Health in Cuba

Abstract

The poorer countries of the world continue to struggle with an enormous health burden from diseases that we have long had the capacity to eliminate. Similarly, the health systems of some countries, rich and poor alike, are fragmented and inefficient, leaving many population groups underserved and often without health care access entirely. Cuba represents an important alternative example where modest infrastructure investments combined with a well-developed public health strategy have generated health status measures comparable with those of industrialized countries. Areas of success include control of infectious diseases, reduction in infant mortality, establishment of a research and biotechnology industry, and progress in control of chronic diseases, among others. If the Cuban experience were generalized to other poor and middle-income countries human health would be transformed. Given current political alignments, however, the major public health advances in Cuba, and the underlying strategy that has guided its health gains, have been systematically ignored. Scientists make claims to objectivity and empiricism that are often used to support an argument that they make unique contributions to social welfare. To justify those claims in the arena of international health, an open discussion should take place on the potential lessons to be learned from the Cuban experience.

Population-based weight loss and gain do not explain trends in asthma mortality in Cuba: A prospective study from 1964 to 2014

“…The strengths of these data are the national nature of the datasets from a country that has a good reputation for providing medical care and reliable health statistics, including mortality data [4], increasing confidence in the reliability of the coding of cause of death. The availability of data on deaths from chronic bronchitis and emphysema is also a strength, as this permits evaluation of the possibility of misclassification between the two disease categories.However, as with any study that uses routinely collected data, we do not have independent validation of the diagnosis of asthma as the cause of death, although we have eliminated the most obvious category of misclassification.…”

“…Since 1995 however, as food has become more available again, average BMI increased by 2.6 kg/m 2 by 2010 [3]. These events thus present a unique opportunity to study the effects of a period of weight loss and subsequent gain on national asthma mortality, over a period when high quality health statistics continued to be collected [4] …”

Which factors confound or modify the relationship between body weight and mortality?

“…16 This period of privation also had negative health consequences, with a small upward rise in infant mortality, presumably because some pregnant women were receiving suboptimal nutrition. 15 An increase in mortality was also observed in people over 65 years of age, as a result of excess deaths due to infectious diseases and recrudescence of latent tuberculosis; no change was seen in cancer mortality. This large-scale social experiment shows that population interventionsFin this case, involuntaryFcan have significant effects on obesity-related disorders, given the large burden of vascular disease in contemporary societies.…”

“…The combined effect was to completely cut off supplies of foreign oil and agricultural products, causing the economy of Cuba to contract by 30%. 15 During the resulting unprecedented period of privation, referred to as the 'special period,' food and gasoline were in short supply, and walking and riding bicycles were the primary modes of transportation. Consequently, weight loss of 15 pounds was observed, which was consistent across the population.…”

The association of low birth weight with serum C reactive protein in 3‐year‐old children living in Cuba: A population‐based prospective study

“…Cuba has an excellent health care system that delivers infant mortality rates comparable to much richer countries (Cooper et al, 2006), with good health infrastructure providing a unique environment where risk factors for disease can be studied. We have used data from a prospective study in young children to test the primary hypothesis that low birth weight is associated with increased hsCRP levels at the age of 3 years.…”