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8/9/2019 An Island of Health Without Wealth Final
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An Island of Health without Wealth 1
An Island of Health without Wealth
Research Analysis: Cubas Health and HealthcareThrough 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
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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
individuals 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 ProgramCuba educates and treats its rural and urban
populations, while implementing medical solutions globally (Council on Hemisperic
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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
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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 Cubas 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). Cubas
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 Cubas 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
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benefits). Quality education is another priority of the Cuban government. Before 1965,
Cubas 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. Cubas 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:
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.
"It would start by giving a child an understanding ofhimself, his world, his culture, his communityThat's what
makes a child hungry to learn-the promise of being a part ofsomething, of mastering his environmentFrom day one he'slearning about someone else's historysomeone else's
culturethis culture he's supposed to learn is the same culture
that's systematically rejected him, denied his humanity,"(Obama, p. 258).
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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
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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, Cubas 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
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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. Cubasjoint
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:
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 Burrs data indicate that in the history of the epidemic 35 people in the US die of
"In 1997, 45,000 people out of the 260-million Americanpopulation will become infected with the AIDS virus, and so far over362,000 Americans have died; Cuba, with an 11-million population,has since the start of the epidemic seen 1,681 infected."So far, [at thewriting of this article] 442 have died."
Coburn & Burr, 1997
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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 Cubas ability to deliver treatments and conduct research. With Cubas 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 ones 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.
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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.
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