we had managed to reduce the burden of Diarrhea to only 3%, mainly due to the improvement in water and sanitation services, as well as much more widespread use of cheap and effective oral rehydration therapy. Lower Respiratory Infections is still an important problem, contributing 6% of the total disease burden for men. However, by 2013, Road Injuries had become the single largest cause of loss of life and health for men in Bolivia (7%); three quarters of those harmed by traffic accidents being pedestrians.

Figure 2: Changes in the Disease Burden for Bolivian Men, 1990 and 2013

Source: Author’s elaboration based on data from


The disease burden graphs above only show the relative importance of different diseases, but data on persons injured in traffic accidents show a dramatic increase between 2000 and 2013 (see Figure 3). In just 13 years, the number of people injured in traffic accidents has more than tripled, from 5,356 in 2000 to 17,204 in 2013. Three of every four injuries in 2013 took place in the departments of La Paz, Santa Cruz and Cochabamba.

Figure 3: Traffic Injuries in Bolivia, 2000-2013, by Department

Source: Author’s elaboration based on data from INE (

While we should certainly continue with the policies designed to reduce child and maternal mortality (mainly by further increasing the coverage of basic services, such as water, sanitation, education, maternal health and family planning), there is a new, rapidly growing threat that needs attention.

It is very dangerous when people get rich enough to buy cars, without being educated enough to follow basic traffic laws. Drivers in Bolivia demonstrate an outrageous disregard for traffic lights and pedestrians, and I have never seen anybody leave their car behind, even after an evening of steady drinking. Pedestrians are not exemplary, either. They cross streets anywhere, at any time, and with a blatant disregard for their own safety. Even the presence of a police man on every street corner does not seem to improve the behavior of neither drivers nor pedestrians.

I walk to work every day, and it is a very rare day when I don’t see one or more cars running a red light in plain daylight right in front of a police man and completely ignoring the pedestrians trying to cross the street lawfully in the zebra crossing. Usually, the most dangerous time to cross at a zebra crossing is just when the light turns green for the pedestrians, because that is when the drivers speed up and possibly close their eyes in an attempt to convince themselves that their light has not turned red yet.

La Paz has several wonderful urban education programs (the main one involving thousands of people dressed up as zebras), and the city also employs an army of traffic police, but nothing seems to significantly improve the situation. I usually bang on offending cars with a flat hand to let them know they are violating a traffic law, but I am severely tempted to escalate my little one-man traffic education program to involve a key in hand, which will “accidentally” scratch cars that come within half an arm’s length while flagrantly violating a traffic law.

Source: INESAD as Zebras for a Day – June 2013 (view post here)

* The author is a Senior Researcher at INESAD, Ph.D. in Economics, views expressed in this article are those of the authors and do not necessarily reflect the views of Fundación INESAD.


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