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Economy of the Dominican Republic

The economy of the Dominican Republic is the seventh largest in Latin America, and is the largest in the Caribbean and Central American region. The Dominican Republic is an upper-middle income developing country with important sectors including mining, tourism, manufacturing (medical devices, electrical equipment, pharmaceuticals, and chemicals), energy, real estate, infrastructure, telecommunications and agriculture. The Dominican Republic is on track to achieve its goal of becoming a high-income country by 2030, and is expected to grow 79% in this decade. The country is the site of the single largest gold mine in Latin America, the Pueblo Viejo mine. Although the service sector is currently the leading employer of Dominicans (due principally to growth in tourism and free-trade zones), agriculture remains an important sector in terms of the domestic market and is in second place (behind mining) in terms of export earnings. Tourism accounts for more than $7.4 billion in annual earnings in 2019. Free-trade zone earnings and tourism are the fastest-growing export sectors. A leading growth engine in the Free-trade zone sector is the production of medical equipment for export having a value-added per employee of $20,000 USD, total revenue of $1.5 billion USD, and a growth rate of 7.7% in 2019. The medical instrument export sector represents one of the highest-value added sectors of the country's economy, a true growth engine for the country's emerging market. Remittances are an important sector of the economy, contributing $8.2 billion in 2020. Most of these funds are used to cover household expenses, such as housing, food, clothing, health care and education. Secondarily, remittances have financed businesses and productive activities. Thirdly, this combined effect has induced investment by the private sector and helps fund the public sector through its value-added tax. The combined import market including the free-trade-zones amounts to a market of $20 billion a year in 2019. The combined export sector had revenues totaling $11 billion in 2019. The consumer market is equivalent to $61 billion in 2019. An important indicator is the average commercial loan interest rate, which directs short-term investment and stimulates long-term investment in the economy. It is currently 8.30%, as of June 2021.

The Dominican Republic's most important trading partner is the United States (over 40% of total commercial exchange; over $12 billion in trade). Other major trade partners are China (over $3 billion in trade), Switzerland (over $1 billion), Puerto Rico (over $800 million), Mexico (over $700 million), Haiti (over $700 million), Spain (over $700 million), the Netherlands (over $700 million), Canada (over $600 million), Brazil (over $500 million), and Germany (over $500 million), in that quantitative order. The country exports free-trade-zone manufactured products (medical devices, electrical equipment, pharmaceuticals, and chemicals), gold, nickel, agricultural products, liquor, cocoa beans, silver, and sauces and seasonings. It imports petroleum, industrial raw materials, capital goods, and foodstuffs. On 5 September 2005, the Congress of the Dominican Republic ratified a free trade agreement with the U.S. and five Central American countries, the Dominican Republic – Central America Free Trade Agreement (CAFTA-DR). CAFTA-DR entered into force for the Dominican Republic on 1 March 2007. The total stock of U.S. foreign direct investment (FDI) in Dominican Republic as of 2019 was U.S. $42 billion, much of it directed to the energy, tourism, real estate, manufacturing, infrastructure and the telecommunications sectors. In 2019 the foreign direct investment stock amounted to $42 billion a significant growth in the last decade and a half. In 2020, during the COVID-19 pandemic, foreign direct investment flows in the Dominican Republic had remained strong at $2.5 billion added to the stock in that year. Having grown to an estimated $44.5 billion, and growing more than ten-fold since 2006 when the liberalization efforts began.

An important aspect of the Dominican economy is the Free Trade Zone industry (FTZ), which made up U.S. $6.2 billion in Dominican exports for 2019. Reports show, however, that the FTZs lost approximately 60,000 between 2005 and 2007 and suffered a 4% decrease in total exports in 2006. The textiles sector experienced an approximate 17% drop in exports in 2006 due in part to the appreciation of the Dominican peso against the dollar, Asian competition following expiration of the quotas of the Multi-Fiber Arrangement, and a government-mandated increase in salaries, which should have occurred in 2005 but was postponed to January 2006. Lost Dominican business was captured by firms in Central America and Asia. The tobacco, jewelry, medical, and pharmaceutical sectors in the FTZs all reported increases for 2006, which offset textile and garment losses. Industry experts from the FTZs expected that entry into force of the CAFTA-DR agreement would promote substantial growth in the FTZ sector in 2007. By the end of the last decade-and-a-half the free-trade-zone sector has rebounded and surpassed the former amounts of $4.5 billion in 2006 to grow to $6.2 billion by 2019.

Agriculture
In 2018, the Dominican Republic produced 644 thousand tons of avocado (it is the 2nd largest producer in the world), 1 million tons of papaya (it is the 4th largest producer in the world), 5.2 million tons of sugarcane, 2.1 million tons of banana, 85 thousand tons of cocoa, 442 thousand tons of palm oil, 407 thousand tons of pineapple, 403 thousand tons of coconut, 627 thousand tons of rice, 160 thousand tons of cassava, 136 thousand tons of orange, in addition to from smaller productions of other agricultural products such as potato, lemon, melon, onion and yam.

With almost 80% of the total land area suitable for crop production and about 17% of the labor force engaged in farming, agriculture remains the primary occupation, accounting for 11% of GDP in 2001. Value of agricultural output grew at an average annual rate of 7.1% during 1968–73, but since 1975 the sector has been hampered by droughts (1975, 1977, and 1979), hurricanes (in 1979 and 1980), and slumping world prices and quota allocations for sugar (since 1985). In 1999, agricultural production was 0.4% higher than during 1989–91. The fertile Cibao Valley is the main agricultural center. In 1998, arable land totaled 1020000 ha; with land under permanent crops at 480000 ha.

After Cuba, the Dominican Republic is the second-largest Caribbean producer of sugarcane, the nation's most important crop. The State Sugar Council operates 12 sugar mills and accounts for about half of total production. Other large producers are the privately owned Vicini, with three mills, and Central Romana Corporation, whose mill is the largest in the country. Sugar is grown in the southeastern plains, around Barahona & on the North Coast Plain. In 1999, sugar production was 4.4 million tons, down from an average of 7.1 million tons during 1989–1991. Output of sugar has declined annually since 1982, and land is gradually being taken out of sugar production and switched to food crops. Production of raw sugar rose from 636,000 tons in 1990 to 813,000 tons in 1997 but fell to 374,000 tons in 1999.

Part of the crop was destroyed by hurricanes in 1979 and 1980, and 1979–80 production was only 670,000 bags (40,200 tons). Although production was usually about 57,000–59,000 tons annually in the 1980s, the acreage harvested declined from 157000 ha in the early 1980s to 139000 ha in 1999, indicating a greater yield per acre. Coffee production in 1999 was estimated at 35,000 tons; exports of coffee in 2001 generated $11 million. Cocoa and tobacco are also grown for export. Dominican Republic is one of the top 10 major producer and exporter of cocoa in the world. Cocoa is also grown in the Cibao Valley around San Francisco de Macoris. Tobacco is also grown in the Cibao Valley, but around Santiago. In 1999, production of cocoa beans was 26,000 tons and of tobacco, 35,000 tons. Rice is grown around Monte Cristi & San Francisco de Macoris. Banana production in 1999 was 432,000 tons. Production of other crops in 1999 (in thousands of tons) included rice, 563; coconuts, 184; cassava, 127; tomatoes, 281; pulses, 69; dry beans, 26; eggplants, 7; and peanuts, 2.

Livestock farming
In 2001, Dominican livestock included 187,000 goats and 106,000 sheep. There were also about 2.1 million head of cattle, 60% for beef and 40% for dairy. The hog population was decimated by African swine fever in 1978, decreasing from 400,000 in 1978 to 20,000 in 1979; by 2001, however, it was 565,000. Poultry is the main meat source because it is cheaper than beef or pork. Poultry production relies on imports of feed grain from the United States. In 2001, 203,000 tons of poultry meat were produced, along with 71,000 tons of beef and 420,000 tons of milk.

Fishing
In 2017 the total marine production was 18,000 metric tons. Marlin, barracuda, kingfish, mackerel, tuna, sailfish, and tarpon are found in the Monte Cristi Bank and Samaná Bay, which also supports bonito, snapper, and American grouper.

Forestry
About 28.4% of the total land area consisted of forests and woodlands in 2000. Round wood production in 2000 totaled 562,000 cu m (19.8 million cu ft). Timber is cut for land clearing for the use of agriculture. There are important national parks protecting the natural resources and aquifers of the country.

