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March 30, 2016

After Obama's visit: How good is Cuba's health care system, really?

Daily Briefing

Sam Bernstein, Daily Briefing

As the United States slowly begins to open its doors to Cuba, Americans will hear more about the isolated communist nation's excellent health care. But how good is it really?  

Cuba's defenders—including its president, Raul Castro—frequently invoke the strength of Cuba's health care system when people criticize the country. For instance, in a press conference during President Obama's visit to the country last week, Castro responded to a question about human rights abuses by talking about Cuba's commitment to high-quality health care.

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"Do you think there's any more sacred right than the right to health, so that billions of children don't die just for the lack of a vaccine or a drug or a medicament?" he asked. "In Cuba, all children are born in a hospital and they are registered that same day, because when mothers are in advance pregnancy, they go to hospitals days before, many days before delivery, so that all children are born in hospitals," he added. 

Looking at the data

Castro isn't necessarily off-base in championing Cuba's health care system; some call it a model for the world.

For instance, Cuba outranks America in infant mortality, with 4.63 deaths per 1,000 live births in 2015, compared with 5.87 for the United States, according to CIA's World Factbook. And according to the World Health Organization, as of 2013, the United States and Cuba had roughly similar life expectancies, despite the United States spending a much higher percentage of GDP on health care—17.1 percent, compared with Cuba's 8.8 percent.

Moreover, according to the Pan American Health Organization, the leading causes of death in Cuba are cardiovascular disease and cancer, so-called "lifestyle" diseases that are more commonly associated with wealthy nations. It also performs better on several metrics than most of its Latin American neighbors.

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But some question whether official statistics tell the entire story. According to a 2007 article published in the Cuban Affairs by Katherine Hirschfeld, an associate professor in the department of anthropology at the University of Oklahoma, "Public criticism of the government is a crime in Cuba," and as a result "formally eliciting critical narratives about health care would be viewed as a criminal act."

Hirschfeld also says that because Cuba recognizes that its health care system is a key way to impress the rest of the world, there is pressure to paint an overly rosy picture.

For instance, filmmaker Michael Moore championed Cuba's health care system as superior to the United State in his 2007 documentary "Sicko," but critics later said he was given VIP treatment when he visited the island.

In addition, Hirschfeld says that "individual doctors are pressured by their superiors to reach certain statistical targets," and face the possibility of being fired if there is an increase in infant mortality in their district. "There is pressure to falsify statistics," Hirschfeld says.

The focus on outcomes may also lead to heavy-handed patient care. According to Hirschfeld, "Cuba does have a very low infant mortality rate, but pregnant women are treated with very authoritarian tactics to maintain [favorable] statistics."

'Exporting' expertise

Cuban officials also tout the country's strength in health care by noting how often it "exports" its expertise. Cuba sends more doctors to assist developing countries than the entire G8 combined, according Robert Huish, an international development professor at Dalhousie University.

Again, though, the story is complicated: Some say the exporting system amounts to "modern slavery," Catherine Porter writes for the Toronto Star. Julio Cesar Alfonso, who runs a Miami-based charity that helps Cuban doctors become accredited in the United States, says Cuban doctors abroad "work long hours and receive tiny salaries while the Cuban government makes good money."

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For example, Cuban doctors who provide treatment in Qatar can make $1,000 a month—but 40 percent of their wages goes directly to the Cuban government. Cuban officials say, though, that the high tax rate is fair compensation for medical education. "Every student studies medicine here free," explains Jorge Juan Delgado Bustillo, the country's deputy director of medical co-operation. "[Paying taxes is] their responsibility to their society."

Doing more with less

Even so, some of Cuba's medical accomplishments are hard to argue with, particularly its development of several advanced therapies for cancer and other diseases.

One benefit of easing trade restrictions on the country could be that the United States gains access to some of those treatments. For instance, Cuban researchers have developed a treatment and vaccine for lung cancer called CimaVax that is in the early stages of being evaluated for the U.S. market. 

Kelvin Lee, chair of the Immunology Department and co-leader of the Tumor Immunology and Immunotherapy Program at the Roswell Park Cancer Institute, which is leading those efforts, told the Huffington Post last year that researchers are "still at the very early stages of assessing the promise of this vaccine." But he said "the evidence so far from clinical trials in Cuba and Europe has been striking."

CimaVax is cheap, costing the Cuban government just $1 per shot, according to Wired. Studies in Cuba indicated the vaccine is both safe and effective—and perhaps suited for more than lung cancer. "There's good reason to believe that this vaccine may be effective in both treating and preventing several types of cancer, including … breast, colorectal, head-and-neck, prostate, and ovarian cancers," Lee says.

A mixed picture

So, the true picture of Cuban health care is mixed. By some metrics, it beats the United States, and by others, it falls short—and even where the system appears to excel, it's not clear we can trust the data.

The bigger story may be that Cuba's health system is undoubtedly exceptional when you consider its limited resources.

"They've had to do more with less," says Candace Johnson, CEO of Roswell Park. "So they've had to be even more innovative with how they approach things." 

Are you leading an evidence-based organization?

While some call Cuban health care practices a model for the world, it's important to assess the data before you look overseas for inspiration.

Our infographic outlines four principles you can use to support evidence-based practices at your organization, along with action steps to implement each one and pitfalls to avoid along the way.


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