An Island of Health without Wealth 1

An Island of Health without Wealth

Research Analysis: Cuba’s Health and Healthcare

Through a lens focused on HIV/AIDS Treatment and Research

Team 4:

Wendy Carrillo, Mahnaz Jeddi, Heather Kindred,

John Retherford, Adrian Wilson, & Sarah Queener-Plourde,

Global Health

Professors Bantz and Li

December 10, 2008

 An Island of Health without Wealth 2

Medicine and healthcare cannot be isolated from the cultural and political realities

they are encompassed by. They are intricately and critically connected to each other

within any particular society (Payer, 1988). In the United States healthcare is treated as a

commodity. Like any commodity it is distributed by market forces according to an

individual’s ability to pay (Payer, 1988). In the US we live in an era when healthcare is

dominated by the treatment of chronic long term illnesses, when long range mass transit

spreads new viral strains and antibiotic resistant super-bacteria around the world in days,

and when constantly diminishing access to the healthcare system across social spectra is

unsustainably driving up costs for the system as a whole.

To rein in costs and maintain public health society must provide universal access

to local health care services including preventive services, health counseling, and health

education (Center of Disease Control and Prevention). This is only possible if the

commodity healthcare paradigm shifts to considering healthcare a universal human right

(Hong, p. 28). Cuba is a nation that strives to live up to this standard. Cuba delivers

healthcare in a cultural and political context quite different from that of the United States.

Cuba guarantees cost-free healthcare locally to every citizen, and despite major economic

and political obstacles it achieves remarkable health outcomes efficiently and equitably.

Cuba has pioneered a system of medical diplomacy in which it provides medical

personnel and medical training to developing countries as an instrument of trade policy.

Through its Comprehensive Health Program Cuba educates and treats its rural and urban

populations, while implementing medical solutions globally (Council on Hemisperic

 An Island of Health without Wealth 3

Affairs). This strategy develops and strengthens valuable diplomatic and trade

relationships while strengthening Cuba domestically by providing its citizens with much

needed healthcare resources, natural resources, and commodities. This is one of the

ingenious policies Cuba has adopted to deal with the severely restrictive US trade and

travel embargos.

To the Republic of Cuba, being isolated and left to its own local resourcefulness

is not a new concept. In fact, we could rightfully say that Cubans are masters of solidarity

(Thompson & Gaviria, 2004). Survival knowledge transfers into all activities of daily

life from one generation to the next. Without question, the embargos have made life

harsh for Cubans in many ways. Yet sometimes things with the potential to destroy

culture and remove life became a source of unifying strength, solidarity, and mobilizing

prowess. This sense of solidarity pervades nearly all aspects of Cuban life and culture.

Every country has its own culture and way of presenting itself. Entering another

culture can sometimes be a shock, but the best way to deal with this is to show respect for

how others choose to live life without analyzing it like a tourist or a film critic (Palomar

College). This respect can only be delivered by preventing one's own way of thinking

about perceived differences to interfere with the experience of immersion and learning

someone else's way of doing things. Listening and observing with a quiet mind is very

difficult task (Chawla & Renesch, p. 266-7). This can be especially true for Americans,

many of whom believe their political and cultural ideals are the only or at least the best

definition of liberty, democracy, and justice (Kohut & Stokes, p.127).

This is a type of subconscious rejection and is one of the ways in which one

culture dominates and displaces another in order to establish hegemony. On the other
 An Island of Health without Wealth 4

hand, a consciousness of equality demands acceptance and respect. Disrespect remains a

major reason for conflicts, persecution, and genocide (International Peace Research

Association). As Americans we must face our own biases, our misinformed and

disinformed thoughts about the culture and customs of the Cuban people, and about the

Republic of Cuba’s core social policies. If we do so we could learn important lessons

about how this small and isolated yet influential country has become a world leader in the

autonomous management of medical research, education, and healthcare delivery,

domestically and internationally (Gorry, 2008).

One central objective of Cuba's Constitution is to entitle all its citizens with a

right to free, quality medical care (Center for Latin American Studies). Cuba’s

government has rejected the use of medicine as a means of generating profit. In this

environment providers are incented more by a desire to make people healthy than by a

desire to maximize profits. Cuban doctors spend their days at their clinic but still make

house calls in the evenings (Salud International) largely because doing so is better for

their patients. Even though medical services are provided to all Cuba’s citizens, medical

supplies such as gloves, syringes, aspirin, general medicines, and medical equipment are

not always available. In fact, patients often have to supply their own linens and personal

hygiene items when at the hospital (Sixto, 2002). Despite being considered an

underdeveloped, third world country, Cuba is nationally respected and admired for its

leadership, advancements, and contributions to local and global medical research and

healthcare delivery (Gorry, 2008).

