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Cuba Cuba ( , ), officially the Republic of Cuba ( es, República de Cuba, links=no ), is an island country comprising the island of Cuba, as well as Isla de la Juventud and several minor archipelagos. Cuba is located where the northern Caribbea ...
n
government A government is the system or group of people governing an organized community, generally a state. In the case of its broad associative definition, government normally consists of legislature, executive, and judiciary. Government is a ...
operates a
national health National Health were an English progressive rock band associated with the Canterbury scene. Founded in 1975, the band featured members of keyboardist Dave Stewart's band Hatfield and the North and Alan Gowen's band Gilgamesh, including guita ...
system and assumes fiscal and administrative responsibility for the
health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
of all its citizens. There are no private hospitals or clinics as all health services are government-run. The present public health minister is Dr. José Angel Portal Miranda. Like the rest of the
Cuban economy The economy of Cuba is a mixed command economy dominated by state-run enterprises. Most of the labor force is employed by the state. In the 1990s, the ruling Communist Party of Cuba encouraged the formation of worker co-operatives and self-empl ...
, Cuban medical care suffered following the end of
Soviet The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a List of former transcontinental countries#Since 1700, transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, ...
subsidies A subsidy or government incentive is a form of financial aid or support extended to an economic sector (business, or individual) generally with the aim of promoting economic and social policy. Although commonly extended from the government, the ter ...
in 1991 and the stepping up of the
United States embargo against Cuba The United States embargo against Cuba prevents American businesses, and businesses organized under U.S. law or majority-owned by American citizens, from conducting trade with Cuban interests. It is the most enduring trade embargo in modern hist ...
at this time also had an effect. Cuba has historically—both before and during Communist rule—performed better than other countries in the region on infant mortality and life expectancy. Some experts say that official statistics provided by the Cuban government should be treated skeptically, or even as outright
propaganda Propaganda is communication that is primarily used to influence or persuade an audience to further an agenda, which may not be objective and may be selectively presenting facts to encourage a particular synthesis or perception, or using loaded ...
.


History

Modern Western medicine has been practiced in Cuba by formally trained
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
s 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 Carlos Juan Finlay (December 3, 1833 – August 20, 1915) was a Cuban epidemiologist recognized as a pioneer in the research of yellow fever, determining that it was transmitted through mosquitoes ''Aedes aegypti''. Biography Early life and ...
, whose mosquito-based theory of
yellow fever Yellow fever is a viral disease of typically short duration. In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle pains – particularly in the back – and headaches. Symptoms typically improve within five days. In ...
transmission was given its final proof under the direction of
Walter Reed Walter Reed (September 13, 1851 – November 22, 1902) was a U.S. Army physician who in 1901 led the team that confirmed the theory of Cuban doctor Carlos Finlay that yellow fever is transmitted by a particular mosquito species rather than b ...
, James Carroll, and
Aristides Agramonte Aristides Agramonte y Simoni (June 3, 1868 – August 19, 1931) was a Cuban American physician, pathologist and bacteriologist with expertise in tropical medicine. In 1898 George Miller Sternberg appointed him as an Acting Assistant Surgeon ...
. During the period of U.S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of
Clara Maass Clara Louise Maass (June 28, 1876 – August 24, 1901) was an American nurse who died as a result of volunteering for medical experiments to study yellow fever. Early life Clara Maass was born in East Orange, New Jersey, to German immigrant ...
and surgeon
Jesse William Lazear Jesse William Lazear (2 May 1866, in Baltimore – 25 September 1900, in Quemados, Cuba) was an American physician. Background Lazear was the son of William and Charlotte née Pettigrew. He attended Trinity Hall Military Academy and Washington ...
. In the 1950s the number of doctors per thousand of the population ranked above Britain, France and the Netherlands. 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. The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America. Following the
Revolution In political science, a revolution (Latin: ''revolutio'', "a turn around") is a fundamental and relatively sudden change in political power and political organization which occurs when the population revolts against the government, typically due ...
and the subsequent
United States embargo against Cuba The United States embargo against Cuba prevents American businesses, and businesses organized under U.S. law or majority-owned by American citizens, from conducting trade with Cuban interests. It is the most enduring trade embargo in modern hist ...
, an increase in
disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
and
infant mortality Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...
worsened in the 1960s. The new
Cuban government Cuba has had a socialist political system since 1959 based on the "one state – one party" principle. Cuba is constitutionally defined as a Marxist–Leninist state. The present Constitution of Cuba, which was passed in a 2019 referendum, also ...
stated that universal healthcare would become a priority of state planning. In 1960 revolutionary and
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
Che Guevara Ernesto Che Guevara (; 14 June 1928The date of birth recorded on /upload.wikimedia.org/wikipedia/commons/7/78/Ernesto_Guevara_Acta_de_Nacimiento.jpg his birth certificatewas 14 June 1928, although one tertiary source, (Julia Constenla, quoted ...
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 the
University of Havana The University of Havana or (UH, ''Universidad de La Habana'') is a university located in the Vedado district of Havana, the capital of the Republic of Cuba. Founded on January 5, 1728, the university is the oldest in Cuba, and one of the first ...
’s medical college. Beginning in 1960, the Ministry of Public Health began a program of
nationalization Nationalization (nationalisation in British English) is the process of transforming privately-owned assets into public assets by bringing them under the public ownership of a national government or state. Nationalization usually refers to pri ...
and
regionalization Regionalisation is the tendency to form decentralised regions. Regionalisation or land classification can be observed in various disciplines: *In agriculture, see Agricultural Land Classification. *In biogeography, see Biogeography#Biogeographi ...
of medical services. In 1965, Cuba became the first Latin American country to legalize abortion. In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised
Cuban constitution Even before attaining its independence from Spain, Cuba had several constitutions either proposed or adopted by insurgents as governing documents for territory they controlled during their war against Spain. Cuba has had several constitutions sin ...
which states "Everybody has the
right to health The right to health is the economic, social, and cultural right to a universal minimum standard of health to which all individuals are entitled. The concept of a right to health has been enumerated in international agreements which include the U ...
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,
polyclinic A polyclinic (where ''poly'' means "many"; not to be confused with the homonym policlinic, where ''poli'' means "city" and which is sometimes used for a hospital's outpatient department) is a clinic or health care facility that provides both gen ...
s, hospitals and preventive and specialist 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 of the population cooperates in these activities and plans through the social and mass organizations." Privatization of healthcare in Cuba is illegal and unnecessary as high quality, equal, care covered by the state is available to everyone as made necessary by Cuba's constitution. 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
vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
s. This helped eradicate many contagious diseases including
polio Poliomyelitis, commonly shortened to polio, is an infectious disease caused by the poliovirus. Approximately 70% of cases are asymptomatic; mild symptoms which can occur include sore throat and fever; in a proportion of cases more severe s ...
,
tetanus Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
,
diphtheria Diphtheria is an infection caused by the bacterium '' Corynebacterium diphtheriae''. Most infections are asymptomatic or have a mild clinical course, but in some outbreaks more than 10% of those diagnosed with the disease may die. Signs and s ...
and
rubella Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...
, though some diseases increased during the period of economic hardship of the 1990s, such as
tuberculosis Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
,
hepatitis Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), poor appetite, vomiting, tiredness, abdominal pa ...
and
chicken pox Chickenpox, also known as varicella, is a highly contagious disease caused by the initial infection with varicella zoster virus (VZV). The disease results in a characteristic skin rash that forms small, itchy blisters, which eventually scab ...
. Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care. As of 2012, infant mortality in Cuba had fallen to 4.83 deaths per 1,000 live births compared with 6.0 for the United States and just behind Canada with 4.8. Some experts have said that these statistics may reflect heavy-handed treatment of pregnant patients. Tassie Katherine Hirschfeld, an associate professor at the department of anthropology of the
University of Oklahoma The University of Oklahoma (OU) is a Public university, public research university in Norman, Oklahoma. Founded in 1890, it had existed in Oklahoma Territory near Indian Territory for 17 years before the two Territories became the state of Oklahom ...
, said that doctors have incentives to falsify statistics, as a spike in infant mortality may cost them their jobs. She also said pregnant women may be pressured to undergo abortions if fetal abnormalities are detected or forcibly placed under monitoring if complications arise. Hirschfeld said Cuba does not allow for independent verification of its health data.


