Free Public Health: An Unquestionable Achievement of Cuba

August 4, 2012 | Print Print |

Elio Delgado Legon

Cuban doctor and pregnant patient. Photo: Sergio Leyva

HAVANA TIMES — One can always criticize the shortcomings and imperfections that exist in any human endeavor, just as one can point to the incorrect or irresponsible attitudes of individuals who have caused extensive damage to the image of our health care system.

Notwithstanding, one cannot fail to recognize that the public health care system in Cuba is one of the most important achievements of the revolution, along with education.

Precisely for this reason, the transnationals of information — always ready to denigrate and to disseminate anything that might give a negative image — refuse to publish anything about the true results of public health care in Cuba.

The same applies to some bloggers who respond to the interests of the enemies of the revolution. The same can be said for those who devote themselves to writing comments that exaggerate situations so as to denigrate an activity that remains the pride of Cuban revolutionaries – while still having plenty of room for improvement.

On several occasions, Margaret Chang, the general director of the World Health Organization (WHO), has referred positively to the Cuban health care system. On her first visit to Cuba in October 2009, she said: “I’m here to learn from the excellent efforts you have made in creating the health care system here. Much of your work — such as primary health care systems, community-based care, and equal health care access for everyone — are all topics of great interest to us.”

She added that she was “fully aware of the economic, commercial and financial impact that the embargo (blockade) applied by Washington has had on the island.” Despite that, she also noted that Cuba has had “outstanding results” in health care and has sent medical missions to many countries in Latin America and Africa.

The main health indicators in Cuba speak for themselves concerning the effectiveness of the system.

Infant mortality, which is one of the main indicators for measuring the health of a country, is among the lowest in the world. For the last four years the rate remained below five per thousand live births, lower than many developed countries – including the United States.

Infant mortality in Cuba is very low. Photo: Sergio Leyva

To ensure that level, and to continue reducing that rate as well as maternal mortalities, there exists a maternal-infant program whereby all pregnant women receive medical monitoring throughout their pregnancy, during childbirth and in the first year of baby’s life.

If a mother fails to go for a check-up at the appropriate time, the doctor will send staff to look for her or the physician will visit her at her home.

This is possible because the whole country is covered by a primary health care system, which regulates all citizens in their area of service.

Life expectancy at birth is almost 80 years, while the principal causes of death in the country are strokes, cancer, heart attacks and accidents.

Deaths due to communicable diseases have been reduced to the minimum because all children are vaccinated against thirteen diseases, of which five have been eradicated completely.

When we compare these results with the reality of today’s world, where three million children die every year from diseases that can be prevented by vaccines, we can only feel pride for our health care system.

Some people are dissatisfied? That’s true. The leaders of the health care system in Cuba are also dissatisfied and are working actively to improve services every day.

As for preventive medicine, the results of Cuba surpass those of the wealthiest nations in the world, according to international statistical comparisons – which include the 15 most developed countries.

There are many obstacles faced by the Cuban government in providing better medical care.

Many latest-generation medicines — even those for saving the lives of children who suffer from cancer — cannot normally be bought because this is prevented by the US.

Instead, Cuba has to search the world and pay top dollar for them, which equate to processing delays that can result in those vital medicines arriving too late.

This isn’t even mentioned in the foreign press.

The Cuban health system is prepared to perform and carries out the most complex operations and transplants. Through this, many lives are saved, without the patients or their families having to pay a single cent, neither for the services nor the medicines.

However, due to the difficulties mentioned above in purchasing some anti-rejection medications, sometimes not all needed operations can be performed.

If all of these real-life situations were analyzed by the press, instead of the media organizing a media campaign against Cuba, their inclusion of this information could help solve many of these problems.

And if these were overcome, I have no doubt that the Cuban health care system would be the very best in the world.

 


What's your opinion?

  • Moses

    As an American, I am reluctant to comment on the drawbacks of the Cuban public health care system in view of the many challenges which continue to plague the US system despite our wealth, technology, and medical innovation. Nonetheless, the biggest drawbacks in the Cuban system are self-imposed. The embargo is the least of the problems which weaken Cuban health care. Low salaries, poor facility maintenance and overzealous politization are by far more damaging. Too many doctors sent abroad by the Cuban regime in pursuit of hard currency leave fewer Cuban doctors in Cuba to treat Cubans. Those who remain in Cuba work under abysmal conditions and are too often interested in outside income and not the business of medicine. Finally, despite the physical count of Cuban hospitals having increased significantly since 1959, the lack of facility maintenance and the use of outdated technology leave many facilities closed or underutilized. Despite these drawbacks, Cuba remains among the best places to receive medical care in the third world. Elio, however, should review the health care system in Canada, Great Britain, Sweden, and France before attempting to lay claim to the title of world’s best.

