After the initial rapprochement in 2014, several major U.S. outlets highlighted the country’s health care system, unique to the Third World, and one which, according to an article in the New England Journal of Medicine, “has solved some problems that ours has not yet managed to address.” Sound heretical? Not to those who have studied it.
Cuba, a country of 11 million people, has achieved health outcomes that are the envy of the Third World. It has one of the lowest infant and young child (under age 5) mortality rates and longest life expectancies in the Americas, outperforming the U.S. on all three of these indicators (although the maternal mortality rate is still considerably higher than that in rich countries). This year, Cuba also became the first nation in the world that, according to the World Health Organization, had eliminated mother-to-child transmission of HIV and syphilis. How has a Third World country, subjected to decades of economic sanctions, accomplished this?
Part of the answer lies in the post-revolutionary government’s establishment of a comprehensive, universal health care system — structured around primary and preventive care — with a network of physicians, nurses and home health workers generally living in the same community as their patients.
To ensure adequate staffing for this initiative, the government invested heavily in medical education, which resulted in Cuba having nearly three times as manyphysicians per capita as the U.S. This also enabled the country to send a self-reported total of 130,000 of its own health professionals to provide low- or no-cost medical care to patients in other Third World countries, with nearly 37,000 working in 70 countriesas of 2008. Cuba was among the first to respond to the past year’s Ebola epidemic, sending more doctors to Sierra Leone than any country besides Great Britain.
The country’s universal vaccination programs eradicated many previously commonplace childhood and tropical diseases, including polio, measles and diphtheria. Many of the vaccines, as well as other medications, are manufactured by a domestic pharmaceutical industry that was developed, in part, in response to the U.S. embargo. This biotechnology sector employs about 10,000 people and manufactures most of the medicines used in the country, including 33 vaccines, 33 cancer drugs, 18 drugs to treat cardiovascular disease and seven drugs for other diseases. At one point, Cuba was the leading provider of pharmaceuticals to Latin America and also supplied medicines to several Asian countries. Its medical infrastructure is also relatively advanced, with 22 medical campuses and academic journals in all of the major medical specialties.
Much of the progress made in improving the well-being of the Cuban population also traces back to policies independent of the health care sector, including universal education, guaranteed nutrition, clean drinking water and modern sanitation. Perhaps more important were the Cuban government’s egalitarian economic policies that dramatically reduced the wealth inequalities that had existed prior to the revolution. An extensive body of research shows that income inequality is closely associated with, and likely a critical determinant of, population health, and Cuba is no exception.