Cuba's superior health system

June 8, 2007

Having just visited Cuba — and as a former head of public health for the Perth east metropolitan region and former chairperson of the Royal Australian College of General Practitioners — it was obvious to me that the 45-year US trade embargo against the island-state has seriously affected its ability to provide health services to its people.

Despite this, the facts speak for themselves. According to the CIA's own website, Cuba's average life expectancy is 77 years compared with the 78 for the US; infant mortality in Cuba is 6.04 per 1000 live births (better than in the 6.37 per 1000 in the US); and, HIV incidence is less than 0.1% (0.6% in the US).

Cuba has achieved these results with one of the lowest levels of health-care spending in the world — about US$250 per capita, compared to $6000 in the US and around $3000 in most First World countries.

Here of course is the rub. Higher spending on health care does not necessarily equate to better health care or a healthier society. Trying to get a hip replacement or coronary bypass in Cuba is restricted to those who need it rather than to those who can afford it.

In Cuba, you will not see a 75-year-old diabetic who still smokes getting coronary treatment that would be provided by private health insurance in Australia or the US.

A young student with whom I travelled previously to Cuba suffered a life threatening cerebral haemorrhage while travelling. Her emergency treatment and subsequent surgery in Cuba, which saved her life, was praised by her Australian neurosurgeons.

Patients with terminal cancer in Cuba are not forced to endure nauseating experimental and highly expensive chemotherapy and radiotherapy to give them a few months more of a terrible life. Yet, paradoxically, the incidence of diseases like cancer are considerably less in Cuba — quite possibly related to Cuba's refusal to use pesticides and other chemicals in producing food.

The incidence of diabetes and obesity — which are lethal time bombs in the US and Australia — are considerably less in Cuba, perhaps because of the lack of junk-food outlets and a general decline in the consumption of unnecessary food. Yet Cuba has performed more than 4000 kidney transplants at no cost to the patient and dialysis services are available in all regional centres.

Childhood immunisation rates in Cuba are almost 100%, whereas in Australia they are 90%. Cuba is one of the world's largest vaccine producers, and supplies many of its vaccines to the Third World. This is despite the efforts of the US government to block the supply of raw materials for vaccines to Cuba by
giant US drug company taking over European manufacturers in. (US legislation prevents any US company or its foreign-based subsidiaries from trading with Cuba).

The same US strategy applies to pharmaceuticals. Cuba manufactures the so-called 46 essential medications for supply to the Third World. These are drugs for the treatment of such basic conditions infections, hypertension and diabetes that have come off patent restrictions.

While these drugs are a bit out of date, from a public health point of view they will prevent over 90% of complications. The marginal 1-2% of improvement by newer, much more expensive drugs that are still on patent does not necessarily result in better health outcomes, yet doctors are easily persuaded by glossy brochures, dinners in top restaurants and slick drug company salespeople to try the newer versions — sometimes with dire results, for example, Vioxx and hormone replacement therapy.

Australia spends less than 1% on health promotion and illness prevention, largely subsidised by a tax on tobacco. In Cuba, by contrast, up to 10% of the health budget goes towards illness prevention.

Cuban GPs spend every afternoon doing home visits and health screening. Exercise physiologists and dieticians run neighbourhood- and school-based programs in physical exercise and nutrition.

These programs also form part of Cuba's agreement with Venezuela to exchange health services for oil. Cuba supplies some 20,000 doctors and public health promoters to the barrios of Caracas and the rural towns of the Andes and Amazon. This program has been responsible for restoring the sight of more than 600,000 patients from Venezuela and Central America who are flown to Cuba for eye surgery.

Cuba also provides secondary health clinics that are better equipped with X-ray, pathology, endoscopy, and ophthalmology than any comparable rural town in Australia.

There are a further 10,000 health workers from Cuba in other Third World countries.

After East Timor won its independence from Indonesia, the first doctors to go into the East Timorese countryside were from Cuba. Over the past three years, a 350-strong Cuban medical brigade, made up of physicians and technicians, has been working and teaching young doctors in East Timor. In addition, 500 East Timorese young people are studying medicine in Cuba, as part of a Cuban government-sponsored program that will allow East Timor to meet its public health needs by 2012.

On May 24, newly elected East Timorese President Jose Ramos-Horta highlighted Cuba for its "unselfish" aid to his impoverished country. "I thank Commander Fidel Castro for his leadership and his vision, which shows that, although our countries are distant, East Timor has always been one of his priorities in the field of medicine and health", Ramos-Horta told a seminar in Dili organised by East Timor, the UN, the European Union, the World Bank and Japan.

All Cubans have access to birthing services, which ensure a very low rate of infant mortality. Australian private obstetric patients who are "too posh to push" have Caesarean section rates approaching 40%, while Australian Indigenous patients in remote communities have no access at all to birthing services — a situation which I believe is similar in the ghettos of the US and in some states where medical litigation has just about caused the eradication of public maternity services.

In Australia, Aboriginal life expectancy is barely 58 for males and 63 for females — hardly evidence of a good medical system.

Yes, it may be hard to buy a headache pill in Cuba, but the country is well-resourced with traditional herbal medicine pharmacies that provide treatment for everything from period pain to migraines — treatments that are probably equally as effective and with less side effects.

Finally, there are around 70,000 young people from other Latin American and Caribbean countries being trained as health workers and doctors by Cuba — surely a better way to win the hearts and minds of the people than the US rulers' policy of rampant exploitation by profit-hungry corporations backed up by threats of "pre-emptive" war.

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