San Marino

San Marino is a small independent nation located in the Apennine Mountains of southern Europe. Only 60.5 kms (23.4 kms) in size, it is the smallest nation in Europe after Vatican City and Monaco, and completely surrounded by Italy.

Once among the poorest regions in Europe, San Marino is now a popular tourist area, playing host to millions of visitors each year. Per capita income is over $34,000 annually.

The population is estimated at 29,600 and growing at 1.22 percent annually. The birth rate and the death rate are almost equal, with 9.89 births per 1,000 population and 8.27 deaths per 1,000 population, and the total fertility rate is 1.39 children born per woman. Population increases are driven primarily by migration, with 10.57 migrants per 1,000 citizens. Sixty-six percent of Sammarinese are between the ages of 15 and 64; the median age is 40.9 years. San Marino has some of the highest life expectancies in Europe, at around 77 years for males and 86 years for females.

San Marino is largely free of major communicable disease. There were no deaths from infectious disease reported between 1995–2000. Clean water and sanitation is on par with other European nations. Most of the population lives well above the poverty line, and there is little, if any, food insecurity. HIV/AIDS has not emerged as a problem within the country.

Noncommunicable diseases accounted for 85 percent of all reported deaths in the period between 1995–2000, with accidents or other external causes accounting for another five percent. Forty-eight percent of deaths were caused by circulatory disorders, and 31 percent from cancers. Major risk factors for disease are based on lifestyle. High tobacco use and high blood pressure among men increases their risk for disease; while for women, high blood pressure and high body mass index are the primary underlying cause of poor health. The healthcare system in San Marino is well funded. The country spends an estimated $3356 per capita, or about 7.4 percent of its gross domestic product, on health. All citizens are entitled to free, comprehensive medical care. The healthcare establishment is expected to undergo some pressure in coming years, as the population continues to age and develop the chronic problems of the elderly.