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Healthcare in Cuba: an interesting comparison

This post is taken from a recent article1 in Science magazine. The US trade embargo with Cuba reaches 50 years this year.  During this time food, drugs and medical supplies flowing from the US to Cuba have been severely restricted.  After the collapse of the Soviet Union in 1989, foreign aid to Cuba faltered and the health of the Cuban people suffered.  By the end of the 20th century few international pharmaceutical companies sold medicines or the raw materials to make them to Cuba.

Despite the impacts of these sanctions on the Cuban economy, effects on the health of the population have been offset by the positive aspects of their healthcare system. Cuba has produced health outcomes comparable to most of the developed countries in terms of life expectancy, physicians per capita, and infant mortality.  And they have done it at a government expenditure of $355 per person (2006), compared to $6714 (public plus private) for the same year in the US.  The success of Cuban health care is due in large part to their emphasis on disease prevention and enhanced primary health care, which have been cultivated during the trade embargo.

“Cuba has one of the most proactive primary health care systems in the world.  By educating their population about disease prevention and health promotion, the Cubans rely less on medical supplies to maintain a healthy population. The converse is the United States, which relies heavily on medical supplies and technologies to maintain a healthy population, but at a very high cost.”1

The Cuban medical education system emphasizes primary care and encourages young doctors to work in rural areas.  About 65% of new doctors choose primary care as a career path, the remainder enter specialty training. Cuba has also created an infrastructure in the form of community-based clinics to support primary care physicians. By contrast, in the US about 20% of new doctors choose primary care, the rest specialize, and the system supports the specialists, both monetarily and psychologically.2 “This emphasis on primary-care medicine, community health literacy, universal coverage, and accessibility of health services may be how Cuba achieves developed-world health outcomes with a developing-world budget.”1

The Science article does not say anything about diet, except that Cuba has experienced some food shortages during the embargo.  It seems reasonable to speculate that at least part of their good health may stem from the lack of imported industrial food.  The embargo on food imports from the US was lifted in 2000, so it will be interesting to see if the health gains in Cuba are sustained into the future.

1Drain, P.K. and M. Barry. 2010. Fifty years of U.S. embargo: Cuba’s health outcomes and lessons. Science 328: 572-3.

2Bodenheimer, T. 2006. Primary care—will it survive? New England Journal of Medicine 355:861-4.

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