Bermuda – Health Issues

What are the most common health issues affecting Bermuda’s population?

Like many high-income island economies, Bermuda’s greatest health challenges come not from infectious disease but from non-communicable diseases (NCDs) — chronic, long-term conditions closely linked to lifestyle, diet, and ageing. In 2023, an estimated 568 deaths in Bermuda were attributed to NCDs, compared with just 28.4 from communicable diseases and 25.7 from injuries. This pattern is typical of wealthier nations worldwide, where cardiovascular disease and cancer are the dominant causes of death.

According to the Government’s Bermuda Health Strategy 2022–2027, 50% of residents — around 31,824 people in a total population of 63,634 — have at least one chronic condition such as diabetes, heart disease, or kidney disease. These figures place Bermuda among the most chronically burdened populations relative to its size anywhere in the developed world, and they drive enormous healthcare costs across the island.

How widespread is obesity in Bermuda?

Obesity is one of the most pressing health issues on the island. Obesity is an important risk factor for health conditions and premature death, increasing the risk of various cancers, cardiovascular disease, and other serious illnesses. In Bermuda, the numbers are striking. The prevalence of overweight and obesity among people aged 15 and older was 62.5% in 2022, and by 2024, 64% of adults were defined as overweight or obese. This is well above global averages and reflects a growing trend across the region.

As far back as 2014, 17.1% of the population reported insufficient physical activity, a figure that compounds the risks associated with high body weight. Limited land space, a car-dependent culture on a small island, and access to high-calorie imported foods all contribute to Bermuda’s obesity challenge — a situation not unlike that seen in other island territories across the Caribbean and Atlantic.

How serious is the diabetes problem in Bermuda?

Diabetes is one of Bermuda’s most acute health crises. According to government data, 8,274 residents — approximately 13% of the population — are diabetic, with only two countries in the OECD recording a higher rate. This is consistent with data from the World Bank, which recorded diabetes prevalence among those aged 20–79 at 13% in 2021, up from 12% in 2011.

The financial impact is severe: $29 million is spent annually on dialysis alone, with demand growing at a rate of 10% each year. The link between diabetes, obesity, and kidney failure means that tackling obesity is central to reducing the dialysis burden on Bermuda’s healthcare system. Expats moving to Bermuda with pre-existing diabetes should be prepared for significant healthcare costs and should ensure their insurance policy covers chronic disease management comprehensively.

How prevalent is heart disease and high blood pressure in Bermuda?

Cardiovascular disease is a leading concern for Bermuda’s population. Around 21,000 residents — roughly 33% of the population — have high blood pressure and/or high cholesterol, both major risk factors for heart disease and stroke. These conditions are directly linked to the high rates of obesity and diabetes on the island, creating a compounding effect on long-term health outcomes.

Heart disease and related vascular conditions form part of the heavy NCD burden that the government’s Bermuda Health Strategy 2022–2027 is designed to address. Routine testing for conditions such as high blood pressure and screening for various cancers are considered vital for family and community wellbeing, yet access to these services is not universal. About 35% of the population are unable to access quality healthcare without financial hardship, including 12% who are uninsured and 23% who are unable to afford adequate health insurance or are underinsured.

What cancers are most common in Bermuda?

Cancer is a significant cause of illness and death in Bermuda, and the island has invested considerably in tracking and treating it. For over 70 years, the Bermuda Cancer and Health Centre (BCHC) has tracked cancer incidence, mortality, and outcomes in Bermuda. The centre plays a central role in prevention programmes, screening initiatives, and treatment — a model comparable to cancer registries found in countries such as New Zealand or Ireland.

Breast cancer is the most common cancer in Bermudian women, with the BCHC examining incidence, screening rates, stage at diagnosis, and outcomes, emphasising that understanding patterns helps improve screening access and early detection. Prostate cancer is the most common cancer in Bermudian men, with data covering incidence, screening practices, and mortality trends — information used to provide better education and care across the community.

A significant milestone in Bermuda’s cancer care came in 2017, when radiation therapy became available on the island for the first time. Before 2017, Bermudians needing radiation therapy had to travel overseas — away from family and at great expense. This development has transformed the experience of cancer treatment for residents and expats alike. The Bermuda Cancer and Health Centre remains the primary institution for cancer prevention, screening, and treatment on the island.

