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The for Public Health is José Ramón Balaguer . HISTORY As was true of the other indigenous societies of the Americas, Cuban Traditional Medicine existed before the Spanish conquest. High status traditional practitioners were called Bohiques . After colonization, Cuban medicine followed the Spanish tradition which was inherited from the Moors , who drew upon classical Greek and Roman medical practices. Chinese Medicine has also been practiced in Cuba, the most famous was the 19th century Doctor Cham Bom Biam or “El Medico Chino”. El Médico Chino Professor Luis Enrique Ramos Guadalupe. Habana Radio , a healthcare educational facility built by the religious order San Juan de Dios in the mid 19th century]] Modern Western Medicine has been practiced in Cuba by formally trained and surgeon Jesse W. Lazear.[http://www.nursingworld.org/hof/maascl.htm Clara Louise Maass] By the 1950s, the island had some of the most positive health indices in the Americas, not far behind the United States and Canada. Cuba was one of the leaders in terms of life expectancy, and the number of doctors per thousand of the population ranked above Britain, France and Holland. In Latin America it ranked in third place after Uruguay and Argentina.Gott, R. (2004) ''Cuba: A New History'' (Yale : Yale University Press) p165. ISBN 0-300-10411-1 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 " the revolution The distribution of food has been erratic. Still, few die of malnutritian and, particuarily in Oriente province, the very poor peasants must be fed better and more reguarily than before the revolution" - "The revolution has in many ways improved everybody's health. The availability of medicines has been much more fairly distributed throughout the country. Preventitive medicine has been much emphasized and many clinics have been established in rural areas." Only 8% of the rural population had access to healthcare. PBS - Views on Cuba Following the Revolution, the new and Regionalization of medical services. In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised Wikisource 1976 Constitution of Cuba 1976 (in Spanish) 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. An evaluation of four decades of Cuban healthcare . Filipe Eduardo Sixto. In the 1960s the government implemented a program of almost universal vaccinations. This helped eradicate many contagious diseases including Polio 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. In 2007, Cuba announced that it has undertaken computerising 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 Computerised 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. {Link without Title} PRESENT
Health indicators and issues Like the rest of the Cuban Economy , Cuban medical care has suffered from severe material shortages following the end of Soviet subsidies and the ongoing United States Embargo Against Cuba that began after the Cuban Missile Crisis . The effects of the U.S. embargo on medicines in Cuba have been studied in numerous reports. • R Garfield and S Santana. Columbia University, School of Nursing, New York; "The impact of the economic crisis and the US embargo on health in Cuba" "this embargo has raised the cost of medical supplies and food Rationing, universal access to primary health services" • American Association for World Health; Online . American Association for World Health Report. March 1997. Accessed '' 6 October 2006 ''. Supplementary source : American Public Health Association website "After a year-long investigation, the American Association for World Health has determined that the U.S. embargo of Cuba has dramatically harmed the health and nutrition of large numbers of ordinary Cuban citizens." • Felipe Eduardo Sixto; An evaluation of Four decades of Cuban Healthcare . "The lack of supplies accompanied by a deterioration of basic infrastructure (potable water and sanitation) resulted in a setback of many of the previous accomplishments. The strengthening of the U.S. embargo contributed to these problems." • Pan American Health organization; Health Situation Analysis and Trends Summary {Link without Title} "The two determining factors underlying the crisis are well known. One is the dissolution of the Soviet Union and the socialist bloc, and the other is the economic embargo the Government of the United States." • Harvard Public Health; Review/Summer 2002 : The Cuban Paradox "Because its access to traditional sources of financing is seriously hindered by the sanctions, which until recently included all food and medicine, Cuba has received little foreign and humanitarian aid to maintain the vitality of its national programs" • The Lancet medical journal; Role of USA in shortage of food and medicine . "The resultant lack of food and medicines to Cuba contributed to the worst epidemic of neurological disease this century." According to the World Health Organization (WHO), the chance of a Cuban child dying at five years of age or younger is 7 per 1000 live births in Cuba, while it's 8 per 1000 in the US. WHO reports that Cuban males have a life expectancy at birth of 75 years and females 79 years. In comparison, the US life expectancy at birth is 75 and 80 years for males and females, respectively. Cuba's infant mortality rate is better than the US with 5 deaths per thousand in Cuba versus 7 per thousand in the US. Cuba has nearly twice as many physicians as the