Health in Cuba

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Health in Cuba refers to the overall health of the population of Cuba.

There was an overall improvement in Health in Cuba in terms of disease and infant mortality rates after the revolution.[1] Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991; the stepping up of the US embargo against Cuba at this time also had an effect. Cuba has one of the highest life expectancy rates in the region, with the average citizen living to 78.05 years old[2] (in comparison to the United States' 78.62 years[3]).

History[edit]

In the 1950s, the island had some of the most positive health indices in the Americas, not far behind the United States and Canada. Cuba was one of the leaders in life expectancy, and the number of doctors per thousand of the population ranked above Britain, France and the Netherlands. In Latin America it ranked in third place after Uruguay and Argentina.[4] There remained marked inequalities however. Most of Cuba's doctors were based in the relatively prosperous cities and regional towns, and conditions in rural areas, notably Oriente, were significantly worse.[5] The mortality rate was the third lowest in the world.[6] According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.[6]

Following the Revolution and the subsequent United States embargo against Cuba, an increase in disease and infant mortality worsened in the 1960s.[1] The new Cuban government asserted that universal healthcare was to become a priority of state planning. In 1960 revolutionary and physician Che Guevara outlined his aims for the future of Cuban healthcare in an essay entitled On Revolutionary Medicine, stating: "The work that today is entrusted to the Ministry of Health and similar organizations is to provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices."[7]

Post-Soviet Union[edit]

The loss of Soviet subsidies brought food shortages to Cuba in the early 1990s.

A Canadian Medical Association Journal paper states that "The famine in Cuba during the Special Period was caused by political and economic factors similar to the ones that caused a famine in North Korea in the mid-1990s. Both countries were run by authoritarian regimes that denied ordinary people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military."[8] The regime did not accept donations of food, medicines and money from the US until 1993.[8]

Malnutrition created epidemics, but it had positive effects too. Manuel Franco describes the Special Period as "the first, and probably the only, natural experiment, born of unfortunate circumstances, where large effects on diabetes, cardiovascular disease and all-cause mortality have been related to sustained population-wide weight loss as a result of increased physical activity and reduced caloric intake".[9]

Present[edit]

WHO health statistics for Cuba
Source: WHO country page on Cuba
Life expectancy at birth m/f: 76.0/80.0 (years)
Healthy life expectancy at birth m/f: 67.1/69.5 (years)
Child mortality m/f: 8/7 (per 1000)
Adult mortality m/f: 131/85 (per 1000)
Total health expenditure per capita: $251
Total health expenditure as % of GDP: 7.3
Rank Countries
surveyed
Statistic Date of
Information
125 167 HIV/AIDS adult prevalence rate 0.10% 2003 est.
162 175 Fertility rate 1.66 (children/woman) 2006.
153 224 Birth rate 11.89 (births/1,000 population) 2006 est.
168 226 Infant mortality rate 6.04 (deaths/1,000 live births) 2006.
129 224 Death rate 6.33 (deaths/1,000 population) 2005.
37 225 Life expectancy at birth 77.23 (years) 2006. est
17 99 Suicide rate 18.3 per 100,000 people per year 1996.*
All statistics from the World Factbook except * taken from World Health Organization figures.

Comparison of pre- and post-revolutionary indices[edit]

Life expectancy at birth in Cuba in 1955 was 63 years.[10] In 1960 it was 63.9 years.[11] To put these values in context, life expectancy at birth in some other regions and countries in 1960 were as follows (World Bank data):
World, 50.18 years;
Latin America and Caribbean, 56.21 years;
high-income OECD countries, 69.01 years;
United States, 69.77 years.[12]

In 2007, the life expectancies at birth were as follows (World Bank data):
Cuba, 78.26 years;
World, 68.76 years;
Latin America and Caribbean, 73.13 years;
high income OECD countries, 79.66 years;
United States, 77.99 years.[13]

The mortality rate for children under five years old was 54 per 1000 in Cuba in 1960 (World Bank).[14] That year in Latin America and the Caribbean it was 154.66 per 1000; in the high-income OECD countries it was 43.11; in the United States, 30.2. No World datum is available for 1960, but for 1970 it was 145.67 per 1000 (all World Bank data).[13]

The mortality rates for children under five in 2007 were as follows (World Bank):
Cuba, 6.5;
World, 68.01;
Latin America and Caribbean, 26.37;
high-income OECD, 5.71;
United States, 7.60.[13]