How does mental health and an ageing population affect Bermuda?

Mental health is an area of growing awareness in Bermuda. The Bermuda Hospitals Board actively promotes mental health services and awareness weeks, and the Mid-Atlantic Wellness Institute is the island’s main provider of psychiatric and psychological care. Conditions prominently addressed by healthcare experts in Bermuda include depression, Alzheimer’s disease, and substance abuse, alongside the more commonly discussed physical conditions.

Alzheimer’s disease is a particular concern given Bermuda’s rapidly ageing demographic. Alzheimer’s disease is the leading cause of dementia in people over the age of 65, and it is estimated that approximately 5% of people in Bermuda over that age and 20% of those over the age of 85 are living with Alzheimer’s disease. This is a significant and growing challenge. In 2024, people over 65 years of age accounted for 21.7% of Bermuda’s total population, an increase of 10.9 percentage points compared to the year 2000. As the population ages, demand for dementia care and mental health services is likely to intensify.

The Bermuda Health Strategy 2022–2027 highlights the high cost of healthcare as the major challenge to equitable access to quality care across the population, a challenge that is especially acute for older residents on fixed incomes and for those without comprehensive insurance coverage.

How common is smoking in Bermuda, and what are public attitudes?

According to the Steps to a Well Bermuda Survey 2014, 20% of men and 7.5% of women smoke, with the average age at which smokers take up the habit being 17.8 years. The overall smoking rate at the time the Tobacco Control Act came into force was approximately 14%, and the stated public health goal was to reduce the percentage of smokers from 14% to less than 10%, and to stop people taking up smoking.

Attitudes towards smoking in Bermuda have shifted considerably in recent decades. Department of Health director David Kendell described the intent of the legislation as ensuring smoking is not normalised, reflecting a broader cultural shift away from acceptance of tobacco use in public spaces. The legislation introduced in 2016 was deliberately designed to change social norms around smoking, particularly among young people.

A Report of the Survey of Students on Knowledge and Attitudes of Drugs and Health 2012 showed that some children in Bermuda start smoking as young as 8 years old, highlighting the urgency of intervention at an early age. The National School Survey 2015 found that 25% of smokers attending middle and high schools get their cigarettes from shops, with reducing smoking among children identified as the main intent of the new policy. These findings prompted tighter controls on point-of-sale access and advertising.

Smoking has “a huge impact on Bermuda’s healthcare costs, which are constantly rising,” and any reduction in smoking rates is seen as a meaningful way to reduce healthcare expenditure. Public awareness of the health and financial costs of smoking appears to be growing, with the government actively promoting cessation support and using public health communications to discourage uptake.

What legislation governs smoking and tobacco in Bermuda?

The Tobacco Control Act 2015 is the primary law governing tobacco control in Bermuda. On 31 July 2016, the Tobacco Control Act 2015 replaced the Tobacco Products (Public Health) Act 1987, which had been in place for nearly three decades. The new Act represented a significant strengthening of Bermuda’s tobacco control framework.

The Act is intended to protect children from tobacco products, strengthen provisions controlling smoking, and control the sale and use of e-cigarettes and cigarette rolling papers in order to protect human health and, in particular, reduce exposure to chronic disease risk factors. This approach mirrors similar legislation seen in other developed jurisdictions, such as the UK’s smoke-free legislation introduced in 2007 and Ireland’s Public Health (Tobacco) Acts.

Smoking is prohibited in all indoor public places, indoor workplaces, and on public transport. In addition, smoking is also prohibited on the premises — including outdoor areas — of all educational facilities and most healthcare facilities. From 1 August 2016, a ban on smoking, including e-cigarettes, both inside and anywhere outside certain government premises came into effect. These premises include healthcare facilities, residential care facilities, educational, daycare and preschool facilities, plus bus and ferry terminals.

The law prohibits many forms of tobacco advertising and promotion. Point-of-sale product display is limited to areas not directly accessible to consumers, and displays may not be within three metres of sweets, toys, candy, and other items that might reasonably appeal to minors. The law also prohibits the sale of tobacco products by vending machines and in healthcare facilities, educational facilities, daycare facilities, preschools, and government buildings.

The sale of tobacco products is prohibited to persons under the age of 18. The law regulates specified contents in cigarettes, including prohibiting flavoured tobacco products except for tobacco and menthol flavours. Violations of smoking prohibitions carry financial penalties: persons found smoking where prohibited are subject to a fine of $1,000, as of the current legislation.

