Healthcare of Cuba
Encyclopedia
The Cuba
n government
operates a national health
system and assumes fiscal and administrative responsibility for the health care
of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present Minister
for Public Health is José Ramón Balaguer.
An overall improvement in terms of disease and infant mortality rates was observed in the 1960s. AIDS
is only one-sixth as common on a per-capita basis as in the United States
. Like the rest of the Cuban economy
, Cuban medical care suffered following the end of Soviet subsidies in 1991; the stepping up of the US embargo against Cuba at this time also had an effect. Cuba has one of the highest life expectancy
rates in the region, with the average citizen living to 78.8 years old (in comparison to the United States' 78.1 years).
, Cuban traditional medicine
existed before the Spanish conquest. High-status traditional practitioners were called Bohiques. After colonization by the Spanish
, Cuban medicine followed the Spanish tradition which was inherited from the Moors
, who in turn drew upon classical Greek and Roman medical practices, which were inherited from the Ancient Egyptians, such as Imhotep
. Chinese medicine
has also been practiced in Cuba; its most famous practitioner was the 19th century doctor
Cham Bom Biam or “El Medico Chino”.
Modern Western medicine has been practiced in Cuba by formally trained doctors
since at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world class doctors, including Carlos Finlay
, whose mosquito-based theory of yellow fever
transmission was given its final proof under the direction of Walter Reed
, James Carroll
, and Aristides Agramonte
. During the period of U.S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass
and surgeon Jesse W. Lazear.
By the 1950s, the island had some of the most positive health indices in the Americas, not far behind the United States
and Canada
. Cuba was one of the leaders in terms of life expectancy
, and the number of doctors per thousand of the population ranked above Britain, France and Holland. In Latin America it ranked in third place after Uruguay and Argentina.
There remained marked inequalities however. Most of Cuba's doctors were based in the relatively prosperous cities and regional towns, and conditions in rural areas, notably Oriente, were significantly worse. Only 8% of the rural population had access to healthcare. The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.
Following the Revolution and the subsequent United States embargo against Cuba
, an increase in disease
and infant mortality
worsened in the 1960s. The new Cuban government
asserted that universal healthcare was to become a priority of state planning. In 1960 revolutionary and physician
Che Guevara
outlined his aims for the future of Cuban healthcare in an essay entitled On Revolutionary Medicine, stating: "The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices." These aims were hampered almost immediately by an exodus of almost half of Cuba’s physicians to the United States, leaving the country with only 3,000 doctors and 16 professors in the University of Havana
’s medical college. Beginning in 1960, the Ministry of Public Health began a program of nationalization
and regionalization of medical services.
In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states "Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All the population cooperates in these activities and plans through the social and mass organizations."
Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9.2 doctors per 10,000 inhabitants in 1958, to 58.2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal vaccination
s. This helped eradicate many contagious diseases including polio and rubella
, though some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis
, hepatitis
and chicken pox. Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care.
A Canadian Medical Association Journal
paper states that "The famine in Cuba during the Special Period was caused by political and economic factors similar to the ones that caused a famine in North Korea in the mid-1990s. Both countries were run by authoritarian regimes that denied ordinary people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military." The regime did not accept donations of food, medicines and cash from the US until 1993.
Malnutrition
created epidemics, but it had positive effects too. Manuel Franco describes the Special Period as "the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake".
In 2007, Cuba announced that it has undertaken computerizing and creating national networks in Blood Banks, Nephrology and Medical Images. Cuba is the second country in the world with such a product, only preceded by France. Cuba is preparing a Computerized Health Register, Hospital Management System, Primary Health Care, Academic Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research-development projects. An important link in wiring process is to guarantee access to Cuba's Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health system. http://www.newkerala.com/news4.php?action=fullnews&id=104143
In 1960 it was 63.9 years.
To put these values in context, life expectancy at birth in some other regions and countries in 1960 were as follows (World Bank data):
World, 50.18 years;
Latin America and Caribbean, 56.21 years;
high-income OECD countries, 69.01 years;
United States, 69.77 years.
In 2007, the life expectancies at birth were as follows (World Bank data):
Cuba, 78.26 years;
World, 68.76 years;
Latin America and Caribbean, 73.13 years;
high income OECD countries, 79.66 years;
United States, 77.99 years.
The mortality rate for children under five years old was 54 per 1000 in Cuba in 1960 (World Bank).
That year in Latin America and the Caribbean it was 154.66 per 1000; in the high-income OECD countries it was 43.11; in the United States, 30.2. No World datum is available for 1960, but for 1970 it was 145.67 per 1000 (all World Bank data).
The mortality rates for children under five in 2007 were as follows (World Bank):
Cuba, 6.5;
World, 68.01;
Latin America and Caribbean, 26.37;
high-income OECD, 5.71;
United States, 7.60.
Infant mortality was 32 per 1000 live births in Cuba in 1957. In 2000-2005 it was 6.1 per 1000 in Cuba; and, for comparison, 6.8 per 1000 in the United States. The 2007 infant mortality rates published by the World Health Organisation in 2009 were:
Cuba, 5;
World, 46;
High income countries, 6;
United States, 6.
The table below shows CEPAL (United nations) data spanning the pre- and post-revolutionary periods for three public health indicators. Health levels were better than the Latin American average before the revolution and showed continued steady improvement throughout the post-revolutionary period. The total mortality rate shown is the crude – i.e., not age-adjusted – rate, and therefore tends to rise as the proportion of elderly people in the population increases, which has been the case in Cuba because the birth rate is falling and life expectancy is rising.
Cuba had 128 physicians and dentists per 100,000 people in 1957. This was comparable to the levels in many European countries and allegedly the highest in Latin America.
In 2005, Cuba had 627 physicians and 94 dentists per 100,000 population. That year the United States had 225 physicians and 54 dentists per 100,000 population; there was no data for Latin America as a region, but the Central American isthmus had 123 physicians and 30 dentists per 100,000.
According to the Pan American Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories):
Cuba, 3,286;
America, 3,205;
Latin America and the Caribbean, 2,875;
Latin Caribbean countries, 2,593;
United States, 3,754.
The reasons people die in Cuba tend to be the same as in high-income, developed, countries. The table at right shows the relative seriousness of communicable diseases, non-communicable diseases (e.g., heart disease and cancer) and injuries, in various parts of the world. Data is from the World Health Organisation and is for year 2004.
Diseases of the circulatory system are the most common cause of death in Cuba, killing 306 people per 100,000 population in 2005. Neoplasms (cancer) are second, killing 173 per 100,000 population in 2005. The numbers killed by some other causes, in 2005 per 100,000 population, were: influenza and pneumonia 64, accidents 40, diabetes mellitus 18, intentional self-harm (suicide) 12, cirrhosis and other chronic liver diseases 10. Total mortality per 100,000 population was 754.
Like the rest of the Cuban economy
, numerous reports have shown that Cuban medical care has long suffered from severe material shortages caused by the US embargo
. The ending of Soviet subsidies in the early 1990s has also affected it.
Abortion
rates, which are high in Cuba, increased dramatically during the 1980s, but had almost halved by 1999 and declined to near-1970s levels of 32.0 per 100 pregnancies. The rate is still among the highest in Latin America.
Among adults less than 49 years old, accidents are the leading cause of death, though occupational accidents have declined significantly in the last decade. The homicide rate is 7.0 per 100,000. The rate of suicide in the island is higher than average in Latin America and has been among the highest in the region and the world since the nineteenth century. Annual suicide deaths per 100,000 population (2003-2005 data) were: Cuba 13.6, Americas 7.7, Latin America and Caribbean 5.8, Latin Caribbean 8.7, United States 10.8.
Among older adults heart disease
and cancer
predominate as causes of mortality. General mortality has been "characterized by a marked predominance of causes associated with chronic noncommunicable diseases", according to the Pan American Health Organization
.
While preventive medical care
, diagnostic test
s and medication
for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental
, and orthopedic processes, wheelchair
s and crutch
es. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge.
report of 2003 there were an estimated 3,300 Cubans living with HIV
/AIDS
(approx 0.05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV
. Those who tested positive were taken to Los Cocos and were not allowed to leave. The policy drew criticism from the United Nations
and was discontinued in the 1990s. Since 1996 Cuba began the production of generic anti-retroviral
drugs reducing the costs to well below that of developing countries. This has been made possible through the substantial government subsidies to treatment.
In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. The UNAIDS
reported that HIV infection rates for Cuba were 0.1%, and for other countries in the Caribbean between 1 - 4%. Education in Cuba concerning issues of HIV infection and AIDS is implemented by the Cuban National Center for Sex Education
.
According to a 2005 report by UNAIDS and the World Health Organization
, "Cuba’s epidemic remains by far the smallest in the Caribbean." They add however that,
In recent years because of the rise in prostitution
due to tourism
, STDs
have increased.
caused problems due to restrictions on the export of medicines from the US to Cuba. In 1992 the US embargo was made more stringent with the passage of the Cuban Democracy Act
resulting in all U.S. subsidiary trade, including trade in food and medicines, being prohibited. The legislation did not state that Cuba cannot purchase medicines from U.S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the Inter-American Commission on Human Rights
of the Organization of American States informed the U.S. Government that such activities violate international law and has requested that the U.S. take immediate steps to exempt medicine from the embargo. The Lancet
and the British Medical Journal
also condemned the embargo in the 90s.
A 1997 report prepared by Oxfam
America and the Washington Office on Latin America
, Myths And Facts About The U.S. Embargo On Medicine And Medical Supplies, concluded that the embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs from foreign subsidiaries of U.S. firms or from non-U.S.sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cuba's medical system. It prohibited foreign subsidiaries of U.S. corporations from selling to Cuba, thus further limiting Cuba's access to medicine and equipment, and raising prices. In addition, the act forbids ships that dock in Cuban ports from docking in U.S. ports for six months. This drastically restricts shipping, and increases shipping costs some 30%.