Post-Soviet Union

Loss of Soviet subsidies brought food shortages to Cuba in the early 1990s. The famine during the
Special Period The Special Period ( es, Período especial, link=no), officially the Special Period in the Time of Peace (), was an extended period of economic crisis in Cuba that began in 1991 primarily due to the dissolution of the Soviet Union and, by exten ...
was caused by an authoritarian regime that denied people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military. The Cuban government began accepting US donations of food, medicines and cash in 1993. It established a system of private
farmers' markets A farmers' market (or farmers market according to the AP stylebook, also farmer's market in the Cambridge Dictionary) is a physical retail marketplace intended to sell foods directly by farmers to consumers. Farmers' markets may be indoors or ...
in 1994 to provide citizens with easy access to locally grown food. Epidemiologist Manuel Franco describes the Special Period as "the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake". In 2007, Cuba announced that it has undertaken computerizing 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 computerized 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.


United States embargo

During the 1990s the ongoing
United States embargo against Cuba The United States embargo against Cuba prevents American businesses, and businesses organized under U.S. law or majority-owned by American citizens, from conducting trade with Cuban interests. It is the most enduring trade embargo in modern hist ...
caused problems due to restrictions on the export of medicines from the US to Cuba. 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 legislation did not state that Cuba cannot purchase medicines from U.S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the
Inter-American Commission on Human Rights The Inter-American Commission on Human Rights (the IACHR or, in the three other official languages Spanish, French, and Portuguese CIDH, ''Comisión Interamericana de los Derechos Humanos'', ''Commission Interaméricaine des Droits de l'Homme'', ...
of the Organization of American States informed the U.S. Government that such activities violate international law and has requested that the U.S. take immediate steps to exempt medicine from the embargo.
The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823. The journal publishes original research articles, ...
and the
British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...
also condemned the embargo in the 90s. 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 forbid ships that dock in Cuban ports from docking in U.S. ports for six months. This drastically restricted shipping, and increased shipping costs some 30%. In 2000, the ''
Trade Sanctions Reform and Export Enhancement Act The Trade Sanction Reform and Export Enhancement Act (Title IX) was enacted by the United States Congress and signed by President Bill Clinton in 2000. The act altered regulations in regards to U.S. trade with Cuba. Under the act, the trade of certa ...
'' was passed. The US became Cuba's single largest source for imported food. The
Cuban American National Foundation The Cuban American National Foundation is a foundation with the aim of assisting members of the Cuban community in Miami, Florida. Background and founding The Cuban National American Foundation was founded at a time when Republican American polit ...
(CANF) 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. CANF also asserts the United States is the largest donor of humanitarian assistance to Cuba and much of this consists of medicines and medical equipment. 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. 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 licenses to be obtained for each transaction. Cuba cannot use its own merchant fleet for transporting these goods, but has to make use of vessels from third countries, primarily the
United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territorie ...
. 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 organization/PAHO and
UNFPA The United Nations Population Fund (UNFPA), formerly the United Nations Fund for Population Activities, is a UN agency aimed at improving reproductive and maternal health worldwide. Its work includes developing national healthcare strategies ...
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 was not able to purchase the isotope I-125 that is 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.