Education, especially reducing illiteracy, is one of the most effective and efficient

ways to reduce illness and disease in a population (not to mention its social and cultural
 An Island of Health without Wealth 5

benefits). Quality education is another priority of the Cuban government. Before 1965,

Cuba’s literacy rate was around 60%, but those figures have since risen to 96%. Cuba

now rates second among all Latin American countries. Elementary education is

mandatory between ages of 6 to 16, and free college or specialized training for a local job

market is offered freely to everyone. Cuba’s curriculum for primary education includes

learning about herbal medicine, renewable energy and climate change, information on

AIDS/HIV prevention, as well as several hours a week working in an agricultural

community.

Cuba's youth are well prepared by their educational system for the local and

international work force.(Inter-American Commission on Human Rights, p.6). It also

enhances their quality of life providing a richer sense of cultural grounding and

connectedness. In his book Dreams from my Father Barak Obama emphasized how

important this type of educational system is to learning by quoting Dr. Asante King, a

Chicago school principal, describing what he believes a real education for black children

would involve:

"It would start by giving a child an understanding of

himself, his world, his culture, his community…That's what
makes a child hungry to learn-the promise of being a part of
something, of mastering his environment…From day one he's
learning about someone else's history…someone else's
culture…this culture he's supposed to learn is the same culture
that's systematically rejected him, denied his humanity,"
(Obama, p. 258).

This model would be applicable to all races and it is apparent that Cuba's

educational system follows this model despite its small size and dense population. Cuba

is roughly the size of Louisiana (Smith, 1921) with over 11 million inhabitants.
 An Island of Health without Wealth 6

Louisiana, on the other hand, has a little over 4 million inhabitants (Robins & Trujillo,

2006). Cuba has, none-the-less, provided its citizens with unique comprehensive services

that rival most developed countries around the world, not only with health care but with

the over all wellbeing of its citizens, in sickness or in health (COHA).

The Cuban philosophy of health is based on the belief that disease prevention is a

more effective approach than treating a disease after it manifests. In 1984 Cuba

developed its Doctor-Nurse Family Team Program, which is a very effective poly-clinic

networking system, whereby each neighborhood has its own primary-health-team

specializing in disease prevention and education(Gorry, p.10-11). Cuba's intervention

programs effectively target specific high risk groups as well as the general population.

Cuba's holistic community-based approach puts the health and "illness aversion"

of all its citizens at the center of government spending. Despite Cuba's size, it has 21

medical schools, 20 hospitals in Havana, and 40 rural polyclinics (Inter-American

Commission on Human Rights). The U.S. for-profit healthcare system spends $6,000 per

capita per year, while Cuba's Universal healthcare costs a mere $320 per person (Cooper,

Kennelly & Garcia, 2006).

Cuba sets a global example caring for its own citizens. It is also developing

superior medical initiatives in cancer and AIDS research, which in turn have created trade

partnerships and alliances among the world's neediest countries. Cuba currently hosts

3,400 medical students from 23 countries, many being subsidized by the Cuban

government. Cuba has developed a world leading, highly sophisticated, Biotech Industry

that supplies inexpensive generic drugs to a global market that currently includes 50

counties (Health Care Systems in Comparison, 2007). It is truly remarkable that Cuba
 An Island of Health without Wealth 7

has overcome its forced isolation to become a global leader in the fight against the

HIV/AIDS epidemic. For the impoverished developing world, which is often unable to

afford expensive exported treatments from the United States, Cuba’s leadership had

created a real sense of hope.

The HIV/AIDS virus in Cuba was first detected in 1986 among returning soldiers

from Angola and Mozambique (Boadle, 2005). The chosen technique to deal with this

crisis was quarantine and surveillance in specialized facilities called Sanatoria. This

approach has proved to be one of the most effective in the world at preventing the spread

of the disease. As a preventive measure, Cuba performs mandatory but confidential

screening of high risks groups including those returning from abroad, its homosexual

population, and Mothers to be (Gorry, p.4).

Along with these measures, the Sanatorias first built to house and isolate returning

infected soldiers have since become housing and long term care facilities for those

diagnosed with HIV/AIDS. Cuba uses its limited resources to provide everything they

can to people with this life threatening condition. Education about risky behavior and

prevention is heavily emphasized. Condom use increased from 47% to 69% between

2001 and 2006. In 2004, over 90 million condoms were sold and made easily attainable

within the communities (Gorry, p.13).