However, in 2000 the Trade Sanctions Reform and Export Enhancement Act
was passed, and the US is now Cuba's single largest source for imported food. The Cuban American National Foundation (CANF) states that should Cuba choose not to purchase from the U.S., it can purchase any medicine or medical equipment it needs from other countries. Such third-country transactions only cost an estimated 2%-3% more than purchases from the U.S. as a result of higher shipping costs. CANF also asserts the United States is the largest donor of humanitarian assistance to Cuba and much of this consists of medicines and medical equipment.
The US government states that since 1992, 36 out of 39 license requests from U.S. companies and their subsidiaries for sales of medical items to Cuba have been approved. The dollar amount of these sales is over $1,600,000. Furthermore, the U.S. government licensed more than $227 million in humanitarian donations of medicines and medical supplies to Cuba between 1993 and 1997. There are other factors beside the embargo explaining the lack of imports, in particular Cuba's lack of hard currency. Those with dollars can easily buy medicines and food in Cuba from Latin America and Canada. Cuba defaulted on its debt to Western banks in 1986 and lacks access to the international credit system in order to get foreign currency. In addition, the collapse of the Soviet Union caused the loss of several billions of dollars in yearly subsidies and overnight required hard currency for all imports. http://www.unc.edu/depts/diplomat/AD_Issues/amdipl_13/linderman_cuba2.html
In a 2006 report to the U.N. Secretary-General, Cuba acknowledged the authorization of medicines, though stated that they were subject to severe restrictions and complicated procedures. Cuba is obliged to make payments in cash and in advance, and is precluded from obtaining credit funding, even from private sources. The sale and transportation of the goods require licenses to be obtained for each transaction. Cuba cannot use its own merchant fleet for transporting these goods, but has to make use of vessels from third countries, primarily the United States
. Payments are made through banks in third countries, since direct banking relationships are prohibited. The Cuban delegation concluded that restrictions on importing medical products were "so extensive that they make such imports virtually impossible". The World Health organization/PAHO and UNFPA concurred that it was impossible for Cuba to purchase equipment, medicines and laboratory materials produced by the United States or covered by United States patents, even though those products were purchased through multilateral cooperation. Cuba was not able to purchase the isotope I-125 that is used to treat eye cancer in children. The companies manufacturing reagents and equipment are 70 per cent United States owned, which makes it difficult to purchase necessary medical equipment and other items
Medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 1.5 times the national mean.
A doctor’s salary in the late 1990s was equivalent to about US$15–20 per month in purchasing power. Therefore, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher.
The San Francisco Chronicle
, the Washington Post, and National Public Radio have all reported on Cuban doctors defecting to other countries.
". According to former leading Cuban neurosurgeon and dissident
Dr Hilda Molina
, "The doctors in the hospitals are charging patients under the table for better or quicker service." Prices for out-of-surgery X-rays have been quoted at $50 to $60. Such "under-the-table payments" reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the "Special Period
" in the 1990s aggravated these payments. The advent of the "dollar economy", a temporary legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans were able to obtain medications and health services that would not be available to them otherwise.
agencies specializing in health: PAHO/WHO
, UNICEF, the United Nations Food and Agriculture Organization
(FAO), the United Nations Population Fund
(UNFPA) and the United Nations Development Fund (UNDP). Since 1989, this collaboration has played a very important role in that Cuba, in addition to obtaining the benefits of being a member country, has strengthened its relations with institutions of excellence and has been able to disseminate some of its own advances and technologies In the 1980s, Cuba's decision to withdrawal military assistance from the Marxist-Leninist regimes in Ethiopia and Angola was partly inrooted in their inability to meet payments. In 1986, Cuba had 219 doctors per 100,000 people (compared with 423.7 doctors in the Soviet Union, which had the most doctors among industrialized countries).
The supply of physicians came to exceed the domestic market. Moreover, Cuban doctors work on much lower salaries than local doctors. A Guatemalan doctor noted "No one's going to work in the mountains for a salary of $400," the salary on which Cuban doctors work. The $400 is 16 times the doctor's salary in Cuba - allowing Cuban doctors to buy refrigerators, stereos and other items that they couldn't afford in Cuba. Cuba's missions in 68 countries are manned by 25,000 Cuban doctors, and medical teams have worked in crisis such as the South Asian Tsunami
and the 2005 Kashmir earthquake
. Nearly 2,000 Cuban doctors are currently working in Africa in countries including South Africa
, Gambia, Guinea Bissau and Mali
. Since the Chernobyl nuclear plant exploded in 1986, more than 20,000 children from Ukraine
, Belarus
and Russia
have traveled to Cuba for treatment of radiation sickness
and psychologically based problems associated with the radiation disaster. In response to the 2005 Hurricane Katrina
disaster, Castro offered to send a "brigade" of 1,500 doctors to the U.S. to provide humanitarian aid, but was never accepted.
Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized oil
. Cuban doctors play a primary role in the Mission Barrio Adentro
(Spanish: "Mission Into the Neighborhood") social welfare program established in Venezuela under current Venezuelan president Hugo Chávez
. The program, which is popular among Venezuela's poor and is intended to bring doctors and other medical services to the most remote slums of Venezuela, has not been without its detractors. Operación Milagro (Operation Miracle) is a joint health program between Cuba and Venezuela, set up in 2005. The Venezuelan Medical Federation has criticized the appointment of Cuban doctors to high-ranking positions, and protests have taken place in the capital Caracas
by Venezuelan medical staff who fear that the Cubans are a threat to Venezuelan jobs. Questions have also been raised by protesters about the level of Cuban medical qualifications, and there have been claims that the Cubans are "political agents" who have come to Venezuela to indoctrinate the workforce. Opposition supporters in Venezuela have called Cuban doctors "Fidel's ambassadors" and refused to go to their clinics. Two defected doctors have claimed that they were told their job was to keep Chavez in power, by asking patients to vote for Chávez in the 2004 recall referendum.
Human Rights Watch
complains that the government "bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics." Doctors are reported to be monitored by "minders" and subject to curfew. The Cuban government uses relatives as hostages to prevent doctors from defecting. According to a paper published in The Lancet
medical journal, "growing numbers of Cuban doctors sent overseas to work are defecting to the USA", some via Colombia, where they have sought temporary asylum.
According to Luis Zuñiga, director of human rights for the Cuban American National Foundation, Cuban doctors are "slave workers" who labor for meager wages while bolstering Cuba's image as a donor nation and "the Cuban government exports these doctors as merchandise".
Cuban doctors have been part of a large-scale plan by the Cuban state to provide free medical aid and services to the international community (especially third world countries) following natural disasters. Currently dozens of American medical students are trained to assist in these donations at the Escuela Latino Americana de Medecina (ELAM) in Cuba.
and Parkinsons disease, cosmetic surgery, addictions treatment, retinitis pigmentosa
and orthopaedics. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming. Cuba also successfully exports many medical products, such as vaccines.
By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around 2 percent of total tourism. Some of these revenues are in turn transferred to health care for ordinary Cubans, although the
size and importance of these transfers is both unknown and controversial. At one nationally prominent hospital/research institute, hard currency payments by foreigners have financed the construction of a new bathroom in the splanic surgery wing; anecdotal
evidence suggests that this pattern is common in Cuban hospitals.
and herbal
solutions to healthcare issues, which can be more accessible and affordable to a broader population In the 1990s, the Cuban Ministry of Public Health officially recognized natural and traditional medicine
and began its integration into the already well established Western medicine model. Examples of alternative techniques used by the clinics and hospitals include: flower essence
, neural and hydromineral therapies, homeopathy
, traditional Chinese medicine
(i.e. acupunctural
anesthesia for surgery), natural dietary supplements, yoga
, electromagnetic and laser devices. Children begin studying the multiple uses of medicinal plants in primary school, learning to grow and tend their own plots of aloe
, chamomile
, and mint
, and later they conduct scientific studies about their uses. Radio and Television programs instruct people on how to relieve common stomach upset and headaches by pressing key points. Acupuncture is offered at all three levels of health care. Cuban biochemists have produced a number of new alternative medicines, including PPG (policosanol
), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang a natural product derived from the bark of mango trees.
s including the ACIMED
, the Cuban Journal of Surgery
and the Cuban Journal of Tropical Medicine
. Because the U.S. government restricts investments in Cuba by U.S. companies and their affiliates, Cuban institutions have been limited in their ability to enter into research and development partnerships, although exceptions have been made for significant drugs.
The Center of molecular immunology
(CIM) developed nimotuzumab
, a monoclonal antibody used to treat cancer. Nimotuzumab is an inhibitor of epidermal growth factor receptor
(EGFR), which is over-expressed in many cancers. Nimotuzumab is now being developed with international partners.
In April 2007, the Cuba IPV Study Collaborative Group reported in the New England Journal of Medicine
that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kourí Institute, U.S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics. Cuba has been free of polio since 1963, but continues with mass immunization campaigns.
In the 1980s, Cuban scientists developed a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U.S. Treasury Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U.S. and elsewhere
s. The most guarded is infant mortality rate. The doctor is pressured to abort the pregnancy whenever screening shows that quotas are in danger. Once a doctor decides to guard his quotas, patients have no right to refuse abortion.
According to previous research about other socialist countries such as the Soviet Union and the People's Republic of China, Marxist "revolutionary" efforts have included such practices as "deliberate manipulation of health statistics, aggressive political intrusion into health care, decision-making, criminalizing dissent, and other forms of authoritarian policing of the health sector designed to insure health changes reflect the (often utopian) predictions of Marxist theory". These practices are well documented for the former Soviet Union and China. Their existence was virtually unknown in the West during the Soviet era and Western social scientists cited favorable the health statistics supplied by the regimes in the USSR and China. Social scientists did not look critically at the ways they were created and maintained by state power.