Mining
In 2019, the country was the 9th largest world producer of nickel. The country had almost zero production of gold until 2011, where it grew exponentially. In 2016 the country produced almost 38 tons. The country had almost zero production of silver until 2008, where it grew exponentially. In 2017 the country produced 147 tons.

Ferronickel was the country's leading export commodity and third-leading industry. Nickel is mined at Bonao. In 2000, nickel production was 39,943 tons, ranking tenth in the world, a decrease from 49,152 in 1997. Currently the most important mineral export is gold.

Production of gold in the Pueblo Viejo mine is the largest gold producing mine in Latin America, and fourth most productive mine in the world producing a total of 30,100 kg of gold in 2018. The extraction by a foreign company of gold at one of the largest mines in the Western Hemisphere has startled and concerned a part of the country who believe that the natural resource should be extracted by local companies and not foreign. Some groups began to protest against Barrick Gold in 2009 and 2010. In 2019 gold is one of the largest exports of the country totaling $1.6 billion and has helped to balance the commodity current account balance.

Production of bauxite, traditionally the principal mining product, ceased in 1992. The Aluminum Co. of America (Alcoa) mined bauxite between 1959 and 1983, when it turned its concession over to the state. Production in 1991 dropped 92% from the previous year, as a presidential decree suspended mining operations at the largest mine, in response to increasing fears of deforestation, although reforestation of mined areas was in progress. Output averaged 1 million tons each year.

The country was one of the few sources of amber in the Western Hemisphere. Salt Mountain, a 16 km block of almost solid salt west of Barahona, was the world's largest known salt deposit. There were also large deposits of gypsum near Salt Mountain, making the Dominican Republic one of three sources of gypsum in the Caribbean. The country also produced hydraulic cement, limestone, marble, and sand and gravel. Substantial lignite deposits were found in the early 1980s. Deposits of copper and platinum are also found in the country.

Industry
The industrial sector contributed an estimated 33.8 percent to the country's GDP in 2017, led by mining and the manufacture of goods for export to the United States, Europe and Asia. To a lesser extent, there is the manufacture of food products, consumer non-durables, and building materials for the local market. The sector employed 20.8 percent of the workforce in 2014.

About 500 companies in the Dominican Republic manufacture goods primarily for the North American market. Situated in 50 industrial free zones around the country, these mostly foreign-owned corporations take advantage of generous tax and other financial inducements offered by the government to businesses that operate within the zones. Approximately 200,000 people, or about 8 percent of the workforce, are employed in this sector. They mostly produce clothing, electronic components, footwear, and leather goods, which are assembled. The raw materials or semi-manufactured goods are usually imported duty-free from other emerging markets (electronic parts are imported from industrialized Puerto Rico) and assembled in the free trade zones. Products include cosmetics, pharmaceuticals, textiles, perfumes & foodstuffs. The value of free-trade-zone exports amounted to US$6.2 billion in 2019, while their imports of intermediate products amounted to US$4 billion.

Other, more traditional manufacturing is based on sugar refining, cement, iron and steel production, and food processing. Rum is a significant export commodity, and beer and cigarettes are manufactured for local consumption. Most industry of this sort is located around the working-class perimeter of Santo Domingo and other large towns.

Tertiary industries
Services were estimated to contribute 61.4% of the GDP in 2017 and employs 64.7% of the population.

Tourism
Since the mid-1980s the tourism sector has become one of the country's most important sources of foreign exchange, and more popular tourist destinations. The country is famous for its favorable location in the Caribbean, tropical climate, beaches, and the restored Spanish colonial architecture. Many foreign investors have and continue to be encouraged to invest here to build and expand resorts and airports around the coasts. During this same period, tourism displaced sugar as the main source of the country's earnings, and by 1997 it was generating more than half of the country's total foreign exchange. In 2019 it generated one-third of the total foreign exchange for the country.

Tourism is the single biggest revenue earner, growing from humble beginnings in 1980 to more than $7.4 billion by 2019. Successive governments have invested heavily in tourism development, creating upgraded airports and other infrastructure. The number of tourist amounted to 6.4 million tourists arriving in the country in 2019. Most come from Europe, with about 25 percent originating from the United States or Canada. The country now has almost 70,000 hotel rooms, more than any other Caribbean country. About 50,000 Dominicans are directly employed in this sector, mostly working in hotels, and another 110,000 are indirectly employed as taxi drivers, tour guides, or tourist-shop staff. Most tourists visit the Dominican Republic on account of its beaches, but there is an expanding eco-tourism and outdoor activity sector, focused on the country's mountains and wildlife.

Although tourism generates large revenues, some scholars and activists argue that the development of tourism also has high impacts on many socioeconomic aspects. For instance, they argue that it involves ecological deterioration, profit leakage, social displacement, disported cultural patterns, rising land values, drugs and prostitution.

Retail
Retail activity in the Dominican Republic takes many forms, from U.S.-style supermarkets and shopping malls in Santo Domingo to rural markets and tiny family-run corner stores in villages. A small but affluent middle class can afford to shop at the former, while the lower-income rural community resorts to buying small amounts of daily essentials from general stores (these small stores often double as pubs). In an attempt to regulate the retail sector, the government has recently reformed taxation laws, so that small shops pay taxes on a regular monthly basis. Many transactions, however, go unrecorded.

Energy
The electricity sector has had big investments in the last decade 2010 to 2020 diversifying the sector away from petroleum which decreased from 50% of energy generation to 7%. The largest generation sources as of 2021 are coal, natural gas and renewables representing together 93% of electricity generation. This has transformed a strategic sector of the economy into a stable and lower cost sector. The rate of electricity loss improved from 38% in 2005 to 30% in 2019 showing improvement in the infrastructure. Low collection rates, illegal connections, infrastructure problems and poor governance are the sources of the high level of electricity loss in the system. The government plans to continue providing subsidies. Congress passed a law in 2007 that criminalizes the act of illegal electric connections. The state subsidizes the cost of electricity, funding the cost via indirect taxation instead of direct price increases for lower-income households, therefore it is a redistributive policy and partly funded by the country as a whole instead of the direct consumers of electricity. The profit from renewables, natural gas, and coal is positive and considered the current and future of the system, given that petroleum derivatives are considered more volatile and expensive in running costs.

As of 2020 significant investments in the electricity sector have been realized with the construction of the Punta Catalina coal-fired plant. Significantly diversifying the electric sector's away from the traditional mix to one with lower cost. The growth of the renewables sector and the natural gas power sector has made significant strides in this respect in the last few years, and is expected to continue to grow with foreign and local investment in the sector.

Data
The following table shows the main economic indicators in 1980–2019 (with IMF staff stimtates in 2020–2025). Inflation below 5% is in green.

Other statistics
GDP: purchasing power parity – $172.4 billion (2017 est.)

GDP – real growth rate: 4.6% (2017 est.)

GDP – per capita: purchasing power parity – $16.900 (2017 est.)

GDP – composition by sector: agriculture: 5.5% industry: 33.8% services: 60.8% (2017 est.)

Inflation rate (consumer prices): 3.3% (2017 est.)

Labor force: 4.732 million (2017 est.)

Labor force – by occupation: agriculture: 14.4% industry: 20.8% services: 64.7% (2014 est.)

Unemployment rate: 5.5% (2017 est.)

Population below poverty line: 30.5% (2016)

Budget: revenues: $7.014 billion

expenditures: $6.985 billion (2007 est.)

Industries: tourism, sugar processing, ferronickel and gold mining, textiles, cement, tobacco, electrical components, medical devices

Electricity – production: 15.53 billion kWh (2015)

Electricity – consumption: 13.25 billion kWh (2015)

Electricity – exports: 0 kWh (2005)

Electricity – imports: 0 kWh (2005)

Oil – production: 0 oilbbl/d (2014)

Oil – consumption: 122300 oilbbl/d (2012 est.)

Oil – exports: 0 oilbbl/d (2017)

Oil – imports: 116700 oilbbl/d (2017)

Oil – proved reserves: 0 oilbbl (1 January 2006 est.)

Natural gas – production: 0 cu m (2005 est.)

Natural gas – consumption: 1.108 million cu m (2015 est).

Natural gas – exports: 0 cu m (2005 est.)

Natural gas – imports: 1.108 million cu m (2015)

Natural gas – proved reserves: 0 cu m (1 January 2006 est.)

