Healthcare lessons from Cuba

By Rosalie Westenskow

The United States could learn a thing or two from Cuba’s healthcare system, some experts say, particularly as U.S. policymakers delve into healthcare reform.

Although Cuba probably isn’t the first thing to pop into most Americans’ minds when they picture efficient healthcare, the small country challenges stereotypes of healthcare in poor regions, said Paul Farmer, a professor of medical anthropologies at Harvard Medical School. “The most important contribution that Cuba’s given to global healthcare is (an) example—the idea that you can introduce the notion of broad healthcare and wipe out the diseases of poverty,” Farmer said in “Salud!” a recently released documentary about Cuba’s healthcare system.

Despite its low per-capita income, Cuba excels in providing preventative, comprehensive care to its citizens, said William Keck, a professor at Northeastern Ohio University’s College of Medicine and the producer of “Salud!”

“Cuba has managed to do a great deal in terms of health status with comparatively few resources,” Keck said at a panel discussion hosted by The Rockefeller Foundation and The Atlantic Philanthropies.

In fact, data from the World Health Organization shows little difference in health benchmarks between the United States and Cuba.

In 2004 the life expectancy for Cuban women exactly equaled that of American women, and the statistic for Cuban men came in just one year younger than the projected age for men in the United States. The healthy life expectancy, probability of dying under age 5 and average number of deaths for 15-to 60-year-old Cubans also came close, and sometimes yielded better numbers, than the same statistics for Americans.

In part, these similarities between data reflect the high degree of health disparity in the United States that creates a wide gap between the health outcomes for the rich and those for the poor, Keck said.

“We have areas that are more healthy than most areas in Cuba, but we also have areas that are much less (healthy), and when you average them out, it comes out to about the same” he told United Press International. “When you go to Cuba, there are differences geographically and regionally, but they’re much less (than in the United States) ... it’s a much more egalitarian approach.”

Although average health outcomes in the two countries may be similar, when it comes to cost, the numbers don’t even come close.

While the United States spent $6,094 per person per year in 2004, or 15.4 percent of its gross domestic product, Cuba spent only $229 per person, or 6.3 percent of GDP.

Cuba operates on a socialized medicine system, providing free healthcare to all citizens, and relies heavily on manpower to keep its system alive. Having enough doctors and nurses is essential, because they compensate for a lack of equipment and shortages of pharmaceuticals, said Fitzhugh Mullan, head professor of medicine and health policy at the George Washington University School of Public Health and Health Services.

“Cuba has a workforce of more than 60,000, which makes it one of the best resourced countries in the world,” Mullan said.

This large workforce—almost double the number of physicians per capita in the United States—allows for personalized care administered by doctors who live in the communities they serve. Most family physicians spend the afternoons making home visits, teaching in the community and holding public health events.

Although the Cuban system has many benefits, social and political differences would make it difficult to uproot it and plant it in the United States, Mullan said. However, some of these practices could be encouraged through policy changes that support programs like the National Health Service Corps, a program that provides loan repayments and scholarships for doctors willing to work in poor communities, he said.

“These are areas where this model of community-based care is more realistic and is really a necessity,” Mullan said.

For medical students graduating with debts of up to $200,000, the lower wages of a primary care physician in a poor area can be difficult to swallow, said Sandeep Krishnan, a student at the University of Missouri-Kansas City Medical School.

“It’d be cool to get back and help in a rural area,” Krishnan toldUPI. “On the other hand, debt is a big deal.”

In addition to the lure of higher salaries elsewhere, some medical students are dissuaded from working in primary care by the stigma attached to it.

“If you say to your attending physician you want to be a family physician, they’ll be like, ‘You’re too smart for that,’” Krishnan said.

In an attempt to introduce some of the benefits of the Cuban approach to medicine into the United States, one non-profit organization helps U.S. students receive their medical training in Cuba. The students receive a full scholarship from the Cuban government on the condition that they work in a poor community in the United States upon graduation.

“Tomorrow is graduation day for the first batch of (eight) U.S. students,” said Gail Reed, international director of the Medical Education Cooperation with Cuba.

Rosalie Westenskow is a United Press International (UPI) Correspondent.


UPI, July 23, 2007