Present


National health system

Cuba's national health system is made up of multiple tiers: 1) the community containing individuals and families, 2) family doctor-and-nurse teams, 3) basic work teams, 4) community polyclinics, 5) hospitals, and 6) medical institutes. Cuba's Family Physician and Nurse program is made up of physician and nurse teams that serve individuals, families, and their communities. They live above their government-built family medicine offices, living directly in the communities they serve and available 24 hours a day. These teams work to improve the public health concerns in the environment as well as provide medical care. They perform a neighborhood health diagnosis biannually where community risk factors are evaluated to focus priorities for improving the health of the community. Clinically, family doctor-and-nurse teams follow the Continuous Assessment and Risk Evaluation (CARE) method which monitors individual and family health by examining community and home environments, current health, and medical history. The teams make home visits to each family at least once yearly to assess and evaluate their health. Individuals with chronic illness are seen at least every three months. These teams' role combine the importance of focusing on both public health and clinical medicine. Polyclinics are community-based clinics that house primary care specialists. They exist in every Cuban community and are well-acquainted with the people and the communities they serve. They can see the social determinants and environment that affect the community's health, bettering their ability to serve their patients. Specialists at the polyclinic are there to support physicians when they are needed. Each clinic of specialists supports 20-40 doctor-and-nurse teams. Basic work teams within the polyclinics supervise and evaluate the neighborhood and clinical health work of the family medicine offices. While preventive medical care,
diagnostic test A medical test is a medical procedure performed to detect, diagnose, or monitor diseases, disease processes, susceptibility, or to determine a course of treatment. Medical tests such as, physical and visual exams, diagnostic imaging, genetic ...
s and
medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...
for hospitalized 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 A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
basis, hearing, dental, and
orthopedic Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
processes,
wheelchair A wheelchair is a chair with wheels, used when walking is difficult or impossible due to illness, injury, problems related to old age, or disability. These can include spinal cord injuries ( paraplegia, hemiplegia, and quadriplegia), cerebr ...
s and
crutch A crutch is a mobility aid that transfers weight from the legs to the upper body. It is often used by people who cannot use their legs to support their weight, for reasons ranging from short-term injuries to lifelong disabilities. History Crutc ...
es. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge.


Health statistics

All statistics from World Health Organization figures.
Cuba had 128 physicians and dentists per 100,000 people in 1957. This was comparable to the levels in many European countries and allegedly the highest in Latin America. In 1986, Cuba had 219 doctors per 100,000 people (compared with 423.7 doctors in the Soviet Union, which had the most doctors among industrialized countries). In 2005, Cuba had 627 physicians and 94 dentists per 100,000 population. That year the United States had 225 physicians and 54 dentists per 100,000 population; the Central American isthmus had 123 physicians and 30 dentists per 100,000. As of 2005, Cuba became the world leader in the ratio of doctors to population with 67 doctors per 10,000 population as compared with 43 in the Russian Federation and 24 in the United States.
Abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
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 1000 pregnancies. The rate is still among the highest in Latin America. The abortion rate in Cuba is 72.8 per 100 births.


Alternative healthcare

Economic constraints and restrictions on medicines have forced the Cuban health system to incorporate
alternative Alternative or alternate may refer to: Arts, entertainment and media * Alternative (''Kamen Rider''), a character in the Japanese TV series ''Kamen Rider Ryuki'' * ''The Alternative'' (film), a 1978 Australian television film * ''The Alternative ...
and
herbal A herbal is a book containing the names and descriptions of plants, usually with information on their medicinal, tonic, culinary, toxic, hallucinatory, aromatic, or magical powers, and the legends associated with them.Arber, p. 14. A herbal m ...
solutions to healthcare issues, which can be more accessible and affordable to a broader population In the 1990s, the Cuban Ministry of Public Health officially recognized natural and
traditional medicine Traditional medicine (also known as indigenous medicine or folk medicine) comprises medical aspects of traditional knowledge that developed over generations within the folk beliefs of various societies, including indigenous peoples, before the ...
and began its integration into the already well established Western medicine model.Cuba : A model for alternative healthcare
National Foundation for Alternative medicine


