Cuba Health Profile 2012

Cuba provides free health care and education, access to athletic facilities, subsidized day care and cafeterias for state enterprise workers, and unemployment compensation for the entire population. Compared to other Latin American countries, Cuba’s social safety net is in many ways without equal. However, the devaluation of the domestic currency has greatly eroded the value of monetary transfers. There is a universal-coverage pension system paid in pesos; the minimum pension rose to approximately $8 per month at the start of 2009. The quality of the health and education system has suffered greatly from the economic crisis and the drain of its workforce to better remunerated sectors.

Rather than social background, a key limitation to equality of opportunity is political loyalty. Open disapproval of the system is likely to affect upward mobility severely. Aside from this, there is considerable equality of opportunity. White-black ethnic differences are minimal with respect to accessing primary and secondary education. Women constitute a majority of students in most university degree programs, including medicine. While gender inequalities appear in top political and managerial jobs, racial inequalities exist in the professions. Because the Cuban diaspora is disproportionately white, Cuban blacks are less likely to benefit from the population’s key source of hard currency, remittances from emigrated relatives. While religious tolerance has greatly increased, religious believers still face some amount of informal discrimination in terms of access to higher office.

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.

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.

By 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 terms of life expectancy, and the number of doctors per thousand of the population ranked above Britain, France and Holland. In Latin America it ranked in third place after Uruguay and Argentina.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."[9] 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.

In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states "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 vaccinations 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 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.

In 2007, Cuba announced that it has undertaken computerising and creating national networks in Blood Banks, Nephrology and Medical Images. Cuba is the second country in the world with such a product, only preceded by France. Cuba is preparing a Computerised Health Register, Hospital Management System, Primary Health Care, Academic Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research-development projects. An important link in wiring process is to guarantee access to Cuba's Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health system.

Health indicators and issues

Like the rest of the Cuban economy, Cuban medical care has suffered from severe material shortages following the end of Soviet subsidies and the ongoing United States embargo against Cuba that began after the Cuban Missile Crisis.

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.

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 suicide rate is 18.2 per 100,000 and the homicide rate is 7.0 per 100,000. The rates of suicide in the island are the highest in Latin America and have been among the highest in the region and the world since the nineteenth century. 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.

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 (e.g. taxi drivers), where earnings could be 50 to 60 times more.

The San Francisco Chronicle, The Washington Post, and NPR have all reported on Cuban doctors defecting to other countries. According to the San Francisco Chronicle, one of the reasons that Cuban doctors defect is because their salary in Cuba is only $15 per month.

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 hospital

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 In the 1990’s, the Cuban Ministry of Public Health officially recognized natural and traditional medicine and began its integration into the already well established Western medicine model. Exampes of alternative techniques used by the clinics and hospitals include: flower essence, neural and hydromineral therapies, homeopathy, traditional Chinese medicine (i.e. acupunctural anesthesia for surgery), natural dietary supplements, yoga, electromagnetic and laser devices. Children begin studying the multiple uses of medicinal plants in primary school, learning to grow and tend their own plots of aloe, chamomile, and mint, and later they conduct scientific studies about their uses. Radio and Television programs instruct people on how to relieve common stomach upset and headaches by pressing key points.Cuban bio-chemists have produced a number of new alternative medicines, including PPG (policosanol), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang a natural product derived from the bark of mango trees.

Medical research in Cuba

The Cuban Ministry of Health produces a number of medical journals including the ACIMED, the Cuban Journal of Surgery and the Cuban Journal of Tropical Medicine. Because the U.S. government restricts investments in Cuba by U.S. companies and their affiliates, Cuban institutions have been limited in their ability to enter into research and development partnerships.

In April 2007, the Cuba IPV Study Collaborative Group reported in the New England Journal of Medicine that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kourí Institute, U.S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics. Cuba has been free of polio since 1963, but continues with mass immunization campaigns.

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