Health in Cuba

There was an overall improvement in Health in Cuba in terms of disease and infant mortality rates after the revolution. 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 (in comparison to the United States' 78.62 years).

Health in Cuba

Health care in Cuba is excellent and this has resulted in health outcomes similar to the United States of America for adults. Life expectancy at birth in 2013 was 78 years in Cuba and 79 years in the USA [1]. Child mortality rates are lower in Cuba than the United States. This is remarkable for a middle income country such as Cuba.

Health care

Health care in Cuba is free of charge. It is provided by the Cuban government and is universal. Health care in Cuba was initially modelled on the National Health Service in the UK. It has since been developed further, with a particular emphasis on prevention. Excellent primary health care is the key to the good health outcomes. Cuba has one of the highest doctor-to-patient ratios in the world [2]. This has been achieved by training their own doctors at universities, where education is free. Almost half of Cuban doctors work as a family doctor. The emphasis is on the doctor knowing each family, both medically and socially. This is extremely important in relation to child health where parents have a major influence on child health outcomes. The family doctor works in a consultorio, in conjunction with the nurse. Together, they are responsible for approximately 1100 patients.

These consultorios are grouped together into basic health groups. These contain approximately 14 consultorios. Each basic health group includes a physician, paediatrician, obstetrician/gynaecologist, dentist, psychologist and a statistician. The basic health groups work from polyclinics, and each polyclinic will contain one to three basic health groups. The basic health groups and polyclinics are a part of primary health care. They enable patients to see specialists within a primary health care setting. This enables communication between the family doctor, the specialist and the patient.

The next level of health care is in the hospital. Hospital services are provided throughout the country and work in a similar manner to hospitals in most high income countries. These include specialist hospitals that provide tertiary care in regional centres.

Child health

Child health is excellent in Cuba [3]. The Millennium Development Goal targets in relation to child health have been achieved. In order to ensure that children are born in as healthy a state as possible, there is a strong emphasis in prevention of disease and education for pregnant women. This includes education for women who are likely to become pregnant. This is where the family doctor plays a crucial role in that they know each family medically and socially.

Child mortality rates (neonatal, infant and under-five) are all lower in Cuba than in the United States of America. The under-five mortality rate is considered by UNICEF to be the best marker of the state of children within a nation. World Health Organisation data from 2013 showed that the under-five mortality rate was 6.2 deaths per thousand live births in Cuba [1]. This contrasts with a figure of 6.9 in the USA for the same time period.

Cuba has successfully managed to reduce the rate of low birth weight babies (less than 2.5 kg) [4]. This has been achieved by a variety of factors. These include reducing socioeconomic inequalities, providing excellent antenatal care as well as providing preconceptional care. In contrast, the percentage of low birth weight babies has been increasing in both the United States of America and the United Kingdom. Low birth weight babies have an increased risk of death and illness, especially in the first year of life.

All births are planned to occur in hospitals. 99.9% of births in Cuba occur in hospitals. The remaining 0.1% are usually born on route to a hospital. Breast feeding is strongly encouraged and breast feeding rates are high. As well as a large number of mothers breast feeding their baby, the proportion who continue to exclusively breast feed in the first few months of life is high. There is an extensive immunisation programme with an uptake rate of greater than 95%.

Maternal health

Life expectancy is higher for females than males. It is currently 81 for women and 76 for men. The majority of health professionals are women and contraception is freely available. There is a strong emphasis on looking after women during pregnancy. The maternity home provides nutrition, rest and education. Each woman receives a minimum of 13 antenatal check-ups during pregnancy. Maternal mortality ratios during childbirth are lower than that of women elsewhere in Latin America. They are however still relatively high. Between 1970 and 2013, infant mortality decreased by 89%. In contrast, maternal mortality only decreased by 45% [5]. Postpartum haemorrhage is the leading cause of maternal mortality in Cuba and is an area where Cuba needs to make further progress.

Adult health care

Adult life expectancy is similar to that of the USA. The main causes of death in adults are malignancies, cardiovascular disease, cerebrovascular disease, influenza and pneumonia, and accidents [2]. These causes of death are similar to that of most high income countries. Hypertension (raised blood pressure) is a greater problem in Cuban adults than adults from neighbouring countries [2]. Obesity is less of a problem than in neighbouring countries but a raised blood glucose is a greater problem in Cuban women than women from neighbouring countries. Infectious diseases are responsible for relatively few deaths. Although health care itself is free, patients do have to purchase medicines [6]. The cost of medicines is minimal.

Social determinants

Worldwide there is increasing recognition that social determinants such as poverty, illiteracy, poor housing, lack of sanitation all contribute to poor health outcomes. Cuba has an excellent free and universal education system. All children receive education. This has resulted in a population that is literate and educated. This is important in relation to preventing infectious diseases.

Hurricanes

Cuba due to its geographical location experiences regular hurricanes. The media warns the population about impending hurricanes and where necessary, individuals are aware that they will need to evacuate their home [7]. Because all adults are educated, they are aware of the risk of hurricanes. Additionally schooling is universal; all school children are taught about the danger of hurricanes. Shelter is provided alongside food and health care during such occasions.

Sanitation

Sanitation is a major factor in relation to infectious diseases. Although 96% of the urban population has access to improved drinking water sources, in the rural areas it is only 86% [2]. Similarly with regards to sanitation facilities, 94% of the urban population has access to sanitation facilities whereas only 87% of the rural population has such access [2].

International assistance

As well as providing excellent health care for its own population, Cuba plays a key role in providing health services in 60 other countries. Cuba for many years has provided emergency medical teams to countries throughout the world. They are now providing more extensive assistance to many countries. Cuba is also providing medical training for students from more than 90 countries at the Latin America School of Medicine in Havana.

References

1. World Health Organisation. World Health Statistics 2015.

2. World Health Organisation. Country Profile – Cuba.

3. Rodriguez FV, Lopez NB, Choonara I. Child health in Cuba. Arch Dis Child 2008; 93: 991-993

4. Lopez NB, Choonara I. Can we reduce the number of low birth-weight babies? The Cuban experience. Neonatology 2009; 95: 193-197.

5. Women and Children First. MEDICC Review 2015; 17: 3.

6. Bárzaga Arencibia Z, López Leyva A, Mejías Peña Y, González Reyes AR, Acosta Nápolez M, Carbonell Perdomo D, Fernández Manzano E, Choonara I. Access to antiepileptic drug therapy in children in Camagüey Province, Cuba. Int J Pharm Pract 2012; 20: 390-394.

7. Sánchez Miranda D, Choonara I. Hurricanes and child health: lessons from Cuba. Arch Dis Child 2011; 96: 328-329.

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".