Agriculture – products: sugarcane, coffee, cotton, cocoa, tobacco, rice, beans, potatoes, corn, bananas; cattle, pigs, dairy products, beef, eggs

Exports: $10.33 billion f.o.b. (2017 est.)

Exports – commodities: ferro nickel, sugar, gold, silver, coffee, cocoa, tobacco, meats, consumer goods

Exports – partners: United States 50.4%, United Kingdom 3.2%, Belgium 2.4% (2017)

Imports: $19 billion f.o.b. (2017 est.)

Imports – commodities: foodstuffs, petroleum, cotton and fabrics, chemicals and pharmaceuticals

Imports – partners: United States 41.4%, China 13.9%, Mexico 4.5%, Brazil 4.3% (2017)

Debt – external: $29.69 billion (31 December 2017 est.)

Economic aid – recipient: $76.99 million (2005)

Currency: Dominican peso (DOP)

Exchange rates: Dominican pesos per US dollar – 33.113 (2007), 33.406 (2006), 30.409 (2005), 42.12 (2004), 30.831 (2003)

Fiscal year: calendar year

title: Economy of the Dominican Republic


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Telecommunications in the Dominican Republic

Telecommunications in the Dominican Republic include radio, television, fixed and mobile telephones, and the Internet.

Numerous television channels are available. Tricom, S.A, WIND Telecom, S.A., Viva (network operator), and Claro Codetel provide television services digitally, with channels from Latin America and elsewhere in the world. There are extensive mobile phone and land-line services. Internet access is available as Cable Internet, ADSL, WiMAX, EDGE, EV-DO and UMTS/HSDPA in most parts of the country. Projects to extend Wi-Fi (wireless internet) hot spots have been undertaken in Santo Domingo. Since 2015 the country has been actively extending its fiber optics network, to provide faster and more reliable internet to business and private users.

The Instituto Dominicano De Telecomunicaciones (INDOTEL) regulates and supervises the development of the country's telecommunications market.

Radio and television

 * Radio stations: AM 146, FM 233, shortwave 14 (2013). A combination of state-owned and privately owned radio stations with more than 300 radio stations operating (2007).
 * Radios: 1.44 million (1997).
 * Television stations: 46 (2012). A combination of state-owned and privately owned broadcast media; 1 state-owned and a number of private TV networks; networks operate repeaters to extend signals throughout country (2007).
 * Pay TV: 49,010 subscribers (2010).
 * Television sets: 770,000 (1997).

Cable television in the Dominican Republic is provided by a variety of companies. These companies offer both English and Spanish language television, plus a range of channels in other languages, high definition channels, pay-per-view movies and events, sports packages, premium movies channels and adult channels such as HBO, Playboy TV, Cinecanal, MLB Extra Innings, etc. The channels are not only from the Dominican Republic, but also the United States and Europe.

In the Dominican Republic there are 46 in VHF and UHF channels free-to-air channels. The programming on the free of charge channels consists mainly of locally produced entertainment shows, news, and comedy shows; and foreign sitcoms, soap operas, movies, cartoons, and sports programs.

The main service provider in the Dominican Republic is Tricom. Aster is concentrated in Santo Domingo, but is expanding its service throughout the Dominican Republic. There are new companies using new technologies that are expanding quickly such as Claro TV (IPTV and Satellite TV), Wind Telecom (MMDS) and SKY (Satellite TV).

On election day in May 2012 government broadcast regulators took two popular national television channels (11 and 33) off the air on the grounds that they violated an electoral law prohibiting distribution of exit poll or other unofficial information regarding the final results of the electoral process. Both channels were closed on the afternoon of 20 May and reopened the next morning.

Telephones

 * Area codes: 809, 829, and 849.
 * International call prefix: +1
 * Fixed lines: 1.14 million lines in use, 70th in the world (2022).
 * Fixed line teledensity: 10 per 100 people (2011).
 * Mobile cellular: 9.0 million lines (2012).
 * Mobile cellular teledensity: 90 per 100 people (2011).
 * VoIP: 45,328 lines (2012).
 * Domestic system: Relatively efficient system based on island-wide microwave radio relay network (2011) and fiber optics lines that cover many of the main cities.
 * Communications cables: Landing point for the Americas Region Caribbean Ring System (ARCOS-1), ANTILLAS I, and the Fibralink submarine cables that provide links to South and Central America, parts of the Caribbean, and the US (2011).
 * Satellite earth station: 1, Intelsat (Atlantic Ocean) (2011).

Internet

 * Top-level domain: .do
 * Internet users: 9.35 million users, 62nd in the world; 85.0% of the population (2021).
 * Fixed broadband: 446,420 subscriptions, 72nd in the world; 4.4% of the population, 108th in the world (2012).
 * Wireless broadband: 1.6 million subscriptions, 65th in the world; 15.4% of the population, 80th in the world (2012).
 * Internet hosts: 404,500 hosts, 55th in the world (2012).
 * IPv4: 857,600 addresses allocated, less than 0.05% of the world total, 85 addresses per 1000 people (2012).
 * Internet service providers (ISPs): 8: Claro (Fiber, ADSL and wireless), Tricom (Fiber, WiMAX, ADSL, and Cable), Aster (CABLE), VIVA (wireless), Orange (wireless), ONEMAX (Fiber GPON, Wireless PTP, Data Center), Wind Telecom (WiMAX) (2008).

Broadband Internet access
The Dominican Republic is considered one of the countries with the most advanced telecommunications infrastructures in Latin America, with over 8.9 million cell phones connected (on just about 10 million populants, with 3.5 million of them on extreme poverty conditions) and large companies like Codetel and Orange (FR) on the telecommunications market. Broadband Internet access is growing, with over 622,931 Internet accounts globally and 3,851,278 Internet users as of December 2010 according to INDOTEL (DR Telecommunications Institute). Broadband DSL represents about 56% of the total Internet subscribers. There is access to regular ADSL, G.SHDSL, and services only on metropolitan areas, costs are high and service is decent. Cable Internet is offered by a couple of cable companies at lower costs than ADSL but the service is very deficient and unreliable. WiFi is becoming more common. It is available in some universities. Most hotels also offer wi-fi internet. The implementation of the WiMAX and HSPA technology by some of the Cellphone service providers are resulting in the rapid investment by other providers in the market to match the new and faster platform of services. Mobile broadband users have seen their percentage grow from 14% in 2007 all the way to 39% in 2010, and will continue to grow as more and more users are opting for this type of technology in a country where Home Broadband speeds are more expensive and slower. Also the ongoing installation of a Fiber-Optic network structure in the National District and the City of Santiago (second largest in the country) will force other competitors into upgrading theirs to be able to compete in the markets they now lead.

Pricing
As of October 2018, not including taxes.

Key: DOP: Dominican peso, USD: United States dollar. Exchange rate ( $50 DOP : US$1 )

 * Pricing – Home Internet Access (By ISP)

The following table shows the speeds/prices* available and designed for home usage. * Note: The pricing and speeds are subject to change since Altice, Claro and Wind have multi plans (Two or Three services combined), those plans have a discount on all services. Up to 25% discount for combined services.

 * Pricing – Mobile Broadband (By ISP)

Currently the mobile internet market is governed by three aspects:

 * 1) The first is based on a contract where you are granted a certain amount of data (MB/GB) per month, after having consumed the data you can continue browsing at 512 kbit/s.
 * 2) Second option is a monthly income (postpaid) for the acquisition of a speed package with "unlimited data" (is subject to fair use policies with unlimited browsing at 512 kbit/s after you surpass the monthly capacity).
 * 3) Third group belongs to the prepaid modality, in this option the client determines the number of days or amount of data he needs to navigate.

Internet censorship and surveillance
There are no government restrictions on access to the Internet or credible reports that the government monitors e-mail or Internet chat rooms without judicial oversight.

The constitution provides for freedom of speech and press, and the government generally respects these rights in practice. An independent press, an effective judiciary, and a functioning democratic political system ensure freedom of speech and press. The independent media are active and express a wide variety of views without restriction. Individuals and groups are generally able to criticize the government publicly and privately without reprisal, although there have been incidents in which authorities intimidated journalists or other news professionals. Local journalists engage in self-censorship, particularly when coverage could adversely affect the economic or political interests of media owners. The government denies using unauthorized wiretapping or other surreptitious methods to interfere with the private lives of individuals and families, however, human rights groups and opposition politicians allege that such interference does occur.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/


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Transport in the Dominican Republic

Transport in the Dominican Republic utilizes a system of roads, airports, ports, harbours, and an urban railway.

