Healthcare in Cuba
The
Like the rest of the
The Cuban healthcare system has emphasized the export of health professionals through international missions, aiding global health efforts. However, while these missions generate significant revenue and serve as a tool for political influence, domestically, Cuba faces challenges including medication shortages and disparities between medical services for locals and foreigners.[7] Despite the income from these missions, only a small fraction of the national budget has been allocated to public health, underscoring contrasting priorities within the nation's healthcare strategy.[7]
History
Modern Western medicine has been practiced in Cuba by formally trained physicians since at least the beginning of the 19th century and the first surgical clinic was established in 1823.[8] 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.[9] During the period of U.S. presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass and surgeon Jesse William Lazear.[9][10]
In the 1950s the number of doctors per thousand of the population ranked above Britain, France and the Netherlands. In Latin America it ranked in third place after Uruguay and Argentina.[11] 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.[12] The mortality rate was the third lowest in the world.[13][14] According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.[13]
Following the
In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised
- by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals and preventive and specialist 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 of the population cooperates in these activities and plans through the social and mass organizations."[19] Privatization of healthcare in Cuba is illegal and unnecessary as high quality, equal, care covered by the state is available to everyone as made necessary by Cuba's constitution.[20]
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. Loss of Soviet subsidies brought food shortages to Cuba in the early 1990s. The famine during the Post-Soviet Union
Epidemiologist 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".[26]
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.
United States embargo
During the 1990s the ongoing
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 forbid ships that dock in Cuban ports from docking in U.S. ports for six months. This drastically restricted shipping, and increased shipping costs some 30%.[31]
In 1997, the American Association for World Health stated that the embargo contributed to malnutrition, poor water access, lack of access to medicine and other medical supplies and concluded that "a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventative medicine to all its citizens."[32]
In 2000, the
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.[36]
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
One effect of the embargo has been to make it necessary for Cuba to create its own biotech industry to produce drugs which it is unable to access.
Years | 1900 | 1910 | 1920 | 1930 | 1940 | 1950 | 1960 | 1970 | 1980 | 1990 | 2000 | 2010 |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Cuba[39][40] | 33.2 | 35.3 | 37.4 | 41.5 | 47.5 | 55.8 | 63.9 | 69.8 | 73.8 | 74.6 | 76.6 | 78.9 |
Increase per decade | 2.1 | 2.1 | 4.1 | 6.0 | 8.3 | 8.1 | 5.9 | 4.0 | 0.8 | 2.0 | 2.3 | |
Latin America[41] | 56.0 | 60.4 | 64.2 | 67.7 | 71.5 | 74.0 | ||||||
Difference with L.A. | 7.9 | 9.4 | 9.6 | 6.9 | 5.1 | 4.9 |
Present
National health system
Cuba's national health system is made up of multiple tiers: 1) the community containing individuals and families, 2) family doctor-and-nurse teams, 3) basic work teams, 4) community polyclinics, 5) hospitals, and 6) medical institutes.[42]
Cuba's Family Physician and Nurse program is made up of physician and nurse teams that serve individuals, families, and their communities. They live above their government-built family medicine offices, living directly in the communities they serve and available 24 hours a day.[42] These teams work to improve the public health concerns in the environment as well as provide medical care. They perform a neighborhood health diagnosis biannually where community risk factors are evaluated to focus priorities for improving the health of the community.[42] Clinically, family doctor-and-nurse teams follow the Continuous Assessment and Risk Evaluation (CARE) method which monitors individual and family health by examining community and home environments, current health, and medical history. The teams make home visits to each family at least once yearly to assess and evaluate their health. Individuals with chronic illness are seen at least every three months.[42] These teams' role combine the importance of focusing on both public health and clinical medicine.[43]
Polyclinics are community-based clinics that house primary care specialists. They exist in every Cuban community and are well-acquainted with the people and the communities they serve. They can see the social determinants and environment that affect the community's health, bettering their ability to serve their patients.[42] Specialists at the polyclinic are there to support physicians when they are needed. Each clinic of specialists supports 20-40 doctor-and-nurse teams. Basic work teams within the polyclinics supervise and evaluate the neighborhood and clinical health work of the family medicine offices.[42]
While
The Cuban health system has been promoted for decades by the government as an international role model due to its free access and broad coverage. However, in practice, there are reports indicating issues such as the deterioration of hospital facilities and the need for patients to provide basic supplies.[45] Challenges for healthcare in Cuba include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs.[3][4]
In October 2023, the Miami Herald cited "insufficient healthcare" as one of the reasons why nearly 425,000 Cubans had fled the country during the previous two years.[46]
As at 2024, Cuba spends 11.4 per cent of its GDP on healthcare, which is more than twice as much as most Latin American countries, and has nine doctors per thousand residents. Child mortality in 2023 was four per thousand, which is similar to that of rich industrialised countries.
