The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens. All healthcare in Cuba is free to Cuban residents. There are no private hospitals or clinics as all health services are government-run.
Like the rest of the Cuban economy, Cuban medical care suffered following the end of Soviet subsidies in 1991. The United States embargo against Cuba also has an effect. Difficulties include low salaries for doctors, poor facilities, poor provision of equipment, and the frequent absence of essential drugs.
The Cuban healthcare system has emphasized the export of health professionals through international missions, aiding global health efforts. However, while these missions generate significant revenue and serve as a tool for political influence, domestically, Cuba faces challenges including medication shortages and disparities between medical services for locals and foreigners. Despite the income from these missions, only a small fraction of the national budget has been allocated to public health, underscoring contrasting priorities within the nation's healthcare strategy.
History
Modern Western medicine has been practiced in Cuba by formally trained physicians since at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world-class doctors, including Carlos Finlay, whose mosquito-based theory of yellow fever transmission was given its final proof under the direction of Walter Reed, James Carroll, and Aristides Agramonte. During the period of U.S. presence (1898–1902) yellow fever was essentially eliminated due to the efforts of Clara Maass and surgeon Jesse William Lazear.
In the 1950s 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. 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.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." The mortality rate was the third lowest in the world. According to the World Health Organization, the island had the lowest infant mortality rate of Latin America.
Following the Revolution and the subsequent United States embargo against Cuba, an increase in disease and infant mortality worsened in the 1960s. The new Cuban government stated that universal healthcare would 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."On Revolutionary Medicine by Che Guevara Monthly review These aims were hampered almost immediately by an exodus of almost half of Cuba's physicians to the United States, leaving the country with only 3,000 doctors and 16 professors in the University of Havana's medical college. Beginning in 1960, the Ministry of Public Health began a program of nationalization and regionalization of medical services. In 1965, Cuba became the first Latin American country to legalize abortion.
In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Cuban constitution which states "Everybody has the right to health protection and care. The State guarantees this right:
by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals and preventive and specialist treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease. All of the population cooperates in these activities and plans through the social and mass organizations."° English translation of the 1976 Constitution of Cuba Wikisource 1976 Constitution of Cuba 1976 (in Spanish) 404 Privatization of healthcare in Cuba is illegal and unnecessary as high quality, equal, care covered by the state is available to everyone as made necessary by Cuba's constitution.
Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9.2 doctors per 10,000 inhabitants in 1958, to 58.2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal vaccinations. This helped eradicate many contagious diseases including polio, tetanus, diphtheria and rubella, though some diseases increased during the period of economic hardship of the 1990s, such as tuberculosis, hepatitis and chicken pox. Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care. As of 2012, infant mortality in Cuba had fallen to 4.83 deaths per 1,000 live births compared with 6.0 for the United States and just behind Canada with 4.8.CIA World Factbook. Some experts have said that these statistics may reflect heavy-handed treatment of pregnant patients. Tassie Katherine Hirschfeld, an associate professor at the department of anthropology of the University of Oklahoma, said that doctors have incentives to falsify statistics, as a spike in infant mortality may cost them their jobs. She also said pregnant women may be pressured to undergo abortions if fetal abnormalities are detected or forcibly placed under monitoring if complications arise. Hirschfeld said Cuba does not allow for independent verification of its health data.
Post-Soviet Union
Loss of Soviet subsidies brought food shortages to Cuba in the early 1990s. The famine during the Special Period was caused by an authoritarian regime that denied people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military. The Cuban government began accepting US donations of food, medicines and cash in 1993. It established a system of private farmers' markets in 1994 to provide citizens with easy access to locally grown food.
Epidemiologist 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".
In 2007, Cuba announced that it has undertaken computerizing and creating national networks in blood banks, nephrology and medical images. Cuba is the second country in the world with such a product, only preceded by France. Cuba is preparing a computerized health register, hospital management system, primary health care, academic affairs, medical genetic projects, neurosciences, and educational software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research-development projects. An important link in wiring process is to guarantee access to Cuba's Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health system.
United States embargo
During the 1990s the ongoing United States embargo against Cuba caused problems due to restrictions on the export of medicines from the US to Cuba.The Impact Of The US Embargo On The Health And Nutrition In Cuba. Online. American Association for World Health Report. March 1997. Accessed 6 October 2006. Supplementary source : American Public Health Association website In 1992 the US embargo was made more stringent with the passage of the Cuban Democracy Act resulting in all U.S. subsidiary trade, including trade in food and medicines, being prohibited. The legislation did not state that Cuba cannot purchase medicines from U.S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the Inter-American Commission on Human Rights of the Organization of American States informed the U.S. Government that such activities violate international law and has requested that the U.S. take immediate steps to exempt medicine from the embargo. The Lancet and the British Medical Journal also condemned the embargo in the 90s.BMA must voice its opposition to Cuban embargo 404. British Medical Journal. 1998. Accessed 6 October 2006.
The embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs from foreign subsidiaries of U.S. firms or from non-U.S.sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cuba's medical system. It prohibited foreign subsidiaries of U.S. corporations from selling to Cuba, thus further limiting Cuba's access to medicine and equipment, and raising prices. In addition, the act forbid ships that dock in Cuban ports from docking in U.S. ports for six months. This drastically restricted shipping, and increased shipping costs some 30%.Myths and Facts about the US embargo on medicines and supplies. Oxfam America and the Washington Office on Latin America.
In 1997, the American Association for World Health stated that the embargo contributed to malnutrition, poor water access, lack of access to medicine and other medical supplies and concluded that "a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventative medicine to all its citizens."
In 2000, the Trade Sanctions Reform and Export Enhancement Act was passed. The US became Cuba's single largest source for imported food. The Cuban American National Foundation (CANF) states that should Cuba choose not to purchase from the U.S., it can purchase any medicine or medical equipment it needs from other countries. Such third-country transactions only cost an estimated 2%–3% more than purchases from the U.S. as a result of higher shipping costs. CANF also asserts the United States is the largest donor of humanitarian assistance to Cuba and much of this consists of medicines and medical equipment.
The US government states that since 1992, 36 out of 39 license requests from U.S. companies and their subsidiaries for sales of medical items to Cuba have been approved. The dollar amount of these sales is over $1,600,000. Furthermore, the U.S. government licensed more than $227 million in humanitarian donations of medicines and medical supplies to Cuba between 1993 and 1997. There are other factors beside the embargo explaining the lack of imports, in particular Cuba's lack of hard currency. Those with dollars can easily buy medicines and food in Cuba from Latin America and Canada. Cuba defaulted on its debt to Western banks in 1986 and lacks access to the international credit system in order to get foreign currency. In addition, the collapse of the Soviet Union caused the loss of several billions of dollars in yearly subsidies and overnight required hard currency for all imports.