Sexual health

According to the
UNAIDS The Joint United Nations Programme on HIV and AIDS (UNAIDS) (, ONUSIDA) is the main advocate for accelerated, comprehensive and coordinated global action on the HIV/AIDS pandemic. The mission of UNAIDS is to lead, strengthen and support an e ...
report of 2003 there were an estimated 3,300 Cubans living with
HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
/
AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
(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 The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
. Those who tested positive were taken to Los Cocos and were not allowed to leave. The policy drew criticism from the
United Nations The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and international security, security, develop friendly relations among nations, achieve international cooperation, and be ...
and was discontinued in the 1990s. Since 1996 Cuba began the production of generic
anti-retroviral The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multip ...
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. Education in Cuba concerning issues of HIV infection and AIDS is implemented by the Cuban National Center for Sex Education. According to a 2005 report by UNAIDS and the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
, "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 2015, Cuba became the first country in the world to eliminate mother-to-child transmission of HIV and syphilis, a major public health accomplishment. In recent years because of the rise in
prostitution in Cuba Prostitution in Cuba is not officially illegal; however, there is legislation against pimps, sexual exploitation of minors, and pornography. Sex tourism has existed in the country, both before and after the 1959 Cuban Revolution. Many Cubans do not ...
, the rate and frequency of persons contracting
STIs The Space Telescope Imaging Spectrograph (STIS) is a spectrograph, also with a camera mode, installed on the Hubble Space Telescope. Aerospace engineer Bruce Woodgate of the Goddard Space Flight Center was the principal investigator and crea ...
has increased.


Fertility

Following the successful 2022 Family Code referendum, surrogacy is legal in Cuba as long as money is not exchanged.


Training doctors

Cuba's healthcare system survives, in part, due to its medical education system. In Cuba, the medical university is not a separate entity from health services, but it exists within the system, a model common in the rest of the developing world. In Cuba, this may include more community-based centers than large hospitals. Medical and nursing students mentor and intern within the national system from the first years of their training,Salas Perea, Ramón, and Arlene Salas Mainegra. "La educación médica cubana. Su estado actual." ''Revista de Docencia Universitaria'' 10 (2012). specifically within primary care facilities rather than hospitals. This is supposed to create a community-based teaching method rather than a typical hospital-based teaching method. Primary care, being the first level of contact to a patient, is ideally located close to the patient's home and work. At primary care facilities, the Cuban government's ethics and values are mandatorily taught as a key part of the Cuban healthcare system, followed by the science and technology. One of the largest medical universities in the world exists in Cuba, the Latin American School of Medicine.


Cuba and international healthcare

Cuba provides more medical personnel to the developing world than all the G8 countries combined. In the 1970s, the Cuban state initiated bilateral service contracts and various money-making strategies. Cuba has entered into agreements with
United Nations The United Nations (UN) is an intergovernmental organization whose stated purposes are to maintain international peace and international security, security, develop friendly relations among nations, achieve international cooperation, and be ...
agencies specializing in health:
PAHO The Pan American Health Organization (PAHO) is an international public health agency working to improve the health and living standards of the people of the Americas. It is part of the United Nations system, serving as the Regional Office for ...
/
WHO Who or WHO may refer to: * Who (pronoun), an interrogative or relative pronoun * Who?, one of the Five Ws in journalism * World Health Organization Arts and entertainment Fictional characters * Who, a creature in the Dr. Seuss book '' Horton He ...
,
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing Humanitarianism, humanitarian and Devel ...
, the
United Nations Food and Agriculture Organization The Food and Agriculture Organization of the United Nations (FAO)french: link=no, Organisation des Nations unies pour l'alimentation et l'agriculture; it, Organizzazione delle Nazioni Unite per l'Alimentazione e l'Agricoltura is an intern ...
(FAO), the
United Nations Population Fund The United Nations Population Fund (UNFPA), formerly the United Nations Fund for Population Activities, is a UN agency aimed at improving reproductive and maternal health worldwide. Its work includes developing national healthcare strategies ...
(
UNFPA The United Nations Population Fund (UNFPA), formerly the United Nations Fund for Population Activities, is a UN agency aimed at improving reproductive and maternal health worldwide. Its work includes developing national healthcare strategies ...
) and the
United Nations Development Fund The United Nations Development Programme (UNDP)french: Programme des Nations unies pour le développement, PNUD is a United Nations agency tasked with helping countries Poverty reduction, eliminate poverty and achieve Sustainable development, ...
(
UNDP The United Nations Development Programme (UNDP)french: Programme des Nations unies pour le développement, PNUD is a United Nations agency tasked with helping countries eliminate poverty and achieve sustainable economic growth and human dev ...
). 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 Cuban doctors have been part of a large-scale plan by the Cuban state to provide free medical aid and services to the international community (especially third world countries) following natural disasters. Currently dozens of American medical students are trained to assist in these donations at the Escuela Latino Americana de Medicina (ELAM). Cuba's missions in 68 countries are staffed by 25,000 Cuban doctors. Medical teams have worked in crisis such as the South Asian tsunami and the
2005 Kashmir earthquake The 2005 Kashmir earthquake occurred at on 8 October in Pakistani-administered Azad Kashmir. It was centred near the city of Muzaffarabad, and also affected nearby Balakot in Khyber Pakhtunkhwa and some areas of Indian-administered Jammu and ...
. Nearly 2,000 Cuban doctors are currently working in Africa in countries including
South Africa South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
,
Gambia The Gambia,, ff, Gammbi, ar, غامبيا officially the Republic of The Gambia, is a country in West Africa. It is the smallest country within mainland AfricaHoare, Ben. (2002) ''The Kingfisher A-Z Encyclopedia'', Kingfisher Publicatio ...
,
Guinea Bissau Guinea-Bissau ( ; pt, Guiné-Bissau; ff, italic=no, 𞤘𞤭𞤲𞤫 𞤄𞤭𞤧𞤢𞥄𞤱𞤮, Gine-Bisaawo, script=Adlm; Mandinka: ''Gine-Bisawo''), officially the Republic of Guinea-Bissau ( pt, República da Guiné-Bissau, links=no ) ...
and
Mali Mali (; ), officially the Republic of Mali,, , ff, 𞤈𞤫𞤲𞥆𞤣𞤢𞥄𞤲𞤣𞤭 𞤃𞤢𞥄𞤤𞤭, Renndaandi Maali, italics=no, ar, جمهورية مالي, Jumhūriyyāt Mālī is a landlocked country in West Africa. Mali ...
. Since the Chernobyl nuclear plant exploded in 1986, more than 20,000 children from
Ukraine Ukraine ( uk, Україна, Ukraïna, ) is a country in Eastern Europe. It is the second-largest European country after Russia, which it borders to the east and northeast. Ukraine covers approximately . Prior to the ongoing Russian inv ...
,
Belarus Belarus,, , ; alternatively and formerly known as Byelorussia (from Russian ). officially the Republic of Belarus,; rus, Республика Беларусь, Respublika Belarus. is a landlocked country in Eastern Europe. It is bordered by R ...
and
Russia Russia (, , ), or the Russian Federation, is a List of transcontinental countries, transcontinental country spanning Eastern Europe and North Asia, Northern Asia. It is the List of countries and dependencies by area, largest country in the ...
have traveled to Cuba for treatment of radiation sickness and psychologically based problems associated with the radiation disaster. In response to the 2005
Hurricane Katrina Hurricane Katrina was a destructive Category 5 Atlantic hurricane that caused over 1,800 fatalities and $125 billion in damage in late August 2005, especially in the city of New Orleans and the surrounding areas. It was at the time the cost ...
disaster, Castro offered to send a "brigade" of 1,500 doctors to the U.S. to provide humanitarian aid, but the U.S. never accepted. Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized
oil An oil is any nonpolar chemical substance that is composed primarily of hydrocarbons and is hydrophobic (does not mix with water) & lipophilic (mixes with other oils). Oils are usually flammable and surface active. Most oils are unsaturated ...
. Cuban doctors play a primary role in the Mission Barrio Adentro (Spanish: "Mission Into the Neighborhood") social welfare program established in Venezuela under former Venezuelan president
Hugo Chávez Hugo Rafael Chávez Frías (; 28 July 1954 – 5 March 2013) was a Venezuelan politician who was president of Venezuela from 1999 until his death in 2013, except for a brief period in 2002. Chávez was also leader of the Fifth Republ ...
. Through Operación Milagro (in English, “Operation Miracle”), Cuba began in 2004 to pay for Venezuelans with reversible blindness to travel to Cuba for free operations to restore their sight. Over 200,000 Venezuelans received this free surgery. In 2005, Cuba established a new ophthalmology center in Venezuela, and later expanded its program to 30 Venezuelan hospitals. Cuba continued to grow the program and by 2017 had established 69 Operación Milagro clinics in 15 different countries. By 2019, over 4 million people in 34 countries had received free surgery through the program. Cuba also successfully exports many medical products, such as
vaccines A vaccine is a biological preparation that provides active acquired immunity The adaptive immune system, also known as the acquired immune system, is a subsystem of the immune system that is composed of specialized, systemic cells and pro ...
.