Many Cubans complain about politics in medical treatment and health care decision-making. There is no right to privacy, patient's informed consent, or right to protest for malpractice. The patient has no right to refuse the treatment, including for religious or ethical reasons. For example, Jehovah's Witnesses
cannot refuse blood transfusions and a Rastafarian cannot refuse an amputation on the grounds that it goes against Rastafari biblical teachings (Rastafari teaches that the body must be whole in order for it to resurrected on Judgement Day). As a result, the experience can be dehumanizing. After spending nine months in Cuban clinics, Katherine Hirschfeld asserted in her paper "My increased awareness of Cuba’s criminalization of dissent raised a very provocative question: to what extent is the favorable international image of the Cuban health care system maintained by the state’s practice of suppressing dissent and covertly intimidating or imprisoning would-be critics?"
In 2006, BBC
flagship news programme Newsnight
featured Cuba's Healthcare system as part of a series identifying "the world's best public services". The report noted that "Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority" The report stated that life expectancy and infant mortality rates are nearly the same as the USA's. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power. A 2006 poll carried out by the Gallup Organization
's Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of urban Cubans responded positively to the question "do you have confidence to your country's health care system".
In 2000, Secretary General of the United Nations Kofi Annan
stated that "Cuba should be the envy of many other nations" adding that achievements in social development are impressive given the size of its gross domestic product per capita. "Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities - health, education, and literacy." The Kaiser Family Foundation
, a non-governmental organization that evaluated Cuba’s healthcare system in 2000-1 described Cuba as "a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources" President of the World Bank James Wolfensohn
also praised Cuba's healthcare system in 2001, saying that "Cuba has done a great job on education and health", at the annual meeting of the Bank and the International Monetary Fund
. Wayne Smith
, former head of the US Interests Section in Havana identified "the incredible dedication" of Cubans to healthcare, adding that "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated". Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it. Furthermore, London's The Guardian newspaper lauded Cuba's public healthcare system for what it viewed as its high quality in a Sept. 12, 2007 article.
In 2001, members of the UK
House of Commons
Health Select Committee travelled to Cuba and issued a report that paid tribute to "the success of the Cuban healthcare system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community".
The Parliament of the United Kingdom
also drew up an analysis of the key features of Cuba's healthcare system, drawing comparisons with the state funded National Health Service
(NHS). The overall conclusion was that many of the features identified would not have occurred had there not been an obvious commitment to health provision demonstrated by the protection and proportion of the budget given the health care. The study concluded the following.
The study also pointed to problems within the system, these included;
Complaints have arisen that foreign "health tourists" paying with dollars and senior Communist party officials receive a higher quality of care than Cuban citizens. Former leading Cuban neurosurgeon and dissident
Dr Hilda Molina
asserts that the central revolutionary objective of free, quality medical care for all has been eroded by Cuba's need for foreign currency. Molina says that following the economic collapse known in Cuba as the Special Period
, the Cuban Government established mechanisms designed to turn the medical system into a profit-making enterprise. This creates an enormous disparity in the quality of healthcare services between foreigners and Cubans leading to a form of tourist apartheid. In 1998 she said that foreign patients were routinely inadequately or falsely informed about their medical conditions to increase their medical bills or to hide the fact that Cuba often advertises medical services it is unable to provide. Others makes similar claims, also stating that senior Communist party and military officials can access this higher quality system free of charge. http://www.canf.org/Issues/medicalapartheid.htm http://www.unc.edu/depts/diplomat/AD_Issues/amdipl_13/linderman_cuba2.html In 2005, an account written by Cuban exile and critic of Fidel Castro, Carlos Wotzkow, appeared showing apparent unsanitary and unsafe conditions in the "Clínico Quirúrgico" of Havana;the article claims that health care for Cubans occurs in worse conditions in the rest of the country.
An article in Canadian newspaper National Post
, based interviews of Cubans, finds that in reality even the most common pharmaceutical items, such as Aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays. http://www.cubaverdad.net/references/for_cubans_a_bitter_pill.htm The Cuban government blames the shortages on the embargo and states that those with more severe chronic diseases receive medicines. http://www.aegis.com/news/ips/2001/IP010312.html However, other sources suggest that also those with such diseases lack medicines. It is also suggested that in some cases the local non-dollar stocks have been shipped abroad.
http://www.urban-renaissance.org/urbanren/index.cfm?DSP=content&ContentID=6341 http://www.cubanet.org/CNews/y05/jun05/27e7.htm
The U.S. State Department has argued that during the economic depression "the Cuban government made a deliberate decision to continue to spend money to maintain its military and internal security apparatus at the expense of other priorities – including healthcare." However, one study found that "the available data show that the fall in Cuba's medicine imports in the '90s didn't correspond to a significant lowering of the government's healthcare spending. Budgetary support for peso-denominated spending – i.e., labor costs of medical professionals, operational costs of hospitals and clinics – has remained strong. Attempts to blame medical shortages in Cuba on resource misallocation are thus misguided, or at least wrongly nuanced."
A recent ABC-TV 20/20 report on Healthcare, based on footage taken from within the island, criticized Michael Moore's portrayals of the Cuban Healthcare system in the movie Sicko. In that film, Moore took a number of Americans to a hospital in Havana where they bought affordable drugs, and were given treatments for free that they could not afford in America. The report highlights the dilapidated conditions of some hospitals that are accessible to regular Cubans by pointing to the bleak conditions of hospital rooms and the filthy conditions of the facilities. The report also addressed the quality of care available to Cubans by arguing that patient neglect was a common phenomenon. Finally, in discussing the infant mortality rate, the report highlights the government's alleged efforts to promote abortions of potentially infirm fetuses and other alleged government efforts to manipulate the rate.
publish regular reports as well as making data available on the web.
Cuba
The Republic of Cuba is an island nation in the Caribbean. The nation of Cuba consists of the main island of Cuba, the Isla de la Juventud, and several archipelagos. Havana is the largest city in Cuba and the country's capital. Santiago de Cuba is the second largest city...
n government
Politics of Cuba
Cuba is constitutionally defined as a "socialist state guided by the principles of José Martí, and the political ideas of Marx, the father of communist states, Engels and Lenin." The present Constitution also ascribes the role of the Communist Party of Cuba to be the "leading force of society and...
operates a national health
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
system and assumes fiscal and administrative responsibility for the health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present Minister
Council of Ministers of Cuba
The Cabinet of Cuba is the highest ranking executive and administrative body of the Republic of Cuba, and constitutes the nation's government...
for Public Health is José Ramón Balaguer.
An overall improvement in terms of disease and infant mortality rates was observed in the 1960s. AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
is only one-sixth as common on a per-capita basis as in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. Like the rest of the Cuban economy
Economy of Cuba
The economy of Cuba is a largely centrally planned economy dominated by state-run enterprises overseen by the Cuban government, though there remains significant foreign investment and private enterprise in Cuba...
, Cuban medical care suffered following the end of Soviet subsidies in 1991; the stepping up of the US embargo against Cuba at this time also had an effect. Cuba has one of the highest life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
rates in the region, with the average citizen living to 78.8 years old (in comparison to the United States' 78.1 years).
History
As was true of the other indigenous societies of the AmericasAmericas
The Americas, or America , are lands in the Western hemisphere, also known as the New World. In English, the plural form the Americas is often used to refer to the landmasses of North America and South America with their associated islands and regions, while the singular form America is primarily...
, Cuban traditional medicine
Traditional medicine
Traditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern medicine...
existed before the Spanish conquest. High-status traditional practitioners were called Bohiques. After colonization by the Spanish
Spanish people
The Spanish are citizens of the Kingdom of Spain. Within Spain, there are also a number of vigorous nationalisms and regionalisms, reflecting the country's complex history....
, Cuban medicine followed the Spanish tradition which was inherited from the Moors
Moors
The description Moors has referred to several historic and modern populations of the Maghreb region who are predominately of Berber and Arab descent. They came to conquer and rule the Iberian Peninsula for nearly 800 years. At that time they were Muslim, although earlier the people had followed...
, who in turn drew upon classical Greek and Roman medical practices, which were inherited from the Ancient Egyptians, such as Imhotep
Imhotep
Imhotep , fl. 27th century BC was an Egyptian polymath, who served under the Third Dynasty king Djoser as chancellor to the pharaoh and high priest of the sun god Ra at Heliopolis...
. Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
has also been practiced in Cuba; its most famous practitioner was the 19th century doctor
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
Cham Bom Biam or “El Medico Chino”.
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
since at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world class doctors, including Carlos Finlay
Carlos Finlay
Carlos Juan Finlay was a Cuban physician and scientist recognized as a pioneer in yellow fever research.- Early life and education :...
, whose mosquito-based theory of yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
transmission was given its final proof under the direction of Walter Reed
Walter Reed
Major Walter Reed, M.D., was a U.S. Army physician who in 1900 led the team that postulated and confirmed the theory that yellow fever is transmitted by a particular mosquito species, rather than by direct contact...
, James Carroll
James Carroll
James Carroll may refer to:* James Carroll * James Carroll , Irish independent politician, represented Dublin South West from 1957–1965...
, and Aristides Agramonte
Aristides Agramonte
-External links:*...
. During the period of U.S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass
Clara Maass
Clara Louise Maass was an American nurse who died as a result of volunteering for medical experiments to study yellow fever.-Early life:...
and surgeon Jesse W. Lazear.
By the 1950s, the island had some of the most positive health indices in the Americas, not far behind the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
. Cuba was one of the leaders in terms of life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
, and the number of doctors per thousand of the population ranked above Britain, France and Holland. In Latin America it ranked in third place after Uruguay and Argentina.
