Central America consists of seven mainland countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama. The Caribbean Sea contains over a thousand islands. Many of the islands are small in both size and population. The countries of Central America and the Caribbean with a population of over a million are listed in table 1.

Child mortality has fallen significantly in all the countries of Central America and the Caribbean. There are however major differences in the under 5 mortality rates both between countries and also between different socioeconomic groups within the countries. There is a more than 10-fold difference between the under 5 mortality rate between Cuba (six deaths per 1000 live births) and Haiti (70 deaths per 1000 live births).1 Haiti, Guatemala and Honduras have some of the greatest health inequalities in Central America.2 More than 50% of the urban population of Guatemala live in slums.3 Overall, 16% of children under the age of 5 years in the poorest 20% of the population of Honduras are underweight.3 In contrast, only 2% of the wealthiest 20% of children under the age of 5 years in Honduras are underweight.3 In many countries, access to healthcare is limited mainly due to the financial costs. Universal access to free healthcare is essential to reduce mortality rates in all sections of society. The introduction in El Salvador in 2009 of a universal social protection system has resulted in …