Health tourism

Cuba attracts about 20,000 paying health tourists, generating revenues of around $40 million 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 Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal ...
disorders such as
multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
and
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
,
cosmetic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniofa ...
, addictions treatment,
retinitis pigmentosa Retinitis pigmentosa (RP) is a genetic disorder of the eyes that causes loss of vision. Symptoms include trouble seeing at night and decreasing peripheral vision (side and upper or lower visual field). As peripheral vision worsens, people may ...
and
orthopaedics Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming. By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around 2 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 splenic surgery wing; anecdotal evidence suggests that this pattern is common in Cuban hospitals.


Cuban Medical Professional Parole Program

Reports surfacing in early 2022 revealed that the doctors that travel abroad on behalf of the Cuban government, often do so against their will and without monetary compensation similar to doctors from other countries. Another report found that nearly 7,000–8,000 doctors since 2006 have gone into hiding or failed to return to Cuba after having gone on abroad as part of the Cuban government's "volunteering" them to provide healthcare to foreign nationals without remuneration. President George W. Bush in 2006 initiated a program called the "Cuban Medical Professional Parole Program", this program allowed for any Cuban doctor serving outside of Cuba to be granted political asylum and permanent resident status in the United States, if only the Cuban national was able to make it to a U.S. embassy anywhere in the world. The program was ended by the Obama administration as part of an effort to warm relations between the United States and the Cuban government.


