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Health Care in Cuba and America

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havana-cheUnder Article 50 of Cuba's Constitution:

"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 vaccination 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 Article 51 also guarantees free universal education at all levels to young people and adults. Cuba isn't perfect, far from it, but imagine if America matched these social benefits, ones Cuba provides at miniscule cost because services eliminate bureaucratic and other waste that enrich Western healthcare provider predators.

Nations should serve their people, not profiteers, even though Havana announced hard times-forced service cutbacks. At the time, numerous reports explained Cuba's announced job cuts, including by Financial Times writer Marc Frank last September 13 headlining, "Cuba to cut 500,000 from state payroll," saying:

Those eliminated will be shifted "to the private sector in 2011," and that "eventually more than a million jobs would be cut," according to the Cuban Workers Confederation (CTC), its only union, saying that:

"Job options will be increased and broadened with new forms of non-state employment, among them leasing land, co-operatives and self-employment absorbing hundreds of thousands of workers in the coming years."

Around half of them will be licensed as self-employed, an agenda begun in the 1990s, including for family-run restaurants, car repair shops, construction, artisan work, and other small businesses. Cooperatives were another earlier initiative to get greater emphasis ahead. Overall, it's the biggest shift to private enterprise since all 58,000 small businesses were nationalized in 1968.

In December 2009, Raul Castro's government reported about five million state workers, over 85% of Cuba's labor force. The private sector employed 591,000, mostly farmers and 143,000 self-employed. Cutting 10% of government workers in 2011 and more ahead represents a significant policy change. It remains to be seen how radically a shift to a more market-run economy will affect Cuba's 60 year model, including its delivery of social services.

On September 13, 2010, Al Jazeera's Juan Jacomino said all Cubans, including private sector ones, will still get state-provided free healthcare, education, and other longstanding social services, the constitutionally mandated hallmark of Cuba's revolution. However, CTC's announcement said policy changes were necessary:

"to increase production and the quality of services, reduce inflated social spending, and eliminate undue gratuities, excessive subsidies, (university) studies as a source of employment, and early retirement."

At issue is hard economic times like elsewhere. Nickel, for example, Cuba's leading export, plummeted from $50,000 a ton to less than $10,000. In addition, tourist revenues and exile remittances fell sharply, forcing measures never before taken. Hopefully, better economic times will improve all mandated services, especially Cuba's model health system that's likely to see cutbacks.

Cuba Under Castro

An earlier 2006 article discussed it.

It discussed Cuba's achievements under embargo, at first partial, then total in February, 1962 when it was expanded to include everything except non-subsidized sales of food and medicines. A month later it banned the import of all goods made from Cuban materials regardless of where produced. In 1992, the embargo further tightened with passage of the Cuban Democracy (Torricelli) Act that legalized the encouragement of pro-US opposition groups to forcefully target Castro's government. In 1996, the Helms-Burton Act hardened it again by authorizing Washington the right to sue any corporation anywhere that does business with Cuba. 

The US embargo remains in place despite sectors of America's business community wanting access to Cuba's market, including oil and other interests, concerned about profits, not ideology or politics.

Last November, the UN General Assembly, for the 19th straight year, called on Washington to end its economic, commercial, and financial embargo, calling it morally indefensible. The vote was 187 in favor, two opposed (America and Israel) with three abstentions (Marshall Islands, Federated States of Micronesia, and Palau).

On April 19, 2009, New York Times writers Sheryl Stolberg and Alexei Barrionuevo headlined, "Obama Says US Will Pursue Thaw With Cuba," saying:

Obama "told a gathering of Western Hemisphere leaders (that) 'the United States seeks a new beginning with Cuba,' and (is) willing to have his administration engage the Castro government on a wide array of issues."

Another promise made, another broken. Cuba is still waiting, though on January 14, the Obama administration eased travel restrictions for academic, religious, and cultural groups and will allow charter flights from more US airports. Americans will also be able to send money to non-government connected Cuban citizens. As always, it remains to be seen how the announced policy turns out. Like so many previous times, it may prove more rhetoric than change.

Revolutionary Cuba

In its early years, Castro made a clean break with world capitalism that turned Cuba into a brothel. He nationalized US industries, carried out land reform, closed the Mafia-owned casinos and ended longstanding, systemic corruption, replacing the former system with state-controlled socialism, a planned economy.

After the Soviet Union dissolved, Cuba modestly changed of necessity, allowing a limited amount of free enterprise, including in agriculture to increase output, relieve food shortages, and neutralize the country's black market by having more readily available affordable food supplies.