There remained marked inequalities however. Most of Cuba's doctors were based in the relatively prosperous cities and regional towns, and conditions in rural areas, notably Oriente, were significantly worse. Only 8% of the rural population had access to healthcare. The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.
Following the Revolution and the subsequent United States embargo against Cuba
United States embargo against Cuba
The United States embargo against Cuba is a commercial, economic, and financial embargo partially imposed on Cuba in October 1960...
, an increase in disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
and infant mortality
Infant mortality
Infant mortality is defined as the number of infant deaths per 1000 live births. Traditionally, the most common cause worldwide was dehydration from diarrhea. However, the spreading information about Oral Re-hydration Solution to mothers around the world has decreased the rate of children dying...
worsened in the 1960s. The new Cuban government
Politics of Cuba
Cuba is constitutionally defined as a "socialist state guided by the principles of José Martí, and the political ideas of Marx, the father of communist states, Engels and Lenin." The present Constitution also ascribes the role of the Communist Party of Cuba to be the "leading force of society and...
asserted that universal healthcare was to become a priority of state planning. In 1960 revolutionary and physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
Che Guevara
Che Guevara
Ernesto "Che" Guevara , commonly known as el Che or simply Che, was an Argentine Marxist revolutionary, physician, author, intellectual, guerrilla leader, diplomat and military theorist...
outlined his aims for the future of Cuban healthcare in an essay entitled On Revolutionary Medicine, stating: "The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices." These aims were hampered almost immediately by an exodus of almost half of Cuba’s physicians to the United States, leaving the country with only 3,000 doctors and 16 professors in the University of Havana
University of Havana
The University of Havana or UH is a university located in the Vedado district of Havana, Cuba. Founded in 1728, the University of Havana is the oldest university in Cuba, and one of the first to be founded in the Americas...
’s medical college. Beginning in 1960, the Ministry of Public Health began a program of nationalization
Nationalization
Nationalisation, also spelled nationalization, is the process of taking an industry or assets into government ownership by a national government or state. Nationalization usually refers to private assets, but may also mean assets owned by lower levels of government, such as municipalities, being...
and regionalization of medical services.
In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states "Everyone has the right to health protection and care. The state guarantees this right by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All the population cooperates in these activities and plans through the social and mass organizations."
Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9.2 doctors per 10,000 inhabitants in 1958, to 58.2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
s. This helped eradicate many contagious diseases including polio and rubella
Rubella
Rubella, commonly known as German measles, is a disease caused by the rubella virus. The name "rubella" is derived from the Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is...
, though some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, hepatitis
Hepatitis
Hepatitis is a medical condition defined by the inflammation of the liver and characterized by the presence of inflammatory cells in the tissue of the organ. The name is from the Greek hepar , the root being hepat- , meaning liver, and suffix -itis, meaning "inflammation"...
and chicken pox. Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care.
Post-Soviet Union
The loss of Soviet subsidies brought famine to Cuba in the early 1990s.A Canadian Medical Association Journal
Canadian Medical Association Journal
The Canadian Medical Association Journal is a general medical journal that is published biweekly by the Canadian Medical Association . It covers research and ideas aimed at improving health for people in Canada and globally. CMAJ publishes original clinical research, analyses and reviews, news,...
paper states that "The famine in Cuba during the Special Period was caused by political and economic factors similar to the ones that caused a famine in North Korea in the mid-1990s. Both countries were run by authoritarian regimes that denied ordinary people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military." The regime did not accept donations of food, medicines and cash from the US until 1993.
Malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
created epidemics, but it had positive effects too. Manuel Franco describes the Special Period as "the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake".
In 2007, Cuba announced that it has undertaken computerizing and creating national networks in Blood Banks, Nephrology and Medical Images. Cuba is the second country in the world with such a product, only preceded by France. Cuba is preparing a Computerized Health Register, Hospital Management System, Primary Health Care, Academic Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research-development projects. An important link in wiring process is to guarantee access to Cuba's Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health system. http://www.newkerala.com/news4.php?action=fullnews&id=104143
Present
| Life expectancy at birth m/f: | 76.0/80.0 (years) |
| Healthy life expectancy at birth m/f: | 67.1/69.5 (years) |
| Child mortality m/f: | 8/7 (per 1000) |
| Adult mortality m/f: | 131/85 (per 1000) |
| Total health expenditure per capita: | $251 |
| Total health expenditure as % of GDP: | 7.3 |
| Rank | Countries surveyed |
Statistic | Date of Information |
|
| 125 | 167 | HIV/AIDS adult prevalence rate | 0.10% | 2003 est. |
| 162 | 175 | Fertility rate | 1.66 (children/woman) | 2006. |
| 153 | 224 | Birth rate | 11.89 (births/1,000 population) | 2006 est. |
| 168 | 226 | Infant mortality rate | 6.04 (deaths/1,000 live births) | 2006. |
| 129 | 224 | Death rate | 6.33 (deaths/1,000 population) | 2005. |
| 37 | 225 | Life expectancy at birth | 77.23 (years) | 2006. est |
| 17 | 99 | Suicide rate | 18.3 per 100,000 people per year | 1996.* |
Comparison of pre- and post-revolutionary indices
Life expectancy at birth in Cuba in 1955 was 63 years.In 1960 it was 63.9 years.
To put these values in context, life expectancy at birth in some other regions and countries in 1960 were as follows (World Bank data):
World, 50.18 years;
Latin America and Caribbean, 56.21 years;
high-income OECD countries, 69.01 years;
United States, 69.77 years.
In 2007, the life expectancies at birth were as follows (World Bank data):
Cuba, 78.26 years;
World, 68.76 years;
Latin America and Caribbean, 73.13 years;
high income OECD countries, 79.66 years;
United States, 77.99 years.
The mortality rate for children under five years old was 54 per 1000 in Cuba in 1960 (World Bank).
That year in Latin America and the Caribbean it was 154.66 per 1000; in the high-income OECD countries it was 43.11; in the United States, 30.2. No World datum is available for 1960, but for 1970 it was 145.67 per 1000 (all World Bank data).
The mortality rates for children under five in 2007 were as follows (World Bank):
Cuba, 6.5;
World, 68.01;
Latin America and Caribbean, 26.37;
high-income OECD, 5.71;
United States, 7.60.
Infant mortality was 32 per 1000 live births in Cuba in 1957. In 2000-2005 it was 6.1 per 1000 in Cuba; and, for comparison, 6.8 per 1000 in the United States. The 2007 infant mortality rates published by the World Health Organisation in 2009 were:
Cuba, 5;
World, 46;
High income countries, 6;
United States, 6.
The table below shows CEPAL (United nations) data spanning the pre- and post-revolutionary periods for three public health indicators. Health levels were better than the Latin American average before the revolution and showed continued steady improvement throughout the post-revolutionary period. The total mortality rate shown is the crude – i.e., not age-adjusted – rate, and therefore tends to rise as the proportion of elderly people in the population increases, which has been the case in Cuba because the birth rate is falling and life expectancy is rising.
| | Years | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1950-55 | 1955-60 | 1960-65 | 1965-70 | 1970-75 | 1975-80 | 1980-85 | 1985-90 | 1990-95 | 1995-00 | 2000-05 | |
| Life expectancy | 59.5 | 62.4 | 65.4 | 68.6 | 71.0 | 73.1 | 74.3 | 74.6 | 74.8 | 76.2 | 77.1 |
| Mortality rate | 10.73 | 9.21 | 8.56 | 7.30 | 6.37 | 5.94 | 6.31 | 6.65 | 7.06 | 6.66 | 7.08 |
| Under-5 mortality | 112.4 | 93.9 | 75.9 | 58.6 | 43.6 | 27.0 | 21.2 | 19.3 | 18.7 | 11.8 | 7.72 |
| Notes: Life expectancy is life expectancy at birth. Mortality rate is the crude mortality rate; i.e., annual number of deaths per 1,000 inhabitants. The under-5 mortality is the number of deaths of children up to age five, per 1,000 live births. Source: United Nations, Comisión Económica para América Latina y el Caribe (Economic Commission for Latin America and the Caribbean—CEPAL), Cepal Stat, Social Indicators and Statistics. | |||||||||||
Cuba had 128 physicians and dentists per 100,000 people in 1957. This was comparable to the levels in many European countries and allegedly the highest in Latin America.
In 2005, Cuba had 627 physicians and 94 dentists per 100,000 population. That year the United States had 225 physicians and 54 dentists per 100,000 population; there was no data for Latin America as a region, but the Central American isthmus had 123 physicians and 30 dentists per 100,000.
Health indicators and issues
Cuba began a food rationing program in 1962 to guarantee all citizens a low-priced basket of basic foods. As of 2007, the government was spending about $1 billion annually to subsidise the food ration. The ration would cost about $50 at an average grocery store in the United States, but the Cuban citizen pays only $1.20 for it. The ration includes rice, legumes , potatoes, bread, eggs, and a small amount of meat. It provides about 30 to 70 percent of the 3,300 kilocalories that the average Cuban consumes daily. The people obtain the rest of their food from government stores (Tiendas), free market stores and cooperatives, barter, their own gardens, and the black market.According to the Pan American Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories):
Cuba, 3,286;
America, 3,205;
Latin America and the Caribbean, 2,875;
Latin Caribbean countries, 2,593;
United States, 3,754.
| Place | Communicable | Non-communicable | Injuries |
|---|---|---|---|
| Cuba | 9 | 75 | 16 |
| World | 51 | 34 | 14 |
| High income countries | 8 | 77 | 15 |
| United States | 9 | 73 | 18 |
| Low income countries | 68 | 21 | 10 |
| Source: World Health Organisation. World Health Statistics 2009, Table 2, "Cause-specific mortality and morbidity". | |||
The reasons people die in Cuba tend to be the same as in high-income, developed, countries. The table at right shows the relative seriousness of communicable diseases, non-communicable diseases (e.g., heart disease and cancer) and injuries, in various parts of the world. Data is from the World Health Organisation and is for year 2004.