Infant mortality was 32 per 1000 live births in Cuba in 1957.[15] In 2000-2005 it was 6.1 per 1000 in Cuba; and, for comparison, 6.8 per 1000 in the United States.[16] The 2007 infant mortality rates published by the World Health Organisation in 2009 were:
Cuba, 5;
World, 46;
High income countries, 6;
United States, 6.[17]

The table below shows CEPAL (United nations) data spanning the pre- and post-revolutionary periods for three public health indicators. Health levels were better than the Latin American average before the revolution and showed continued steady improvement throughout the post-revolutionary period. The total mortality rate shown is the crude – i.e., not age-adjusted – rate, and therefore tends to rise as the proportion of elderly people in the population increases, which has been the case in Cuba because the birth rate is falling and life expectancy is rising.

Cuba: Public health 1950-2005
1950-55 1955-60 1960-65 1965-70 1970-75 1975-80 1980-85 1985-90 1990-95 1995-00 2000-05
Life expectancy 59.5 62.4 65.4 68.6 71.0 73.1 74.3 74.6 74.8 76.2 77.1
Mortality rate 10.73 9.21 8.56 7.30 6.37 5.94 6.31 6.65 7.06 6.66 7.08
Under-5 mortality 112.4 93.9 75.9 58.6 43.6 27.0 21.2 19.3 18.7 11.8 7.72
Notes:

Life expectancy is life expectancy at birth. Mortality rate is the crude mortality rate; i.e., annual number of deaths per 1,000 inhabitants. The under-5 mortality is the number of deaths of children up to age five, per 1,000 live births.
Source: United Nations, Comisión Económica para América Latina y el Caribe (Economic Commission for Latin America and the Caribbean—CEPAL), Cepal Stat, Social Indicators and Statistics.

Health indicators and issues[edit]

Cuba began a food rationing program in 1962 to guarantee all citizens a low-priced basket of basic foods. As of 2007, the government was spending about $1 billion annually to subsidise the food ration. The ration would cost about $50 at an average grocery store in the United States, but the Cuban citizen pays only $1.20 for it. The ration includes rice, legumes, potatoes, bread, eggs, and a small amount of meat. It provides about 30 to 70 percent of the 3,300 kilocalories that the average Cuban consumes daily. The people obtain the rest of their food from government stores (Tiendas), free market stores and cooperatives, barter, their own gardens, and the black market.[18]

According to the Pan American Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories):
Cuba, 3,286;
America, 3,205;
Latin America and the Caribbean, 2,875;
Latin Caribbean countries, 2,593;
United States, 3,754.[19]

Distribution of years of life lost by cause (%)
Place Communicable Non-communicable Injuries
Cuba 9 75 16
World 51 34 14
High income countries 8 77 15
United States 9 73 18
Low income countries 68 21 10
Source: World Health Organisation. World Health Statistics 2009, Table 2, "Cause-specific mortality and morbidity".

The reasons people die in Cuba tend to be the same as in high-income, developed, countries. The table at right shows the relative seriousness of communicable diseases, non-communicable diseases (e.g., heart disease and cancer) and injuries, in various parts of the world. Data is from the World Health Organisation and is for year 2004.

Diseases of the circulatory system are the most common cause of death in Cuba, killing 306 people per 100,000 population in 2005. Neoplasms (cancer) are second, killing 173 per 100,000 population in 2005. The numbers killed by some other causes, in 2005 per 100,000 population, were: influenza and pneumonia 64, accidents 40, diabetes mellitus 18, intentional self-harm (suicide) 12, cirrhosis and other chronic liver diseases 10. Total mortality per 100,000 population was 754.

Abortion rates, which are high in Cuba, increased dramatically during the 1980s, but had almost halved by 1999 and declined to near-1970s levels of 32.0 per 1000 pregnancies. The rate is still among the highest in Latin America.[20]

Among adults less than 49 years old, accidents are the leading cause of death, though occupational accidents have declined significantly in the last decade. The homicide rate is 7.0 per 100,000. The rate of suicide in the island is higher than average in Latin America and has been among the highest in the region and the world since the nineteenth century.[21] Annual suicide deaths per 100,000 population (2003-2005 data) were: Cuba 13.6, Americas 7.7, Latin America and Caribbean 5.8, Latin Caribbean 8.7, United States 10.8.[22] Among older adults heart disease and cancer predominate as causes of mortality. General mortality has been "characterized by a marked predominance of causes associated with chronic noncommunicable diseases", according to the Pan American Health Organization.[23]