Health statistics
Indicators | Statistic | Date of information |
---|---|---|
Life expectancy at birth | 79 (years) | 2012 |
Life expectancy at age 60 | 22 (years) | 2012 |
Fertility rate | 1.4 (children born/woman) | 2013 |
Number of live births | 107.1 (thousands) | 2013 |
Maternal mortality ratio | 80 (per 100,000 live births) | 2013 |
Under-five mortality rate | 6 (deaths/1,000 live births) | 2013 |
Number of deaths | 95.9 (thousands) | 2013 |
Deaths due to HIV/AIDS | 2.6 (per 100,000 population) | 2012 |
Total health expenditure per capita | 2,475 (Intl $) | 2014 |
Total health expenditure as % of GDP | 11.1 | 2014 |
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.[49] 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).[50] 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; the Central American isthmus had 123 physicians and 30 dentists per 100,000.[51] As of 2005, Cuba became the world leader in the ratio of doctors to population with 67 doctors per 10,000 population as compared with 43 in the Russian Federation and 24 in the United States.[52]
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 1000 pregnancies. The rate is still among the highest in Latin America.[21] The abortion rate in Cuba is 72.8 per 100 births.[53]
Alternative healthcare
Economic constraints and restrictions on medicines have forced the Cuban health system to incorporate
Sexual health
A 2002 report stated that there had been a significant increase in STIs in Cuba due to an increase in prostitution and lack of prevention.[21]
According to the
In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world.[56] 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."[57] 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.[58]
In 2015, Cuba became the first country in the world to eliminate mother-to-child transmission of HIV and syphilis, a major public health accomplishment.[59]
Fertility
Following the successful 2022 Family Code referendum, surrogacy is legal in Cuba as long as money is not exchanged.[60]
Training doctors
Cuba's healthcare system survives, in part, due to its medical education system. In Cuba, the medical university is not a separate entity from health services, but it exists within the system, a model common in the rest of the developing world. In Cuba, this may include more community-based centers than large hospitals. Medical and nursing students mentor and intern within the national system from the first years of their training,
Cuba and international healthcare
Cuba provides more medical personnel to the developing world than all the
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
Cuba's missions in 68 countries are staffed by 25,000 Cuban doctors. Medical teams have worked in crisis such as the
Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized oil.[71] Around 30,000 medical professionals were sent to the country in exchange for more than 100,000 barrels of oil per day.[72] Cuban doctors play a primary role in the Mission Barrio Adentro (Spanish: "Mission Into the Neighborhood") social welfare program established in Venezuela under former Venezuelan president Hugo Chávez.[73]
Through Operación Milagro (in English, “Operation Miracle”), Cuba began in 2004 to pay for Venezuelans with reversible blindness to travel to Cuba for free operations to restore their sight.[74] Over 200,000 Venezuelans received this free surgery.[74] In 2005, Cuba established a new ophthalmology center in Venezuela, and later expanded its program to 30 Venezuelan hospitals.[74] Cuba continued to grow the program and by 2017 had established 69 Operación Milagro clinics in 15 different countries.[74] By 2019, over 4 million people in 34 countries had received free surgery through the program.[74]
Cuba also exports many medical products, such as
Health tourism
Cuba attracts about 20,000
Cuban Medical Professional Parole Program
President George W. Bush in 2006 initiated a program called the "Cuban Medical Professional Parole Program", this program allowed for any Cuban doctor serving outside of Cuba to be granted political asylum and permanent resident status in the United States, if only the Cuban national was able to make it to a U.S. embassy anywhere in the world. The program was ended by the Obama administration as part of an effort to warm relations between the United States and the Cuban government. 7,117 applications by Cuban doctors working abroad have been approved since 2006.[72]
International medical missions