Diseases of the circulatory system are the most common cause of death in Cuba, killing 306 people per 100,000 population in 2005. Neoplasms (cancer) are second, killing 173 per 100,000 population in 2005. The numbers killed by some other causes, in 2005 per 100,000 population, were: influenza and pneumonia 64, accidents 40, diabetes mellitus 18, intentional self-harm (suicide) 12, cirrhosis and other chronic liver diseases 10. Total mortality per 100,000 population was 754.
Like the rest of the Cuban economy
Economy of Cuba
The economy of Cuba is a largely centrally planned economy dominated by state-run enterprises overseen by the Cuban government, though there remains significant foreign investment and private enterprise in Cuba...
, numerous reports have shown that Cuban medical care has long suffered from severe material shortages caused by the US embargo
United States embargo against Cuba
The United States embargo against Cuba is a commercial, economic, and financial embargo partially imposed on Cuba in October 1960...
. The ending of Soviet subsidies in the early 1990s has also affected it.
Abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
rates, which are high in Cuba, increased dramatically during the 1980s, but had almost halved by 1999 and declined to near-1970s levels of 32.0 per 100 pregnancies. The rate is still among the highest in Latin America.
Among adults less than 49 years old, accidents are the leading cause of death, though occupational accidents have declined significantly in the last decade. The homicide rate is 7.0 per 100,000. The rate of suicide in the island is higher than average in Latin America and has been among the highest in the region and the world since the nineteenth century. Annual suicide deaths per 100,000 population (2003-2005 data) were: Cuba 13.6, Americas 7.7, Latin America and Caribbean 5.8, Latin Caribbean 8.7, United States 10.8.
Among older adults heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
and cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
predominate as causes of mortality. General mortality has been "characterized by a marked predominance of causes associated with chronic noncommunicable diseases", according to the Pan American Health Organization
Pan American Health Organization
The Pan American Health Organization is an international public health agency with over 100 years of experience working to improve health and living standards of the people of the Americas...
.
While preventive medical care
Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases, rather than curing them or treating their symptoms...
, diagnostic test
Medical test
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. For example:* to diagnose diseases, and preferably sub-classify it regarding, for example, severity and treatability...
s and medication
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental
Dental insurance
Dental insurance is a type of health insurance designed to pay a portion of the costs associated with dental care. There are several different types of individual, family, or group dental insurance plans grouped into three primary categories: Indemnity which allows you to see any dentist you want...
, and orthopedic processes, wheelchair
Wheelchair
A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
s and crutch
Crutch
Crutches are mobility aids used to counter a mobility impairment or an injury that limits walking ability.- Types :There are several different types of crutches:...
es. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge.
Sexual health
According to the UNAIDSJoint United Nations Programme on HIV/AIDS
The Joint United Nations Programme on HIV and AIDS, or UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the HIV epidemic....
report of 2003 there were an estimated 3,300 Cubans living with HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
/AIDS
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
(approx 0.05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
. Those who tested positive were taken to Los Cocos and were not allowed to leave. The policy drew criticism from the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
and was discontinued in the 1990s. Since 1996 Cuba began the production of generic anti-retroviral
Antiretroviral drug
Antiretroviral drugs are medications for the treatment of infection by retroviruses, primarily HIV. When several such drugs, typically three or four, are taken in combination, the approach is known as Highly Active Antiretroviral Therapy, or HAART...
drugs reducing the costs to well below that of developing countries. This has been made possible through the substantial government subsidies to treatment.
In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. The UNAIDS
Joint United Nations Programme on HIV/AIDS
The Joint United Nations Programme on HIV and AIDS, or UNAIDS, is the main advocate for accelerated, comprehensive and coordinated global action on the HIV epidemic....
reported that HIV infection rates for Cuba were 0.1%, and for other countries in the Caribbean between 1 - 4%. Education in Cuba concerning issues of HIV infection and AIDS is implemented by the Cuban National Center for Sex Education
Cuban National Center for Sex Education
The National Center for Sex Education is a government-funded body in Cuba. The center is best known for advocating tolerance of Lesbian, Gay, Bisexual and transgender issues on the island...
.
According to a 2005 report by UNAIDS and the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
, "Cuba’s epidemic remains by far the smallest in the Caribbean." They add however that,
... new HIV infections are on the rise, and Cuba’s preventive measures appear not to be keeping pace with conditions that favour the spread of HIV, including widening income inequalities and a growing sex industry. At the same time, Cuba’s prevention of mother-to-child transmission programme remains highly effective. All pregnant women are tested for HIV, and those testing positive receive antiretroviral drugs.
In recent years because of the rise in prostitution
Prostitution
Prostitution is the act or practice of providing sexual services to another person in return for payment. The person who receives payment for sexual services is called a prostitute and the person who receives such services is known by a multitude of terms, including a "john". Prostitution is one of...
due to tourism
Tourism
Tourism is travel for recreational, leisure or business purposes. The World Tourism Organization defines tourists as people "traveling to and staying in places outside their usual environment for not more than one consecutive year for leisure, business and other purposes".Tourism has become a...
, STDs
Sexually transmitted disease
Sexually transmitted disease , also known as a sexually transmitted infection or venereal disease , is an illness that has a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex...
have increased.
Embargo
During the '90s the ongoing United States embargo against CubaUnited States embargo against Cuba
The United States embargo against Cuba is a commercial, economic, and financial embargo partially imposed on Cuba in October 1960...
caused problems due to restrictions on the export of medicines from the US to Cuba. In 1992 the US embargo was made more stringent with the passage of the Cuban Democracy Act
Cuban Democracy Act
The Cuban Democracy Act was a bill presented by U.S. Congressman Robert Torricelli and passed in 1992 which prohibited foreign-based subsidiaries of U.S. companies from trading with Cuba, travel to Cuba by U.S. citizens, and family remittances to Cuba...
resulting in all U.S. subsidiary trade, including trade in food and medicines, being prohibited. The legislation did not state that Cuba cannot purchase medicines from U.S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the Inter-American Commission on Human Rights
Inter-American Commission on Human Rights
The Inter-American Commission on Human Rights is an autonomous organ of the Organization of American States .Along with the...
of the Organization of American States informed the U.S. Government that such activities violate international law and has requested that the U.S. take immediate steps to exempt medicine from the embargo. The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
and the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
also condemned the embargo in the 90s.
A 1997 report prepared by Oxfam
Oxfam
Oxfam is an international confederation of 15 organizations working in 98 countries worldwide to find lasting solutions to poverty and related injustice around the world. In all Oxfam’s actions, the ultimate goal is to enable people to exercise their rights and manage their own lives...
America and the Washington Office on Latin America
Washington Office on Latin America
The Washington Office on Latin America is an American non-governmental organization whose stated goal is to promote human rights, democracy and social and economic justice in Latin America and the Caribbean....
, Myths And Facts About The U.S. Embargo On Medicine And Medical Supplies, concluded that the embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs from foreign subsidiaries of U.S. firms or from non-U.S.sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cuba's medical system. It prohibited foreign subsidiaries of U.S. corporations from selling to Cuba, thus further limiting Cuba's access to medicine and equipment, and raising prices. In addition, the act forbids ships that dock in Cuban ports from docking in U.S. ports for six months. This drastically restricts shipping, and increases shipping costs some 30%.
However, in 2000 the Trade Sanctions Reform and Export Enhancement Act
Trade sanctions reform and export enhancement act
The Trade Sanction Reform and Export Enhancement Act was passed by United States’ former President Bill Clinton in 2000 . The act altered regulations in regards to U.S. trade with Cuba...
was passed, and the US is now Cuba's single largest source for imported food. The Cuban American National Foundation (CANF) states that should Cuba choose not to purchase from the U.S., it can purchase any medicine or medical equipment it needs from other countries. Such third-country transactions only cost an estimated 2%-3% more than purchases from the U.S. as a result of higher shipping costs. CANF also asserts the United States is the largest donor of humanitarian assistance to Cuba and much of this consists of medicines and medical equipment.
The US government states that since 1992, 36 out of 39 license requests from U.S. companies and their subsidiaries for sales of medical items to Cuba have been approved. The dollar amount of these sales is over $1,600,000. Furthermore, the U.S. government licensed more than $227 million in humanitarian donations of medicines and medical supplies to Cuba between 1993 and 1997. There are other factors beside the embargo explaining the lack of imports, in particular Cuba's lack of hard currency. Those with dollars can easily buy medicines and food in Cuba from Latin America and Canada. Cuba defaulted on its debt to Western banks in 1986 and lacks access to the international credit system in order to get foreign currency. In addition, the collapse of the Soviet Union caused the loss of several billions of dollars in yearly subsidies and overnight required hard currency for all imports. http://www.unc.edu/depts/diplomat/AD_Issues/amdipl_13/linderman_cuba2.html
In a 2006 report to the U.N. Secretary-General, Cuba acknowledged the authorization of medicines, though stated that they were subject to severe restrictions and complicated procedures. Cuba is obliged to make payments in cash and in advance, and is precluded from obtaining credit funding, even from private sources. The sale and transportation of the goods require licenses to be obtained for each transaction. Cuba cannot use its own merchant fleet for transporting these goods, but has to make use of vessels from third countries, primarily the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. Payments are made through banks in third countries, since direct banking relationships are prohibited. The Cuban delegation concluded that restrictions on importing medical products were "so extensive that they make such imports virtually impossible". The World Health organization/PAHO and UNFPA concurred that it was impossible for Cuba to purchase equipment, medicines and laboratory materials produced by the United States or covered by United States patents, even though those products were purchased through multilateral cooperation. Cuba was not able to purchase the isotope I-125 that is used to treat eye cancer in children. The companies manufacturing reagents and equipment are 70 per cent United States owned, which makes it difficult to purchase necessary medical equipment and other items
Medical staff
According to the World Health Organization, Cuba provides a doctor for every 170 residents, and has the second highest doctor-to-patient ratio in the world after Italy.Medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 1.5 times the national mean.
