Costa Rica’s chronic disease burden is reshaping its health system

Diabetes, obesity and cardiovascular disease now account for most of Costa Rica’s health burden, putting long-term pressure on the CCSS while infectious illnesses remain a threat.

Costa Rica is confronting a profound shift in the burden of disease, with chronic conditions now dominating a health system that still has to keep infectious illnesses in view. At the country’s eighth health forum, epidemiologist Roy Wong of the Costa Rican Social Security Fund said diabetes, high blood pressure and excess weight are increasingly shaping consultations, hospital stays and deaths, reflecting what public health experts call an epidemiological transition.

The scale of the problem is stark. According to the figures Wong presented, the share of adults living with diabetes has risen markedly over the past decade and a half, while excess weight has become the norm rather than the exception. He said about 15,000 people are diagnosed with diabetes each year, and that roughly three-quarters of adults are now either overweight or obese. The International Diabetes Federation’s country data for 2024 also shows Costa Rica with an estimated 375,700 adults living with diabetes, underlining how widely the disease now affects the population.

Wong warned that obesity is not simply a condition in its own right but a major driver of other cardiovascular risks. He said people with obesity are far more likely to develop diabetes and hypertension together, creating a pattern of multiple long-term illnesses in the same patient. That kind of multimorbidity places extra pressure on families and the public health system because it requires repeated follow-up, medication and monitoring over many years.

The burden on services is already visible in the way patients use the health system. Wong’s analysis, based on nearly 20 million CCSS contacts between 2019 and 2023, found that cardiovascular disease generates far more repeated care than acute respiratory infections and keeps people in hospital for longer. Chronic non-communicable diseases accounted for more than 60% of inpatient days in the public system, he said, with cardiovascular cases averaging around 10 days in hospital. He also cautioned against normalising deaths from heart disease and cancer, which he said should remain urgent public health priorities even after the Covid-19 crisis.

Mortality data points in the same direction. Wong said more than 80% of deaths in Costa Rica are now linked to non-communicable diseases, a pattern that makes prevention central to the response. He argued that the country must strengthen health promotion, improve early detection and make sure people with chronic illness can access timely, high-quality care. The task for the CCSS, he said, is to manage a population that increasingly needs long-term treatment without losing sight of communicable diseases that still demand vigilance.