By Leni Villagomez Reeves
The United States spends more on healthcare and gets worse results than any other industrialized country. Many people don’t have access to care, life expectancy rates are falling and about half of all bankruptcies are related to medical expenses. But it isn’t just first-world countries that have better health indicators than the United States.
There is a small third-world country that has achieved better results with fewer resources. That country is Cuba.
Cuba’s success demonstrates that universal access and universal health coverage are feasible. What is required is the political will. Cuba spends about 11% of its GDP on healthcare (the United States spends about 17%), but this is not just about more doctors or money spent.
Ché said, “In order to be a revolutionary doctor, there must be a revolution.” This is a system of care.
Universal Access
Cuba differs from other countries, even other socialist countries, in the way it initially allocated resources. Because rural areas were the most neglected and had the worst conditions and health indicators, the Cuban government initially concentrated on the rural sector.
In 1959, there was one rural hospital. Now there are 64. In 1960, the revolution started the process of providing care for the whole population. By 1961, the Cuban national healthcare system was totally socialized. In 1959, Cuba had 6,286 doctors, concentrated in urban areas. About 3,000 left, looking for continued privilege and lured by better offers from the United States, which tried to destabilize Cuba by every possible means. Now there are more than 95,000.
Over the years, the model has evolved to the integrated system now in place. The base is the MGI (Medicina General Integral)—the family practitioner—13,000 of them, who run local family practice offices offering care to a defined patient population in the immediately surrounding community. They know their patients, of course, because they live in the neighborhood. (If you skip your hypertension checkup, your doctor might find you in line at the bakery and grab you there.)
Each family practitioner cares for 1,000–1,500 people. Polyclinics are the backup, offering specialty services as well as additional public health services.
The next level is represented by the 150-plus community hospitals. The tertiary care level is provided by 12 institutes that give highly specialized care and do sub-specialty research and teaching.
Biomedical research is also carried out at a biotechnology institute that prioritizes the national health system’s needs (nonprofit), collaboration (not competition) and working on screening and the prevention of preventable disease. Research integrated with needs of people and subjected to a rigorous risk analysis rather than a profitability analysis—what a concept.
Fewer Infant Deaths
In 1959, Cuba’s infant mortality rate was 37.3 per 1,000 live births. (This statistic hid a huge rural-urban disparity though.) Now it is 4.3, which is better than the U.S. rate of 5.8. (That U.S. statistic also hides a significant disparity: The U.S. rate for Black infants is 11.3 deaths per 1,000 live births.)
How Does Cuba Do This?
Cuban neonatologist Fernando Dominguez describes the Cuban system:
- “Our emphasis is always on prevention first, and we’ve seen good results using this approach.”
- “What really has an impact on infant mortality in developing world contexts is ensuring optimal maternal health, before and during pregnancy, and that each child is born in the best health possible.”
- “Our system is universal and guarantees access; we take a preventive approach; and Cuba is illiteracy-free. This is a very important element that can’t be underestimated: If someone can’t read, how are they going to understand the treatment prescribed by their doctor? All of these actions have contributed to improving both maternal and infant health.”
(Note: Cuba spends about 13% of GDP on education, which is also free and universal; the United States spends 5%.)
Cuba was the first country in the world to eliminate polio, with a vaccine campaign in 1962. It was the first country in the world that eliminated vertical transmission of HIV and syphilis—declared by the WHO in 2015. In the United States, in that year, there were 69 infants infected with HIV from infected mothers. They did not receive adequate testing, prenatal care and medication. The majority were Black.
Cuba Still Struggling with the U.S. Blockade
There are problems and shortages. For a small third-world country to offer free universal healthcare is a big challenge.
Many of the shortages are effects of the U.S. blockade, which prohibits trade with Cuba by companies anywhere in the world, with the penalty of fines and seizure of a company’s U.S. assets. Any company with a U.S. affiliate can be prevented from trading with Cuba; this includes pharmaceutical companies.
Any medical device with any component made by a company with a U.S. affiliate is prohibited to be sold to Cuba. The blockade prevents medicines, including antibiotics, pain medications and chemotherapy drugs, pacemakers, heart valves, surgical tools, MRI machines and even medical books from being sold to Cuba through normal channels of trade at normal prices.
The blockade as it has been imposed for 60 years has not been severe enough for the current U.S. regime. Starting in June 2017, more than 170 new measures to damage Cuba’s economy and harm the Cuban people were put in place.
U.S. Students Can Go to Medical School in Cuba
In 1959, there was one medical school in Cuba. Now there are 21 for Cubans and the Latin American School of Medicine (ELAM), which trains doctors from other countries, created in 1999 as a response to Hurricane Mitch’s devastation in Central America.
The ELAM now has thousands of students from many countries, all pledged to study medicine in Cuba, then return home to serve the medical needs of their people. This includes students from the United States. If you are young, from a family that could not afford to send you to medical school, and dream of studying medicine and serving poor people, you might be able to apply through the Interreligious Foundation for Community Organization’s Pastors for Peace for a complete scholarship.
For more information, visit https://ifconews.org/medical-school/frequently-asked-questions.
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Leni Villagomez Reeves is a local physician and activist. Contact her at lenivreeves@gmail.com.