The Cuban healthcare system, renowned for the quality of its medical services, has largely strategized its approach around the export of health professionals through international medical missions. These missions have enabled Cuba to establish a medical presence across various regions of the world, especially in areas with healthcare deficiencies. During the COVID-19 pandemic, medical brigades were deployed to 41 territories, spanning nations in Latin America, the Caribbean, Africa, and Europe.[7] Historically, these professionals have conducted millions of operations and have had a substantial impact on global health.[7]
Cuban doctors, accustomed to working under resource-constrained conditions, have been requested to assist in the pandemic response abroad. Yoani Sánchez of 14ymedio wrote in 2020 that there are concerns regarding the working conditions and the distribution of their salaries when they work abroad, as a significant portion is retained by the Cuban government.[45] According to Reason in early 2022, doctors that travel abroad on behalf of the Cuban government often do so against their will and without monetary compensation similar to doctors from other countries.[78] Sánchez wrote that nearly 7,000–8,000 doctors since 2006 have gone into hiding or failed to return to Cuba after having gone on abroad as part of the Cuban government's "volunteering" them to provide healthcare to foreign nationals without remuneration. While Cuban doctors are sent abroad to assist in medical missions, domestically, although wages in the health sector have increased in recent years, they are still considered low compared to the prices of basic goods in Cuba.[45]
The medical missions have also been a subject of critiques and controversies. There are testimonies from professionals indicating human rights violations during their participation in these missions across different countries. These accounts reflect concerns over limitations on fundamental freedoms and the potential instrumentalization of these doctors for political and propagandistic purposes. Although the salary on these missions is higher than what they might earn in Cuba, a significant portion is retained by the Cuban government.[7]
Domestically, the Cuban healthcare system has faced challenges, particularly during the pandemic. The shortage of medications and other essential resources has been a recurring issue, despite Cuba's efforts to develop its own COVID-19 vaccines.[7] Furthermore, there is a notable disparity between the medical service offered to Cuban citizens and the "health tourism" targeted at foreigners, with the latter being of higher quality and enjoying a better international reputation.[7]
The financing and distribution of resources also raise questions about governmental priorities. Despite the revenues generated by the medical missions, only 0.8% of the national budget was allocated to public health in the first half of 2021, compared to 45.5% focused on international tourism and other business activities.[7]
Medical research
The Cuban Ministry of Health produces a number of
In the 1980s, Cuban scientists developed a vaccine against a strain of
The
In April 2007, the Cuba IPV Study Collaborative Group reported in the
During the
Assessments
Praise
In reviewing five books about Cuba's medical system for Family Medicine magazine, William Ventres concluded that Cuba's state-run medical system has been quite successful, due largely to its family medicine model.[84]
In 2006,
In 2000, Secretary General of the United Nations
In 2001, members of the
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.
- 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 polyclinics.
- 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.[92]
Margaret Chan, former director of the World Health Organization, recommended other countries follow Cuba's example in health care.[93]
Criticism
The preceding study also pointed to problems within Cuba's health system, including:
- 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.[92]
Tassie Katherine Hirschfeld, an associate professor at the department of anthropology of the University of Oklahoma,[24] did her Ph.D. thesis on the Cuban health system, spending nine months conducting ethnographic work in Cuba in the late 1990s. According to Hirschfeld, "public criticism of the government is a crime in Cuba", which means 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".[94] Nevertheless, she was able to hear from many Cubans, including health professionals, "serious complaints about the intrusion of politics into medical treatment and health care decision-making".[94] She points out that "there is no right to privacy in the physician-patient relationship in Cuba, no patients’ right of informed consent, no right to refuse treatment, and no right to protest or sue for malpractice".[94] In her view medical care in Cuba can be dehumanizing.