Roadways
Five main highways (DR-1, DR-2, DR-3, DR-4, DR-5) connect the Dominican Republic's biggest cities and tourist centers; they are in good condition. There are nearly 19705 km of highways and roads, 9,872 being paved and 9833 km (2002 est.) unpaved. Like any underdeveloped nation, the Dominican Republic suffers from a lack of good paved roads to connect smaller towns and less populated areas, though work on paving them proceeds. Major town roads are kept in good condition.

Mass transit
The Santo Domingo Metro is the first mass transit system in the country, and the second among Caribbean & Central American nations. It is the most extensive metro system in the region by length and total number of stations. On February 27, 2008, the incumbent president Leonel Fernández test-rode the system for the first time, and thereafter free service was offered several times. Commercial service began on January 30, 2009. Several additional lines are currently planned.

Santiago Light Rail is a planned light rail system, still at the development stage, in the Dominican Republic's second-largest city Santiago de los Caballeros. Construction was slated to begin in mid-2008 but is currently on hold, due to lack of approval and of central government funds.

Buses
The Dominican Republic has a bus system that is rather reliable, and most of these public transportation vehicles are fairly comfortable. The fare is generally inexpensive, and there are bus terminals and stops in most of the island's major cities.

Public Cars (Carros Públicos)
The Public Cars (Carros Públicos–Conchos) are privately owned passenger cars that transit a specific route daily Passengers may request a stop anywhere along the route. Carros Públicos carry a significant portion of commuters in Santo Domingo and other major cities. The system is not very reliable and lacks oversight and regulation which leads to congestion and other issues. They may also be somewhat uncomfortable, since drivers try to fit as many people as possible inside the vehicles. Carros Públicos are often standard sedans, but can be packed with as many as six passengers.

Railways

Rail operations are provided by one state-owned operator and several private operators (mainly for sugar mills). There are no rail connections with neighboring Haiti.
 * Central Romana Railroad was established in 1911 in the sugarcane fields. The total length of the line is 757 km, 375 km being the standard gauge.
 * The Dominican Republic Government Railway (United Dominican Railways or Ferrocarriles Unidos Dominicanos) was a 139 km narrow gauge railway.
 * There are 240 km operated by other sugarcane companies in various gauges:, , gauges (1995).

Ports and harbors
Major ports and harbours in the Dominican Republic:

Ports

 * The Port of Santo Domingo, with its location in the Caribbean, is well suited for flexible itinerary planning and has excellent support, road, and airport infrastructure within the Santo Domingo region, which facilitate access and transfers. The port is suitable for both turnaround and transit calls.
 * Haina Occidental Port, located just 20 km west of Santo Domingo, is one of the most important ports in the Dominican Republic. About 70% of all cargo, excluding Caucedo and free zone exports/imports, is moved through this port.
 * DP World's terminal Multimodal Caucedo Port maritime terminal and logistic center operates under the Free Zone Regime. Actually 85% of Free Zone exports to the United States is shipped from Caucedo terminal. Multimodal Caucedo port is also able to act as a trans-shipment hub to the Caribbean and Latin America for Asia specifically Japan as a door to the American market.
 * Port of Puerto Plata is the main commercial port on the north coast of the Dominican Republic.
 * Port of Boca Chica is located about 20 miles east of the capital city and five miles from the International airport Las Americas. Currently the port is almost exclusively used for containers and some lumber, newsprint and homogeneous cargoes.
 * Port of San Pedro de Macoris is located on the Higuamo river. This port is mainly used to discharge bulk fertilizer. Cement clinker, coal, wheat, diesel and LPG. It is also used to export sugar and molasses produced by several sugar cane mills in the region.
 * Central Romana Port, located in La Romana, belong to Central Romana Corporation which is a private company established in 1912 and has the largest sugar mill in the country.

The following six local ports are a single pier with berth facility:

 * Cayo Levantado Port or (Arroyo Barruk/Puerto Duarte) is located in the Samaná Bay.
 * Manzanillo Port is located very close to the Haitian border.
 * Port of Cabo Rojo is located in Cabo Rojo, southeast to the border.
 * Port of Barahona is located in Barahona, in the bay of Neyba.
 * Port of Azua in Azua, also called Puerto Viejo is located at Ocoa Bay.
 * Palenque Port is located southwest of Santo Domingo.

A local ferry service runs daily between the Samaná and Sabana del Mar ports.

Merchant marine

 * Total:
 * 1 ship (1,000 GT or over) totaling 1,587 GT/
 * Ships by type:
 * cargo 1 (1999 est.)

Entering the ports
Boaters and sailors who wish to dock in any of the Dominican Republic's ports must follow certain entry requirements:
 * Upon approaching the port, ships must display a quarantine flag, which has the letter 'Q' on it, and wait for admittance into the port.
 * The passengers of the vessel must pay a fee, get a tourist card, and show proper identification including a valid passport.
 * Military officials must sometimes grant the passengers clearance to come ashore.
 * For entering or leaving the Dominican Republic, the Dominican e-Ticket is required. It is an electronic system designed to streamline immigration procedures and enhance border security.

Airports

In 2009, there were seven major and 31 minor airports in the Dominican Republic. The major ones were:
 * Las Américas International Airport, Santo Domingo City, Santo Domingo
 * Punta Cana International Airport, Punta Cana / Higüey
 * Cibao International Airport, Santiago City, Santiago
 * Gregorio Luperón International Airport, Puerto Plata
 * La Romana International Airport, La Romana City, La Romana
 * Samana El Catey International Airport, Sanchez, Samana
 * María Montez International Airport, Barahona City, Barahona

Airports - with paved runways

 * Total: 10 (1999 est.)
 * Over 3,047 m:     3
 * 2,438 to 3,047 m: 1
 * 1,524 to 2,437 m: 4
 * 914 to 1,523 m:   3
 * under 913 m:      2

Airports - with unpaved runways

 * Total: 15 (1999 est.)
 * 1,524 to 2,437 m: 2
 * 914 to 1,523 m:   4
 * under 914 m:      9

National airlines

 * Dominicana de Aviación was the national airline of the Dominican Republic for more than 50 years. This title was passed on to various other companies after Dominicana stopped flying.
 * After operations at Dominicana de Aviación ceased, PAWA Dominicana became the flag carrier of the country in 2015. However, the airline ceased operation in January 2018.

Flights
There are direct flights to and from the Dominican Republic from the United States, Cuba, Canada, Mexico, Venezuela, Colombia, Argentina, Brazil, Europe and the Caribbean.

title: Transport in the Dominican Republic


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Armed Forces of the Dominican Republic

The Armed Forces of the Dominican Republic (Fuerzas Armadas de la República Dominicana) are the military forces of the Dominican Republic. They consist of approximately 56,000 active duty personnel. The president is the commander in chief of the Armed Forces of the Dominican Republic and the Ministry of Defense (Spanish: Ministerio de Defensa de la República Dominicana) is the chief managing body of the armed forces. The primary missions of the Armed Forces of the Dominican Republic are to defend the nation and protect the territorial integrity of the country. The Armed Forces of Dominican Republic are the strongest army in the Caribbean after Cuba.

The Army, with 28,750 active duty personnel, consists of six infantry brigades, an air cavalry squadron and a combat service support brigade. The Air Force operates two main bases, one in southern region near Santo Domingo and one in the northern region of the country, the air force operates approximately 40 aircraft including helicopters. The Navy maintains three ageing vessels which were donated from the United States, around 25 patrol crafts and interceptor boats and two helicopters.

There is a counter-terrorist group formed by members of the three branches. This group is highly trained in counter-terrorism missions. The armed forces participate fully in counter-illegal drug trade efforts, for this task, there is a taskforce known as DEPROSER 24/7 (DEfender, PROteger y SERvir). They also are active in efforts to control contraband and illegal immigration from Haiti to the Dominican Republic and from the Dominican Republic to the United States (via illegal transportation of immigrants to Puerto Rico).