Small retailing and light manufacturing were also permitted as private for-profit businesses. In the mid-1990s, 100% foreign commercial ownership was allowed in joint ventures, up from the 1982-established 49%.

Social services have been Cuba's hallmark, its most notable successes, especially in areas of education and health care. Besides constitutionally mandated rights, Cuba (in 1983) adopted the Public Health Law that obligates the state permanently to assure, improve, and protect its citizens' health, including those rehabilitating from physical or mental disabilities.

In 1989, the World Health Organization (WHO) called Cuba's health system a "model for the world." It cited its extensive system of family doctors and sophisticated tertiary care facilities, its emphasis on nutrition and preventive care, its low infant mortality rate at 6 per 1,000 population that equals the developed world's average and betters America's at 7%.

Cuba also matches America's life expectancy, has double the number of physicians per 1,000 population, and an overall lower mortality rate. Moreover, it has the most complete infant immunization coverage in the developing world and an exemplary national health and nuitrition education program, emphasizing chemical-free, non-GMO, organically grown fresh produce which it planned to have enough of to feed its entire population in a climate thought inhospitable to grow chemical-free food. Cuba proved it could be done.

It also delivers top quality health care at miniscule cost compared to America with, by far, the world's highest per capita expense, because corporate providers game the system for profit, regardless of quality of care delivered.

Yet America leaves over 50 million of its citizens uninsured, and about 40% of them will remain so under Obamacare, an outrageous program to ration care and enrich providers by leaving them mostly unregulated to operate as they wish.

In late 1990's, shortages of pharmaceuticals and medical supplies impacted Cuba's health system adversely, yet it devised innovative solutions, including development of a world-class biotechnology industry in state-of-the-art research labs where new drugs are developed for home use and export.

A May 2008 WHO assessment of "Cuba's primary health care revolution, 30 years on" cited impressive achievements even under embargo. WHO again said Cuban indicators "are close (to) or equal those in developed countries," including seven deaths per 1,000 children aged five or less, a decrease from 46 over 40 years earlier. At 77 years, Cubans also have one of the world's highest life expectancies.

The nation's centerpiece is its 498 community-based polyclinics, serving from 30,000 - 60,000 people. They act as organizational hubs for 20 - 40 neighborhood-based family doctor/nurse offices, and as accredited research and teaching centers for medical, nursing, and allied health sciences students. They're the backbone of Cuba's health system.

Most Cuban doctors practice general medicine because it's mandated for over 97% of medical graduates. Later they can apply for a second specialty area.

Since 2002, 241 polyclinics underwent extensive renovation, a process continuing today to maintain high standards consistent with modern technology, including care formerly only available in hospitals.

As a result, 22 services are offered, including rehabilitation, x-rays, ultrasound, optometry, ophthalmology, endoscopy, thrombolysis, emergency services, traumatology, clinical lab services, family planning, emergency dentistry, pre and postnatal child care, immunization, diabetic and elderly care. Other specialties include dermatology, psychiatry, psychology, cardiology, family and internal medicine, pediatrics, obstetrics, and gynecology, mouth diseases, plus other services.

They include acupuncture, message therapy, electromagnetic therapy, mud therapy, reflex therapy, heat therapy, speech therapy, physical therapy, adult and children's gym, and more. At all times, quality care and patient satisfaction are stressed.

World Health Organization (WHO) Assessment of World Health Systems

In 2000, the WHO assessed them, using five performance indicators to measure effectiveness in 191 member states. They included:

  • overall level of health;
  • health distribution;
  • responsiveness, including respect for patients, access, quality of basic amenities and choice of providers;
  • distribution and amount of financing; and
  • ability to perform certain functions, including investment, training, delivery of services, and overall stewardship of resources and those entrusted with them.

France performed best followed by Italy, Spain, Oman, Austria and Japan. America ranked 37th, despite spending double the average amount of other developed nations.

Highest rated Latin American countries were Colombia, Chile, Costa Rica and Cuba, rated 22nd, 33rd, 36th and 39th in the world respectively. In terms of fairness, Cuba ranked 23rd, America 54th.

In 2009, WHO issued a more detailed report.