U.S. -- 5.91 doctors per thousand people compared to 2.56 doctors per thousand, according to WHO. [http://www.who.int/countries/cub/en WHO , retrieved Aug 1 , 2007 Abortion rates, which are high in Cuba, increased dramatically during the 1980s, but had almost halved by 1999 and declined to near 1970s levels of 32.0 per 100 pregnancies. The rate is still among the highest in Latin America and also one explanation for the low infant mortality rate. Among adults less than 49 years old, accidents are the leading cause of death, though occupational accidents have declined significantly in the last decade. The suicide rate is 18.2 per 100,000 is higher and the homicide rate is 7.0 per 100,000. The rates of suicide in the island are the highest in Latin America and have been among the highest in the region and the world since the nineteenth century. To Die in Cuba: Suicide and Society. By Louis A. Pérez, Jr. access online Cuban-American suicide rates in Miami are lower than other Miami groups. Study: Suicide epidemic exists under Castro Miami Herald June 18 , 1998 Among older adults Heart Disease and Cancer predominate as causes of mortality. General mortality has been "characterized by a marked predominance of causes associated with chronic noncommunicable diseases", according to the Pan American Health Organization . Cuba Demographic indicators Pan American Health Organization While basis, hearing, Dental , and Orthopedic processes, Wheelchair s and Crutch es. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidised by the state. For patients on a low-income, these items are free of charge.Jerry M. Spiegel and Annalee Yassi "Lessons from the margins of globalization: appreciating the Cuban health paradox" in Journal of Public Health Policy, Volume 25, Number 1, 2004, pp. 85-110(26) online . "Patients pay for drugs, hearing, dental,and orthopedic prostheses, wheelchairs, crutches, and similar items but prices are low and subsidized by the state; and in the case of low-income patients, these items are offered free of charge" However, these drugs are usually not of the current generation in use, and in general free drugs and treatments are not of the modern variety . Sexual health According to the UNAIDS report of 2003 there were an estimated 3,300 Cubans living with HIV / AIDS (approx 0.05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for HIV . Those who tested positive were taken to Los Cocos and were not allowed to leave. The policy drew criticism from the United Nations and was discontinued in the 1990s. Since 1996 Cuba began the production of generic Anti-retroviral drugs reducing the costs to well below that of developing countries. This has been made possible through the substantial government subsidies to treatment. Approaches to the management of HIV/Aids in Cuba World Health Organization In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. High HIV-1 genetic diversity in Cuba AIDS 2002 Official Journal of the International AIDS society. The . According to Avert , an international AIDS charity, "Cuba’s epidemic remains by far the smallest in the Caribbean." They add however that,
In recent years because of the increase in Prostitution and lack of prevention, STDs have increased significantly. Embargo During the 90s the ongoing 2006 ''. The Impact Of The US Embargo On The Health And Nutrition In Cuba. Online . American Association for World Health Report. March 1997. Accessed '' 2006 . A 1997 report prepared by Oxfam America and the Washington Office on Latin America, ''Myths And Facts About The U.S. Embargo On Medicine And Medical Supplies'', concluded that 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 forbids ships that dock in Cuban ports from docking in U.S. ports for six months. This drastically restricts shipping, and increases shipping costs some 30%. Myths and Facts about the US embargo on medicines and supplies . Oxfam America and the Washington Office on Latin America. However, in 2000 the ''Trade Sanctions Reform and Export Enhancement Act'' was passed, and the US is now the single largest source for imported food.http://globalization.about.com/od/bigstories/a/cubaembargo.htmhttp://www.cbsnews.com/stories/2006/09/24/eveningnews/main2036729.shtml The Cuban American National Foundation state that the US embargo does not include medicines and medical supplies to the Cuban people. It also 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. {Link without Title} 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. {Link without Title} In a 2006 report to the U.N. Secretary-General, Cuba acknowledged the authorization of medicines, though stated that they were subject to severe restrictions and complicated procedures. Cuba is obliged to make payments in cash and in advance, and is precluded from obtaining credit funding, even from private sources. The sale and transportation of the goods require licences to be obtained for each transaction. Cuba cannot use its own merchant fleet for transporting these goods, but has to make use of vessels from third countries, primarily the United States . Payments are made through banks in third countries, since direct banking relationships are prohibited. The Cuban delegation concluded that restrictions on importing medical products were "so extensive that they make such imports virtually impossible". The World Health organisation/PAHO and UNFPA concurred that it was impossible for Cuba to purchase equipment, medicines and laboratory materials produced by the United States or covered by United States patents, even though those products were purchased through multilateral cooperation. Cuba was not able to purchase the isotope I-125 that is used to treat eye cancer in children. The companies manufacturing reagents and equipment are 70 per cent United States owned, which makes it difficult to purchase necessary medical equipment and other itemsReport of the Secretary-General. 