A doctor’s salary in the late 1990s was equivalent to about US$15–20 per month in purchasing power. Therefore, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher.
The San Francisco Chronicle
San Francisco Chronicle
thumb|right|upright|The Chronicle Building following the [[1906 San Francisco earthquake|1906 earthquake]] and fireThe San Francisco Chronicle is a newspaper serving primarily the San Francisco Bay Area of the U.S. state of California, but distributed throughout Northern and Central California,...
, the Washington Post, and National Public Radio have all reported on Cuban doctors defecting to other countries.
Black market healthcare
The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning black market economy, sometimes termed "sociolismoSociolismo
Sociolismo also known as amiguismo meaning "partner-ism" or "friend-ism" is the informal term used in Cuba to describe the reciprocal exchange of favors by individuals, usually relating to circumventing bureaucratic restrictions or obtaining hard-to-find goods.It comes from the Spanish word socio...
". According to former leading Cuban neurosurgeon and dissident
Dissident
A dissident, broadly defined, is a person who actively challenges an established doctrine, policy, or institution. When dissidents unite for a common cause they often effect a dissident movement....
Dr Hilda Molina
Hilda Molina
Dr. Hilda Molina is the former chief neurosurgeon of Cuba. Molina was also a deputy in the Cuban National Assembly but has been a critic of the Cuban government since the early 1990s. Her criticisms focus primarily on Cuba's state-governed healthcare system.In 1987, Molina founded the neurosurgery...
, "The doctors in the hospitals are charging patients under the table for better or quicker service." Prices for out-of-surgery X-rays have been quoted at $50 to $60. Such "under-the-table payments" reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the "Special Period
Special Period
The Special Period in Time of Peace in Cuba was an extended period of economic crisis that began in 1991 after the dissolution of the Soviet Union and, by extension, the Comecon. The economic depression of the Special Period was at its most severe in the early-to-mid 1990s before slightly declining...
" in the 1990s aggravated these payments. The advent of the "dollar economy", a temporary legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans were able to obtain medications and health services that would not be available to them otherwise.
Cuba and international healthcare
In the 1970s, the Cuban state initiated bilateral service contracts and various money-making strategies. Cuba has entered into agreements with United NationsUnited Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
agencies specializing in health: PAHO/WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
, UNICEF, the United Nations Food and Agriculture Organization
Fão
Fão is a town in Esposende Municipality in Portugal....
(FAO), the United Nations Population Fund
United Nations Population Fund
The United Nations Population Fund is a UN organization. The work of the UNFPA involves promotion of the right of every woman, man and child to enjoy a life of health and equal opportunity. This is done through major national and demographic surveys and with population censuses...
(UNFPA) and the United Nations Development Fund (UNDP). Since 1989, this collaboration has played a very important role in that Cuba, in addition to obtaining the benefits of being a member country, has strengthened its relations with institutions of excellence and has been able to disseminate some of its own advances and technologies In the 1980s, Cuba's decision to withdrawal military assistance from the Marxist-Leninist regimes in Ethiopia and Angola was partly inrooted in their inability to meet payments. In 1986, Cuba had 219 doctors per 100,000 people (compared with 423.7 doctors in the Soviet Union, which had the most doctors among industrialized countries).
The supply of physicians came to exceed the domestic market. Moreover, Cuban doctors work on much lower salaries than local doctors. A Guatemalan doctor noted "No one's going to work in the mountains for a salary of $400," the salary on which Cuban doctors work. The $400 is 16 times the doctor's salary in Cuba - allowing Cuban doctors to buy refrigerators, stereos and other items that they couldn't afford in Cuba. Cuba's missions in 68 countries are manned by 25,000 Cuban doctors, and medical teams have worked in crisis such as the South Asian Tsunami
2004 Indian Ocean earthquake
The 2004 Indian Ocean earthquake was an undersea megathrust earthquake that occurred at 00:58:53 UTC on Sunday, December 26, 2004, with an epicentre off the west coast of Sumatra, Indonesia. The quake itself is known by the scientific community as the Sumatra-Andaman earthquake...
and the 2005 Kashmir earthquake
2005 Kashmir earthquake
The 2005 Kashmir earthquake was a major earthquake centered in Pakistan-administered Kashmir known as Azad Kashmir, near the city of Muzaffarabad, affecting Gilgit-Baltistan and Khyber Pakhtunkhwa province of Pakistan. It occurred at 08:52:37 Pakistan Standard Time on 8 October 2005...
. Nearly 2,000 Cuban doctors are currently working in Africa in countries including South Africa
South Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
, Gambia, Guinea Bissau and Mali
Mali
Mali , officially the Republic of Mali , is a landlocked country in Western Africa. Mali borders Algeria on the north, Niger on the east, Burkina Faso and the Côte d'Ivoire on the south, Guinea on the south-west, and Senegal and Mauritania on the west. Its size is just over 1,240,000 km² with...
. Since the Chernobyl nuclear plant exploded in 1986, more than 20,000 children from Ukraine
Ukraine
Ukraine is a country in Eastern Europe. It has an area of 603,628 km², making it the second largest contiguous country on the European continent, after Russia...
, Belarus
Belarus
Belarus , officially the Republic of Belarus, is a landlocked country in Eastern Europe, bordered clockwise by Russia to the northeast, Ukraine to the south, Poland to the west, and Lithuania and Latvia to the northwest. Its capital is Minsk; other major cities include Brest, Grodno , Gomel ,...
and Russia
Russia
Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...
have traveled to Cuba for treatment of radiation sickness
Radiation Sickness
Radiation Sickness is a VHS by the thrash metal band Nuclear Assault. The video is a recording of a concert at the Hammersmith Odeon, London in 1988. It was released in 1991...
and psychologically based problems associated with the radiation disaster. In response to the 2005 Hurricane Katrina
Hurricane Katrina
Hurricane Katrina of the 2005 Atlantic hurricane season was a powerful Atlantic hurricane. It is the costliest natural disaster, as well as one of the five deadliest hurricanes, in the history of the United States. Among recorded Atlantic hurricanes, it was the sixth strongest overall...
disaster, Castro offered to send a "brigade" of 1,500 doctors to the U.S. to provide humanitarian aid, but was never accepted.
Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized oil
Oil
An oil is any substance that is liquid at ambient temperatures and does not mix with water but may mix with other oils and organic solvents. This general definition includes vegetable oils, volatile essential oils, petrochemical oils, and synthetic oils....
. Cuban doctors play a primary role in the Mission Barrio Adentro
Mission Barrio Adentro
Mission Barrio Adentro is a Bolivarian national social welfare program established under current Venezuelan president Hugo Chávez. The program seeks to provide comprehensive publicly-funded health care, dental care, and sports training to poor and marginalized communities in Venezuela...
(Spanish: "Mission Into the Neighborhood") social welfare program established in Venezuela under current Venezuelan president Hugo Chávez
Hugo Chávez
Hugo Rafael Chávez Frías is the 56th and current President of Venezuela, having held that position since 1999. He was formerly the leader of the Fifth Republic Movement political party from its foundation in 1997 until 2007, when he became the leader of the United Socialist Party of Venezuela...
. The program, which is popular among Venezuela's poor and is intended to bring doctors and other medical services to the most remote slums of Venezuela, has not been without its detractors. Operación Milagro (Operation Miracle) is a joint health program between Cuba and Venezuela, set up in 2005. The Venezuelan Medical Federation has criticized the appointment of Cuban doctors to high-ranking positions, and protests have taken place in the capital Caracas
Caracas
Caracas , officially Santiago de León de Caracas, is the capital and largest city of Venezuela; natives or residents are known as Caraquenians in English . It is located in the northern part of the country, following the contours of the narrow Caracas Valley on the Venezuelan coastal mountain range...
by Venezuelan medical staff who fear that the Cubans are a threat to Venezuelan jobs. Questions have also been raised by protesters about the level of Cuban medical qualifications, and there have been claims that the Cubans are "political agents" who have come to Venezuela to indoctrinate the workforce. Opposition supporters in Venezuela have called Cuban doctors "Fidel's ambassadors" and refused to go to their clinics. Two defected doctors have claimed that they were told their job was to keep Chavez in power, by asking patients to vote for Chávez in the 2004 recall referendum.
Human Rights Watch
Human Rights Watch
Human Rights Watch is an international non-governmental organization that conducts research and advocacy on human rights. Its headquarters are in New York City and it has offices in Berlin, Beirut, Brussels, Chicago, Geneva, Johannesburg, London, Los Angeles, Moscow, Paris, San Francisco, Tokyo,...
complains that the government "bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics." Doctors are reported to be monitored by "minders" and subject to curfew. The Cuban government uses relatives as hostages to prevent doctors from defecting. According to a paper published in The Lancet
The Lancet
The Lancet is a weekly peer-reviewed general medical journal. It is one of the world's best known, oldest, and most respected general medical journals...
medical journal, "growing numbers of Cuban doctors sent overseas to work are defecting to the USA", some via Colombia, where they have sought temporary asylum.
According to Luis Zuñiga, director of human rights for the Cuban American National Foundation, Cuban doctors are "slave workers" who labor for meager wages while bolstering Cuba's image as a donor nation and "the Cuban government exports these doctors as merchandise".