War of Independence

Haiti under their president Jean-Pierre Boyer had invaded and occupied Dominican Republic from 1822 to 1844. The military forces of the First Republic's army comprised about 4,000 soldiers organized into seven line infantry regiments, several loose battalions, 6 escudrones cavalry and 3 artillery brigades with 2/2 brigades; This army was supplemented with national civic guard militia composed of the provinces, the National Naval Armada, original name of the Navy today; It composed of 10 ships, seven owned and 3 taken in requición and armed by the government: the Cibao frigate with 20 cannons; the brigantine schooner San Jose, five guns; the schooner La Libertad, five guns; General schooner Santana 7 guns; the schooner La Merced, five guns; Separation schooner, 3 guns; the schooner February 27, five guns. The requisition taken: the schooner Maria Luisa, 3 guns; the schooner March 30, 3 guns; and the schooner Hope, 3 guns. 674 operated by a man. In addition to the aforementioned military corps expeditionary southern army recruited by Pedro and Ramon Santana in Hato Mayor and El Seibo, with a permit issued by the Central Governing Board with the rank of commander in chief of the army existed. These men were skilled in handling machete and spear. His deputy commander was Brigadier General Antonio Duvergé. The other expeditionary army was the Northern Borders created to defend these borders: its commander was Major General Francisco A. Salcedo.

The Dominican forces would reach levels of organization and efficiency of considerable notoriety. As an example of this, it would suffice to highlight the fact of the achievement and preservation of National Independence, with the Dominican victory over repeated Haitian military invasions in the 12-year period that followed the proclamation of Independence; In addition, 55 percent of the National Budget was allocated to it.

20th century

The events that led to the United States military intervention of 1916, brought about the disappearance of any vestige of military structure in the Dominican Republic, setting the intervening forces a military government headed by Captain William Knapp, who make an interim police force called "Constabulary "equivalent to an" armed police force as a military unit "and he had the task of maintaining internal order and enforce the implementing provisions of the US government. This body, purely police function disappears in 1917, leading to the creation of a National Guard. As a result of this historic event of our recent past, the country inherited a hierarchical and organizational akin to the US Marine Corps structure, which served as a platform to the transformations that later gave rise to the armed forces we know today, made up of three components, terrestrial one, one naval and one air.

This land component, now called the National Army, inherited by both its organizational structure of the National Guard organized by the US occupation forces, which operated from April 7, 1917, until June 1921, when it becomes Dominican National Police by Executive Order No. 631 of Rear Admiral Thomas Snowden, who was at that time the military governor of Santo Domingo. After the US military occupation in 1924, Horacio Vásquez wins the presidential elections of that same year. Among his first decisions, decrees the change of the Dominican National Police in National Brigade, a situation that continues until 17 May 1928, when new turn changes the name of the Army by Law No. 928, but basically inheriting a structure Police, who obeyed schemes imposition of public order demanded by the country at that time and not those of an army in their typical roles.

Due to its characteristics and missions, organizational structure that demanded presence throughout the country, which was realized with the creation of posts and detachments in different parts of the country and the establishment in some provinces of company size units, many of which still Army retains today. Over the years and already existing National Police created by decree No. 1523 of March 2, 1936, of President Trujillo, many of these units, posts and detachments became part of it, perfectly adapted to its structure, since These were essentially created to play a policing role. So great was the influence that had the National Guard in Dominican society and very particularly in the rural population, which even today are many Dominicans who often referred to the Armed Forces and unique way to the Army as " The Guard ".

Meanwhile, the Navy has remained since its inception attached to the principles that gave rise, assuming only two name changes since its inception, but gradually evolving the transformation of what was a body created for military purposes, capable of landing and ships with weapons to face possible naval invasions, to be a component mainly responsible for enforcing the provisions on navigation, trade and fishing, as well as international treaties

The Dominican Air Force, meanwhile, emerges as an independent component in 1948, under the chairmanship of Generalissimo Rafael L. Trujillo Molina, with characteristics of innovation and modernism, which gave mobility, versatility and depth to the Armed Forces and the complement in the following years would become: a military capacity to project military power in the Caribbean environment. The situation of this air component has changed significantly after reaching its climax in the 50s, when it was one of the best air force equipped in the region, which was due to the strategic guidelines of a long-lived military dictatorship It made efforts to stay in power and he saw in this component one of its mainstays against any invasion or subversion against the dictatorship.

Army of the Dominican Republic
The Dominican Army was founded in 1844. Its basic strength is concentrated in the infantry which in general can be said to be well equipped with combat rifles and combat equipment for soldiers. The vehicles (both transport and armored vehicles) and the artillery and anti-tank pieces that are in service. Currently, tanks and modern armor systems have been included.

Navy of the Dominican Republic
The Dominican Navy was founded in 1844 also with the National Independence with 15,000 troops after Haiti had occupied the eastern part of the island for twenty five years. It keeps around 34 ships in operation, mostly coast guards, patrol boats and small speedboats. It also operates dredges, tugboats and patrol boats of height. The Navy has a small air body composed helicopter utilities Bell OH-58C Kiowa.

The Navy operates two main bases, one in the port of Santo Domingo in the Dominican capital called "Naval Base 27 de Febrero" and another in Bahía de las Calderas, in the province of Peravia, called Las Calderas Naval Base in the southern part from the country. It also has presence in the commercial ports of the country, comandancias of ports and is divided into three naval areas that in turn have posts and naval detachments.

Air Force of the Dominican Republic
The Dominican Air Force was founded in 1948 with 20,000 people. It has two main bases: the base area of San Isidro in the South-Central zone of the country near the capital city Santo Domingo; and the other operates jointly in the civil facilities belonging to the Gregorio Luperón International Airport, near the city of Puerto Plata in the North of the Republic. Until August 2009, the possibility of starting military operations from the María Montez airport, in the city of Barahona in the Southwest of the country and from the Punta Cana airport in the extreme east is under study.

It keeps the following fixed-wing aircraft in operation: 8 Embraer EMB 314 Super Tucano, 3 CASA C-212-400 transport; 6 T35B Pilot training; as well as around 25 helicopters such as Bell 206, Bell UH-1 Iroquois, Bell OH-58 Kiowa, Eurocopter Dauphin, OH-6 Cayuse and Sikorsky S-300.

Specialized Security Corps
The Specialized Security Corps are military security agencies dependent on the Ministry of Defense and they are made up of military and civilian personnel specialized in their different areas of function. Overall their duty is to support state institutions, defend national interests in peace and war, and as force multiplers of the Armed Forces as well as the National Police.

 * Antiterrorism Command of the Dominican Armed Forces
 * National Department of Investigations (DNI)
 * Airport Security and Civil Aviation Special Forces (CESAC)
 * Specialized Corps of Metro and Cable Car Railway Security (CESMET)
 * Specialized Corps of Tourist Security (CESTUR)
 * Specialized Corps of Fuel Control (CECCOM)
 * Task Force Ciudad Tranquila (FT-CIUTRAN)
 * Specialized Port Security Corps (CESEP)
 * Presidential Security Corps (CUSEP)
 * Specialized Border Security Corps (CESFRONT)
 * National Special Corps of Environmental and Parks Protection (SENPA)
 * Military and Police Commission of the Ministry of Public Works and Communications (COMIPOL-MOPC)

title: Armed Forces of the Dominican Republic


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Foreign relations of the Dominican Republic

The foreign relations of the Dominican Republic are the Dominican Republic's relations with other governments.

The Dominican Republic has a close relationship with the United States and with the other states of the Inter-American system. It has accredited diplomatic missions in most Western Hemisphere countries and in principal European capitals.

History
The island nation of the Dominican Republic maintains very limited relations with most of the countries of Africa, Asia, the Middle East, and Eastern Europe. It concentrated its diplomatic activities in four critical arenas: the circum-Caribbean, countries in the Americas, the United States, and Western Europe (mainly West Germany, Spain, and France).

Diplomatic relations
List of countries which the Dominican Republic maintains diplomatic relations with:

Multilateral relations
The Dominican Republic is a founding member of the United Nations and many of its specialized and related agencies, including the World Bank, International Labour Organization, International Atomic Energy Agency, and International Civil Aviation Organization. It also is a member of the OAS, World Trade Organization, World Health Organization, World Customs Organization the Inter-American Development Bank, Central American Integration System, and ACP Group.


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Disease

A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are associated with specific signs and symptoms. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies, and autoimmune disorders.

In humans, disease is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person affected, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases can affect people not only physically but also mentally, as contracting and living with a disease can alter the affected person's perspective on life.