    • Luis

      But Moses, if “The embargo is the least of the problems which weaken Cuban health care”, what causes “the lack of facility maintenance and the use of outdated technology”?

      • Moses

        Luis, we will likely have to agree to disagree on this point but there is little doubt that most Cuban health facilities do not the hygienic standards common in modern medicine. These failures, are often blamed on the lack of access to the US market but I assert the truth is a lack of will on the part of the medical community to mop floors and empty wastebaskets. Too many bathrooms suffter from stolen toilets and sink fixtures. Missing flourescent light bulbs are often blamed on the effort to conserve energy but a hospital should be well lit. I do not know the last time you visited a Cuban hospital, but I visited Calixto Garcia and Fructuosa Rodriguez in Havana in February to see a friend. The hallways are dim and ventilation is poor. As far as technology, because the wiring in Calixto Garcia was old and unstable, most of the monitors used today in modern medicine are too sensitive to the constant power surges to function properly. Lacking the wherewithal (parts, repair manuals) to adequately maintain these machines, many go underused. The point I am trying to make Luis is that the embargo is the excuse that is most readily available but much could be done to dramatically improve service without more money.

        • Luis

          “I assert the truth is a lack of will on the part of the medical community to mop floors and empty wastebaskets. Too many bathrooms suffter from stolen toilets and sink fixtures.”

          “As far as technology, because the wiring in Calixto Garcia was old and unstable, most of the monitors used today in modern medicine are too sensitive to the constant power surges to function properly. Lacking the wherewithal (parts, repair manuals) to adequately maintain these machines, many go underused.”

          But you say:

          “much could be done to dramatically improve service without more money.”

          Of course, but health staff, spare parts and maintenance do cost money.

          Anyway, if it’s all that it is, then why make such a big deal? You should know me, I am from a developing country (Brazil), much richer than Cuba, and AFAIC we have much to be done in the area of public health, even if we do have a rather good system (the SUS). So we’ve got different standards… you said earlier of European health systems that are truly great but when put into context, it’s like comparing apples to oranges.

    • john sparre

      moses, prophet, or profit, was reluctant to criticise the cuban health system but i am happy to see he gave it his best shot. what american health system????????????? the michael moore documentary, SICKO, says it all. i have not had experience of the swedish or canadian systems but in my experience the british national health is shitty and the system of la france is as good as it gets. but the french pharmaceutical benefits system is too cheap which leads to the french taking too many drugs. in australia, the government put the price of medications up to $5.30 to discourage over medication but gave the unemployed an extra $5 a week. this was to change behaviour. the cuban system is not as good as some people in other countries think but the problem is money, not the lack of doctors. cuba has too many doctors. a bigger problem is pharmacies with few drugs. again, money is the problem because no one really needs american drugs. china and india make very cheap generic drugs out of patent and several european counries make all kinds of drugs. some are better than american drugs. by the time all these idiotic embargoes end, everyone else will have the cuban business. who needs american cars? chery cars and vans are not the best for quality control but cuba is full of expert mechanics. the main thing is fuel economy. chery makes a rolls royce copy. it’s a bargain at a mere 30,000 pounds. that’s the british currency, not the weight. BMW has threatened to sue for copyright infringement but they wouldn’t win in a chinese court. moses, you too can drive a roller. a volksroller for the shirking class.

  • http://mivos.wordpress.com Andy

    haha this is so funny, first of all the name of the article is misleading, there’s no such a thing as FREE, heath care in Cuba is “free of out of pocket cost” for Cubans, however somehow the government needs to get the money in order to pay for it, and How does the government gets the money? By taxing everybody’s income so much that a Cuban salary for a doctor is maximum 25$ to 30$ a month. A regular worker earns 15 to 20$ a month, no wonder why malnutrition is so common. Health care in Cuba may be somewhat efficient and good but it cannot be compared to the quality of health care provided in the U.S or any European country. Regarding education, YOU think it is an achievement of the revolution, I in the other hand believe it to be the worst thing the Revolution has done to my country. First of all the so called “emergent teachers” can’t even speak Spanish (instead they speak some kind of low class dialect very common today in Cuba), on top of that ideological indoctrination is very common, ranging from school textbooks hiding “inconvenient facts” from history to biology textbooks teaching you only and exclusively one theory of evolution predicated by Marx’s political philosophy. Please, there’s no excuse for Revolutionary Cuba, The world really knows what is going on behind that veil of hypocrisy. “La primera libertad, base de todas, es la de la mente” Jose Marti.

  • http://www.GRDPublishing.com Grady Ross Daugherty

    Thank you, once again, Elio, for an excellent post.