Bermuda is a British Overseas Territory and falls under the jurisdiction of the United Kingdom. The UK became a party to the WHO Framework Convention on Tobacco Control on 16 March 2005; however, the WHO FCTC has not been extended to Bermuda. Despite this, Bermuda’s own legislation reflects many of the same principles and aims. The full text of the Tobacco Control Act 2015 is available through the Government of Bermuda official website.

How are e-cigarettes regulated in Bermuda?

The law prohibits the use of e-cigarettes in places where smoking is prohibited, because the Tobacco Control Act defines “smoking” to include the use of “cigarette products,” which includes e-cigarettes. This means that the same indoor and outdoor restrictions that apply to traditional cigarettes apply equally to vaping devices — a stricter approach than is found in some other jurisdictions.

The sale of e-cigarettes is allowed in Bermuda, but their use is prohibited in indoor public places, indoor workplaces, and on public transport. In addition, e-cigarette advertising and promotion are prohibited, and there are restrictions on the publicity of sponsorship contributions. This balanced approach aims to permit e-cigarettes as a potential cessation tool while preventing their normalisation, particularly among young people.

Under the Act, electronic cigarettes are only available in pharmacies, which reflects the government’s intention to treat nicotine delivery products as medicines to be used for therapeutic purposes rather than as consumer goods freely available in general retail settings. Anyone arriving in Bermuda who uses e-cigarettes or vaping devices should be aware of these restrictions and plan accordingly.

Frequently asked questions

Is Bermuda’s population particularly unhealthy compared to other countries?

Not overall, but Bermuda does face specific chronic disease challenges that are disproportionate for its size. Life expectancy at birth in 2023 was 82.3 years, which is relatively high by global standards. However, rates of diabetes, obesity, and chronic conditions are among the highest in the OECD, creating a significant strain on the healthcare system despite the population’s overall longevity.

What is the biggest health challenge currently facing Bermuda?

The Bermuda Health Strategy 2022–2027 highlights the high cost of healthcare as the major challenge to equitable access to quality care. Underlying this is the heavy burden of chronic non-communicable diseases — particularly diabetes, obesity-related conditions, and cardiovascular disease — that affect a large proportion of the population.

Can I smoke in restaurants or bars in Bermuda?

Smoking is prohibited in all indoor public places, indoor workplaces, and on public transport. This includes restaurants, bars, cafes, and all other indoor hospitality venues. You may only smoke in outdoor areas that are not attached to educational or healthcare premises. Violations are subject to a fine of $1,000.

Are there designated smoking areas in Bermuda?

There are no formal designated outdoor smoking areas mandated by law, but smoking is generally permitted in open outdoor spaces that are not attached to schools, healthcare facilities, or public transport terminals. Expats and visitors should check locally, as individual businesses may have their own additional policies.

Where can I buy cigarettes in Bermuda?

The law prohibits the sale of tobacco products by vending machines and in healthcare facilities, educational facilities, daycare facilities, preschools, and government buildings. Cigarettes are available in general retail outlets and convenience stores. The sale of tobacco products is prohibited to persons under the age of 18.

Where can I buy e-cigarettes in Bermuda?

Under the Tobacco Control Act, electronic cigarettes are only available in pharmacies. This restriction reflects the government’s position that nicotine products should be treated as therapeutic rather than recreational items. E-cigarette advertising is also prohibited, so you are unlikely to find them promoted in shops or online within Bermuda.

Is there support available to help me quit smoking in Bermuda?

The Department of Health and various community health organisations in Bermuda provide cessation support. The government has framed nicotine delivery via e-cigarettes as a therapeutic option for those trying to quit, which is why e-cigarettes are sold through pharmacies. The Government of Bermuda’s Health Information pages and the Bermuda Cancer and Health Centre (cancer.bm) are good starting points for accessing current cessation resources.

How does Bermuda’s cancer care compare to other countries?

Before 2017, Bermudians needing radiation therapy had to travel overseas — away from family and at great expense — but the opening of radiation therapy services on the island showed what accessible, excellent care can look like. The Bermuda Cancer and Health Centre now provides a range of cancer screening, prevention, and treatment services locally, though complex cases may still require travel abroad for specialist treatment.