Death due to disease is called death by natural causes. There are four main types of disease: infectious diseases, deficiency diseases, hereditary diseases (including both genetic and non-genetic hereditary diseases), and physiological diseases. Diseases can also be classified in other ways, such as communicable versus non-communicable diseases. The deadliest diseases in humans are coronary artery disease (blood flow obstruction), followed by cerebrovascular disease and lower respiratory infections. In developed countries, the diseases that cause the most sickness overall are neuropsychiatric conditions, such as depression and anxiety.

The study of disease is called pathology, which includes the study of etiology, or cause.

Concepts
In many cases, terms such as disease, disorder, morbidity, sickness and illness are used interchangeably; however, there are situations when specific terms are considered preferable.

 * Disease
 * The term disease broadly refers to any condition that impairs the normal functioning of the body. For this reason, diseases are associated with the dysfunction of the body's normal homeostatic processes. Commonly, the term is used to refer specifically to infectious diseases, which are clinically evident diseases that result from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular organisms, and aberrant proteins known as prions. An infection or colonization that does not and will not produce clinically evident impairment of normal functioning, such as the presence of the normal bacteria and yeasts in the gut, or of a passenger virus, is not considered a disease. By contrast, an infection that is asymptomatic during its incubation period, but expected to produce symptoms later, is usually considered a disease. Non-infectious diseases are all other diseases, including most forms of cancer, heart disease, and genetic disease.

 * Acquired disease
 * An acquired disease is one that began at some point during one's lifetime, as opposed to disease that was already present at birth, which is congenital disease. Acquired sounds like it could mean "caught via contagion", but it simply means acquired sometime after birth. It also sounds like it could imply secondary disease, but acquired disease can be primary disease.

 * Acute disease
 * An acute disease is one of a short-term nature (acute); the term sometimes also connotes a fulminant nature

 * Chronic condition or chronic disease
 * A chronic disease is one that persists over time, often for at least six months, but may also include illnesses that are expected to last for the entirety of one's natural life.

 * Congenital disorder or congenital disease
 * A congenital disorder is one that is present at birth. It is often a genetic disease or disorder and can be inherited. It can also be the result of a vertically transmitted infection from the mother, such as HIV/AIDS.

 * Genetic disease
 * A genetic disorder or disease is caused by one or more genetic mutations. It is often inherited, but some mutations are random and de novo.

 * Hereditary or inherited disease
 * A hereditary disease is a type of genetic disease caused by genetic mutations that are hereditary (and can run in families)

 * Iatrogenic disease
 * An iatrogenic disease or condition is one that is caused by medical intervention, whether as a side effect of a treatment or as an inadvertent outcome.

 * Idiopathic disease
 * An idiopathic disease has an unknown cause or source. As medical science has advanced, many diseases with entirely unknown causes have had some aspects of their sources explained and therefore shed their idiopathic status. For example, when germs were discovered, it became known that they were a cause of infection, but particular germs and diseases had not been linked. In another example, it is known that autoimmunity is the cause of some forms of diabetes mellitus type 1, even though the particular molecular pathways by which it works are not yet understood. It is also common to know certain factors are associated with certain diseases; however, association does not necessarily imply causality. For example, a third factor might be causing both the disease, and the associated phenomenon.

 * Incurable disease
 * A disease that cannot be cured. Incurable diseases are not necessarily terminal diseases, and sometimes a disease's symptoms can be treated sufficiently for the disease to have little or no impact on quality of life.

 * Primary disease
 * A primary disease is a disease that is due to a root cause of illness, as opposed to secondary disease, which is a sequela, or complication that is caused by the primary disease. For example, a common cold is a primary disease, where rhinitis is a possible secondary disease, or sequela. A doctor must determine what primary disease, a cold or bacterial infection, is causing a patient's secondary rhinitis when deciding whether or not to prescribe antibiotics.

 * Secondary disease
 * A secondary disease is a disease that is a sequela or complication of a prior, causal disease, which is referred to as the primary disease or simply the underlying cause (root cause). For example, a bacterial infection can be primary, wherein a healthy person is exposed to bacteria and becomes infected, or it can be secondary to a primary cause, that predisposes the body to infection. For example, a primary viral infection that weakens the immune system could lead to a secondary bacterial infection. Similarly, a primary burn that creates an open wound could provide an entry point for bacteria, and lead to a secondary bacterial infection.

 * Terminal disease
 * A terminal disease is one that is expected to have the inevitable result of death. Previously, AIDS was a terminal disease; it is now incurable, but can be managed indefinitely using medications.

 * Illness
 * The terms illness and sickness are both generally used as synonyms for disease; however, the term illness is occasionally used to refer specifically to the patient's personal experience of their disease.  In this model, it is possible for a person to have a disease without being ill (to have an objectively definable, but asymptomatic, medical condition, such as a subclinical infection, or to have a clinically apparent physical impairment but not feel sick or distressed by it), and to be ill without being diseased (such as when a person perceives a normal experience as a medical condition, or medicalizes a non-disease situation in their life – for example, a person who feels unwell as a result of embarrassment, and who interprets those feelings as sickness rather than normal emotions). Symptoms of illness are often not directly the result of infection, but a collection of evolved responses – sickness behavior by the body – that helps clear infection and promote recovery. Such aspects of illness can include lethargy, depression, loss of appetite, sleepiness, hyperalgesia, and inability to concentrate.

 * A disorder is a functional abnormality or disturbance that may or may not show specific signs and symptoms. Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders. The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances. In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions; however, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as metabolic disorders.
 * A disorder is a functional abnormality or disturbance that may or may not show specific signs and symptoms. Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders. The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances. In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions; however, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as metabolic disorders.

 * Medical condition or health condition
 * A medical condition or health condition is a broad concept that includes all diseases, lesions, disorders, or nonpathologic condition that normally receives medical treatment, such as pregnancy or childbirth. While the term medical condition generally includes mental illnesses, in some contexts the term is used specifically to denote any illness, injury, or disease except for mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the widely used psychiatric manual that defines all mental disorders, uses the term general medical condition to refer to all diseases, illnesses, and injuries except for mental disorders. This usage is also commonly seen in the psychiatric literature. Some health insurance policies also define a medical condition as any illness, injury, or disease except for psychiatric illnesses.
 * As it is more value-neutral than terms like disease, the term medical condition is sometimes preferred by people with health issues that they do not consider deleterious. However, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of the autism rights movement.
 * The term medical condition is also a synonym for medical state, in which case it describes an individual patient's current state from a medical standpoint. This usage appears in statements that describe a patient as being in critical condition, for example.

 * Morbidity is a diseased state, disability, or poor health due to any cause. The term may refer to the existence of any form of disease, or to the degree that the health condition affects the patient. Among severely ill patients, the level of morbidity is often measured by ICU scoring systems. Comorbidity, or co-existing disease, is the simultaneous presence of two or more medical conditions, such as schizophrenia and substance abuse.
 * In epidemiology and actuarial science, the term morbidity (also morbidity rate or morbidity frequency) can refer to either the incidence rate, the prevalence of a disease or medical condition, or the percentage of people who experience a given condition within a given timeframe (e.g., 20% of people will get influenza in a year). This measure of sickness is contrasted with the mortality rate of a condition, which is the proportion of people dying during a given time interval. Morbidity rates are used in actuarial professions, such as health insurance, life insurance, and long-term care insurance, to determine the premiums charged to customers. Morbidity rates help insurers predict the likelihood that an insured will contract or develop any number of specified diseases.
 * In epidemiology and actuarial science, the term morbidity (also morbidity rate or morbidity frequency) can refer to either the incidence rate, the prevalence of a disease or medical condition, or the percentage of people who experience a given condition within a given timeframe (e.g., 20% of people will get influenza in a year). This measure of sickness is contrasted with the mortality rate of a condition, which is the proportion of people dying during a given time interval. Morbidity rates are used in actuarial professions, such as health insurance, life insurance, and long-term care insurance, to determine the premiums charged to customers. Morbidity rates help insurers predict the likelihood that an insured will contract or develop any number of specified diseases.

 * Pathosis or pathology
 * Pathosis (plural pathoses) is synonymous with disease. The word pathology also has this sense, in which it is commonly used by physicians in the medical literature, although some editors prefer to reserve pathology to its other senses. Sometimes a slight connotative shade causes preference for pathology or pathosis implying "some [as yet poorly analyzed] pathophysiologic process" rather than disease implying "a specific disease entity as defined by diagnostic criteria being already met". This is hard to quantify denotatively, but it explains why cognitive synonymy is not invariable.