Complaints have also 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
A recent ABC-TV
Researchers at Texas Tech University wrote that official statistics provided by the Cuban government should be treated sceptically.[99]
Cuban 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.[100] 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.[21]
Cuban doctors that have been sent on international missions by the Cuban government have reported being paid less than the local doctors and treated poorly by the local government. They are sometimes monitored by the local government in case of defecting.
A 2020 study using a synthetic control method found that infant mortality increased in the first years of the Castro administration relative to other similar countries, but that infant mortality reverted to trend during the 1970s irrespective of foreign aid.[103]
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
See also
- Health in Cuba
- Carlos Finlay
- Center of Molecular Immunology
- ELAM (Latin American School of Medicine) Cuba
- Sicko
- Cuban medical internationalism
- Mission Barrio Adentro
- List of hospitals in Cuba
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- ^ Mason Essif (30 December 2002). "Health Care in Cuba". The Henry J. Kaiser Family Foundation.
- ^ Learn from Cuba, Says World Bank World History Archives. May 2001
- ^ ‘Sicko,’ Castro and the ‘120 Years Club’ The New York Times. May 27, 2007
- ^ Carroll, Rory (September 12, 2007). "Cuban Healthcare: First World Results on a Third World Budget". The Guardian (London).
- ^ a b CUBAN HEALTH CARE SYSTEMS AND ITS IMPLICATIONS FOR THE NHS PLAN Archived 2013-08-21 at the Wayback Machine. Select Committee on Health.
- ^ Hamblin, James (November 29, 2016). "How Cubans Live as Long as Americans at a Tenth of the Cost". The Atlantic. Retrieved December 22, 2018.
- ^ a b c Katherine Hirschfeld (July 2007). "Re-examining the Cuban Health Care System: Towards a Qualitative Critique" (PDF). Cuban Affairs. 2 (3). Archived from the original (PDF) on 2009-03-17.
- ^ Cuban Medicine Today by Dr Archived 2006-05-29 at the Wayback Machine Hilda Molina Center for a free Cuba – link fails 16.9.06
- ^ "Cuban American National Foundation - CANF".
- ^ El cuento de la Salud en Cuba 404 Archived 2006-08-12 at the Wayback Machine, Publicado el 06.03.2005 11:32 Por Carlos Wotzkow, María Elena Morejón y Equipo Informativo de Gentiuno.com
- ^ News, A. B. C. "Healthy in Cuba, Sick in America?". ABC News.
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has generic name (help) - PMID 29893849.
- ^ Economic crisis and access to care: Cuba's health care system since the collapse of the Soviet Union. Nayeri K, Lopez-Pardo CM. p.13 online
- ^ a b "On a mission: how Cuba uses its doctors abroad" by Sara Carrillo de Albornoz. This article discusses Cuba's healthcare help abroad, but also critiques that it may be contributing to a shortage of care and resources at home.
- ^ Juan Forero (25 February 2007). "Cuban doctors defect from Venezuela posts". San Francisco Chronicle.; Joshua Goodman (2 February 2007). "Cuban Doctors Awaiting U.S. Response". Washington Post.; Juan Forero (20 February 2007). "Cuban Doctors Seek Path to U.S." National Public Radio.
- S2CID 229073336.
- ^ Miami Herald. August 04, 2006. [dead link]
- ^ Cuba's Health in Transition and the Central and Eastern European. Countries Experience. Antonio Maria de Gordon.
External links
- "The Paradox of Good Health and Poverty: Assessing Cuban Health Outcomes under Castro" by Vincent Geloso and Gilbert Berdine
- 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
- MEDICC Review An international journal of Cuban health and medicine
- Cuban Affairs "Re-examining the Cuban Health Care System."