2006. "Necessity of ending the economic, commercial and financial embargo imposed by the United States of America against Cuba" (A/60/150) online Medical staff in Cuba According to the World Health Organization, Cuba provides a doctor for every 170 residents, Medical know-how boosts Cuba's wealth . BBC online. and has the second highest doctor to patient ratio in the world after Italy. Commitment to health: resources, access and services United Nations Human Development report All fiscal and administrative aspects of health care in Cuba are run by the state; no private hospitals or clinics are permitted, and medical workers are required to work for the state. Historically, Cuba has long ranked high in numbers of medical personnel; in 1957, before the revolution, it ranked third in Latin America and ahead of many European nations. Medical professionals are not paid high salaries by national or international standards. In 2002 the mean monthly salary was 261 pesos, thus 1.5 times the national mean.Economic crisis and access to care: Cuba's health care system since the collapse of the Soviet Union. Nayeri K, Lopez-Pardo CM. p.13 online A doctor’s salary is equivalent to about US$15-20 per month according to the official rate of exchange between peso and dollar. Therefore, many prefer to work in different occupations, generally in the lucrative tourist industry, where earnings can be 50 to 60 times more. Black market healthcare The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning " in the 1990s aggravated these payments. The advent of the "dollar economy", a temporary legalisation of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans were able to obtain medications and health services that would not be available to them otherwise.[http://www.finlay-online.com/finlayinstitute/healthintransition.htm Cuba's Health in Transition and the Central and Eastern European]. Countries Experience. Antonio Maria de Gordon. CUBA AND INTERNATIONAL HEALTHCARE Cuba has entered into agreements with / WHO , UNICEF , the United Nations Food And Agriculture Organization (FAO), the United Nations Population Fund ( UNFPA ), and the United Nations Development Fund ( UNDP ). Since 1989, this collaboration has played a very important role in that Cuba, in addition to obtaining the benefits of being a member country, has strengthened its relations with institutions of excellence and has been able to disseminate some of its own advances and technologies Because the education of physicians came to exceed the country's internal requirements, Cuba has been able to export primary care practitioners and specialists for periods of service in other , 2006 Since the Chernobyl Nuclear Plant exploded in 1986, more than 20,000 children from Ukraine , Belarus and Russia have traveled to Cuba for treatment of Radiation Sickness and psychologically based problems associated with the radiation disaster. 15,000 sick Ukrainian kids get treatment in Cuba San Francisco Chronicle Cuban doctors play a primary role in the by Venezuelan medical staff who fear that the Cubans are a threat to Venezuelan jobs. Questions have also been raised by protestors about the level of Cuban medical qualifications, and there have been claims that the Cubans are "political agents" who have come to Venezuela to indoctrinate the workforce. Operación Milagro See also: Healthcare Of Venezuela Operación Milagro (Operation Miracle) is a joint health programme between Cuba and ns.http://www.granma.cu/espanol/2006/junio/mier21/milagro.html - Granma - in Spanish All flights, accommodation and food are funded by the Venezuelan government. The scheme was intended to expand to 500,000 operations a year in 2006. Havana's Operation Miracle helps eye patients see light News Scotsman.com Opponents of the Cuban government accuse it of sending the doctors to Venezuela for political motives. {Link without Title} Health tourism and pharmaceutics Cuba attracts nearly 20000 Commentary: A Novel Tourism Concept Caribbean Net News paying Health Tourists , generating revenues of around $40m a year for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years. The country operates a special division of hospitals specifically for the treatment of foreigners and diplomats. Foreign patients travel to Cuba for a wide range of treatments including Eye-surgery , Neurological disorders such as Multiple Sclerosis and Parkinsons Disease , Cosmetic Surgery , addictions treatment, Retinitis Pigmentosa and Orthopaedics . Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming. Cuba also successfully exports many medical products, such as Vaccines . Cuba sells its medical expertise BBC News ALTERNATIVE HEALTHCARE Economic constraints and restrictions on medicines have forced the Cuban health system to incorporate ), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang® a natural product derived from the bark of Mango Tree s. MEDICAL RESEARCH IN CUBA The Cuban Ministry of Health produces a number of Medical Journal s including the ACIMED , the Cuban Journal Of Surgery and the Cuban Journal Of Tropical Medicine . Because private investment is prohibited and the only possible source of funds for research is the government, Medical research has not been able to expand beyond the Cuban governments ability to fund the research. In April 2007, the The Cuba IPV Study Collaborative Group (Cuban Ministry of Public Health, Kourí Institute, U.S. Centers for Disease Control and Prevention, Pan American Health Organization, World Health Organization) published an article in the New England Journal Of Medicine which established that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The Cuba collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics. Cuba has been free of polio since 1963, but continues with mass immunization campaigns. 17429085 PRAISE FOR THE CUBAN HEALTHCARE SYSTEM In 2006, 2007 In 2000, Secretary General of the United Nations also praised Cuba's healthcare system in 2001, saying that "Cuba has done a great job on education and health", at the annual meeting of the Bank and the International Monetary Fund . Wayne Smith, former head of the US Interests Section In Havana identified "the incredible dedication" of Cubans to healthcare, adding that "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated". Learn from Cuba, Says World Bank World History Archives. May 2001 Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it. ‘Sicko,’ Castro and the ‘120 Years Club’ The New York Times. May 27, 2007 Studies of the Cuban health system in the United Kingdom In 2001, members of the UK House Of Commons Health Select Committee traveled to Cuba and issued a report that paid tribute to "the success of the Cuban healthcare system", based on its "strong emphasis on disease prevention" and "commitment to the practice of medicine in a community". The Parliament Of The United Kingdom also drew up an analysis of the key features of Cuba's healthcare system, drawing comparisons with the state funded National Health Service (NHS). The overall conclusion was that many of the features identified would not have occurred had there not been an obvious commitment to health provision demonstrated by the protection and proportion of the budget given the health care. The study concluded the following.
The study also pointed to problems within the system, these included;
CRITICISMS The US State Department , citing many independent sources, states that Cuba's infant mortality rate in 1957 was the lowest in Latin America and the 13th lowest in the world, according to UN data. Cuba ranked ahead of France, Belgium, West Germany, Israel, Japan, Austria, Italy, and Spain, all of which would eventually pass Cuba in this indicator during the following decades. Cuba’s comparative world ranking has fallen from 13th to last out of the 25 countries examined. Also missing from the conventional analysis of Cuba's infant mortality rates is its very high abortion rate, which, because of selective termination of "high-risk" pregnancies, yields lower numbers for infant mortality. Cuba's abortion rate was the 3rd highest out of the 60 countries studied. In terms of physicians and dentists per capita, Cuba in 1957 ranked third in Latin America, behind only Uruguay and Argentina -- both of which exceeded the United States in this measure. Cuba's physicians and dentists in 1957 was the same as the Netherlands, and ahead of the United Kingdom and Finland. The report states "Unfortunately, the UN statistical yearbook no longer publishes these statistics, so more recent comparisons are not possible, but it is completely erroneous to characterize pre-Revolutionary Cuba as backward in terms of healthcare." {Link without Title} Complaints have arisen that foreign "health tourists" paying with dollars and senior Communist party officials receive a higher quality of care than Cuban citizens. Former leading Cuban , appeared showing apparent unsanitary and unsafe conditions in the "Clínico Quirúrgico" of Havana;the article claims that health care for Cubans occurs in worse conditions in the rest of the country. ''El cuento de la Salud en Cuba'' , Publicado el 06.03.2005 11:32 Por Carlos Wotzkow, María Elena Morejón y Equipo Informativo de Gentiuno.com An article in Canadian newspaper National Post , based interviews of Cubans, finds that in reality even the most common pharmaceutical items, such as Aspirin and antibiotics are conspicuously absent or only available on the black market. Surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays. The Cuban government blames the shortages on the embargo and states that those with more severe chronic diseases receive medicines.[http://www.aegis.com/news/ips/2001/IP010312.html However, other sources suggest that also those with such diseases lack medicines. It is also suggested that in some cases the local non-dollar stocks have been shipped abroad. {Link without Title} {Link without Title} An article in The Boston Globe , partially based on interviews with Cubans, argues that the massive export of doctors and other medical personal to Venezuela in exchange for oil has caused shortages in Cuba. Regarding Operación Milagro, "It's all the Venezuelans who need cataracts surgery first, and then the Cubans if there's any time left", said Georgina, 60, a retired Havana clerk. {Link without Title} SEE ALSO
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