 * Syndrome
 * A syndrome is the association of several signs and symptoms, or other characteristics that often occur together, regardless of whether the cause is known. Some syndromes such as Down syndrome are known to have only one cause (an extra chromosome at birth). Others such as Parkinsonian syndrome are known to have multiple possible causes. Acute coronary syndrome, for example, is not a single disease itself but is rather the manifestation of any of several diseases including myocardial infarction secondary to coronary artery disease. In yet other syndromes, however, the cause is unknown. A familiar syndrome name often remains in use even after an underlying cause has been found or when there are a number of different possible primary causes. Examples of the first-mentioned type are that Turner syndrome and DiGeorge syndrome are still often called by the "syndrome" name despite that they can also be viewed as disease entities and not solely as sets of signs and symptoms.

 * Predisease
 * Predisease is a subclinical or prodromal vanguard of a disease. Prediabetes and prehypertension are common examples. The nosology or epistemology of predisease is contentious, though, because there is seldom a bright line differentiating a legitimate concern for subclinical or premonitory status and the conflict of interest–driven over-medicalization (e.g., by pharmaceutical manufacturers) or de-medicalization (e.g., by medical and disability insurers). Identifying legitimate predisease can result in useful preventive measures, such as motivating the person to get a healthy amount of physical exercise, but labeling a healthy person with an unfounded notion of predisease can result in overtreatment, such as taking drugs that only help people with severe disease or paying for treatments with a poor benefit–cost ratio.
 * One review proposed three criteria for predisease:
 * a high risk for progression to disease making one "far more likely to develop" it than others are- for example, a pre-cancer will almost certainly turn into cancer over time
 * actionability for risk reduction – for example, removal of the precancerous tissue prevents it from turning into a potentially deadly cancer
 * benefit that outweighs the harm of any interventions taken – removing the precancerous tissue prevents cancer, and thus prevents a potential death from cancer.

Types by body system

 * Mental
 * Mental illness is a broad, generic label for a category of illnesses that may include affective or emotional instability, behavioral dysregulation, cognitive dysfunction or impairment. Specific illnesses known as mental illnesses include major depression, generalized anxiety disorders, schizophrenia, and attention deficit hyperactivity disorder, to name a few. Mental illness can be of biological (e.g., anatomical, chemical, or genetic) or psychological (e.g., trauma or conflict) origin. It can impair the affected person's ability to work or study and can harm interpersonal relationships. The term insanity is used technically as a legal term.

 * Organic
 * An organic disease is one caused by a physical or physiological change to some tissue or organ of the body. The term sometimes excludes infections. It is commonly used in contrast with mental disorders. It includes emotional and behavioral disorders if they are due to changes to the physical structures or functioning of the body, such as after a stroke or a traumatic brain injury, but not if they are due to psychosocial issues.

Stages
In an infectious disease, the incubation period is the time between infection and the appearance of symptoms. The latency period is the time between infection and the ability of the disease to spread to another person, which may precede, follow, or be simultaneous with the appearance of symptoms. Some viruses also exhibit a dormant phase, called viral latency, in which the virus hides in the body in an inactive state. For example, varicella zoster virus causes chickenpox in the acute phase; after recovery from chickenpox, the virus may remain dormant in nerve cells for many years, and later cause herpes zoster (shingles).
 * Acute disease
 * An acute disease is a short-lived disease, like the common cold.

 * Chronic disease
 * A chronic disease is one that lasts for a long time, usually at least six months. During that time, it may be constantly present, or it may go into remission and periodically relapse. A chronic disease may be stable (does not get any worse) or it may be progressive (gets worse over time). Some chronic diseases can be permanently cured. Most chronic diseases can be beneficially treated, even if they cannot be permanently cured.

 * Clinical disease
 * One that has clinical consequences; in other words, the stage of the disease that produces the characteristic signs and symptoms of that disease. AIDS is the clinical disease stage of HIV infection.

 * Cure
 * A cure is the end of a medical condition or a treatment that is very likely to end it, while remission refers to the disappearance, possibly temporarily, of symptoms. Complete remission is the best possible outcome for incurable diseases.

 * Flare-up

 * A flare-up can refer to either the recurrence of symptoms or an onset of more severe symptoms.

 * Progressive disease
 * Progressive disease is a disease whose typical natural course is the worsening of the disease until death, serious debility, or organ failure occurs. Slowly progressive diseases are also chronic diseases; many are also degenerative diseases. The opposite of progressive disease is stable disease or static disease: a medical condition that exists, but does not get better or worse.

 * A refractory disease is a disease that resists treatment, especially an individual case that resists treatment more than is normal for the specific disease in question.
 * A refractory disease is a disease that resists treatment, especially an individual case that resists treatment more than is normal for the specific disease in question.

 * Subclinical disease
 * Also called silent disease, silent stage, or asymptomatic disease. This is a stage in some diseases before the symptoms are first noted.

 * Terminal phase
 * If a person will die soon from a disease, regardless of whether that disease typically causes death, then the stage between the earlier disease process and active dying is the terminal phase.

 * Recovery
 * Recovery can refer to the repairing of physical processes (tissues, organs etc.) and the resumption of healthy functioning after damage causing processes have been cured.

Extent

 * Localized disease
 * A localized disease is one that affects only one part of the body, such as athlete's foot or an eye infection.

 * Disseminated disease
 * A disseminated disease has spread to other parts; with cancer, this is usually called metastatic disease.

 * Systemic disease
 * A systemic disease is a disease that affects the entire body, such as influenza or high blood pressure.

Classification
Diseases may be classified by cause, pathogenesis (mechanism by which the disease is caused), or by symptoms. Alternatively, diseases may be classified according to the organ system involved, though this is often complicated since many diseases affect more than one organ.

A chief difficulty in nosology is that diseases often cannot be defined and classified clearly, especially when cause or pathogenesis are unknown. Thus diagnostic terms often only reflect a symptom or set of symptoms (syndrome).

Classical classification of human disease derives from the observational correlation between pathological analysis and clinical syndromes. Today it is preferred to classify them by their cause if it is known.

The most known and used classification of diseases is the World Health Organization's ICD. This is periodically updated. Currently, the last publication is the ICD-11.

Causes
Diseases can be caused by any number of factors and may be acquired or congenital. Microorganisms, genetics, the environment or a combination of these can contribute to a diseased state.

Only some diseases such as influenza are contagious and commonly believed infectious. The microorganisms that cause these diseases are known as pathogens and include varieties of bacteria, viruses, protozoa, and fungi. Infectious diseases can be transmitted, e.g. by hand-to-mouth contact with infectious material on surfaces, by bites of insects or other carriers of the disease, and from contaminated water or food (often via fecal contamination), etc. Also, there are sexually transmitted diseases. In some cases, microorganisms that are not readily spread from person to person play a role, while other diseases can be prevented or ameliorated with appropriate nutrition or other lifestyle changes.

Some diseases, such as most (but not all) forms of cancer, heart disease, and mental disorders, are non-infectious diseases. Many non-infectious diseases have a partly or completely genetic basis (see genetic disorder) and may thus be transmitted from one generation to another.

Social determinants of health are the social conditions in which people live that determine their health. Illnesses are generally related to social, economic, political, and environmental circumstances. Social determinants of health have been recognized by several health organizations such as the Public Health Agency of Canada and the World Health Organization to greatly influence collective and personal well-being. The World Health Organization's Social Determinants Council also recognizes Social determinants of health in poverty.

When the cause of a disease is poorly understood, societies tend to mythologize the disease or use it as a metaphor or symbol of whatever that culture considers evil. For example, until the bacterial cause of tuberculosis was discovered in 1882, experts variously ascribed the disease to heredity, a sedentary lifestyle, depressed mood, and overindulgence in sex, rich food, or alcohol, all of which were social ills at the time.

When a disease is caused by a pathogenic organism (e.g., when malaria is caused by Plasmodium), one should not confuse the pathogen (the cause of the disease) with disease itself. For example, West Nile virus (the pathogen) causes West Nile fever (the disease). The misuse of basic definitions in epidemiology is frequent in scientific publications.

