Michael Blumenthal, the President of the Commonwealth Fund, published an essay yesterday, November 28, entitled “Fidel Castro’s Health Care Legacy.”
As our readers are no doubt aware, Cuba’s former president Fidel Castro passed away on Friday.
In his essay, Dr. Blumenthal noted the concerted efforts by the the U.S. government — over a period of 60 years, and under both Republican and Democratic administrations — to bring about the fall of Cuba’s socialist government. Those efforts included half a century of economic sanctions and embargoes, travel prohibitions, attempted invasions, and documented attempts to assassinate the Cuban President. (Some authorities estimate that Castro survived more than 600 assassination attempts.)
There’s no doubt these American government efforts have made life more difficult for the Cuban people, who earn on average about $20 a month. To what purpose? By objective standards, the oppression of the Cuban people hardly seems worth the trouble. The population — 11 million — is smaller than Ohio’s; its land mass about the size of Pennsylvania. Its per capita gross domestic product (GDP) ranks behind Mongolia and Albania.
Dr. Blumenthal’s essay grew out of his visit to Cuba earlier this month. In it, he examines Cuba’s investments in primary care and public health and their impact on the health of the population — and looks at Castro’s emphasis on training medical professionals and on biomedical research, which have produced exportable services and pharmaceuticals.
Here are a few excerpts from what I found to be a fascinating story about healthcare in a desperately poor country.
“When it comes to health care, Cuba is a success story with few parallels. Since its 1959 revolution, Cuba’s infant mortality rate has fallen from 37.3 to 4.3 per 1000 live births — a rate equivalent to Australia’s and lower than the United States’ (5.8). From 1970 to 2016 life expectancy increased from 70.04 to 78.7 years, approaching expectancy in the United States (79.8). Cuba’s leading health care problems — non-communicable diseases such as heart disease, cancer, and stroke — are typical of much more wealthy countries.
“Cuba achieved these successes despite the trials of what it euphemistically calls its ‘special period’ (lasting much of the 1990s) when its GDP dropped precipitously by a depression-equivalent of 35 percent. This downturn resulted from the collapse of the Soviet Union and Cuba’s loss of its economic subsidies. The average Cuban shed 25 to 35 pounds because of food and fuel shortages during the special period. Cuba has also had to contend with the crippling U.S. embargo that restricts access to many drugs and medical devices.
“By almost all accounts, Cuba’s health care achievements directly reflect the decisions of Fidel Castro. The Cubans we met consistently reported that Castro personally prioritized two services: education and health care. While these reports may reflect the Cuban party line, there is objective evidence reflecting these investments. Cuba’s literacy rate is 99.8 percent (some health care personnel actually complained, tongue-in-cheek, of how knowledgeable and demanding their patients are). The nation’s commitments to health care are also widely apparent.
“Cuba spends about 10 percent of its GDP on health care. Services are free and funded by the state. Its delivery system prioritizes primary care and public health, and extends into virtually all the island’s communities. The system operates at three levels. At its base is a network of almost 13,000 local family practices and 451 polyclinics that offer general and specialty care. Family practices consist of a physician and a nurse who live in the communities they serve. Each practice is responsible for between 1,000 and 1,500 patients, and physicians are required to visit every patient in their home at least yearly (or more often, if indicated).
“Cuba’s investments in health care go beyond direct services and reflect Castro’s evident belief in health and biomedical science as long-term mainstays of the Cuban economy. Cuba has trained a surplus of physicians in its 13 medical schools, and sends 50,000 health professionals, including 25,000 physicians, abroad annually to provide care in developing countries. Recently, it has begun charging for these services, making health care an export equivalent and a source of scarce foreign exchange.”
These are some remarkable numbers, when we compare the vast wealth of the United States — now expending more than 17 percent of its GDP on healthcare services — with the poverty of an island nation that spends only 10 percent of its meager GDP on healthcare, and yet educates so many doctors and other healthcare professionals that it can afford to export doctors to other countries.
We can each come to our own conclusions, from reading Dr. Blumenthal’s essay. One conclusion might be that capitalism is an appropriate economic system for certain types of industries — but if we want optimum health for all our citizens, a system of medical care based on capitalism might be the poorest choice for a wealthy nation.