Medical research

The Cuban Ministry of Health produces a number of
medical journal A medical journal is a peer-reviewed scientific journal that communicates medical information to physicians, other health professionals. Journals that cover many medical specialties are sometimes called general medical journals. History The first ...
s including the Acimed, the
Cuban Journal of Surgery Cuban may refer to: * Something of, from, or related to Cuba, a country in the Caribbean * Cubans, people from Cuba, or of Cuban descent ** Cuban exile, a person who left Cuba for political reasons, or a descendant thereof * Cuban citizen, a perso ...
and the Cuban Journal of Tropical Medicine. MEDICC Review is an English-language journal which works to bring Cuban medical and public health policy, research, programs, and outcomes to the attention of the global health community. 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, although exceptions have been made for significant drugs. 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 GSK plc, formerly GlaxoSmithKline plc, is a British multinational pharmaceutical and biotechnology company with global headquarters in London, England. Established in 2000 by a merger of Glaxo Wellcome and SmithKline Beecham. GSK is the tent ...
to enter into a deal to develop the vaccine for use in the U.S. and elsewhere. The Center of molecular immunology (CIM) developed
nimotuzumab Nimotuzumab (h-R3, BIOMAb EGFR, Biocon, India; TheraCIM, CIMYM Biosciences, Canada; Theraloc, Oncoscience, Europe, CIMAher, Center of Molecular Immunology, Havana, Cuba) is a humanized monoclonal antibody that as of 2014 had orphan status in the ...
, a monoclonal antibody used to treat cancer. Nimotuzumab is an inhibitor of
epidermal growth factor receptor The epidermal growth factor receptor (EGFR; ErbB-1; HER1 in humans) is a transmembrane protein that is a receptor for members of the epidermal growth factor family (EGF family) of extracellular protein ligands. The epidermal growth factor recept ...
(EGFR), which is over-expressed in many cancers. Nimotuzumab is now being developed with international partners. In April 2007, the Cuba IPV Study Collaborative Group reported in the
New England Journal of Medicine ''The New England Journal of Medicine'' (''NEJM'') is a weekly medical journal published by the Massachusetts Medical Society. It is among the most prestigious peer-reviewed medical journals as well as the oldest continuously published one. Hist ...
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. During the
COVID-19 pandemic The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identif ...
, Cuba developed two
COVID-19 vaccines A COVID19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), the virus that causes coronavirus disease 2019 (COVID19). Prior to the COVID19 pandemic, an est ...
.
Soberana 02 Soberana 02 or Soberana 2, technical name FINLAY-FR-2, is a COVID-19 vaccine produced by the Finlay Institute, a Cuban epidemiological research institute. The vaccine is known as PastoCovac ( fa, پاستوکووک) in Iran, where it has been ...
is produced by the
Pasteur Institute of Iran Pasteur Institute of Iran is a medical research center located in Tehran, Iran. The institute is one of the oldest leading research and public health centers in Iran and the Middle East, established in 1920 following an agreement between the Inst ...
and the Finlay Institute, a Cuban epidemiological research institute.
Abdala Abdala or Abdalá is both a given name and a surname. It is a Spanish variation of the common Arabic name Abdullah. Notable people with the name include: Surname *Alberto Abdala (1920–1986) Uruguayan politician, painter and Vice President of Urug ...
was developed by the
Center for Genetic Engineering and Biotechnology The Center for Genetic Engineering and Biotechnology ( es, Centro de Ingeniería Genética y Biotecnología, CIGB) is a research institute in Havana, Cuba. It is responsible for creating the Abdala vaccine. The Centre developed the COVID-19 vac ...
in Cuba.


Assessments

The issue of the effectiveness of the Cuban health system is politically polarized. According to William Ventres in his review of five books about Cuba's medical system (including one by Katherine Hirschfeld; see below), it is "difficult to make sense of the reality of Cuban health care."


Praise

In reviewing five books about Cuba's medical system, William Ventres concluded that Cuba's state-run medical system has been quite successful, due largely to its family medicine model. In 2006,
BBC #REDIRECT BBC #REDIRECT BBC Here i going to introduce about the best teacher of my life b BALAJI sir. He is the precious gift that I got befor 2yrs . How has helped and thought all the concept and made my success in the 10th board exam. ...
...
flagship news programme ''
Newsnight ''Newsnight'' (or ''BBC Newsnight'') is BBC Two's news and current affairs programme, providing in-depth investigation and analysis of the stories behind the day's headlines. The programme is broadcast on weekdays at 22:30. and is also availa ...
'' featured Cuba's Healthcare system as part of a series identifying "the world's best public services". The report alleged 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 nearly 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.Keeping Cuba healthy
BBC online. 1 August 2006
A 2006 poll carried out by the
Gallup Organization Gallup, Inc. is an American analytics and advisory company based in Washington, D.C. Founded by George Gallup in 1935, the company became known for its public opinion polls conducted worldwide. Starting in the 1980s, Gallup transitioned its bu ...
's Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of urban Cubans responded positively to the question "do you have confidence to your country's health care system".Cuban have faith in their country’s healthcare system
CubaHeal. 5 Juil. 2019
In 2000, Secretary General of the United Nations
Kofi Annan Kofi Atta Annan (; 8 April 193818 August 2018) was a Ghanaian diplomat who served as the seventh secretary-general of the United Nations from 1997 to 2006. Annan and the UN were the co-recipients of the 2001 Nobel Peace Prize. He was the founder ...
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 have if they focus on the right priorities – health, education, and literacy." The
Kaiser Family Foundation KFF (Kaiser Family Foundation), also known as The Henry J. Kaiser Family Foundation, is an American non-profit organization, headquartered in San Francisco, California. It prefers KFF since its legal name can cause confusion as it is no longer a ...
, 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 Sir James David Wolfensohn (1 December 193325 November 2020) was an Australian-American lawyer, investment banker, and economist who served as the ninth president of the World Bank Group (1995–2005). During his tenure at the World Bank, he is ...
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 The International Monetary Fund (IMF) is a major financial agency of the United Nations, and an international financial institution, headquartered in Washington, D.C., consisting of 190 countries. Its stated mission is "working to foster globa ...
. Wayne Smith, former head of the
US Interests Section in Havana The United States Interests Section of the Embassy of Switzerland in Havana, Cuba or USINT Havana (the State Department telegraphic address) represented United States interests in Cuba from September 1, 1977, to July 20, 2015. It was staffed by ...
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, who was president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, traveled to Cuba to see firsthand how doctors were 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 ''The Guardian'' is a British daily newspaper. It was founded in 1821 as ''The Manchester Guardian'', and changed its name in 1959. Along with its sister papers ''The Observer'' and ''The Guardian Weekly'', ''The Guardian'' is part of the Gu ...
'' newspaper lauded Cuba's public healthcare system for what it viewed as its high quality in a September 12, 2007 article. In 2001, members of the UK
House of Commons The House of Commons is the name for the elected lower house of the bicameral parliaments of the United Kingdom and Canada. In both of these countries, the Commons holds much more legislative power than the nominally upper house of parliament. ...
Health
Select committee Select committee may refer to: *Select committee (parliamentary system), a committee made up of a small number of parliamentary members appointed to deal with particular areas or issues *Select or special committee (United States Congress) *Select ...
travelled 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". The
Parliament of the United Kingdom The Parliament of the United Kingdom is the supreme legislative body of the United Kingdom, the Crown Dependencies and the British Overseas Territories. It meets at the Palace of Westminster, London. It alone possesses legislative suprema ...
also drew up an analysis of the key features of Cuba's healthcare system, drawing comparisons with the state funded
National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
(NHS). The overall conclusion was that many of the features identified would not have occurred had there not been an obvious commitment to health provision demonstrated by the protection and proportion of the budget given the health care. The study concluded the following. *There appeared to be little evidence of a divide between the prevention/proactive response and the disease management/reactive response within Cuban healthcare. *By far the biggest difference was the ratio of doctors per person. In Cuba it was one doctor per 175 people, in the UK the figure was one doctor per 600 people. *There is a commitment in Cuba to the triple diagnosis (physical/psychological/social) at all levels. *Extensive involvement of "patient" and the public in decision making at all levels. *Integration of hospital/community/primary care via polyclinics. *Team-work that works is much more evident both in the community and the hospital sector and the mental-health and care of the elderly sites visited were very well staffed and supported.CUBAN HEALTH CARE SYSTEMS AND ITS IMPLICATIONS FOR THE NHS PLAN
. Select Committee on Health.
Margaret Chan Margaret Chan Fung Fu-chun, (born 21 August 1947) is a Chinese-Canadian physician, who served as the Director-General of the World Health Organization (WHO) delegating the People's Republic of China from 2006–2017. Chan previously served a ...
, former director of the World Health Organization, recommended other countries follow Cuba's example in health care.