Types of causes

 * Airborne: An airborne disease is any disease that is caused by pathogens and transmitted through the air.
 * Foodborne: Foodborne illness or food poisoning is any illness resulting from the consumption of food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites.
 * Infectious: Infectious diseases, also known as transmissible diseases or communicable diseases, comprise clinically evident illness (i.e., characteristic medical signs or symptoms of disease) resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism. Included in this category are contagious diseases – an infection, such as influenza or the common cold, that commonly spreads from one person to another – and communicable diseases – a disease that can spread from one person to another, but does not necessarily spread through everyday contact.
 * Lifestyle: A lifestyle disease is any disease that appears to increase in frequency as countries become more industrialized and people live longer, especially if the risk factors include behavioral choices like a sedentary lifestyle or a diet high in unhealthful foods such as refined carbohydrates, trans fats, or alcoholic beverages.
 * Non-communicable: A non-communicable disease is a medical condition or disease that is non-transmissible. Non-communicable diseases cannot be spread directly from one person to another. Heart disease and cancer are examples of non-communicable diseases in humans.

Prevention
Many diseases and disorders can be prevented through a variety of means. These include sanitation, proper nutrition, adequate exercise, vaccinations and other self-care and public health measures,.

Treatments
Medical therapies or treatments are efforts to cure or improve a disease or other health problems. In the medical field, therapy is synonymous with the word treatment. Among psychologists, the term may refer specifically to psychotherapy or "talk therapy". Common treatments include medications, surgery, medical devices, and self-care. Treatments may be provided by an organized health care system, or informally, by the patient or family members.

Preventive healthcare is a way to avoid an injury, sickness, or disease in the first place. A treatment or cure is applied after a medical problem has already started. A treatment attempts to improve or remove a problem, but treatments may not produce permanent cures, especially in chronic diseases. Cures are a subset of treatments that reverse diseases completely or end medical problems permanently. Many diseases that cannot be completely cured are still treatable. Pain management (also called pain medicine) is that branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain.

Treatment for medical emergencies must be provided promptly, often through an emergency department or, in less critical situations, through an urgent care facility.

Epidemiology
Epidemiology is the study of the factors that cause or encourage diseases. Some diseases are more common in certain geographic areas, among people with certain genetic or socioeconomic characteristics, or at different times of the year.

Epidemiology is considered a cornerstone methodology of public health research and is highly regarded in evidence-based medicine for identifying risk factors for diseases. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges from outbreak investigation to study design, data collection, and analysis including the development of statistical models to test hypotheses and the documentation of results for submission to peer-reviewed journals. Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic. Epidemiologists rely on a number of other scientific disciplines such as biology (to better understand disease processes), biostatistics (the current raw information available), Geographic Information Science (to store data and map disease patterns) and social science disciplines (to better understand proximate and distal risk factors). Epidemiology can help identify causes as well as guide prevention efforts.

In studying diseases, epidemiology faces the challenge of defining them. Especially for poorly understood diseases, different groups might use significantly different definitions. Without an agreed-on definition, different researchers may report different numbers of cases and characteristics of the disease.

Some morbidity databases are compiled with data supplied by states and territories health authorities, at national levels or larger scale (such as European Hospital Morbidity Database (HMDB)) which may contain hospital discharge data by detailed diagnosis, age and sex. The European HMDB data was submitted by European countries to the World Health Organization Regional Office for Europe.

Burdens of disease
Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators.

There are several measures used to quantify the burden imposed by diseases on people. The years of potential life lost (YPLL) is a simple estimate of the number of years that a person's life was shortened due to a disease. For example, if a person dies at the age of 65 from a disease, and would probably have lived until age 80 without that disease, then that disease has caused a loss of 15 years of potential life. YPLL measurements do not account for how disabled a person is before dying, so the measurement treats a person who dies suddenly and a person who died at the same age after decades of illness as equivalent. In 2004, the World Health Organization calculated that 932 million years of potential life were lost to premature death.

The quality-adjusted life year (QALY) and disability-adjusted life year (DALY) metrics are similar but take into account whether the person was healthy after diagnosis. In addition to the number of years lost due to premature death, these measurements add part of the years lost to being sick. Unlike YPLL, these measurements show the burden imposed on people who are very sick, but who live a normal lifespan. A disease that has high morbidity, but low mortality, has a high DALY and a low YPLL. In 2004, the World Health Organization calculated that 1.5 billion disability-adjusted life years were lost to disease and injury. In the developed world, heart disease and stroke cause the most loss of life, but neuropsychiatric conditions like major depressive disorder cause the most years lost to being sick.

Society and culture

How a society responds to diseases is the subject of medical sociology.

A condition may be considered a disease in some cultures or eras but not in others. For example, obesity can represent wealth and abundance, and is a status symbol in famine-prone areas and some places hard-hit by HIV/AIDS. Epilepsy is considered a sign of spiritual gifts among the Hmong people.

Sickness confers the social legitimization of certain benefits, such as illness benefits, work avoidance, and being looked after by others. The person who is sick takes on a social role called the sick role. A person who responds to a dreaded disease, such as cancer, in a culturally acceptable fashion may be publicly and privately honored with higher social status. In return for these benefits, the sick person is obligated to seek treatment and work to become well once more. As a comparison, consider pregnancy, which is not interpreted as a disease or sickness, even if the mother and baby may both benefit from medical care.

Most religions grant exceptions from religious duties to people who are sick. For example, one whose life would be endangered by fasting on Yom Kippur or during the month of Ramadan is exempted from the requirement, or even forbidden from participating. People who are sick are also exempted from social duties. For example, ill health is the only socially acceptable reason for an American to refuse an invitation to the White House.

The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognition of diseases such as repetitive stress injury (RSI) and post-traumatic stress disorder (PTSD) has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations, and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread.

Lepers were people who were historically shunned because they had an infectious disease, and the term "leper" still evokes social stigma. Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma.

Social standing and economic status affect health. Diseases of poverty are diseases that are associated with poverty and low social status; diseases of affluence are diseases that are associated with high social and economic status. Which diseases are associated with which states vary according to time, place, and technology. Some diseases, such as diabetes mellitus, may be associated with both poverty (poor food choices) and affluence (long lifespans and sedentary lifestyles), through different mechanisms. The term lifestyle diseases describes diseases associated with longevity and that are more common among older people. For example, cancer is far more common in societies in which most members live until they reach the age of 80 than in societies in which most members die before they reach the age of 50.

Language of disease
An illness narrative is a way of organizing a medical experience into a coherent story that illustrates the sick individual's personal experience.

People use metaphors to make sense of their experiences with disease. The metaphors move disease from an objective thing that exists to an affective experience. The most popular metaphors draw on military concepts: Disease is an enemy that must be feared, fought, battled, and routed. The patient or the healthcare provider is a warrior, rather than a passive victim or bystander. The agents of communicable diseases are invaders; non-communicable diseases constitute internal insurrection or civil war. Because the threat is urgent, perhaps a matter of life and death, unthinkably radical, even oppressive, measures are society's and the patient's moral duty as they courageously mobilize to struggle against destruction. The War on Cancer is an example of this metaphorical use of language. This language is empowering to some patients, but leaves others feeling like they are failures.

Another class of metaphors describes the experience of illness as a journey: The person travels to or from a place of disease, and changes himself, discovers new information, or increases his experience along the way. He may travel "on the road to recovery" or make changes to "get on the right track" or choose "pathways". Some are explicitly immigration-themed: the patient has been exiled from the home territory of health to the land of the ill, changing identity and relationships in the process. This language is more common among British healthcare professionals than the language of physical aggression.

Some metaphors are disease-specific. Slavery is a common metaphor for addictions: The alcoholic is enslaved by drink, and the smoker is captive to nicotine. Some cancer patients treat the loss of their hair from chemotherapy as a metonymy or metaphor for all the losses caused by the disease.

Some diseases are used as metaphors for social ills: "Cancer" is a common description for anything that is endemic and destructive in society, such as poverty, injustice, or racism. AIDS was seen as a divine judgment for moral decadence, and only by purging itself from the "pollution" of the "invader" could society become healthy again. More recently, when AIDS seemed less threatening, this type of emotive language was applied to avian flu and type 2 diabetes mellitus. Authors in the 19th century commonly used tuberculosis as a symbol and a metaphor for transcendence. People with the disease were portrayed in literature as having risen above daily life to become ephemeral objects of spiritual or artistic achievement. In the 20th century, after its cause was better understood, the same disease became the emblem of poverty, squalor, and other social problems.

title: Disease