In the news and media, Cuba is portrayed as a country too ambitious for the political reality we live in. The political reality we live in here in the United States tells the story of a free market-based health care system, where the government is not responsible for the well-being of its people. But is this the only feasible reality? Cuba says otherwise. Cuba’s communist rule does not necessarily imply that Cuba is an example of bad government. On the contrary, under this political system, Cuba universal health care system has flourished and is now ranked as one of the highest quality across the world. But how could a country under a communist regime achieve such great success in the medical field?
The Political Revolution: Where it all started
The Cuban socialist revolution of 1959 not only gave birth to a socialist republic but a national healthcare system as well. This republic operates similarly to a dictatorship in that the Castro family and the Communist Party and the sole controllers of government, and the people have less say in the administration and the operation of the government. The political revolution brought some social changes with it. The social agreement of the revolution devalued the importance of wages to achieve economic equality and to finance the social programs it will provide for its citizens. Similarly to a social contract, where the people gave up some rights for the state protection, Cuba contracted with its people for social protections. A couple of years after the revolution, the government established a program called “el servicio médico rural” or the Rural Medical Service to improve medical coverage and services in rural areas. It employed 750 physicians and medical students to work in these areas, mostly mountainous and coastal communities. These services aimed at improving disease prevention and reviving access to medical services.
The real transformation in the medical system did not come until about a decade post-Cuban Revolution. During the 1970s, universal healthcare advocates like Dr. Cristina Luna, Cuba National Director of Ambulatory Care pushed for more health care access and reform. The 1978 Declaration of Alma-Ata established multi-specialty family polyclinics, which focused on providing services within communities across Cuba. By the year 1990, this program had reached 95 percent of the Cuban population. The Cuban government has been financing the social services, including healthcare, by extracting the surplus value of workers’ wages, which of course can be problematic with lack of high wages for workers. But how successful has this program been in providing and maintaining quality health care for Cubans?
The Social Revolution: The focus on community and disease prevention
Cuba has been able to maintain its high-quality health care services by centering the community and focusing on disease prevention. Healthcare in Cuba has a social aspect to it, particularly in the community and the family. In 1984, Cuba shifted its focus to the community by integrating healthcare in the community and in tight-knit neighborhoods instead of a disconnected hospital system outside of the community and its reach. Health care is organized at the local level with about 7.59 physicians per 1000 patients (highest in the world) and the doctors generally live in the same area or neighborhood as the patients they provide service for. This system has not only made it easier for patients to access clinics, but it has also developed a communal relationship between the patient and the doctor. To put it into perspective, in the U.S. doctors and medical providers are often secluded in a high socioeconomic area, where the patient and the physician don’t often share as many commonalities, like coming from the same neighborhood. One way the health care system in Cuba maintains this family-oriented health care is by requiring all medical students to complete a family practice residency. The fact that clinics are family based and community focused does not mean that the quality will drop. In contrast, primary care providers constantly try to maintain the quality of the services they provide by taking health statistics on the families and communities they serve and having public health officials routinely review the quality.
Cuba’s health care system also follows a proactive structural approach. The focus of this approach is providing preventative medical services, nationwide coverage, and access to treatment. The preventative aspect of medical care has allowed Cuba to climb to the top of the world when it comes to vaccination and life expectancy. According to the World Bank, as of 2016, Cuba’s life expectancy is about 79 years, while the U.S. is at about 78. Additionally, in 1985, Cuba invented the first and only vaccine against meningitis B. Cuba has also completely blocked the transmission of HIV and syphilis from the mother to the child. Nonetheless, with complete government control, how is the medical field incentivizes to innovate without any market competition? That’s the question that seems to haunt the minds of many free-market economists.
The Economic Revolution: Innovation and pioneering in medicine
The common expectancy when it comes to socialist or government-controlled forms of health care is that the country is unlikely to produce innovations and advancements in the medical field. However, not only has the health care system in Cuba introduced significant innovations to the world, but it has also financed the national economy as well. Cuba has encouraged many students to go into the medical field by providing them with opportunities to research and practice medicine at home and abroad. This system has created a large workforce that is constantly trying to improve medical services and coverage. More recently the government has also institutionalized and focused on biotechnology in health care. It has invested in the workforce and the industry of biotechnology and this created a strong production infrastructure for the medical field and the economy of Cuba as well. This investment has ultimately knowledge sharing and interdisciplinary collaboration. Therefore, the government has directly subsidized more innovation and technological development without the need for free-market competition.
Exporting the Cuban Model
The unique healthcare system of Cuba is far from perfect but it has presented a model for the world to follow. With its cutting-edge innovations in preventative medicine and surgical technologies, Cuba is leading the world in healthcare, but how can we follow? We must recenter the importance of the community in providing collective support. The U.S. is capable of establishing a single-payer system if it were to bring healthcare clinics to the communities that are most impacted by the disease. This country spends about 9,403 dollars on health care while it costs about 813 dollars per person in Cuba. The U.S. has industrialized health care and transformed it into a multi-billion dollar industry focused on profit rather than patient care. It needs to also invest in providing access to education for medical students and incentivize to be involved in community health care. The Cuban model is possible to replicate, the U.S. is one of a few developed countries that still haven’t invested in a universal healthcare system.
This model could be essentially perfected in the United States. The Cuban health care model has its own problems. With the somewhat unstable political and economic system, the health care system has been infiltrated by the black market with access to more off-market drugs and medicines, like painkillers. Another problem is the lack of well-paying job opportunities in the health care sector. The substitute that the Cuban government provides is more educational opportunities and foreign aid work abroad. However, it’s important to keep in mind that the Cuban health care system cannot be simply compared to that of the United States because of the varying political contexts they exist in. Considering that Cuba is a developing country that’s been through a recent revolution, they were able to recreate a health care system that focuses on communities, especially in rural areas and drastically reduces the mortality rate. Ultimately, the takeaways from this model are focusing on providing educational opportunities for students to enter the medical field, addressing disease prevention rather than disease treatment, and finally, centering the health care system around the community and increasing access to more impacted neighborhoods.
To conclude, Cuba’s health care system has revolutionized the way we view health care. Cuba brought health care back to the community and dismantled the systemic barriers that stand in the way between the patient and the doctor. Cuba’s community-based health care system has not only promoted the health outcomes of Cubans but also constructed a structure that focuses on the role of society as a collective. This collective continues to inspire the rest of the world today. So maybe it’s time we take off the lenses of free market healthcare and look at it from the lenses of universal health care centering the family and the community.
Featured Image Source: Antonio Levi/AFP