Health in Cuba

Health in Cuba refers to the overall health of the population of Cuba.

There was an overall improvement in Health in Cuba in terms of disease and infant mortality rates after the revolution.^[1] 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 78.05 years old in 2009^[2] (in comparison to the United States' 78.62 years in 2009^[3]).

History[]

In 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 life expectancy, and 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.^[4] 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.^[5] The mortality rate was the third lowest in the world.^[6] According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.^[6]

Following the Revolution and the subsequent United States embargo against Cuba, an increase in disease and infant mortality worsened in the 1960s.^[1] 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 , 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."^[7]

Post-Soviet Union[]

The loss of Soviet subsidies brought food shortages to Cuba in the early 1990s.

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."^[8] The regime did not accept donations of food, medicines and money from the US until 1993.^[8]

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".^[9]

Present[]

Comparison of pre- and post-revolutionary indices[]

Life expectancy at birth in Cuba in 1955 was 63 years^[10] in 1960 it was 63.9 years.^[11] To put these values in context, life expectancy at birth in some other regions and countries in 1960 were as followed (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.^[12]

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.^[13]

The mortality rate for children under five years old was 54 per 1000 in Cuba in 1960 (World Bank).^[14] 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 (World Bank data).^[13]

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.^[13]

Infant mortality was 32 per 1000 live births in Cuba in 1957.^[15] In 2000–2005 it was 6.1 per 1000 in Cuba; and, for comparison, 6.8 per 1000 in the United States.^[16] The 2007 infant mortality rates published by the World Health Organization in 2009 were: Cuba, 5; World, 46;
High income countries, 6; United States, 6.^[17]

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.

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.^[18]

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.^[19]

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 Organization 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.

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.^[20]

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.^[21] 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.^[22] 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.^[23]

While preventive medical care, diagnostic tests 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, wheelchairs and crutches. 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.^[24]

'Child health'''' Cuba has excellent child health as illustrated by its low child mortality rates. Child mortality rates (under 5, infant and neonatal) in Cuba have all been lower than in the USA for many years. WHO figures for 2016 for under 5 child mortality (U5M) show that Cuba has a U5M rate of 5.5 per 1000 live births, whereas the USA has a U5M rate of 6.5 and Costa Rica a rate of 9.7.^[25] Cuba has the second lowest U5M in the Americas behind Canada with a rate of 4.9. U5M is considered to be an excellent indicator of child health by UNICEF.^[26] Cuba is a middle income country with considerable economic problems exacerbated by the blockade imposed by the USA. How then has it achieved such good child health outcomes? Cuba’s achievements in child health are due to a combination of factors.^[27] Cuba has an integrated health care system with all sections cooperating fully. Universal health care and universal education are the basis for good health. Literacy is at 99.7% and this enables public health campaigns to reach the entire population. Free universal education has resulted in Cuba having one of the highest doctor to population ratios. Programmes such as “Educa a tu hijo” (educate your child) are in place to prepare young children for school.^[28] This non-institutional based programme was developed in rural areas, and subsequently extended throughout the country, as it was recognised that early child development is essential for child wellbeing.

Primary health care is a key feature of health care in Cuba.  Almost half of all Cuban doctors work in primary health care.  Primary health care exists both in urban and remote rural areas.  The presence of health facilities even in remote rural areas is essential to ensure universal access to health.  The primary health care team usually consists of a doctor and nurse working together in a consultorio  (primary health care facility).  Each team is usually responsible for approximately 300 families.  The team know each family both medically and socially, which is important due to the effect of social determinants on child health.  There is a strong emphasis on the prevention of disease. Health promotion is a key feature of Cuban society and  involves children’s TV programmes as well as schools and the mass media. Healthy eating, the importance of handwashing and exercise alongside sexual health have all been featured in a variety of different campaigns. 

Empowerment of women in civil society has been a major achievement in Cuba. Firstly all girls attend school. Women have the same rights as men in Cuban law and receive equal pay. Maternity leave is 12 months and the women’s job is protected by law. The majority of professionals in Cuba are women.^[29] Additionally, the majority of Members of Parliament in Cuba are women, with Cuba having the second highest proportion of women in parliament worldwide. This representation in Parliament is a reflection of the importance of gender equality in Cuba. This empowerment is likely to be a contributory factor to child health in Cuba. Unlike many other Latin American countries, women are in full control of their sexual and reproductive health through the widespread availability of family planning clinics alongside specialised services. Different forms of birth control are available and abortion is provided where requested in a safe environment.

Socioeconomic determinants contribute to health and to child health in particular.  Inequality is a problem in Cuba like all other countries.  The greatest inequalities involve people working for foreign investment companies, self-employees, private workers and individuals working in the tourist industry , who may receive significantly more than official incomes.  The Cuban government  constantly looks at ways of reducing the inequalities by either raising salaries of state employees or increasing taxes in the private sector. Additionally, Cuba’s welfare state  ensures that nobody is destitute.  Severe malnutrition in children was declared absent in Cuba by UNICEF over a decade ago and malnutrition is not considered a major problem in Cuba.[30]  This is despite the problems caused by the economic blockade of Cuba by the United States.  Inequalities between regions in Cuba are less than in other countries.  Regional U5M rates for the years 2015-2018 show the highest rate in Guantanamo in the East (7.5) and the lowest in Pinar del Rio in the West (4.1).[31] 

The Cuban government recognises health as a priority. This is of major importance and is recognised as such by groups such as UNICEF.^[32] Investment in people through health, education and social services has, unfortunately, resulted in less money being available for other services such as roads, transport and housing. Cuba has shown that, despite limited resources, a country can achieve excellent child health if the government and citizens are committed to making health and children a priority. Cuba is an example of what is possible. The key factors for ensuring children are healthy are listed below.^[33]

See also[]

• Healthcare in Cuba

References[]