Criticism

The preceding study also pointed to problems within Cuba's health system, including: *Low pay of doctors. *Poor facilities—buildings in poor state of repair and mostly outdated. *Poor provision of equipment. *Frequent absence of essential drugs. *Concern regarding freedom of choice both for patient and doctor. Tassie Katherine Hirschfeld, an associate professor at the department of anthropology of the
University of Oklahoma The University of Oklahoma (OU) is a Public university, public research university in Norman, Oklahoma. Founded in 1890, it had existed in Oklahoma Territory near Indian Territory for 17 years before the two Territories became the state of Oklahom ...
, did her Ph.D. thesis on the Cuban health system, spending nine months conducting ethnographic work in Cuba in the late 1990s. According to Hirschfeld, "public criticism of the government is a crime in Cuba", which means that "formally eliciting critical narratives about health care would be viewed as a criminal act both for me as a researcher, and for people who spoke openly with me". Nevertheless, she was able to hear from many Cubans, including health professionals, "serious complaints about the intrusion of politics into medical treatment and health care decision-making". She points out that "there is no right to privacy in the physician-patient relationship in Cuba, no patients’ right of informed consent, no right to refuse treatment, and no right to protest or sue for malpractice". In her view medical care in Cuba can be dehumanizing. Complaints have also 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 Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
and
dissident A dissident is a person who actively challenges an established Political system, political or Organized religion, religious system, doctrine, belief, policy, or institution. In a religious context, the word has been used since the 18th century, and ...
Dr
Hilda Molina Hilda Molina (born Hilda Molina y Morejon in 1943 in Ciego de Avila, Cuba) is the former neurosurgery, chief neurosurgeon of Cuba. Molina was also a deputy in the Cuban National Assembly but has been a critic of the Cuban government since the ear ...
said that the central revolutionary objective of free, quality medical care for all has been eroded by Cuba's need for foreign currency. Molina said that following the economic collapse known in Cuba as the
Special Period The Special Period ( es, Período especial, link=no), officially the Special Period in the Time of Peace (), was an extended period of economic crisis in Cuba that began in 1991 primarily due to the dissolution of the Soviet Union and, by exten ...
, the Cuban Government established mechanisms designed to turn the medical system into a profit-making enterprise. This created an enormous disparity in the quality of healthcare services between foreigners and Cubans, leading to a form of
tourist apartheid The dual economy of Cuba was developed after the dissolution of the Soviet Union, which caused major economic changes on the island. Tourism was regarded as the only stable sector of the Cuban economy and became the subject of policy changes to e ...
. 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 is 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. 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. A recent ABC-TV
20/20 Visual acuity (VA) commonly refers to the clarity of vision, but technically rates an examinee's ability to recognize small details with precision. Visual acuity is dependent on optical and neural factors, i.e. (1) the sharpness of the retinal ...
report on Healthcare, based on footage taken from within the island, criticized Michael Moore's portrayals of the Cuban Healthcare system in the movie Sicko. In that film, Moore took a number of Americans to a hospital in Havana where they bought affordable drugs, and were given treatments for free that they could not afford in America. The report highlights the dilapidated 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. Cuban medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 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, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher. Cuban doctors that have been sent on international missions by the Cuban government have reported being paid less than the local doctors and treated poorly by the local government. They are sometimes monitored by the local government in case of defecting."On a mission: how Cuba uses its doctors abroad" by Sara Carrillo de Albornoz. This article discusses Cuba's healthcare help abroad, but also critiques that it may be contributing to a shortage of care and resources at home. The ''
San Francisco Chronicle The ''San Francisco Chronicle'' is a newspaper serving primarily the San Francisco Bay Area of Northern California. It was founded in 1865 as ''The Daily Dramatic Chronicle'' by teenage brothers Charles de Young and M. H. de Young, Michael H. de ...
'', the ''
Washington Post ''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large nati ...
'', and
National Public Radio National Public Radio (NPR, stylized in all lowercase) is an American privately and state funded nonprofit media organization headquartered in Washington, D.C., with its NPR West headquarters in Culver City, California. It differs from other n ...
have all reported on Cuban doctors defecting to other countries when on international missions. Cuban doctors at home have experienced an increased work-load to cover for the doctors abroad, although there is no evidence that this has negatively affected health outcomes. A 2020 study using a
synthetic control method The synthetic control method is a statistical method used to evaluate the effect of an intervention in comparative case studies. It involves the construction of a weighted combination of groups used as controls, to which the treatment group is comp ...
found that infant mortality increased in the first years of the Castro administration relative to other similar countries, but that infant mortality reverted to trend during the 1970s irrespective of foreign aid.


