Cuba una lección en salud

Cuba: health lessons not under embargo

The Lancet

DOI: http://dx.doi.org/10.1016/S0140-6736(14)62463-6

Article Info

• Summary
• Full Text
• Tables and Figures

2014 ended with a historic change in relations between Cuba and the USA. “After all, these 50 years have shown that isolation has not worked”, stated US President Barack Obama on Dec 17. Although issues around politics, freedom, and civil rights still stand and should not be overlooked, Obama pointed out, “Where we can advance shared interests, we will—on issues like health, migration, counterterrorism, drug trafficking and disaster response”. Obama cited health. With a life expectancy of 79 years, 67 doctors per 10 000 people (whereas the regional average is 21 per 10 000), and with hundreds of Cuban doctors now fighting Ebola in west Africa, health indeed does come to mind first when one thinks of Cuba.

According to the Global Burden of Disease 2013 data published in The Lancet, Cuba's top three killers (ischaemic heart disease, stroke, and lung cancer) are typical of high-income countries. Cuba's maternal mortality ratio of 39·8 per 100 000 livebirths is low compared with that of Brazil and Mexico (58·7 and 54·0, respectively), and has improved notably in the past decade. Cuba has an under-5 mortality rate of 5·7 per 1000 livebirths, below that of the USA (6·6).

While under economic sanctions, the country could be considered paralysed, but health indicators are telling us a different story—a complex story, a paradox. Although the embargo has had severe consequences for many sectors of Cuban life, such as infrastructures and technologies, health has been a success. Cuba's health system has been able to solve some issues that other countries have not. The Cuban health system, which is free and firmly anchored in disease prevention and primary care, provides good health outcomes at a cost within the reach of most middle-income countries.

Despite the severe constraints on resources that Cuba has had to endure, the country provides an interesting example of what can be achieved by prioritising health and education. As Anthony Robbins points out in a letter in today's issue, public health could and should lead the way in a renewed relationship between Cuba and the USA.

Melvyn Longhurst/Corbis