THE Vision 2030 national development plan for Jamaica, which was developed in 2009, is grounded in a vision of Jamaica as the place of choice to live, work, raise families and do business.

We are now in 2022 and not any closer, in my opinion, to the maddening elusive hopes and dreams of all Jamaicans for a happier, more equitable and inclusive society.

It is within that context that my attention was drawn to a recent International Monetary Fund (IMF) Finance and Development article on Denmark, New Zealand, and Costa Rica, three countries that are making great strides in improving health and promoting happiness in their respective countries. Based on the article, the experience of these three countries clearly demonstrates that effectively delivering services at the community level, cultivating social trust, and accounting for well-being at the highest policy level are critical drivers in creating a happier, more equitable and inclusive society. This article is based on the Costa Rican experience outlined in that IMF article.

While Jamaica is similar in many ways to Costa Rica, the 2021 World Happiness Report ranks Costa Rica as the 16th happiest place on earth with Jamaica trailing in 36th position. Professor Mariano Rojas, a Costa Rican economist, attributes the country’s high level of well-being to strong social relationships and a sense of community.

Maybe more importantly, Costa Rica has a strong welfare system and Costa Ricans have access to free education and a guaranteed State pension. It is the only country in Central America where 100 per cent of the population has access to electricity and a source of drinking water. It is also one of the few countries in the region that offers universal health coverage. Clearly the absence of many of the highlighted services and policy imperatives in Jamaica are the drivers for the higher placing Costa Rica has achieved in the 2021 World Happiness Report.

Costa Rica has prioritised public health for decades, investing heavily in targeting the most readily preventable kinds of death and disability. In the 1970s, the country spent more on health as a proportion of gross domestic product (GDP) than even some advanced economies, including the United Kingdom. Those investments have paid off as by 1985, Costa Rica’s life expectancy was the longest in Latin America and matched that of the United States. In addition, child mortality rates dropped from about 74 deaths per 1,000 in 1970 to 17 by 1989.

What sets Costa Rica apart, however, is its primary health-care model. Implemented in the 1990s, the model built on decades of experience with rural and community health programmes, changing the culture of care delivery in the country. Every Costa Rican is assigned to an ‘equipo básico de atención integral en salud’ (EBAIS) — a local primary health-care team of physicians, nurses, and community health workers. Health workers visit each household annually in the area to which they’re assigned to assess needs. The data they gather are combined with electronic health records and used to set targets, track progress, and focus resources on higher-risk areas.

When the system was first introduced, EBAIS teams were sent to the country’s most medically underserved rural areas before expanding to urban centres. That allowed the country to build a very robust information system on the determinants of health – the conditions in which people live. This system goes beyond solely attending to disease. Investment in health starts with improving the conditions and quality of people’s lives. It’s a very comprehensive vision of what health and wellness is.

The evidence shows the model works. Life expectancy rose from 75 years in 1990 to 80 years (well above the US). An enviable health outcome, yet the country now spends less on health care as a percentage of GDP than the world average (7.3 percent versus 10 percent in 2017). Again, the evidence is clear that access to primary health care pays and Costa Rica has had a long democratic history of leaders who have made primary health care a government priority.

In 1869 (not a typo), Costa Rica became one of the first countries in the world to make primary school education both free and compulsory. Costa Rica has also been wise enough to maintain a certain level of well-being through a very robust fight against poverty. The sense of security, empowerment, and equality that these two factors bring about in the Costa Rican populace is priceless.

What are the lessons therefore for Jamaica from the Costa Rican experience? I suggest the following three main lessons:

1) The primary government policy driver must be an investment in primary health-care delivery at the community level and compulsory school education to age 18 based on means tested subsidies and grants (ideally this should be free but funding this may not be possible in the short or medium term).

2) Cultivate social trust by developing a social safety net – guaranteeing a State pension, 100 per cent access to electricity, drinking water and universal health coverage. I believe that this will prove to be the biggest factor in driving down crime and violence over time.

3) Focus on driving economic growth through ‘greening’ the environment which creates more jobs, improving tax compliance for all Jamaicans earning income (not just the PAYE labour force), and the elimination of corruption with its linkages to crime, poverty, and societal inefficiencies.

Let us indeed make Jamaica a place of choice to live, work, raise families and do business. Let us turn the hopes and dreams of all Jamaicans for a happier, more equitable and inclusive society into reality. Let us ensure that before being born, every Jamaican is guaranteed life, education, food, social security, and that he/she will only learn about crime and violence through the movies!

Hugh Reid is currently general manager, JN Life Insurance Company Limited, which is a part of the Jamaica National Group. He an experienced financial services executive and entrepreneur, with a track record of success in Jamaica and the United States. Hugh has an MSc in Accounting and a BSc in Economics from The University of the West Indies and is a Fellow of the Chartered Association of Certified Accountants in the UK as well as a Fellow of the Life Management Institute in the US.