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Global Snapshots: Cuba - a triumph of public health
The James Bond film Die Another Day once again brought the eminence of Cuba's healthcare system into the spotlight. The prestigious fictional Cuban clinic featured in the film is depicted as executing groundbreaking gene therapy. Fiction, yes, but just how close is this to the truth? Cuba, many believe, has accomplished mission impossible. Despite the collapse of the Soviet Union, its prime financier, and the stringent restrictions of a US embargo, Cuba has triumphed: While Cuba's primary health care lacks equipment that British general practitioners take for granted and spends a fraction of the UK budget on health, it has health indicators equal to those of Europe.1
Obviously, there is more to Cuba's health than cigars. The constitution guarantees free medical treatment and preventive care, including prescriptions and vaccines.2 According to the Kaiser Family Foundation, a non-governmental organisation that evaluated Cuba's healthcare system in 2000-1, Cuba is 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.3
But Cuba's health struggles are not all a success. Many medicines--even those once produced by the country's prestigious pharmaceutical industry--are almost unobtainable because their components are on the US embargo list.2 The system of quarantining HIV positive and AIDS patients has also sacrificed human rights in the guise of public good. Before 1993, the government isolated patients infected with HIV, allowing them to leave sanatoriums only with escorts.4
AP/JOSE GOITIA
Now Mécdecins Sans Frontiéres has joined forces with the government to implement a new policy promoting public awareness, availability, access to condoms, and treatment with essential drugs. The cooperation of the government with international aid agencies regarding AIDS arose when healthcare workers realised that Cuba cannot afford to quarantine everyone infected with HIV.4 Despite these advances in social recognition only slightly more than half of the people infected can get the drugs they need, and of those who do, many get them from friends and relatives from other countries.3
Cuban expenditure on health, as a percentage of gross domestic product, is higher than any country in the hemisphere except for Canada and 34% higher than the United States.5 Cuba's health policy has been characterised as a dual policy of equity and priority for vulnerable groups.6 Although the country's health policy is less than faultless, important lessons remain to be learned. Despite tremendous scarcity, the country has managed to achieve enviable health indicators through a focus on primary health care. Perhaps necessity is the mother of invention after all.
Charlotte Chamberlain medical student intercalating in international health, University College London
- London Library and Information Development Unit. Meeting healthcare librarians in Cuba. www.londonlinks.ac.uk/rliu/northcirc/issue25/cuba.htm (accessed 8 Apr 2003).
- Roberts D. The US attack on Cuban health. www.coha.org/opeds/cuba_healthcare.htm (accessed 9 Apr 2003).
- Essif M. Health care in Cuba. Kaiser Family Foundation, 21 April-2 May 2001. www.kff.org/docs/fellowships/essifcubareport.html (accessed 7 Apr 2003).
- Darling J. New day for AIDS policy in Cuba. The nation which has quarantined people with HIV, is now allowing an international group to design a public health campaign to prevent virus spread. Los Angeles Times July 24, 1997. http://www.aegis.com/news/lt/1997/lt970706.html (accessed 9 Apr 2003).
- Kirkpatrick AF. The US attack on Cuban health. CMAJ 1997;157:281-4.
- Garfied R, Santana S. The impact of the economic crisis and the US embargo on health in Cuba. Am J Public Health 1997;87:15-9.
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