Everything about Healthcare In Cuba totally explained
The
Cuban
government operates a
national health system and assumes fiscal and administrative responsibility for the
health care of its citizens. No private hospitals or clinics are permitted. The present
Minister for Public Health is
José Ramón Balaguer.
History
As was true of the other indigenous societies of the Americas, Cuban
traditional medicine existed before the
Spanish conquest. High status traditional practitioners were called
Bohiques. After colonization, Cuban medicine followed the Spanish tradition which was inherited from the
Moors, who drew upon classical Greek and Roman medical practices.
Chinese medicine has also been practiced in Cuba, the most famous 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, who determined how
Yellow fever was spread 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.
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.
Following the Revolution, 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 University of Havana’s medical college. Beginning in 1960, the Ministry of Public Health began a program of
nationalization and
regionalization of medical services.
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 vaccinations. 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.
According to the
World Health Organization (WHO), the chance of a Cuban child dying at five years of age or younger is 7 per 1000 live births in Cuba, while it's 8 per 1000 in the US. WHO reports that Cuban males have a life expectancy at birth of 75 years and females 79 years. In comparison, the US life expectancy at birth is 75 and 80 years for males and females, respectively. Cuba's infant mortality rate is lower than the US with 5 deaths per thousand in Cuba versus 7 per thousand in the US. Cuba has nearly twice as many physicians as the U.S. -- 5.91 doctors per thousand people compared to 2.56 doctors per thousand, according to WHO.
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 and also one explanation for the low infant mortality rate. Cuban-American suicide rates in Miami are lower than other Miami groups, according to the anti-Castro Cuban American National Council. 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 tests and
medication for hospitalised 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 subsidised by the state. For patients on a low-income, these items are free of charge..
Sexual health
According to the
UNAIDS 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
Avert, an international
AIDS charity, "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 increase in
prostitution and lack of prevention, STIs have increased significantly. 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 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 the single largest source for imported food. The
Cuban American National Foundation state that the US embargo doesn't include medicines and medical supplies to the Cuban people. It also 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.
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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.
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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 licences to be obtained for each transaction. Cuba can't 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 organisation/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 wasn't able to purchase the isotope I-125 that's 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 in Cuba
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. All fiscal and administrative aspects of health care in Cuba are run by the state; no private hospitals or clinics are permitted, and medical workers are required to work for the state. Historically, Cuba has long ranked high in numbers of medical personnel; in 1957, before the revolution, it ranked third in
Latin America and ahead of many
European nations.
Medical professionals are not paid high salaries by national or international standards. In 2002 the mean monthly salary was 261 pesos, thus 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, many prefer to work in different occupations, generally in the lucrative tourist industry (for example taxi drivers), where earnings could be 50 to 60 times more. 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 legalisation 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 wouldn't be available to them otherwise.
Cuba and international healthcare
Cuba has entered into agreements with
United Nations 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 Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized
oil. 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.
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, hasn't been without its detractors. The Venezuelan Medical Association has criticised 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 protestors 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. The project is also part of ALBA (
Bolivarian Alternative for the Americas). Under the agreement, patients from Venezuela and other Latin American nations, are flown to into Cuba for eye surgeries and other major treatments. This is part of a package which includes the Cuban personnel sent to Venezuela (see above) and the fact 90,000 barrels of crude oil per day at preferential rates. In late 2005, Operación Milagro was extended to
Panamanians, and in June 2006 to
Nicaraguans. All flights, accommodation and food are funded by the Venezuelan government. The scheme was intended to expand to 500,000 operations a year in 2006.
Opponents of the Cuban government accuse it of sending the doctors to Venezuela for political motives.
Health tourism and pharmaceutics
Cuba attracts nearly 20000 paying
health tourists, generating revenues of around $40m 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 sclerosis 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 two 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
alternative and
herbal solutions to healthcare issues, which can be more accessible and affordable to a broader population Examples of alternative techniques used by the clinics and hospitals include:
flower essence, neural and hydromineral therapies,
homeopathy,
traditional Chinese medicine (for example
acupunctural anesthesia for surgery), natural dietary supplements,
yoga, electromagnetic and laser devices. Cuban bio-chemists have produced a number of new alternative medicines, including PPG (
policosanol), a natural product derived from sugarcane wax that's effective at reducing total cholesterol and LDL levels, and Vimang a natural product derived from the bark of
mango trees.
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
Praise for the Cuban Healthcare System
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 pretty much 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. In fact, a recent poll carried out by
the Gallup Organization's Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of Cuban citizens are positive about their country's education and healthcare systems.
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've 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.
Studies of the Cuban health system in the United Kingdom
In 2001, members of the
UK House of Commons Health
Select Committee traveled 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".
Criticisms
The US
State Department, citing many independent sources, states that Cuba's infant mortality rate in 1957 was the lowest in Latin America and the 13th lowest in the world, according to UN data. Cuba ranked ahead of France, Belgium, West Germany, Israel, Japan, Austria, Italy, and Spain, all of which would eventually pass Cuba in this indicator during the following decades. Cuba’s comparative world ranking has fallen from 13th to last out of the 25 countries examined. Also missing from the conventional analysis of Cuba's infant mortality rates is its very high abortion rate, which, because of selective termination of "high-risk" pregnancies, yields lower numbers for infant mortality. Cuba's abortion rate was the 3rd highest out of the 60 countries studied. In terms of physicians and dentists per capita, Cuba in 1957 ranked third in Latin America, behind only Uruguay and Argentina -- both of which exceeded the United States in this measure. Cuba's physicians and dentists in 1957 was the same as the Netherlands, and ahead of the United Kingdom and Finland. The report states "Unfortunately, the UN statistical yearbook no longer publishes these statistics, so more recent comparisons are not possible, but it's completely erroneous to characterize pre-Revolutionary Cuba as backward in terms of healthcare."
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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's 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.
(External Link)(External Link) 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.
WWWW 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.
(External Link) The Cuban government blames the shortages on the embargo and states that those with more severe chronic diseases receive medicines.
(External Link) 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.
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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 – for example, 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."
An article in
The Boston Globe, partially based on interviews with Cubans, argues that the massive export of doctors and other medical personal to Venezuela in exchange for oil has caused shortages in Cuba. Regarding Operación Milagro, "It's all the Venezuelans who need cataracts surgery first, and then the Cubans if there's any time left", said Georgina, 60, a retired Havana clerk.
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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. The report highlights the dilapitated 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.
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