    The European healthcare systems have been excellent, it is true, but these have been put into effect mainly by pressure from the organized labor movement. Now however the capitalists are attacking all the historic benefits won by the workers. It remains to be seen whether the excellent European healthcare system will remain intact.

    Tens of thousands of poor people in the US die each year due to lack of basic healthcare. Almost four times the population of Cuba are without healthcare insurance in the US because they can’t afford it. Anyone who brags about the US healthcare system is a moron.

    Best wishes, Elio, and to the valiant Cuban people.

  • Michael N. Landis

    Like Grady, I’d like to praise Elio’s article, too! Despite its problems, the proof that the Cuban health care system has accomplished much are in the mortality and actuarial statistics, which are on the same, or in some cases even exceed, First World levels.
    Instead of yelling “against the wind” about the system’s shortcomings, perhaps there should be more local organizing to do stuff in a positive way. Many hospitals up here have “Friends of…” support groups, mostly composed of grateful former patients and their families, which raise supplementary funds and do volunteer work for their hospitals. Some of these groups are responsible for the very survival of their hospital, as was the case for the Grace Cottage Hospital, in nearby Townshend, Vermont, which the centralized health care authorities and their insurance company masters wanted to close, and to “consolidate” to a larger, and more distant, facility. The community group was–and is–fierce in their loyalty and support, and this small, but much beloved, hospital existes–and flourishes–to this day. An engaged and loyal support group for some of the neglected hospitals in Cuba could do much to advocate for a just distribution of advanced diagnostic and treatment equipment, for preventing the theft of hospital fixtures, and for the proper maintainance of facilities. Again, the key here would be for “grass roots” communities to be involved, and not to wait for the central authorities, ministries and agencies to take the lead. Ditto for the political insitutions of Cuba, too, starting with the nacional, provincial, and local assemblies, and going right down to the CDR’s in each neighborhood and on each block.

    • http://www.GRDPublishing.com Grady Ross Daugherty

      Well said, Michael.

  • http://www.cubaverdad.net Cubaverdad

    Health care in Cuba in fact is not “free”.

    The Cuba health care system is divide up in two segregated parts:
    – the national health care for the people
    – the tourist / elite health care for foreigners and the elite.

    The easiest to describe is the “tourist / elite” part of the health care system. It is utterly unaffected by the “embargo” and lacks neither equipment, medicines, staff and investment in the infrastructure.
    In this forum itself the son of a military man described good care and steak for lunch. (1)
    The hospital were Chavez was treated lacked nothing but is not accessible for the Cuban people with some propaganda exceptions. (2)

    In the “popular” part of the apartheid health system.
    As authors here have confirmed the infrastructure of the system is falling apart. (3) Hospitals all over the country are in a bad state of repair and lacks everything from disinfectants to bed sheets. (4)
    lots of equipment isn’t functioning. Even elevators are often not running in lots of hospitals.
    Corruption is rife and “under the table” payments ensure you get on a list or to the top of the list.
    Often medicines are “not available” until a payment in CUC is made. Even with corruption lots of items are lacking, even in the “international clinics” where people have to pay.
    Cuban people pay for their treatments in contributions (medical items, medicines, disinfectants, bandaging, food, bedlinen, …) gifts, corruption payments and “exchanges of favors” throughout the Cuban system.
    The days of free health care are long and gone.
    Cuba now has an elite / tourist paying system closed to the average Cuban and a “Cuban” system lacking doctors, equipment, medicines, …that has become rife with corruption.
    This is no attack on Cuba doctors. underpaid and overworked as they are they struggle to cope in a system that rewards everything but selfless acts.

    (1) Perks for Cuba’s ‘Revolutionary’ Military, February 23, 2012
    http://www.havanatimes.org/?p=62724
    (2) Cuba: trato a Chávez fue excepción
    La atención médica que recibió el mandatario venezolano en la isla no se compara en nada con la que tienen acceso los mismos cubanos.
    http://www.voanoticias.com/content/cuba-medicina-chavez-126348808/102300.html
    (3) Colapsa mi Consultorio del Médico de la Familia
    julio 18, 2012
    http://www.havanatimes.org/sp/?p=67589
    (4) See: hygiene, hospital
    http://saludcuba.blogspot.ca/search/label/Higiene
    http://saludcuba.blogspot.ca/search/label/Hospital

  • Luis
  • Isidro

    I agree with you, Giraldilla. Everything can be improved and we shouldn’t be content with what we have now. However, in that I lived in Africa and Asia for a long time, I can say that with regard to health care in those places (where how many lives haven’t been saved), Cuba far surpasses other countries at similar levels of economic development.

  • john sparre

    the cuban military gets good medical care. the u.s.military doesn’t ????????????? why do they sign up? do they like desert adventures? do they love bringing democracy to the world?