Socially isolating the virus does not include socially isolating the person from

what makes him/her a member of that socio-economic community. Their civil liberties

remain in tact, along with their personal effects (Feinberg, 2006). In fact, they are so

protected from social isolation that the Cuban government enforces anti-bias philosophies

for potentially marginalized communities (Garcia & Daniel, 2001). Additionally, after a
 An Island of Health without Wealth 8

six months stabilization period, patients have the choice to live at the Sanatoria or in their

home. In the U.S. there is no such choice unless you can pay for specialized long-term

care. In Cuba there is no dehumanizing stigma. In Cuba one can keep their job and their

wages, and can continue to be loved by their family and community. Cuba’s joint

government-citizen responsible response to the needs of the larger community has a

dynamic message to send to the masses (WHO, 2004). The policy aids a person in living

to their fullest potential despite a debilitating illness. They enabling patients to keep their

human dignity and are certainly a model for the world to learn from.

The U.S. and Cuba deal with the same social issues in drastically contrasting

ways. According to Avert International Aids Charity Organization the United States HIV

outbreak was practically ignored until late in 1981, time in which the virus spread to

other populations of gay men and injection-drug-users (2008). By July 1982, 452 cases

had been reported to the CDC from 23 states. By the end of 1982 it had become clear that

the disease was appearing in European countries as well. Another article reported

disturbing estimated figures:

"In 1997, 45,000 people out of the 260-million American

population will become infected with the AIDS virus, and so far over
362,000 Americans have died; Cuba, with an 11-million population,
has since the start of the epidemic seen 1,681 infected."So far, [at the
writing of this article] 442 have died."
Coburn & Burr, 1997

While the numbers are difficult to compare directly Cuba has a new infection rate

of only .015% over a 15 year period, while the U.S. has a new infection rate of .017% in

the year 1997 alone. Even after accounting for the difference in population size Coburn

and Burr’s data indicate that in the history of the epidemic 35 people in the US die of
 An Island of Health without Wealth 9

AIDS for every 1 AIDS related death in Cuba. The number of reported AIDS cases in

Cuba is the lowest in the Western Hemisphere (Uriarte, 2002).

This emphasizes that Cuba has the experience and expertise to respond quickly

and efficiently to disastrous situations when they happen. In the beginning of the

outbreak, Cuba understood that HIV/AIDS was an infectious disease that could infect

anyone in the entire population, regardless of a person's sexual behavior. In 1987 Cuba

launched the National Program for Prevention and Control in Havana. HIV test kits

became available and 33 research laboratories were established. A free Generic Anti-

retroviral drug was developed in 2001. One other very crucial step Cuba took to prevent

an epidemic to dispose of some 20,000 imported and possibly infected blood products

and make blood screening standard practice as early as 1986 (Gorry, p.6-8).

The U.S. embargo has left Cuba extremely restricted from imports of simple but

essential medical supplies that they themselves cannot manufacture (Farag, 2000). It

cripples Cuba’s ability to deliver treatments and conduct research. With Cuba’s wealth

of experienced personnel this stifling effect does significant damage to world efforts to

combat HIV/AIDS. What Cuba has demonstrated foremost is that health and wellness

can be a national priority. Public expendetures can efficiently and effectively provide free

universal health care and education to the public. Access to health and medicine need not

be dependent on one’s ability to pay. What Cuba has also demonstrated is that rapid

response and isolation of a life threatening epidemic disease (and government

coordination of interventions, education, and medical research) is essential to controlling

potential outbreaks.
 An Island of Health without Wealth 10

To the United States Cuba may well be the most controversial, misunderstood,

and neglected foreign neighbor. Yet many facts about healthcare and health in Cuba are

laudable. Equality is a social policy that promotes, guarantees, and distributes adequate

basic human rights necessary to sustain life. Disparity and social policies that create

inequality, on the other hand, increases poverty, create discrimination and disparity, and

damage the health of entire populations (Betzruchka, 2004). Inequality creates an

environment of disease, illness, and high mortality. Solidarity is what a people bound to

one another through their history and culture can have while surviving all odds together

as a Nation.

Cuba leads the world in promoting responsible choices for the entire world

population. Disease management knows no borders or boundaries. Recognizing this

fundamental truth Cuba not only develops solutions to its own crisis situations, it

responsibly shares its expertise and its resources (as limited as they are) with other

struggling countries. Cuba sets a humanitarian example for the world to follow despite

low economic output. In 1989, when the Soviet system collapsed, Cuba was 85%

dependent upon them for imports and exports. It quickly had to develop creative means

of surviving. Yet when Cuba's need was at its highest, the U.S., its closest neighbor,

made the embargo restrictions even more severe, in the minds of some bordering on in-

humane and genocidal. Cuba continues, none the less, to send its star, out to an ailing

world. If the world looks carefully it might find valuable lessons contained in this island

of health without wealth.

 An Island of Health without Wealth 11

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 An Island of Health without Wealth 13

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