While preventive medical care, diagnostic tests and medication for hospitalized patients are free, some aspects of healthcare are paid for by the patient. Items which are paid by patients who can afford it are: drugs prescribed on an outpatient basis, hearing, dental, and orthopedic processes, wheelchairs and crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge.[24]

See also[edit]

Healthcare in Cuba

References[edit]

  1. ^ a b Dominguez, Jorge (1993), "Cuba since 1959", in Bethell, Leslie (ed., 1993), Cuba: a short history, Cambridge: Cambridge University Press
  2. ^ CIA World FactBook - Cuba - 2009
  3. ^ CIA World FactBook - US - 2009
  4. ^ Gott, R. (2004) Cuba: A New History (Yale : Yale University Press) p165. ISBN 0-300-10411-1
  5. ^ Hugh Thomas, Cuba : The pursuit of Freedom. p968-970 "[since the revolution] The distribution of food has been erratic. Still, few die of malnutrition and, particularly in Oriente province, the very poor peasants must be fed better and more regularly than before the revolution" - "The revolution has in many ways improved everybody's health. Medicines are more fairly distributed throughout the country. Preventative medicine has been much emphasized and many clinics have been established in rural areas."
  6. ^ a b "Cuba Before Fidel Castro". 
  7. ^ On Revolutionary Medicine by Che Guevara Monthly review
  8. ^ a b "Health consequences of Cuba's Special Period". Canadian Medical Association Journal. 
  9. ^ Carroll, Rory (27 September 2007). "Economic crisis boost to health of Cubans". London: The Guardian. Retrieved 4 May 2010. 
  10. ^ "Cuba facts issue 43". December 2008. 
  11. ^ Life expectancy at birth, total (years); retrieved 2010-10-29.
  12. ^ World Bank, Quick Query (op cit.), retrieved 2009. High income OECD (Organisation for Economic Cooperation and Development) countries were defined by the World Bank in 2009 as those with 2007 per capita GNI of at least $US 11,456 (notes to Quick Query).
  13. ^ a b c World Bank, Quick Query, op cit., retrieved July 2009.
  14. ^ Quick Query, op cit., retrieved July 2009
  15. ^ Note: the source for this datum quotes data selectively and may not be a reliable source according to Wikipedia's standards. Kirby Smith and Hugo Llorens. "Renaissance and decay: A comparison of socioeconomic indicators in pre-Castro and current-day Cuba" (PDF). Archived from the original (PDF) on 2009-07-13. 
  16. ^ http://www.un.org/esa/population/publications/wpp2006/WPP2006_Highlights_rev.pdf
  17. ^ These are the probability of dying between birth and age one, per 1000 live births. World Health Organisation, World Health Statistics 2009, Table 1, "Mortality and burden of disease." Retrieved July 2009.
  18. ^ Snow, Anita (2 July 2007). "Living on Cuban Food Ration Isn't Easy". Washington Post. Retrieved 4 May 2010. ;
    United States Department of Agriculture, "Cuba's Food & Agriculture Situation Report" (PDF). Archived from the original (PDF) on 2013-11-05. . The Post article says that the government estimates that the ration meets about 1/3 of a person's food requirement; but the USDA Report (p 24 of the.pdf) says the ration meets roughly 2/3, although estimates vary.
  19. ^ Pan American Health Organization, "Health situation in the Americas: Basic Indicators 2008"; retrieved July 2009.
  20. ^ An evaluation of four decades of Cuban healthcare Archived 2010-06-19 at the Wayback Machine.. Filipe Eduardo Sixto, 2002.
  21. ^ To Die in Cuba: Suicide and Society. By Louis A. Pérez, Jr. access online
  22. ^ Pan American Health Organization, Health situation in the Americas: Basic Indicators 2009, op cit., p 6.
  23. ^ "Cuba Demographic indicators". Pan American Health Organization. 
  24. ^ Jerry M. Spiegel and Annalee Yassi "Lessons from the margins of globalization: appreciating the Cuban health paradox" in Journal of Public Health Policy, Volume 25, Number 1, 2004, pp. 85–110(26)online. "Patients pay for drugs, hearing, dental,and orthopedic prostheses, wheelchairs, crutches, and similar items but prices are low and subsidized by the state; and in the case of low-income patients, these items are offered free of charge"