Black market healthcare

The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning
black market A black market, underground economy, or shadow economy is a clandestine market or series of transactions that has some aspect of illegality or is characterized by noncompliance with an institutional set of rules. If the rule defines the se ...
economy, sometimes termed "
sociolismo ''Sociolismo'' ("partner-ism"), also known as ''amiguismo'' ("friend-ism"), is the informal term used in Cuba to describe the reciprocal exchange of favors by individuals, usually relating to circumventing bureaucratic restrictions or obtaining har ...
". According to former leading Cuban
neurosurgeon Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
and
dissident A dissident is a person who actively challenges an established Political system, political or Organized religion, religious system, doctrine, belief, policy, or institution. In a religious context, the word has been used since the 18th century, and ...
Dr
Hilda Molina Hilda Molina (born Hilda Molina y Morejon in 1943 in Ciego de Avila, Cuba) is the former neurosurgery, chief neurosurgeon of Cuba. Molina was also a deputy in the Cuban National Assembly but has been a critic of the Cuban government since the ear ...
, "The doctors in the hospitals are charging patients under the table for better or quicker service." Prices for out-of-surgery X-rays have been quoted at $50 to $60. 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 The Special Period ( es, Período especial, link=no), officially the Special Period in the Time of Peace (), was an extended period of economic crisis in Cuba that began in 1991 primarily due to the dissolution of the Soviet Union and, by exten ...
" in the 1990s aggravated these payments. The advent of the "dollar economy", a legalization 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 would not be available to them otherwise.Cuba's Health in Transition and the Central and Eastern European
Countries Experience. Antonio Maria de Gordon.


See also

*
Health in Cuba Health in Cuba refers to the overall health of the population of Cuba. Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991; the stepping up of the US embargo against Cuba at this time also ...
*
Carlos Finlay Carlos Juan Finlay (December 3, 1833 – August 20, 1915) was a Cuban epidemiologist recognized as a pioneer in the research of yellow fever, determining that it was transmitted through mosquitoes ''Aedes aegypti''. Biography Early life and ...
* Center of Molecular Immunology *
ELAM (Latin American School of Medicine) Cuba ''Escuela Latinoamericana de Medicina'' (ELAM in Spanish; in English: Latin American School of Medicine (LASM)), formerly ''Escuela Latinoamericana de Ciencias Médicas'' (Latin American School of Medical Sciences), is an international public m ...
* ''
Sicko ''Sicko'' is a 2007 American political documentary film by filmmaker Michael Moore. Investigating health care in the United States, it focuses on the country's health insurance and the pharmaceutical industry. The film compares the for-profit no ...
'' *
Cuban medical internationalism After the 1959 Cuban Revolution, Cuba established a program to send its medical personnel overseas, particularly to Latin America, Africa, and Oceania, and to bring medical students and patients to Cuba for training and treatment respectively. In 2 ...
* Mission Barrio Adentro * List of hospitals in Cuba


References


External links


"The Paradox of Good Health and Poverty: Assessing Cuban Health Outcomes under Castro" by Vincent Geloso and Gilbert Berdine

Cubans Reap Health Rewards With Preventive Medicine Strategy
– December 2010 Video Report by ''
PBS Newshour ''PBS NewsHour'' is an American evening television news program broadcast on over 350 PBS The Public Broadcasting Service (PBS) is an American public broadcaster and non-commercial, free-to-air television network based in Arlington, Virg ...
''
Letter from Cuba
Cuba: plenty of care, few condoms, no corruption. Hans Veeken, public health consultant, Medecins Sans Frontieres ''BMJ'' 1995;311:935–937 (7 October)
Cuba AIDS Project
— HIV and AIDS in Cuba
''MEDICC Review''
An international journal of Cuban health and medicine
''Cuban Affairs''
"Re-examining the Cuban Health Care System." {{DEFAULTSORT:Healthcare In Cuba Healthcare in Cuba