Some of its findings are as follows:

(1) Children aged five years underweight for age:

  • no data for Cuba, but it likely matches developed world percentages;
  • 1.3% in America

(2) Under age five mortality rate:

  • 8 per 1,000 live births in America;
  • 6 per 1,000 live births in Cuba;

(3) Measles immunization coverage among one-year olds:

  • 93% in America;
  • 99% in Cuba;

(4) Maternal mortality ratio per 100,000 live births:

  • 11 in America; a 2010 Lancet study puts the figure at 16.7; Encyclopedia of the Nations data is 11 in 2005;
  • 45 in Cuba; the same Lancet study has Cuba at 40.1; Encyclopedia of the Nations data is 29.4 in 2008;

(5) Births attended by skilled health personnel:

  • 99% in America;
  • 100% in Cuba;

(6) Contraceptive Prevalence:

  • 72.8% in America;
  • 73.3% in Cuba;

(7) Adolescent fertility rate per 1,000 girls aged 15 - 19:

  • 41 in America;
  • 42 in Cuba;

(8) Percentage of prenatal care:

  • no data for America, though many poor women don't get it;
  • 100% in Cuba;

(9) Percent of unmet need for family planning:

  • no data for America or Cuba;

(10) HIV/AIDS prevalence among adults aged 15 or older per 100,000 population:

  • 452 in America;
  • 67 in Cuba;

(11) Popular knowledge about HIV/AIDS among males aged 15 - 24:

  • no data for America or Cuba;

(12) Comparable knowledge for females;

  • no data for America;
  • 30% in Cuba;

(13) Antiretroviral therapy for HIV/AIDS infected persons;

  • no data for America;
  • 95% in Cuba;

(14) Successful TB Treatment

  • 64% in America;
  • 90% in Cuba; it's also been successful in eradicating or minimizing other communicable diseases like dengue fever, polio and malaria;

(15) Access to "improved" drinking water sources:

  • 99% in America;
  • 91% in Cuba;

(16) Access to improved sanitation:

  • 100% in America;
  • 98% in Cuba;

(17) Life expectancy:

  • 78 in America;
  • 78 in Cuba;

(18) Health service coverage:

  • partial data only for America but well under 100%;
  • 100% in Cuba;

(19) Number of physicians per 10,000 population

  • 26 in America;
  • 59 in Cuba;

(20) Number of nurses and other medical professionals per 10,000 population:

  • 94 in America;
  • 74 in Cuba; and

(21) Number of dentists per 10,000 population:

  • 16 in America;
  • 9 in Cuba.

A Final Comment

In Cuba, health care is a human right. In America it's a commodity to be sold for maximum profits, making it partly or fully unaffordable for millions.

In Cuba, the state is responsible for health care delivery. In America, it's the private sector though government partly pays for those qualifying under Medicare or Medicaid. The latter provides less than full care, especially for expensive treatments, and Medicare recipients increasingly pay more for what was originally promised free, using payroll deductions to fund it.

According to WHO standards, health services must fulfill three model determinants:

  • effectiveness;
  • high "quantitative health indicators like infant mortality, nutritional status, and life expectancy;" and
  • have social impact with regard "not only (to) social justice and the mobilization of community resources but the process through which people gain greater control over the social, political, economic, and environmental factors that affect their health."

According to WHO measures, Cuba fulfills these standards. It has 21 medical schools and 70,000 doctors for a population of 11 million. It also has 284 hospitals, nearly 500 polyclinics, 11 research institutes, and a community-based system serving everyone.

All physicians must complete a nine year program, including five years of basic education, a one-year hospital internship, and three years in rural practice. Above all, preventive care and family medicine are emphasized. However, doctors wishing to specialize must fulfill three more years of training.

On graduation, they must abide by Cuba's model health code to serve people, renounce private practice, cooperate with government policies, emphasize prevention and human welfare, and work for the common goal of national wellness.

In America, profit is the only goal, and it shows in effectiveness and cost. Cuba spends less than $200 per capita annually or about 4% of US expenditures, by far the world's highest, yet millions are left partly or fully uncovered.

All Cubans get free health services. Americans must pay, including those on Medicare, and employed Medicaid recipients by payroll tax deductions plus out-of-pocket costs.

Removing profit from the equation minimizes or eliminates administrative costs, over-treatment, unnecessary drugs and frills, as well as exorbitant incomes, while stressing prevention and assuring everyone needing health care gets it. Cuba's Constitution mandates it. America increasingly ignores it.

Cuba also sends thousands of doctors to about 70 other countries needing them, besides offering free medical education to thousands of students from about 100 countries at the Latin American School of Medicine (ELAM). In return, they must provide their people Cuban-style healthcare in under-served communities.

Its model offers a better way to practice medicine, what millions of Americans lack and won't get under Obamacare, designed for profit, not good health.


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