Cuban doctors have been part of a large-scale plan by the Cuban state to provide free medical aid and services to the international community (especially third world countries) following natural disasters. Currently dozens of American medical students are trained to assist in these donations at the Escuela Latino Americana de Medecina (ELAM) in Cuba.
Health tourism and pharmaceutics
Cuba attracts about 20,000 paying health tourists, generating revenues of around $40 million a year for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years. The country operates a special division of hospitals specifically for the treatment of foreigners and diplomats. Foreign patients travel to Cuba for a wide range of treatments including eye-surgery, neurological disorders such as multiple sclerosisMultiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...
and Parkinsons disease, cosmetic surgery, addictions treatment, retinitis pigmentosa
Retinitis pigmentosa
Retinitis pigmentosa is a group of genetic eye conditions that leads to incurable blindness. In the progression of symptoms for RP, night blindness generally precedes tunnel vision by years or even decades. Many people with RP do not become legally blind until their 40s or 50s and retain some...
and orthopaedics. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming. Cuba also successfully exports many medical products, such as vaccines.
By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around 2 percent of total tourism. Some of these revenues are in turn transferred to health care for ordinary Cubans, although the
size and importance of these transfers is both unknown and controversial. At one nationally prominent hospital/research institute, hard currency payments by foreigners have financed the construction of a new bathroom in the splanic surgery wing; anecdotal
evidence suggests that this pattern is common in Cuban hospitals.
Alternative Healthcare
Economic constraints and restrictions on medicines have forced the Cuban health system to incorporate alternativeAlternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
and herbal
Herbalism
Herbalism is a traditional medicinal or folk medicine practice based on the use of plants and plant extracts. Herbalism is also known as botanical medicine, medical herbalism, herbal medicine, herbology, herblore, and phytotherapy...
solutions to healthcare issues, which can be more accessible and affordable to a broader population In the 1990s, the Cuban Ministry of Public Health officially recognized natural and traditional medicine
Traditional medicine
Traditional medicine comprises unscientific knowledge systems that developed over generations within various societies before the era of modern medicine...
and began its integration into the already well established Western medicine model. Examples of alternative techniques used by the clinics and hospitals include: flower essence
Bach flower remedies
Bach flower remedies are dilutions of flower material developed by Edward Bach, an English bacteriologist, pathologist and homeopath, in the 1930s. Bach believed that dew found on flower petals retain healing properties of that plant...
, neural and hydromineral therapies, homeopathy
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
, traditional Chinese medicine
Traditional Chinese medicine
Traditional Chinese Medicine refers to a broad range of medicine practices sharing common theoretical concepts which have been developed in China and are based on a tradition of more than 2,000 years, including various forms of herbal medicine, acupuncture, massage , exercise , and dietary therapy...
(i.e. acupunctural
Acupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
anesthesia for surgery), natural dietary supplements, yoga
Yoga
Yoga is a physical, mental, and spiritual discipline, originating in ancient India. The goal of yoga, or of the person practicing yoga, is the attainment of a state of perfect spiritual insight and tranquility while meditating on Supersoul...
, electromagnetic and laser devices. Children begin studying the multiple uses of medicinal plants in primary school, learning to grow and tend their own plots of aloe
Aloe
Aloe , also Aloë, is a genus containing about 500 species of flowering succulent plants. The most common and well known of these is Aloe vera, or "true aloe"....
, chamomile
Chamomile
Chamomile or camomile is a common name for several daisy-like plants of the family Asteraceae. These plants are best known for their ability to be made into an infusion which is commonly used to help with sleep and is often served with either honey or lemon. Because chamomile can cause uterine...
, and mint
Mentha
Mentha is a genus of flowering plants in the family Lamiaceae . The species are not clearly distinct and estimates of the number of species varies from 13 to 18. Hybridization between some of the species occurs naturally...
, and later they conduct scientific studies about their uses. Radio and Television programs instruct people on how to relieve common stomach upset and headaches by pressing key points. Acupuncture is offered at all three levels of health care. Cuban biochemists have produced a number of new alternative medicines, including PPG (policosanol
Policosanol
Policosanol is the generic term for a natural extract of plant waxes. It is used as a nutritional supplement intended to lower LDL cholesterol and increase HDL cholesterol and to help prevent atherosclerosis, though some studies have raised questions about the effectiveness of policosanol.-...
), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang a natural product derived from the bark of mango trees.
Medical research
The Cuban Ministry of Health produces a number of medical journalMedical journal
A public health journal is a scientific journal devoted to the field of public health, including epidemiology, biostatistics, and health care . Public health journals, like most scientific journals, are peer-reviewed...
s including the ACIMED
ACIMED
ACIMED is a Spanish language journal of medical informatics published by the National Center of Information on Medical Sciences in Cuba. It was first published in 1993 and is the first Spanish language journal to be published on the subject of medical informatics....
, the Cuban Journal of Surgery
Cuban Journal of Surgery
The Revista Cubana de Cirugía is a medical journal of surgery published in Spanish in Havana, Cuba. The journal is abstracted and indexed in Excerpta Medica, Index Medicus, and Biological Abstracts....
and the Cuban Journal of Tropical Medicine
Cuban Journal of Tropical Medicine
The Revista Cubana de Medicina Tropical is a Cuban medical journal concerning tropical medicine. The journal was first published in 1945 and is published in Spanish, although abstracts are available in English. Electronic versions in PDF format are available of articles published after 1995 online...
. Because the U.S. government restricts investments in Cuba by U.S. companies and their affiliates, Cuban institutions have been limited in their ability to enter into research and development partnerships, although exceptions have been made for significant drugs.
The Center of molecular immunology
Center of molecular immunology
The Center of Molecular Immunology or CIM, is a cancer research institution located on the west side of Havana, Cuba...
(CIM) developed nimotuzumab
Nimotuzumab
Nimotuzumab is a humanized monoclonal antibody used to treat squamous cell carcinomas of the head and neck, recurrent or refractory high grade malignant glioma, anaplastic astrocytomas, glioblastomas and diffuse...
, a monoclonal antibody used to treat cancer. Nimotuzumab is an inhibitor of epidermal growth factor receptor
Epidermal growth factor receptor
The epidermal growth factor receptor is the cell-surface receptor for members of the epidermal growth factor family of extracellular protein ligands...
(EGFR), which is over-expressed in many cancers. Nimotuzumab is now being developed with international partners.
In April 2007, the Cuba IPV Study Collaborative Group reported in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kourí Institute, U.S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics. Cuba has been free of polio since 1963, but continues with mass immunization campaigns.
In the 1980s, Cuban scientists developed a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U.S. Treasury Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U.S. and elsewhere
Analysis
According to Katharine Hirschfeld, criticizing the government is a crime in Cuba, and penalties are severe. She noted that "Formally eliciting critical narratives about health care would be viewed as a criminal act both for me as a researcher, and for people who spoke openly with me". According to Hirschfeld the Cuban Ministry of Health (MINSAP) sets statistical targets that are viewed as production quotaProduction quota
A production quota is a goal for the production of a good. It is typically set by a government or an organization, and can be applied to an individual worker, firm, industry or country. Quotas can be set high to encourage production, or can be used to limit production to control the supply of goods...
s. The most guarded is infant mortality rate. The doctor is pressured to abort the pregnancy whenever screening shows that quotas are in danger. Once a doctor decides to guard his quotas, patients have no right to refuse abortion.
According to previous research about other socialist countries such as the Soviet Union and the People's Republic of China, Marxist "revolutionary" efforts have included such practices as "deliberate manipulation of health statistics, aggressive political intrusion into health care, decision-making, criminalizing dissent, and other forms of authoritarian policing of the health sector designed to insure health changes reflect the (often utopian) predictions of Marxist theory". These practices are well documented for the former Soviet Union and China. Their existence was virtually unknown in the West during the Soviet era and Western social scientists cited favorable the health statistics supplied by the regimes in the USSR and China. Social scientists did not look critically at the ways they were created and maintained by state power.
Many Cubans complain about politics in medical treatment and health care decision-making. There is no right to privacy, patient's informed consent, or right to protest for malpractice. The patient has no right to refuse the treatment, including for religious or ethical reasons. For example, Jehovah's Witnesses
Jehovah's Witnesses
Jehovah's Witnesses is a millenarian restorationist Christian denomination with nontrinitarian beliefs distinct from mainstream Christianity. The religion reports worldwide membership of over 7 million adherents involved in evangelism, convention attendance of over 12 million, and annual...
cannot refuse blood transfusions and a Rastafarian cannot refuse an amputation on the grounds that it goes against Rastafari biblical teachings (Rastafari teaches that the body must be whole in order for it to resurrected on Judgement Day). As a result, the experience can be dehumanizing. After spending nine months in Cuban clinics, Katherine Hirschfeld asserted in her paper "My increased awareness of Cuba’s criminalization of dissent raised a very provocative question: to what extent is the favorable international image of the Cuban health care system maintained by the state’s practice of suppressing dissent and covertly intimidating or imprisoning would-be critics?"
In 2006, BBC
BBC
The British Broadcasting Corporation is a British public service broadcaster. Its headquarters is at Broadcasting House in the City of Westminster, London. It is the largest broadcaster in the world, with about 23,000 staff...
flagship news programme Newsnight
Newsnight
Newsnight is a BBC Television current affairs programme noted for its in-depth analysis and often robust cross-examination of senior politicians. Jeremy Paxman has been its main presenter for over two decades....
featured Cuba's Healthcare system as part of a series identifying "the world's best public services". The report noted that "Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority" The report stated that life expectancy and infant mortality rates are nearly the same as the USA's. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power. A 2006 poll carried out by the Gallup Organization
The Gallup Organization
The Gallup Organization, is primarily a research-based performance-management consulting company. Some of Gallup's key practice areas are - Employee Engagement, Customer Engagement and Well-Being. Gallup has over 40 offices in 27 countries. World headquarters are in Washington, D.C. Operational...
's Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of urban Cubans responded positively to the question "do you have confidence to your country's health care system".
In 2000, Secretary General of the United Nations Kofi Annan
Kofi Annan
Kofi Atta Annan is a Ghanaian diplomat who served as the seventh Secretary-General of the UN from 1 January 1997 to 31 December 2006...
stated that "Cuba should be the envy of many other nations" adding that achievements in social development are impressive given the size of its gross domestic product per capita. "Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities - health, education, and literacy." The Kaiser Family Foundation
Kaiser Family Foundation
The Henry J. Kaiser Family Foundation , or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. It focuses on the major health care issues facing the nation, as well as the U.S. role in global health policy...
, a non-governmental organization that evaluated Cuba’s healthcare system in 2000-1 described Cuba as "a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources" President of the World Bank James Wolfensohn
James Wolfensohn
Sir James David Wolfensohn AO KBE FKC was the ninth president of the World Bank Group.-Early life:James Wolfensohn was born in Sydney, Australia, on 1 December 1933...
also praised Cuba's healthcare system in 2001, saying that "Cuba has done a great job on education and health", at the annual meeting of the Bank and the International Monetary Fund
International Monetary Fund
The International Monetary Fund is an organization of 187 countries, working to foster global monetary cooperation, secure financial stability, facilitate international trade, promote high employment and sustainable economic growth, and reduce poverty around the world...
. Wayne Smith
Wayne Smith (diplomat)
Wayne S. Smith is a former US diplomat, and currently an academic and author.-Government service:In 1949, Smith joined the United States Marine Corps, and served until 1953, including combat in the 1950-1953 Korean War. In 1957, he joined the US State Department, and served in the Soviet Union,...
, former head of the US Interests Section in Havana identified "the incredible dedication" of Cubans to healthcare, adding that "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated". Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it. Furthermore, London's The Guardian newspaper lauded Cuba's public healthcare system for what it viewed as its high quality in a Sept. 12, 2007 article.
In 2001, members of the UK
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
House of Commons
British House of Commons
The House of Commons is the lower house of the Parliament of the United Kingdom, which also comprises the Sovereign and the House of Lords . Both Commons and Lords meet in the Palace of Westminster. The Commons is a democratically elected body, consisting of 650 members , who are known as Members...
Health Select Committee travelled to Cuba and issued a report that paid tribute to "the success of the Cuban healthcare system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community".
The Parliament of the United Kingdom
Parliament of the United Kingdom
The Parliament of the United Kingdom of Great Britain and Northern Ireland is the supreme legislative body in the United Kingdom, British Crown dependencies and British overseas territories, located in London...
also drew up an analysis of the key features of Cuba's healthcare system, drawing comparisons with the state funded National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
(NHS). The overall conclusion was that many of the features identified would not have occurred had there not been an obvious commitment to health provision demonstrated by the protection and proportion of the budget given the health care. The study concluded the following.
- There appeared to be little evidence of a divide between the prevention/proactive response and the disease management/reactive response within Cuban healthcare.
- By far the biggest difference was the ratio of doctors per person. In Cuba it was one doctor per 175 people, in the UK the figure was one doctor per 600 people.
- There is a commitment in Cuba to the triple diagnosis (physical/psychological/social) at all levels.
- Extensive involvement of "patient" and the public in decision making at all levels.
- Integration of hospital/community/primary care via polyclinicPolyclinicPolyclinics in England are intended to offer a far greater range of services than can be offered by current general practitioner practices and local health centres. In addition to traditional GP services they would offer extended urgent care, healthy living services, community mental health...
s. - Team-work that works is much more evident both in the community and the hospital sector and the mental-health and care of the elderly sites visited were very well staffed and supported.
The study also pointed to problems within the system, these included;
- Low pay of doctors
- Poor facilities—buildings in poor state of repair and mostly outdated.
- Poor provision of equipment.
- Frequent absence of essential drugs.
- Concern regarding freedom of choice both for patient and doctor.
Complaints have arisen that foreign "health tourists" paying with dollars and senior Communist party officials receive a higher quality of care than Cuban citizens. Former leading Cuban neurosurgeon and dissident
Dissident
A dissident, broadly defined, is a person who actively challenges an established doctrine, policy, or institution. When dissidents unite for a common cause they often effect a dissident movement....
Dr Hilda Molina
Hilda Molina
Dr. Hilda Molina is the former chief neurosurgeon of Cuba. Molina was also a deputy in the Cuban National Assembly but has been a critic of the Cuban government since the early 1990s. Her criticisms focus primarily on Cuba's state-governed healthcare system.In 1987, Molina founded the neurosurgery...
asserts that the central revolutionary objective of free, quality medical care for all has been eroded by Cuba's need for foreign currency. Molina says that following the economic collapse known in Cuba as the Special Period
Special Period
The Special Period in Time of Peace in Cuba was an extended period of economic crisis that began in 1991 after the dissolution of the Soviet Union and, by extension, the Comecon. The economic depression of the Special Period was at its most severe in the early-to-mid 1990s before slightly declining...
, the Cuban Government established mechanisms designed to turn the medical system into a profit-making enterprise. This creates an enormous disparity in the quality of healthcare services between foreigners and Cubans leading to a form of tourist apartheid. In 1998 she said that foreign patients were routinely inadequately or falsely informed about their medical conditions to increase their medical bills or to hide the fact that Cuba often advertises medical services it is unable to provide. Others makes similar claims, also stating that senior Communist party and military officials can access this higher quality system free of charge. http://www.canf.org/Issues/medicalapartheid.htm http://www.unc.edu/depts/diplomat/AD_Issues/amdipl_13/linderman_cuba2.html In 2005, an account written by Cuban exile and critic of Fidel Castro, Carlos Wotzkow, appeared showing apparent unsanitary and unsafe conditions in the "Clínico Quirúrgico" of Havana;the article claims that health care for Cubans occurs in worse conditions in the rest of the country.
An article in Canadian newspaper National Post
National Post
The National Post is a Canadian English-language national newspaper based in Don Mills, a district of Toronto. The paper is owned by Postmedia Network Inc. and is published Mondays through Saturdays...
, based interviews of Cubans, finds that in reality even the most common pharmaceutical items, such as Aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays. http://www.cubaverdad.net/references/for_cubans_a_bitter_pill.htm The Cuban government blames the shortages on the embargo and states that those with more severe chronic diseases receive medicines. http://www.aegis.com/news/ips/2001/IP010312.html However, other sources suggest that also those with such diseases lack medicines. It is also suggested that in some cases the local non-dollar stocks have been shipped abroad.
http://www.urban-renaissance.org/urbanren/index.cfm?DSP=content&ContentID=6341 http://www.cubanet.org/CNews/y05/jun05/27e7.htm
The U.S. State Department has argued that during the economic depression "the Cuban government made a deliberate decision to continue to spend money to maintain its military and internal security apparatus at the expense of other priorities – including healthcare." However, one study found that "the available data show that the fall in Cuba's medicine imports in the '90s didn't correspond to a significant lowering of the government's healthcare spending. Budgetary support for peso-denominated spending – i.e., labor costs of medical professionals, operational costs of hospitals and clinics – has remained strong. Attempts to blame medical shortages in Cuba on resource misallocation are thus misguided, or at least wrongly nuanced."
A recent ABC-TV 20/20 report on Healthcare, based on footage taken from within the island, criticized Michael Moore's portrayals of the Cuban Healthcare system in the movie Sicko. In that film, Moore took a number of Americans to a hospital in Havana where they bought affordable drugs, and were given treatments for free that they could not afford in America. The report highlights the dilapidated conditions of some hospitals that are accessible to regular Cubans by pointing to the bleak conditions of hospital rooms and the filthy conditions of the facilities. The report also addressed the quality of care available to Cubans by arguing that patient neglect was a common phenomenon. Finally, in discussing the infant mortality rate, the report highlights the government's alleged efforts to promote abortions of potentially infirm fetuses and other alleged government efforts to manipulate the rate.
See also
- Carlos FinlayCarlos FinlayCarlos Juan Finlay was a Cuban physician and scientist recognized as a pioneer in yellow fever research.- Early life and education :...
- Cuban Center of molecular immunology
- Latin American School of Medicine (Cuba)
- SickoSickoSicko is a 2007 documentary film by American filmmaker Michael Moore. The film investigates health care in the United States, focusing on its health insurance and the pharmaceutical industry. The movie compares the for-profit, non-universal U.S...
Data
The World Health Organisation, and its regional branch, the Pan American Health Organization,publish regular reports as well as making data available on the web.
- World Health Organisation, World Health Statistics 2009 consists mostly of tables (.pdf format) of health indicators, for most countries, for selected years between 1990 and 2008.
World Health Organisation, National Accounts Series consists of statistics on the financing of health care in various countries. Cuba tables, covers years 1995-2007. - Pan American Health Organisation, Health situation in the Americas: Basic Indicators 2008. Table of health indicators for countries, one datum from a recent year (2000-2008) for each indicator.
Pan American Health Organisation, Health in the Americas 2007 is primarily a text report; also contains tables. First section is on the region as a whole, second section is reports on individual countries, including Cuba.
External links
- Cubans Reap Health Rewards With Preventive Medicine Strategy - December 2010 Video Report by PBS Newshour
- Letter from Cuba Cuba: plenty of care, few condoms, no corruption. Hans Veeken, public health consultant, Medecins Sans Frontieres. BMJ 1995;311:935-937 (7 October)
- Cuba AIDS Project — HIV and AIDS in Cuba
- Apartheid in Cuba's Health system
- "Cuban Socialism Builds Model Health System" - Part I, II, III, IV, V by Workers World
- MEDICC Review An international journal of Cuban health and medicine