Former Costa Rican President Alvarado describes his country’s public health successes

Carlos Alvarado Quesada speaking at Harvard. Photo by Kent Dayton

3 min read

The U.S. has a lot to learn from Costa Rica.

That message came through loud and clear in a fireside chat with former Costa Rican President Carlos Alvarado Quesada, held Oct. 13 at Harvard T.H. Chan School of Public Health.

Alvarado took office in 2018 at the age of 38 and stepped down last May, at the end of his constitutionally limited term. He is currently serving as a professor of practice at Tufts University’s Fletcher School of Law and Diplomacy.

Alvarado guided Costa Rica through the COVID-19 pandemic, which the country was able to weather well due to its strong universal healthcare system and extensive network of primary health care clinics and vaccination sites. Alvarado also made climate change a top priority, launching a National Decarbonization Plan with the goal of achieving net zero emissions nationwide by 2050.

“Costa Rica is an example of how a small country can succeed in tackling great challenges—and become a global model,” Dean Michelle Williams said as she introduced Alvarado to a small group of faculty and students for the fireside chat.

Speaking at the event with student Cornelius Rau, who is working toward a master of science in epidemiology, Alvarado acknowledged that politics tends to reward big, flashy announcements and investments over the quiet and painstaking work of investing in public health.

“The best actions you can take in public health are not necessarily correlated with a lot of spending. They’re simple things like reminding people about hand washing, vaccination, and how not to let standing water accumulate” to avoid attracting the mosquitoes that spread dengue, he said. “For a politician, it might be better to inaugurate a big fancy hospital.”

Williams noted in her introduction that Costa Rica’s investment in public health began in earnest in the 1970s with a concerted effort to design a system that prioritized primary and preventive care. The government created dedicated public health teams in every community and built high-quality clinics even in the most remote rural regions. Successive campaigns focused on critical issues including maternal mortalitynutrition, sanitation, and vaccinations. “It has been an astounding success,” Williams said.

Today, life expectancy in Costa Rica approaches 81 years. In the U.S., by contrast, it’s at 76 after dropping sharply the last two years.

“We have a lot to learn from Costa Rica when it comes to health care policy and management,” Williams said.

Alvarado stressed the importance of recognizing health—and health care access—as a “basic right.”

Asked to share some advice with Harvard Chan students, Alvarado urged them to identify their passion and make that their guiding star. “You need to [follow] that with all your courage,” he said. “Change is possible. If a small country like Costa Rica can do these things … you can make good change happen, too.”

Stephanie Simon